CPC Chapter 11- Digestive System Review Questions

Question 1

The suffix meaning artificial or surgical opening:
A. -ectasis
B. -stomy
C. -cele
D. -lysis

Answer 1

B. -stomy

Rationale: -ectasis means dilation, -cele means hernia, -lysis means release.

Question 2

The prefix meaning lip:
A. an/o
B. cec/o
C. cheil/o
D. col/o

Answer 2

C. cheil/o

Rationale: An/o means anus, cec/o means cecum, col/o means colon.

Question 3

What is the function of the gallbladder?
A. It plays a role in maintaining glucose levels in the blood.
B. It conveys and stores bile.
C. It breaks down and stores waste products.
D. It produces acidic juices for digestion.

Answer 3

B. It conveys and stores bile.

Rationale: The gallbladder is a sac-shaped organ located under the liver. It stores bile that is produced by the liver.

Question 4

Name the three sections of the small intestine.
A. Sigmoid, rectum, ilium
B. Jejunum, duodenum, ilium
C. Cecum, jejunum, ileum
D. Duodenum, jejunum, ileum

Answer 4

D. Duodenum, jejunum, ileum

Rationale: The three sections of the small intestine are the duodenum, jejunum, and the ileum. The ilium (note spelling) is one of the bones located in the pelvis. The sigmoid, rectum, and cecum are parts of the large intestine.

Question 5

What is the name of the portion of the large intestine that runs horizontally across the abdomen?
A. Sigmoid colon
B. Transverse colon
C. Descending colon
D. Ascending colon

Answer 5

B. Transverse colon

Rationale: The name of the large intestine that runs horizontally across the abdomen is the transverse colon.

Question 6

What organ in the human body has the capability to regenerate?
A. Pancreas
B. Kidney
C. Liver
D. Intestine

Answer 6

C. Liver

Rationale: The liver is the only organ in the human body that can self-regenerate, which is why an adult can donate a portion of a liver to a child and that transplanted portion will regenerate, usually within six weeks of the procedure.

Question 7

What are the two processes of digestion?
A. Mechanical and chemical
B. Chewing and absorption
C. Ingestion and defecation
D. Secretion and propulsion

Answer 7

A. Mechanical and chemical

Rationale: Digestion consists of two processes, mechanical and chemical. Mechanical digestion is chewing (or mastication) of the food, then your stomach churning the food, and finally the small intestine (duodenum) absorbing the food. Chemical digestion is the work the stomach acids, bile, and enzymes do by breaking large carbohydrate, lipid, protein, and nucleic acid molecules into their subcomponents of nutrients.

Question 8

What are the three categories of teeth?
A. Enamel, Root, Crown
B. Incisors, Cuspids, Molars
C. Baby teeth, Adolescent teeth, Wisdom teeth
D. There are not three categories of teeth

Answer 8

B. Incisors, Cuspids, Molars

Rationale: There are three categories of teeth:

The Incisors—The teeth in the front of the mouth. They are shaped like chisels and are useful in biting off large pieces of food. Each person has eight of these (four on the top, four on the bottom).
The Cuspids—The pointy teeth immediately behind the incisors. Also called the canines, these teeth are used for grasping or tearing food. Each person has four of these (two on the top and two on the bottom).
The Molars—The flattened teeth used for grinding food. They are the furthest back in the mouth, and their number can vary among people.

Question 9

Approximately how long is the large intestine in normal anatomy?
A. 6 ft. long
B. 9 ft. long
C. 3 ft. long
D. 5 ft. long

Answer 9

D. 5 ft. long

Rationale: The large intestine is about 5 ft. long.

Question 10

How many lobes are in the liver?
A. 4 lobes
B. 3 lobes
C. 2 lobes
D. 5 lobes

Answer 10

A. 4 lobes

Rationale: The human liver has four lobes: the right lobe and left lobe, which may be seen in an anterior view, plus the quadrate lobe and caudate lobe.

