Question on digestive system.

1
1. A physician performs a diagnostic colonoscopy through a stoma. During the colonoscopy, the
physician removes a foreign body from the colon through the scope. How would these services be
reported?
a. 45379
b. 44390
c. 45378, 45378-51
d. 44388, 44390-51

2. Two surgeons working together perform a partial esophagectomy with cervical esophagostomy,
without reconstruction. How would these services be reported?
a. 43124, 43124-51
b. 43124
c. 43124-62 for one surgeon, 43124-62 for the second surgeon
d. 43122-62 for one surgeon, 43122-62 for the second surgeon

3. A surgeon biopsies four lesions during a rigid esophagoscopy. How would these services be reported?
a. 43200, 43202-51
b. 43193 x 4
c. 43202
d. 43193

4. The physician removed a foreign body during a flexible esophagoscopy under radiological supervision
and interpretation. The procedure was performed in a hospital. How would the physician report these
services?
a. 43200, 74235-26
b. 43215, radiological S&I is bundled
c. 43216
d. 43215, 74235-26

6. How would a partial colectomy performed in conjunction with a “take-down” of the splenic flexure be
reported?
a. 44140
b. 44139
c. 44140, 44139-51
d. 44140, 44139

7. A morbidly obese patient presents to the surgeon for laparoscopic insertion of gastric neurostimulator
electrodes into the lesser curvature of the stomach. How would the surgeon report for his services?
a. 43881
b. 43647
c. 43659
d. 43647, 43659
8. When an appendectomy is performed for an indicated purpose at the time of another major surgery,
what additional code is reported for the appendectomy?
a. 44950
b. This procedure is bundled within the primary procedure.
c. 44955
d. 44950-52

9. A patient undergoes a laparoscopic partial colostomy of the transverse colon, including low pelvic
anastomosis, due to cancer of the colon and rectum.

A. 44146,
B. 44207
C. 44208
D. 99208

10. A general surgeon performs an initial femoral hernia repair on a 37 year-old patient, followed by
implantation of mesh. The hernia was incarcerated. How would these services be reported?
a.49550
b.49550, 49568
c. 49553, 49568
d. 49553

Question 11
A 67-year-old male patient is referred for a flex sigmoidoscopy exam to remove polyps. The physician
found three polyps in the rectosigmoid junction. They were removed by hot biopsy forceps. The path
report indicated the polyps were benign. Code the encounter.
A. 45333
B. 45315
C. 45384
D. 45346

12. Name of Procedure: Endoscopic retrograde cholangiopancreatogram with stent placement and
antral biopsy. Indications: 50-year-old male who underwent liver transplantation for end-stage liver
disease secondary to chronic hepatits C and hepatocellular carcinoma in 01/2007. The patient has
chloestatic liver enzymes, requiring ERCP before placement of a 7-French 12 cm stent and to evaluate
the biliary system. Description of Procedure: The patient was taken to the fluoroscopy suite in the GI lab
where he was found to be alert and oriented x 3. After discussing risks and benefits of the procedure,
informed consent was obtained. Patient was kept in the semi prone position. After adequated conscious
sedation, an Olympus side-viewing therapeutic scope was inserted through the mouth all the way to the
second portion of the duodenum. Then, the common bile duct was cannulated and the cholangiogram
was obtained. After the fluoroscopy evaluation of the choangiogram a 12 cm stent was deployed for
biliary drainage. A biopsy from the antrum was obtained. The patient tolerated the procedure well.
There were no immediate [Link] CPT® codes should be reported?
A. 43276, 43261-51
B. 43274, 43261-51
C. 43266, 43239-51
D. 43212, 43202-51
13. A patient with rectal bleeding underwent a proctosigmoidoscopy that showed she had two internal
hemorrhoids. The anus was prepped and draped. A field block with Marcaine 0.25% was then placed.
There was an internal prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by
applying two bands. In the posterior midline, there was another internal hemorrhoid that was banded in
the same manner. Code the procedure.
A. 0249T
B. 46221
C. 46945
D. 46930

14. A patient comes in for surgery today to address complications from his previous partial enterectomy
performed 5 months ago. Upon reopening the patient’s previous incision the surgeon resected the ileum
and a portion of the colon. An ileocolostomy was performed to complete the procedure with no
complications. The appropriate CPT® code to report is:
A. 44144
B. 44160
C. 44150
D. 44205

