Ch. 11 Digestive System

Question 1

What ICD-10-CM code is reported for a patient with a family history of colon cancer?

Answer 1

d. Z80.0

Response Feedback:
Rationale: Family history of a disease/condition is represented by Z codes. Look in the ICD-10-CM Alphabetic Index for History/family (of)/malignant neoplasm (of) NOS/gastrointestinal tract which refers you to code Z80.0. The Tabular List verifies code Z80.0 is reported for a family history of malignant neoplasm of digestive organs.

Question 2

A patient is seen in the ED for nausea and vomiting that has persisted for 4 days. The ED physician treats the patient for dehydration which is documented in the patient’s record as the final diagnosis. What ICD-10-CM code(s) is/are reported for this encounter?

Answer 2

d.
E86.0

Response Feedback:
Rationale: Dehydration is the definitive diagnosis. Nausea and vomiting are signs and symptoms of dehydration and would not be coded. This is supported by General Coding Guideline 1.B.5, Conditions that are an integral part of a disease process. In the ICD-10-CM Alphabetic Index, look for Dehydration which directs you to E86.0. Verify code selection in the Tabular List.

Question 3

What CPT® and ICD-10-CM codes are reported for a hemicolectomy performed on a patient with colon cancer?

Answer 3

c.
44140, C18.9

Response Feedback:
Rationale: For the CPT® code, hemi- means half or partial and colectomy is the removal of the colon. Look in the CPT® Index for Colectomy/Partial which directs you to code 44140.

Next, look in the ICD-10-CM Alphabetic Index for Carcinoma, which directs you to see also, Neoplasm, by site, malignant. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/colon which directs you to see also Neoplasm/intestine/large and report code C18.9 under the Malignant Primary column. There is no documentation the cancer is secondary or had metastasized from another site, it is considered primary. Verify the code in the Tabular List.

Question 4

What is the CPT® code for removal of a foreign body from the esophagus via the thoracic area?

Answer 4

b.
43045

Response Feedback:
Rationale: In the CPT® Index, look for Esophagus/Removal/Foreign Bodies which directs you to 43020, 43045, 43194, 43215, 74235. There are two open approaches and two endoscopic approaches in the CPT® code book for the removal of a FB from the esophagus. 43020 is via a cervical approach and 43045 is via a thoracic approach, making code 43045 the correct choice.

Question 5

A patient is seen to have an esophageal motility procedure with acid perfusion study performed. What CPT® code(s) is/are reported?

Answer 5

b. 91010, 91013

Response Feedback:
Rationale: This is a diagnostic gastrointestinal procedure. Look in the CPT® Index for Gastroenterology, Diagnostic/Esophagus Tests/Motility Study which directs you to codes 91010, 91013. 91010 best describes the motility study with add-on code 91013 used to identify the acid profusion study. Parenthetical note under add-on code 91013 indicates it is reported with code 91010.

Question 6

What CPT® and ICD-10-CM codes are reported for diagnosis of a recurrent unilateral reducible femoral hernia repair?

Answer 6

b.
49555, K41.91

Response Feedback:
Rationale: Look in the CPT® Index for Repair/Hernia/Femoral/Recurrent/Reducible which directs you to code 49555. You could also look for Hernia Repair/Femoral/Recurrent which also guides you to 49555.

Look in the ICD-10-CM Alphabetic Index for Hernia/femoral/unilateral/recurrent. Verification in the Tabular List confirms code K41.91 represents a recurrent femoral hernia, unilateral.

Question 7

What is the correct ICD-10-CM code for a patient with IBS?

Answer 7

c.
K58.9

Response Feedback:
Rationale: IBS stands for Irritable Bowel Syndrome. Look in the ICD-10-CM Alphabetic Index for Syndrome/irritable/bowel which refers you to code K58.9. Verify the code in the Tabular List.

Question 8

What ICD-10-CM code is reported for acute gastritis with bleeding?

Answer 8

a.
K29.01

Response Feedback:
Rationale: In ICD-10-CM, Gastritis is identified by specific 4th character codes to indicate with or without bleeding. Look in the ICD-10-CM Alphabetic Index for Gastritis (simple)/acute (erosive)/with bleeding which refers you to K29.01. Verify code selection in the Tabular List.

Question 9

A patient is seen in the gastroenterologist’s clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three using a snare technique to send to pathology for further testing. What is/are the correct CPT® code(s) to report?

Answer 9

b.
45385

Response Feedback:
Rationale: A surgical endoscopy always includes a diagnostic endoscopy so only the surgical is reported. Reporting 45385 is the correct code for the colonoscopy with removal of polyps by snare technique. In the CPT® Index, look for Colonoscopy/Flexible/Removal/Polyp which directs you to 45384, 45385. Reviewing the descriptions of both codes directs you to 45385 which includes use of snare technique.