Question 11

A 42-year-old patient visits his doctor for chest pain and a dry cough lasting for two months. After evaluating the patient, the physician states the patient has GERD. What is/are the correct diagnosis code(s)?
A. K21.00
B. K21.9
C. K63.9, R05.9
D. R07.9, R05.9

Answer 11

B. K21.9

Rationale: GERD is the definitive diagnosis. Chest pain and a dry cough are both symptoms of GERD and are not reported separately. GERD is an acronym for Gastroesophageal Reflux Disease. In the ICD-10-CM Alphabetic Index, look for Disease, diseased/gastroesophageal reflux (GERD) or look for GERD, and you are guided to K21.9. There is no indication the patient has esophagitis.

Question 12

A 28-year-old female has constant abdominal pain and diarrhea. The provider runs blood tests and takes a stool sample. A colonoscopy with biopsy is performed to rule out ulcerative colitis. The provider determines the patient has IBS. What is/are the correct diagnosis code(s)?
A. K22.0
B. K58.0, R10.9, R19.7
C. K51.90, K58.0
D. K58.0

Answer 12

D. K58.0

Rationale: IBS is an acronym for Irritable Bowel Syndrome and can cause the intestinal tract to contract stronger and longer than normal. This may cause symptoms such as abdominal pain, constipation or diarrhea, and/or flatulence. To find IBS in the ICD-10-CM, look in the ICD-10-CM Alphabetic Index for Syndrome/irritable/bowel/with/diarrhea leading you to code K58.0. Abdominal pain and diarrhea are symptoms of IBS, and not coded separately. Ulcerative colitis is a rule-out diagnosis and is not coded.

Question 13

A patient with a large prolapsed hemorrhoid arrives at the Emergency Department. After multiple attempts, the provider is unable to reduce it. The physician applies granulated sugar to the hemorrhoid and is then able to reduce the hemorrhoid. What is the correct diagnosis code?
A. K64.4
B. K64.0
C. K64.8
D. K64.5

Answer 13

C. K64.8

Rationale: Hemorrhoids are dilated or enlarged varicose veins which occur in and around the anus and rectum. The condition can be complicated by thrombosis, strangulation, prolapse, and ulceration. To find hemorrhoids in the ICD-10-CM Alphabetic Index, locate Hemorrhoids/prolapsed directing you to K64.8. Verify code selection in the Tabular List.

Question 14

A patient was seen in the outpatient GI lab of the hospital for rectal bleeding. A colonoscopy revealed three polyps in the transverse colon. The polyps were removed by snare technique and determined to be benign. What is the correct diagnosis code for this procedure?
A. K63.5
B. D12.3
C. K92.1
D. K62.5

Answer 14

B. D12.3

Rationale: The definitive diagnosis is polyps and identified as benign. Rectal bleeding is a sign of polyps in the colon and not coded. In the ICD-10-CM Alphabetic Index, look for Polyp, polypus/colon/adenomatous/transverse directing you to D12.3. You can also use the Table of Neoplasms and look for Neoplasm, neoplastic/Intestine, intestinal/large/transverse; the Benign column indicates D12.3.

Question 15

The patient is a 65-year-old female with type 2 diabetes. She is seen today by her primary care physician for extreme abdominal bloating and discomfort after eating. The patient also complains of constant heartburn. This occurs frequently and is not relieved by anything the patient has tried. The patient recorded her blood sugar this morning as 178. Her A1C taken in the office was 8.2. The physician diagnoses gastroparesis due to the patient’s diabetes. Code the ICD-10-CM diagnosis(es).
A. E10.43
B. K31.84
C. E11.43
D. E11.43, K31.84

Answer 15

D. E11.43, K31.84

Rationale: Gastroparesis is also called delayed gastric emptying. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract. The most common cause of gastroparesis is diabetes. In this case, the physician did link the gastroparesis to the patient’s diabetes, so we will use a diabetic complication code. In ICD-10-CM Alphabetic Index look for Diabetes, diabetic/type 2/with/gastroparesis which directs you to E11.43. Even if the provider had not linked the gastroparesis with diabetes, because it is listed under ‘with’ in the Alphabetic Index, there is a presumed causal relationship. In the Tabular List, there is an instructional note for code K31.84 that indicates to Code first underlying disease, if known and code E11.43 is listed.