15. PREOPERATIVE DIAGNOSIS: History of prior colon polyps POSTOPERATIVE DIAGNOSIS:

Colon polyps, diverticulosis, hemorrhoids PROCEDURE: A rectal exam was performed and revealed
small external hemorrhoids. The video colonoscope was passed without difficulty from anus to cecum. The
colon was well prepped. The instrument was slowly withdrawn with good views obtained throughout.
There was a 3 mm polyp in the proximal ascending colon. This polyp was removed with hot biopsy
forceps and retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the proximal rectum.
The polyp was removed by hot biopsy forceps. There was also moderate diverticulosis extending from the
hepatic flexure to the distal sigmoid colon. Code the CPT® procedure(s).
A. 45384
B. 45385
C. 45388
D. 45384 x 2, 45378-59

17. Patient with RUQ pain and nausea suspected of having a stone or other obstruction in the biliary tract
is brought in for ERCP under radiologic guidance. Procedure: The patient was brought to the outpatient
endoscopy suite and placed supine on the table. The mouth and throat were anesthetized. Under radiologic
guidance, the scope was inserted through the oropharynx, esophagus, stomach, and into the small intestine.
The ampulla of Vater was cannulated and filled with contrast. It was clear that there was an obstruction in
the common bile duct. The endoscope was advanced retrograde to the point of the obstruction, which was
found to be a stone that was removed with a stone basket. The rest of the biliary tract was visualized and
no other obstructions or anomalies were found. The scope was removed without difficulty. The patient
tolerated the procedure well.
A. 47554, 74363-26
B. 43264, 74328-26
C. 43265, 74328-26
D. 43275, 74329-26
18. Preoperative Diagnosis: Lower left inguinal pain
Postoperative Diagnosis: Inguinal hernia
Procedure: This 30-year-old patient presented with lower left inguinal pain and on examination was found
to have a left inguinal hernia. The decision to perform a left inguinal hernia repair was made. The
procedure was performed in the outpatient hospital surgery center. Risks and benefits of the surgery were
discussed with the patient and the patient decided to proceed with the surgery. A skin incision was placed
at the umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle was retracted
laterally. Balloon dissector was passed below the muscle and above the peritoneum. Insufflation and
deinsufflation were done with the balloon removed. The structural balloon was placed in the preperitoneal
space and insufflated to 10 mm Hg carbon dioxide. The other trocars were placed in the lower midline
times two. The hernia sac was easily identified and was well-defined. It was dissected off the cord
anteromedially. It was an indirect sac. It was taken back down and reduced into the peritoneal cavity. Mesh
was then tailored and placed overlying the defect, covering the femoral, indirect, and direct spaces, tacked
into place. After this was completed, there was good hemostasis. The cord, structures, and vas were left
intact. The trocars were removed. The wounds were closed with 0 Vicryl for the fascia, 4-0 for the skin.
Steri-Strips were applied. The patient was awakened and carried to the recovery room in good condition,
having tolerated the procedure well. What are the correct procedure and diagnostic codes?
A. 49650-LT, K40.90
B. 49651-LT, 49568, K40.90
C. 49650-LT, K40.20
D. 49652-LT, K40.20

19. Preoperative Diagnosis: Chronic tonsillitis.

Chronic adenoiditis. Postoperative Diagnosis:
[Link]: Tonsillectomy and adenoidectomy. Patient is a 24-year-old male who was taken to the
operating room and put under IV sedation by the anesthesia department. An initial curettage of adenoids
was done, and packing was placed. The left tonsil was then identified and dissected out extracapsular and
removed with scissors. Hemostasis was maintained by packing the left tonsil. Next, the right tonsil was
identified, and incision was made. Dissection was done extracapsular, and the right tonsil was then
removed. Both the right and left tonsil were sent as specimens as well as adenoid tissue. What are the
procedure and diagnosis codes?
A. 42826, 42831-59, J35.02
B. 42820, J35.03
C. 42821, 42836-59, J35.01, J35.02
D. 42821, J35.03

