Digestive system (Series 40000)

Question 1
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® and ICD-10-
CM
codes are reported?
A. 47564, K81.2
B. 47562, K81.1
C. 47610, K81.2
D. 47600, K81.1

Rationale: The answer is B. One way to narrow down your choices is by the diagnosis. The patient has
chronic cholecystitis. In the
ICD-10-CM Alphabetic Index, look for Cholecystitis/chronic, referring you to code K81.1. Verify code in
the Tabular List for accuracy. This eliminates multiple choice A and C. The patient had a laparoscopic
cholecystectomy, eliminating multiple choice answer D.

Question 2
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 and spending
an extra hour to lysis the adhesions 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

Rationale: The answer is C. This surgical procedure was not performed by a laparoscope, it was an open
surgery, eliminating multiple choice answers B and D. It is documented that the adhesions were
“extensive,” “time consuming,” and
"spending an extra hour" to free up the attachments to the gastrointestinal tract. These are key words in
indicating modifier 22 should be appended to the procedure code. Appendix A lists the modifiers.

Question 3
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 flap was tacked over this area and anchored in place using
interrupted 3-0 Vicryl sutures to secure the repair. What CPT® and ICD-10-CM codes are reported?
A. 44950, K35.89
B. 44960, 49905, K35.3
C. 44950, 49905-51, K35.2
D. 44970, K37

Rationale: The answer is B. Patient had an open surgery appendectomy, eliminating multiple choice
answer D. The scenario
documents that there was also an abscess, eliminating A and C. 44905 is an add-on code, which modifier
51 is not reported. Look in the ICD-10-CM Alphabetic Index for Appendicitis/with peritoneal abscess,
referring you to code K35.3. Verify code in the Tabular List.

Question 4
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. What is the CPT® code to report for this encounter?
A. 45333
B. 45315
C. 45384
D. 45346

Rationale: The answer is A. The procedure was a flexible sigmoidoscopy, eliminating multiple choice B
and C. The polyps were
removed by hot biopsy forceps, eliminating multiple choice D. Three polyps were removed by the same
technique and will only be reported once, will not be reported three times.

Question 5
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) is (are) reported?
A. 49560, 49568
B. 49652
C. 49653
D. 49652, 49568

Rationale: The answer is B. The patient is having a laparoscopic ventral hernia repair, eliminating
multiple choice answer A. The
hernia is not documented as being incarcerated or strangulated, eliminating multiple choice answer C. A
parenthetical note under the code description for 49652 indicates that a mesh insertion (49568) is not
reported with this code when performed; eliminating multiple choice answer D.