Question 10

A 45 year-old woman underwent a laparoscopic cholecystectomy. The procedure was performed for recurrent bouts of acute cholecystitis. What CPT® and ICD-10-CM codes are reported?

Answer 10

c.
47562, K81.0

Response Feedback:
Rationale: In the CPT® Index, look for Cholecystectomy/Laparoscopic which directs you to 47562-47564. 47600 and 47605 are open cholecystectomy codes. By turning to the numeric section of CPT and reviewing the code descriptions, you can verify that 47562 is the appropriate code for a laparoscopic cholecystectomy with no additional procedures performed.

Acute cholecystitis is indexed in ICD-10-CM Alphabetic Index under Cholecystitis/acute for code K81.0. Verify code selection in the Tabular List.

Question 11

If a perianal abscess is identified, incised and drained during the course of performing an internal and external hemorrhoidectomy, what CPT® codes are reported?

Answer 11

a.
46255, 46050-51

Response Feedback:
Rationale: The hemorrhoidectomy is indexed in CPT® under Hemorrhoidectomy/Simple which directs you to code 46255. When you read all the code descriptions for hemorrhoidectomies, code 46255 is correct to report for the procedure since internal and external hemorrhoids were removed. The I&D code for the perianal abscess is indexed under Incision and Drainage/Abscess/Anal referring you to codes 46045-46050. Reviewing the descriptions of the codes directs you to code 46050 for Incision and drainage of the perianal abscess. Modifier 51 is appended to indicate multiple procedures during the same operative session.

Question 12

What is the correct coding for a physician who performs an UGI radiological evaluation of the esophagus, stomach and first portion of the duodenum with barium and double-contrast in the hospital GI lab? (Physician is not employed by the hospital)

Answer 12

b.
74246-26

Response Feedback:
Rationale: A radiological evaluation is an X-ray. UGI stands for Upper Gastrointestinal (GI). Look in the CPT® Index for X ray/Gastrointestinal Tract follow the further pathway given. The first portion of duodenum was performed on making 74246 the most appropriate code. The UGI is performed in the hospital using hospital equipment. The physician is not indicated to be an employee of the hospital so we must report the professional services (component) only by appending modifier 26.

Question 13

A 7 year-old female presents to the same day surgery unit for a tonsillectomy. During the surgery the physician notices the adenoids are very inflamed and must be taken out as well. The adenoids, although not planned for removal, are removed following the tonsillectomy.
What CPT® code(s) is/are reported for the procedure?

Answer 13

a. 42820

Response Feedback:
Rationale: In the CPT® Index look for Tonsils/Excision/with Adenoids directing you to 42820-42821. Code 42820 represents the removal of both the tonsils and adenoids. These are age specific codes and 42820 represents anyone younger than age 12.

Question 14

A patient presents with a 2 cm benign lip lesion. The provider decides to remove the lesion along with a portion of the lip by performing a wedge excision. Single-layer suture repair is performed. What CPT® code(s) is/are reported for this service?

Answer 14

b. 40510

Response Feedback:
Rationale: Because the physician is not only removing the lesion, but also removing part of lip, code 11422 is not reported. The lesion and a portion of the lip are removed by a transverse wedge technique. Look in the CPT® Index for Wedge Excision/Lip referring you to code 40510. The code description for code 40510 includes primary closure (suture repair) indicating an integumentary system repair code (12011) is not reported separately.

Question 15

What is the correct ICD-10-CM code for a 30 year-old obese patient with a BMI of 32.5?

Answer 15

b.
E66.9, Z68.32

Response Feedback:
Rationale: In the ICD-10-CM Alphabetic Index, look for Obesity. You are directed to E66.9. In the Tabular List under category code E66 there is an instructional note to use additional code to identify body mass index (BMI), if known (Z68.-). Code Z68.32 represents an adult BMI of 32.0-32.9.

Question 16

A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm). What CPT® code(s) is/are reported?

Answer 16

d.
43220

Response Feedback:
Rationale: Because the esophageal dilation using a bougie (43450) was unsuccessful, it is not reported. The esophagus was successfully dilated by performing transendoscopic balloon dilation 43220. This is the only code reported. In the CPT® Index, look for Esophagus/Dilation/Endoscopic.

Question 17

A patient is admitted for a simple primary examination of the gastrointestinal system to rule out GI cancer. An Esophagogastroduodenoscopy (EGD) is performed, which includes examination of the esophagus, stomach and portions of the small intestine. During the examination, a stricture of the esophagus is identified and subsequently dilated via balloon dilation (20 mm). What CPT® and ICD-10-CM codes are reported?