20. Diagnostic esophagogastroduodenoscopy of the esophagus, stomach, and duodenum was performed
after esophageal balloon dilation (less than 30 mm diameter) was done at the same operative session. Code
the procedure(s).
A. 43249, 43235-51
B. 43249
C. 43220, 43200-51
D. 43220

21. 27-year-old male has obesity with a BMI of 35. He has decided to have a Roux-En-Y gastric bypass.
The patient is brought to the operating room and placed in supine position. A midline abdominal incision is
made. The stomach is mobilized, and the proximal stomach is divided and stapled creating a small
proximal pouch in continuity with the esophagus. A short limb of the proximal bowel of 115cm is divided.
It is brought up and anastomosed to the gastric pouch. The other end of the divided bowel is connected
back into the distal small bowel to the short limb’s gastric anastomosis to restore intestinal continuity. The
abdominal incision is closed.
A. 43645
B. 43644
C. 43846
D. 43847

Digestive system 2
1. Lynn has a family history of colon cancer and is scheduled for a screening colonoscopy. During the
procedure, three polyps were discovered and removed via hot biopsy forceps technique. The polyps
were reported as benign. What procedure(s) codes capture these services?

a. 45315, 45331

b. 45384

c. 45378

d. 45378, 45384

2. Dr. Blue performs a secondary closure of the abdominal wall for evisceration (outside the
postoperative period). He opens the former incision and removes the remaining sutures; necrotic fascia
is debrided down to viable tissue. The abdominal wall is then closed with sutures. How would you report
the closure?

a. 11043

b. This is a bundled procedure and not reported

c. 39541

d. 49900

3. Heather lost her teeth following a motorcycle accident. She underwent a posterior, bilateral
vestibuloplasty, which allows her to wear complete dentures. How would you report this procedure?

a. 40845, 15002

b. 40843-50

c. 40844
d. 40843

4. Dr. Erin is treating a 58-year-old male patient with a history of chewing tobacco. Dr. Erin finds a 3.4
cm tumor at the base of his tongue. She places needles under fluoroscopic guidance for sub-sequential
interstitial radioelement application. How would you report the professional services?

a. 41019, 77002-26

b. 41019, 77012-26, 77021-26

c. 61770, 41019-59

d. 77002

5. An 88-year-old male patient suffering from dementia accidentally pulled out his gastrostomy tube
during the night. Dr. Keys, an interventional radiologist, takes him into an angiography suite, administers
moderate sedation (an independent observer was present during the procedure), probes the site with a
catheter and injects contrast medium for assessment and tube placement. Dr. Keys finds that the entry
site remains open and replaced the tube into the proper position. The intra-service time for the
procedure took 45 minutes. How would Dr. Keys report his services?

a. 49440, 99149, 99150

b. 49440, 49450-59

c. 49450, 99152, 99153x2

d. 49450

6. Katherine had a hernioplasty to repair a recurrent ventral incarcerated hernia with implantation of
mesh for closure. The surgeon completed debridement for necrotizing soft tissue due to infection. How
would you report this procedure?

a. 49566, 11005-51, 49568

b. 49565, 11005-51, 49568

c. 49565

d. 49525, 11006, 49568-51

7. A 28-year-old patient underwent a proctosigmoidoscopy with ablation of five tumors under moderate
sedation. The same provider performed the procedure and the sedation. The intra-service time for the
procedure was 30 minutes. How would you report this procedure?

a. 45320-P1

b. 45320 x 5

c. 45320

d. 45320, 99152, 99153

8. Harry had a sphincterotomy and an ERCP with a stent placed into the bile duct. How would you report
this procedure?

a. 43274

b. 43262, 43274

c. 43260, 43262

d. 43264

9. Incidental appendectomy during an intra-abdominal surgery does not usually warrant a separate
identification. If it is necessary to report a separate identification, what modifier should you add?

a. 52

b. 59

c. 51

d. 57

10. Sharon had a laparoscopic cholecystectomy with cholangiography. How would you report this
procedure?

a. 47605, 47570-59

b. 47605

c. 47563

d. 47579

11. A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic
cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to
the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope
was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the
gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were
taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried
out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once
distally and transected. The gallbladder was then taken down from the bed using electrocautery,
delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port. What
CPT should be reported?