Question 16

What CPT® coding is reported for a peritoneoscopy with laparoscopic partial colectomy and anastomosis?
A. 44140
B. 44204
C. 49320, 44140
D. 49320, 44204

Answer 16

B. 44204

Rationale: A peritoneoscopy is a separate procedure and is not separately reportable when it is performed with a more extensive procedure. It is incidental to the laparoscopic partial colectomy and anastomosis. Look in the CPT® Index for Colectomy/Partial/with Anastomosis/Laparoscopic. The code is selected based on whether additional procedures, such as a coloproctostomy, are performed. There are no additional procedures in this case making 44204 the correct code choice.

Question 17

What CPT® code is reported for an intraoral incision and drainage of a hematoma of the tongue, submandibular space?
A. 41008
B. 41009
C. 41015
D. 41017

Answer 17

A. 41008

Rationale: CPT® code 41008 is specifically for Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space. Look in the CPT® Index for Drainage/Hematoma/Mouth/Submandibular Space. The code selection is made because it is intraoral, not extraoral.

Question 18

What CPT® code is reported for a proximal subtotal pancreatectomy, with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy, with pancreatojejunostomy?
A. 48150
B. 48152
C. 48153
D. 48154

Answer 18

A. 48150

Rationale: The CPT® code 48150 is specifically for pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy. Look in the CPT® Index for Pancreas/Excision/Partial.

Question 19

A 43-year-old male has a chronic posterior anal fissure. The posterior anal fissure was excised down to the internal sphincter muscle. Which CPT® code is reported?
A. 46200
B. 46261
C. 4627
D. 46275

Answer 19

A. 46200

Rationale: In the CPT® Index, look for Anus/Fissure/Excision. You are referred to 46200. This is the correct code. There was a removal (excision) of a fissure, not fistula, without a sphincterotomy or hemorrhoidectomy.

Question 20

A 55-year-old patient underwent a repair of an initial left inguinal hernia. An incision was made at the groin. A hernia sac was readily identified and cleared from the surrounding tissue, inverted into the preperitoneal space, and plugged. Mesh was tacked to the surrounding muscle layers and then placed over the entire floor. What CPT® code(s) is/are reported?
A. 49500-LT
B. 49505-LT
C. 49507-LT
D. 49650-LT

Answer 20

B. 49505-LT

Rationale: In the CPT® Index, look for Hernia Repair/Inguinal/Initial, Child 5 years or older. You are referred to 49505 and 49507. Review the codes to choose the appropriate service. 49505 is the correct code. The repair was through an incision (not by laparoscopy) on an initial inguinal hernia on a patient over five years of age and the hernia was not incarcerated or strangulated. Modifier LT is appended to indicate the hernia is on the left side.

Question 21

What is the CPT® code for removal of a foreign body from the esophagus via the thoracic area?
A. 43020
B. 43215
C. 43500
D. 43045

Answer 21

D. 43045

Rationale: In the CPT® Index, look for Esophagus/Removal/Foreign Bodies referring 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 22

What ICD-10-CM code is reported for internal hemorrhoids?
A. K64.8
B. K64.4
C. K64.9
D. K64.0

Answer 22

A. K64.8

Rationale: Look in the ICD-10-CM Alphabetic Index for Hemorrhoids (bleeding) (without mention of degree)/internal (without mention of degree) which refers you to K64.8. Verification in the Tabular List confirms code selection.