Answer 17

b.
43249, K22.2

Response Feedback:
Rationale: In the CPT® Index, look for Esophagogastroduodenoscopy/Flexible Transoral/Dilation of Esophagus which directs you to 43233, 43249. The procedure began as a diagnostic EGD which is represented by code 43235. During the exam, a stricture of the esophagus is identified and a surgical endoscopic balloon dilation is performed. The stricture of the esophagus is dilated 20 mm confirming 43249 is the correct code for the procedure. Surgical endoscopy always includes diagnostic endoscopy.

Look in the ICD-10-CM Alphabetic Index for Stricture/esophagus referring you to K22.2. Reviewing the code descriptor in the Tabular List indicates stricture of esophagus as one of the conditions listed. We do not code GI cancer because it has not been established as a definitive diagnosis and rule-out diagnoses are not reported in outpatient coding.

Question 18

A 28 year-old female had symptoms of RLQ abdominal pain, fever and vomiting. She was diagnosed with acute appendicitis. The surgeon makes an abdominal incision to remove the appendix. The appendix was not ruptured. The incision is closed. What CPT® and ICD-10-CM codes are reported for this encounter?

Answer 18

c.
44950, K35.80

Response Feedback:
Rationale: In the CPT® Index, look for Appendectomy/Appendix Excision, you are directed to 44950, 44955, 44960. Look for the description for these codes in the main section of CPTÒ. 44950 is Excision, Appendectomy which correlates with the procedure performed. The appendectomy was performed via open incision and not laparoscopically

According to the ICD-10-CM Official Coding Guidelines Section I.B.4, I.B.5, and I.C.18, if a definitive diagnosis is established, it is reported. Any signs or symptoms that would be an integral part of a definitive diagnosis/disease process would not be separately reported. RLQ abdominal pain, fever and vomiting are signs and symptoms of acute appendicitis; only the definitive diagnosis code, K35.80, is reported. In the ICD-10-CM Alphabetic Index, look for Appendicitis/acute which refers you to K35.80. Verification in the Tabular List indicates this code is for unspecified acute appendicitis which includes: Acute appendicitis NOS and Acute appendicitis without (localized) (generalized) peritonitis.

Question 19

Surgical laparoscopy with a cholecystectomy and exploration of the common bile duct for cholelithiasis. What CPT® and ICD-10-CM codes are reported?

Answer 19

b.
47564, K80.20

Response Feedback:
Rationale: Look in the CPT® Index for Cholecystectomy/Laparoscopic which refers you to 47562-47564. Code 47564 is accurate for laparoscopic cholecystectomy when the exploration of the common bile duct is also performed.
There is a diagnosis of cholelithiasis but no mention of obstruction and not with cholecystitis. The correct ICD-10-CM code is K80.20. In the ICD-10-CM Alphabetic Index, look for Cholelithiasis (cystic duct) (gallbladder) (impacted) (multiple) which instructs you to see Calculus, gallbladder. Look for Calculus/gallbladder you are directed to K80.20. Verify code selection in the Tabular List.

Question 20

An 11 year-old patient is seen in the OR for a secondary palatoplasty for complete unilateral cleft palate. Shortly after general anesthesia is administered, the patient begins to seize. The surgeon quickly terminates the surgery in order to stabilize the patient. What CPT® and ICD-10-CM codes are reported for the surgeon?

Answer 20

d.
42220-53, Q35.9, R56.9

Response Feedback:
Rationale: In the CPT® Index, look for Palatoplasty 42145, 42200-42225. An alternate path is Cleft Palate/Repair which refers you to 42200-42225. Review of the code descriptions in the main section confirms code 42220 represents a secondary repair to a cleft palate. Modifier 53 is appended because the procedure was terminated after anesthesia due to extenuating circumstances.

The diagnosis of a complete unilateral cleft palate is indexed in the ICD-10-CM Alphabetic Index under Cleft/palate referring you to code Q35.9. The unspecified code is the appropriate code because the surgeon did not provide specific information for the location of the cleft. Next, look for Seizure(s) (see also Convulsions) R56.9. Both listings direct the coder to R56.9 Unspecified convulsions. Code R56.9 is reported because the patient began to seize after administering the general anesthesia. Verify all code selections in the Tabular List.

Question 21

Operative Report
Indications: This is a third follow-up EGD dilation on this 40 year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation.
Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray.
Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following the diagnostic exam, a 15 mm balloon was placed across the stricture, dilated to maximum pressure, and withdrawn. There was minimal bleeding post-op. Much easier access into the duodenum was accomplished after the dilation. Follow-up biopsies were also taken to evaluate Helicobacter noted on a previous exam. The patient tolerated the procedure well.

Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated.

Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat endoscopy and final dilation will be accomplished. He will almost certainly need chronic H2 blocker therapy to avoid recurrence of this divesting complicated ulcer.

What CPT® and ICD-10-CM codes are reported?

Answer 21

c.
43245, 43239-51, K31.1, Z87.11

Response Feedback:
Rationale: The procedures performed are correctly represented by codes 43245 (balloon dilation) and 43239 (biopsies). In the CPT® Index, look for Esophagogastroduodenoscopy/Flexible Transoral/Dilation of Gastric/Duodenal Stricture which directs you to 43245. Next, look for Esophagogastroduodenoscopy/Flexible Transoral/Biopsy which directs you to 43239. Modifier 51 is reported to indicate multiple procedures performed on the same day, same session.

In the operative note, the diagnosis codes are reported from the Impressions. ICD-10-CM codes are K31.1 for the pyloric stricture. In the ICD-10-CM Alphabetic Index look for Stricture/pylorus. The stricture was acquired due to peptic ulcer disease, which is healed. Report with history code Z87.11. In the Alphabetic Index, look for History/personal (of)/disease or disorder (of)/digestive system/peptic ulcer disease which directs you to Z87.11. Verify codes in the Tabular List.

Question 22

A female patient was taken to the emergency room for severe abdominal pain, nausea and vomiting. A WBC (white blood cell count) was taken and the results showed an elevated WBC count. The general surgeon suspected appendicitis and performed an emergency appendectomy. The patient had extensive adhesions secondary to two previous cesarean deliveries. Dissection of this altered the anatomical field and required the surgeon to spend 40 additional intraoperative minutes. The surgeon discovered the appendix was not ruptured nor was it hot. Extra time was documented in order to thoroughly irrigate the peritoneum. What CPT® and ICD-10-CM codes are reported?

Answer 22

b.
44950-22, R10.9, R11.2, D72.829

Response Feedback:
Rationale: Code 44950 represents the appendectomy performed. In the CPT® Index, look for Appendectomy/Appendix Excision. Modifier 22 is appended due to the extensive adhesions that required 40 additional minutes be spent in order to perform the procedure safely and correctly.

The signs and symptoms are reported because the surgeon suspected appendicitis but it is never confirmed. In the ICD-10-CM Alphabetic Index, look for Pain(s)/abdominal, which directs you to R10.9. Next, in the Alphabetic Index look for Nausea/with vomiting and you are directed to R11.2. Then, look for Leukocytosis, abnormally large number of leukocytes, which directs you to D72.829. Verification in the Tabular List confirms code selections.

Question 23

A 66 year-old female is admitted to the hospital with a diagnosis of stomach cancer. The surgeon performs a total gastrectomy with formation of an intestinal pouch. Due to the spread of the disease, the physician also performs a total en bloc splenectomy. What CPT® codes are reported?

Answer 23

b.
43622, 38102

Response Feedback:
Rationale: In the CPT® Index, look for Gastrectomy/Total, you are directed to 43620-43622. A review of the code descriptors confirms CPT® code 43622 represents the complete gastrectomy with intestinal pouch formation. Code 38102 represents the en bloc total splenectomy and is an add-on code so it is modifier 51 exempt. In the CPT® Index, look for Splenectomy/Total/En bloc which directs you to 38102.

Question 24

A 20 year-old patient presented to the hospital for a sigmoidoscopy due to a history of bloody stools for three weeks duration. The patient was prepped and the sigmoidoscope was passed without difficulty to about 40 cm. The entire mucosal lining was erythematosus. There was no friability of the overlying mucosa and no bleeding noted. No pseudo polyps were identified. Biopsies were taken at about 30 cm; these were thought to be representative of the mucosa in general. The scope was retracted; no other abnormalities were seen. What CPT® and ICD-10-CM codes are reported?

Answer 24

b.
45331, K92.1

Response Feedback:
Rationale: CPT® code for a sigmoidoscopy with single or multiple biopsies is reported 45331. This is indexed in CPT® under Sigmoidoscopy/Biopsy. Diagnostic sigmoidoscopy is always bundled with a surgical sigmoidoscopy when both are performed in the same operative session.

The ICD-10-CM code for bloody stools is found looking in the ICD-10-CM Alphabetic Index for Blood/in/feces or Hematochezia ( see also Melena) and refers you to K92.1. When a patient comes in with a GI symptom (bloody stool, abdominal pain, etc.) and no definitive diagnosis is documented, the symptom(s) should be reported. Verify code selection in the Tabular List.