A. 47564 B. 47562

C. 47610 D. 47600

12. A 70-year-old female who has a history of symptomatic ventral hernia was advised to undergo
laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried
down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant
and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to
the area of the hernia where a small defect was clearly visualized. There was some omentum, which was
adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to
cover the defect. What procedure code(s) should be used?

A. 49560, 49568 B. 49653

C. 49652 D. 49653, 49568

14. An 82-year-old female had a CAT scan which revealed evidence of a proximal small bowel
obstruction. She was taken to the Operating Room where an elliptical abdominal incision was made,
excising the skin and subcutaneous tissue. There were extensive adhesions along the entire length of the
small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time- consuming
tedious lysis of adhesions was performed to free up the entire length of the gastrointestinal tract from
the ligament to Treitz to the ileocolic anastomosis. The correct CPT code is:

A. 44005

B. 44180-22

C. 44005-22

D. 44180-59

15. 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a
catheter placement. The endoscope is passed through the cricopharyngeal muscle area without
difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted.
Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach at
least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged
due to high grade narrowing in the pyloric channel. It seems to be a high grade outlet obstruction with a
superimposed volvulus. What code should be used for this procedure?

A. 43246-52

B. 43241-52

C. 43235

D. 43234

16. The patient is a 78-year-old white female with morbid obesity that presented with small bowel
obstruction. She had surgery approximately one week ago and underwent exploration, which required a
small bowel resection of the terminal ileum and anastomosis leaving her with a large inferior ventral
hernia. Two days ago she started having drainage from her wound which has become more serious. She
is now being taken back to the operating room. Reopening the original incision with a scalpel, the
intestine was examined and the anastomosis was reopened , excised at both ends, and further excision
of intestine. The fresh ends were created to perform another end- to-end anastomosis. The correct
procedure code is:

A. 44120-78

B. 44126-79
C. 44120-76

D. 44202-58

17. PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula POST OPERATIVE DIAGNOSIS:

Diverticulitis, perforated diverticula PROCEDURE: Hartman procedure, which is a sigmoid resection with
Hartman pouch and colostomy. DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in
the supine position under general anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and
Rocephin IV piggyback. A lower midline incision was made, abdomen was entered. Upon entry into the
abdomen, there was an inflammatory mass in the pelvis and there was a large abscessed cavity, but no
feces. The abscess cavity was drained and irrigated out. The left colon was immobilized, taken down the
lateral perineal attachments. The sigmoid colon was mobilized. There was an inflammatory mass right at
the area of the sigmoid colon consistent with a divertiliculitis or perforation with infection. Proximal to
this in the distal left colon, the colon was divided using a GIA stapler with 3.5 mm staples. The sigmoid
colon was then mobilized using blunt dissection. The proximal rectum just distal to the inflammatory
mass was divided using a GIA stapler with 3.5 mm staples. The mesentary of the sigmoid colon was then
taken down and tied using two 0 Vicryl ties. Irrigation was again performed and the sigmoid colon was
removed with inflammatory mass. The wall of the abscessed cavity that was next to the sigmoid colon
where the inflammatory mass was, showed no leakage of stool, no gross perforation, most likely there is
a small perforation in one of the diverticula in this region. Irrigation was again performed throughout
the abdomen until totally clear. All excess fluid was removed. The distal descending colon was then
brought out through a separate incision in the lower left quadrant area and a large 10 mm 10 French JP
drain was placed into the abscessed cavity. The sigmoid colon or the colostomy site was sutured on the
inside using interrupted 3-0 Vicryl to the peritoneum and then two sheets of film were placed into the
intra- abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and
intermittently a #2 nylon retention suture was placed. The colostomy was matured using interrupted 3-0
chromic sutures. I palpated the colostomy; it was completely patent with no obstructions. Dressings
were applied. Colostomy bag was applied. Which CPT code should be used?

A. 44140

B. 44143

C. 44160

D. 44208

18. Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant
transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large
amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and
aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until
clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was
taken down and tied using 0-Vicryl ties and the appendix fell off completely since it was already
ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to
tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied
twice using figure of 8 vicryl sutures. Omentum was tacked over this area and anchored in place using
interrupted 3-0 Vicryl sutures to secure the repair. What CPT codes should be reported?
A. 44950

B. 44960, 49905

C. 44950, 49905

D. 44970

19. 15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied
tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was
digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by
dissection. The uvula was a huge size because of edema, a part of this was removed and the raw surface
over sewn with 3-0 chromic catgut. Which CPT code(s) should be used?

A. 42821

B. 42825, 42104-51

C. 42826, 42106-51

D. 42842

20. 34-year-old male developed a ventral hernia when lifting a 60 pound bag. The patient is in surgery
for a ventral herniorrhaphy. The abdomen was entered through a short midline incision revealing the
fascial defect. The hernia sac and contents were able to easily be reduced and a large plug of mesh was
placed into the fascial defect. The edge of the mesh plug was sutured to the fascia. What procedure
code(s) should be used?

A. 49560

B. 49561, 49568

C. 49652

D. 49560, 49568

21. A 67-year-old male patient with a history of carcinoma of the sigmoid colon is referred for a
diagnostic colorectal cancer screening. The patient completed all treatment for his cancer in 2004. The
physician performed a diagnostic flex sigmoidoscopy exam to screen for recurrent colon cancer and
examine the anatomic site. During the exam, the physician found three polyps in the rectosigmoid
junction. They were removed by hot biopsy forceps. The path report indicated the polyps were benign.
Code the encounter.

A. 45333 B. 45331

C. 45338 D. 45339

22. Postoperative Diagnosis: Calculi of the gallbladder Procedure: Removal of gallbladder Indications:
The patient is a 40-year-old woman who has a six month history of RUQ pain, which ultrasound revealed
to be multiple gallstones. She presents for removal of her gallbladder. Procedure: The patient was
brought to the OR and prepped and draped in a normal sterile fashion. After adequate general
endotracheal anesthesia was obtained, a trocar was placed and CO2 was insufflated into the abdomen
until an adequate pneumoperitoneum was achieved. A camera was placed at the umbilicus and the
gallbladder and liver bed were visualized. The gallbladder was enlarged and thickened, and there was
evidence of chronic inflammatory changes. Two additional ports were placed and graspers were used to
free the gallbladder from the liver bed with a combination of sharp dissection and electrocautery.
Several attempts were made before it was decided that additional exposure was needed and I converted
to an open approach. The trocars were removed and a midline incision was made. At this time, it was
clear that there were multiple adhesions in the area, and once these were carefully taken down, we
were able to grasp the gallbladder. The cystic duct was carefully ligated and the gallbladder carefully
removed from the field. The area was copiously irrigated, and a needle biopsy of the liver was taken.
Then the skin was reapproximated in layers. Sponges and needle counts were correct, and the patient
was taken to the recovery room in good condition.

A. 47600-22 B. 47600-22, 47001

C. 47562, 47600-22, 47001 D. 47562-22, 47000

23. A patient with rectal bleeding undergoes a proctosigmoidoscopy. During the proctosigmoidoscopy,
the physician identifies internal hemorrhoids. The proctoscope was withdrawn, and the anus was
prepped and draped. A field block with Marcaine 0.25% was then placed. Anoscope was inserted. There
was a prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by applying two
bands. In the posterior midline, there was another hemorrhoid that was banded in the same manner.
Code the procedures.

A. 46221, 45300-51, 46600-51 B. 46221, 45300-51

C. 46945, 45300 D. 46934, 45300-51, 46600-51

24. A patient diagnosed with GERD presents to the same day surgery department for an upper GI
endoscopy. The procedure is done in order to treat the GERD by delivering thermal energy to the muscle
of the gastric cardia and lower esophageal sphincter. Anesthesia was administered and as the physician
begins the procedure, the patient’s blood pressure drops to a dangerously low level. The physician
decides not to finish the procedure due to the risk it may cause the patient. What are the codes for this
procedure

A. 43257-73 B. 43499

C. 43257-74 D. 43257-53

25. Preoperative diagnosis: History of prior colon Polyp’s Postoperative diagnosis: Colon polyps,
diverticulosis, hemorrhoids Procedure: A rectal exam was performed and revealed small external
hemorrhoids. The video colonoscope was passed without difficulty from anus to cecum. The colon was
well prepped. The instrument was slowly withdrawn with good views obtained throughout. There was a
3 mm polyp in the proximal ascending colon. This polyp was removed with hot biopsy forceps and
retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the proximal rectum. The polyp
was removed by hot biopsy forceps. There was also moderate diverticulosis extending from the hepatic
flexure to the distal sigmoid colon. Code the CPT® procedure(s).

A. 45384 B. 45384, 45384-51

C. 45380, 45384 D. 45380

26. A patient with esophageal cancer is brought to the OR for subtotal esophagectomy. A thoracotomy
incision is made, and the esophagus is identified. The tumor is carefully dissected free of the
surrounding structures. No invasion of the aorta or IVC is identified. The cervical esophagus is controlled
with purse string sutures and then transected above the sternal notch. The esophagus is then dissected
free of the stomach and the entire specimen is removed from the chest cavity and sent to pathology.
The stomach is then pulled into the chest cavity and anastomosed to the remaining cervical esophageal
stump. The anastomosis is tested for patency and no leaks are found. Hemostasis is assured. The chest is
examined for any signs of additional disease but is grossly free of cancer. The chest is closed in layers
and a chest tube is place through a separate stab incision. The patient tolerated the procedure well and
was taken to the PACU in stable condition.

A. 43101 B. 43117

C. 43107 D. 43112

27. Patient with RUQ pain and nausea suspected of having a stone or other obstruction in the biliary
tract is brought in for ERCP under radiologic guidance. Procedure: The patient was brought to the
hospital outpatient endoscopy suite and placed supine on the table. The mouth and throat were
anesthetized. Under radiologic guidance, the scope was inserted through the oropharynx, esophagus,
and stomach and into the small intestine. The ampulla of Vater was cannulated and filled with contrast.
It was clear that there was an obstruction in the common bile duct. The endoscope was advanced
retrograde to the point of the obstruction, which was found to be a stone that was removed with a
stone basket. The rest of the biliary tract was visualized and no other obstructions or anomalies were
found. The scope was removed without difficulty. The patient tolerated the procedure well.

A. 43260, 74328-26 B. 43264, 74328-26

C. 43265 D. 43265, 74329

28. Preoperative Diagnosis: Lower left inguinal pain Postoperative Diagnosis: Inguinal hernia Procedure:
This 30-year-old patient presented with lower left inguinal pain and on examination was found to have a
left inguinal hernia. The decision to perform a left inguinal hernia repair was made. The procedure was
performed in the outpatient hospital surgery center. Risks and benefits of the surgery were discussed
with the patient and the patient decided to proceed with the surgery. A skin incision was placed at the
umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle was retracted laterally.
Balloon dissector was passed below the muscle and above the peritoneum. Insufflation and DE
insufflation were done with the balloon removed. The structural balloon was placed in the preperitoneal
space and insufflated to 10 mm Hg carbon dioxide. The other trocars were placed in the lower midline
times two. The hernia sac was easily identified and was well-defined. It was dissected off the cord
anteromedially. It was an indirect sac. It was taken back down and reduced into the peritoneal cavity.
Mesh was then tailored and placed overlying the defect, covering the femoral, indirect, and direct
spaces, tacked into place. After this was completed, there was good hemostasis. The cord, structures,
and vas were left intact. The trocars were removed. The wounds were closed with 0 Vicryl for the fascia,
4-0 for the skin. Steri-Strips were applied. The patient was awakened and carried to the recovery room
in good condition, having tolerated the procedure well. What are the correct procedure codes?
A. 49505-LT B. 49505-LT, 49568

C. 49507-LT D. 49501-LT, 49568

29. Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis. Postoperative Diagnosis: Same.
Procedure: Tonsillectomy and adenoidectomy. Patient is a 24-year old male who was taken to the
operating room and put under IV sedation by the anesthesia department. An initial curettage of
adenoids was done and packing was placed. The left tonsil was then identified and dissected out
extracapsular and removed with scissors. Hemostasis was maintained by packing the left tonsil. Next,
the right tonsil was identified and incision was made. Dissection was done extracapsular and the right
tonsil was then removed. Both the right and left tonsil were sent as specimens as well as adenoid tissue.
What are the procedure

A. 42826, 42831-59 B. 42826, 42831-51-59

C. 42821-50, 42809-59 D. 42821

30. Diagnostic upper GI endoscopy of the esophagus, stomach, and duodenum was performed after
esophageal balloon dilation (less than 30 mm diameter) was done at the same operative session. Code
the procedure(s).

A. 43235 B. 43249

C. 43226, 43200 D. 43220, 43235

31. A patient with ongoing symptoms of weight loss, constipation, and blood in stool verified with occult
testing underwent a rectal approach colonoscopy with snare removal of three colonic polyps. The
pathology report, which was returned to the physician the same day of the procedure, revealed benign
colon polyps. How should you report this?

a. 44378

b. 45385 x 3

c. 45378, 45385 x 3

d. 45385

32. A patient was fully prepped for a diagnostic colonoscopy; however, an object then shifted into the
descending colon just below the splenic flexure. The physician was unable to advance the scope beyond
the splenic flexure. How would you report this diagnostic colonoscopy?

a. 44388-52

b. 45330

c. 45378-53

d. None of the above

33. Jennifer, a 3-year-old patient, swallowed a marble that became lodged in her esophagus. An
esophagotomy via thoracic approach was completed for removal of the foreign body. The patient
tolerated the procedure well and was returned to the recovery room in good condition. How should you
code this procedure?

a. 43045

b. 43020

c. 43215

d. 43135

34. An otherwise healthy 22-year-old patient was scheduled for repair of an incarcerated bilateral
recurrent inguinal hernia. The patient was taken into a same-day OR, where she was prepped,
positioned, and draped in the usual fashion. The anesthesiologist administered general anesthesia and
indicated the patient was ready for the surgery to begin. The surgeon created the incision and started
the procedure. At this point, the patient went into shock due to the surgery and the procedure was
halted. The patient was stabilized and returned to the recovery room. How should the surgeon report
this procedure?

a. 49521-74

b. 49521-53

c. 00830-P1, 49521-51

d. 49521-47

35. How would the following case be coded?

Preoperative diagnosis: Lesion, buccal submucosa, right lower lip

Postoperative diagnosis: Same

Procedure performed: Excision of lesion, buccal submucosa, right lower lip

Anesthesia: Local

Procedure: The patient was placed in the supine position. A measured 7x8 mm hard lesion is felt under
the submucosa of the right lower lip. After application of 1% Xylocaine with 1:1000 epinephrines, the
lesion was completely excised. The lesion does not extend into the muscle layer. The 8-cm wound was
closed with complex mattress sutures to the submucosal level and dressed in typical sterile fashion. The
patient tolerated the procedure well and returned to the recovery area in satisfactory condition.

a. 40816

b. 40814, 40831-51

c. 40814

d. 40818

36. A patient underwent an EGD with transendoscopic ultrasound-guided transmural fine needle
aspiration. How should you code this procedure?
a. 43242, 76942-26

b. 43242

c. 43235, 43238-59

d. 43235, 43242-51, 76942-26

37. A patient underwent a laparoscopic repair of a Para esophageal hernia with fundoplasty with
implantation of mesh. During the procedure, a laparoscopic esophageal lengthening was completed.
Which codes capture this procedure?

a. 43327, 43282-59

b. 43333, 43283-51

c. 43281, 43282-59, 43283-51

d. 43282, 43283

38. A patient underwent an enterectomy in the small intestine with four resections and anastomoses.
How should you report this type of procedure?

a. 44130

b. 44120 x 4

c. 44111

d. 44120, 44121 x 3

39. Veronica, a 55-year-old patient, has left upper quadrant pain with a negative ultrasound. Veronica’s
physician explains the need for a diagnostic and possible surgical procedure to determine the cause of
this pain. She agrees to the procedure, completes overnight fast and prep, signs a consent for surgery,
and is then taken to a procedure room. After nasal spray of 2% Xylocaine is administered, the tube is
introduced through one nostril, down the back of the throat, and positioned into the stomach as the
patient swallows. The diagnostic duodenal intubation and aspiration is completed. However, the
physician decides to reposition the tube under fluoroscopic guidance and obtain multiple duodenal fluid
specimens during the same operative session. The patient tolerates the procedure well and is moved to
the recovery suite. How would you report the physician services?

a. 43757

b. 43756, 43757-52

c. 43755

d. 43755, 43756-59, 43757-59

40. A patient has an adjustable gastric restrictive device component removed and replaced via a
laparoscopic procedure. How should you code this procedure?

a. 43773
b. 43772, 43773-51

c. 43888

d. 43845