Question 23

A patient is seen to have an esophageal motility procedure with acid perfusion study performed. What CPT® code(s) is/are reported?
A. 91010
B. 91010, 91013
C. 91030
D. 91020

Answer 23

B. 91010, 91013

Rationale: This is a diagnostic gastrointestinal procedure. Look in the CPT® Index for Gastroenterology, Diagnostic/Esophagus Tests/Motility Study referring 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 24

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?
A. R11.10, R11.0, E86.0
B. R11.2, E86.0
C. R11.14
D. E86.0

Answer 24

D. E86.0

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 25

Where is the vermilion border located?
A. Stomach lining
B. Underneath the tongue
C. Upper and lower lips
D. In the esophagus

Answer 25

C. Upper and lower lips

Rationale: The cutaneous portion of the upper lip extends from the bottom of the nose to the nasolabial folds laterally to the vermilion border or lipstick area of the lips. It is the red margin of the upper and lower lips.

Question 26

What CPT® coding is reported when a physician makes two separate incisions to perform a laparoscopic appendectomy and laparoscopic cholecystectomy?
A. 47562, 44970-59
B. 44960, 47562
C. 47562
D. 47562, 44970-51

Answer 26

A. 47562, 44970-59

Rationale: Code 47562 represents the laparoscopic cholecystectomy. In the CPT® Index look for Laparoscopy/Biliary Tract/Cholecystectomy or Cholecystectomy/Laparoscopic. Referring you to 47562-47564. Next, look in the CPT® Index for Laparoscopy/Appendix/Appendectomy. Referring you to 44970. Both codes can be reported because the physician made two separate laparoscopic site incisions to remove the gallbladder and appendix. We indicate this by appending modifier 59 to the 2nd code.

Question 27

What CPT® and ICD-10-CM codes represent the creation of an opening into the stomach to insert a temporary feeding tube for nutritional support in an adult patient with proximal esophageal carcinoma due to alcohol dependence? A gastric tube was not created.
A. 43653, C15.9, F10.20
B. 43831, D49.0, F10.10
C. 43830, C15.3, F10.20
D. 43870, C15.8, F10.99

Answer 27

C. 43830, C15.3, F10.20

Rationale: A gastrostomy is the creation of an opening into the stomach. Look in the CPT® Index for Gastrostomy/Temporary referring you to 43830. You could also look for Stomach/Creation/Stoma Temporary referring you to 43830, 43831. Code 43830 represents an open placement (accessing the stomach through the abdominal wall) for a feeding device, such as a tube.

In the ICD-10-CM Alphabetic Index look for Carcinoma, which directs us to see also, Neoplasm, by site, malignant. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/
esophagus/proximal (third)/Malignant Primary column referring you to code C15.3. The Tabular List confirms that code C15.3 represents the primary cancer of the upper or proximal third of the esophagus. There is an instructional note to report an additional code to identify alcohol abuse or dependence (F10.-). Alcohol dependence is reported with code F10.20. Verify code selection in the Tabular List.

Question 28

What is the correct ICD-10-CM code for a 30-year-old obese patient with a BMI of 32.5?
A. E66.9, Z68.32
B. E66.01, Z68.35
C. E66.9, Z68.30
D. E66.3, Z68.32

Answer 28

A. E66.9, Z68.32

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 29

What ICD-10-CM code is reported for acute gastritis with bleeding?
A. K29.70
B. K29.71
C. K29.00
D. K29.01

Answer 29

D. K29.01

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 referring you to K29.01. Verify code selection in the Tabular List.

Question 30

What CPT® and ICD-10-CM codes are reported for diagnosis of a recurrent unilateral reducible femoral hernia repair?
A. 49555, K41.91
B. 49505, K41.31
C. 49555, K41.21
D. 49550, K41.91

Answer 30

A. 49555, K41.91

Rationale: Look in the CPT® Index for Repair/Hernia/Femoral/Recurrent/Reducible referring 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 31

What is the correct ICD-10-CM code for a patient with IBS?
A. K58.9
B. K59.89
C. K59.2
D. K58.0

Answer 31

A. K58.9

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 32

What is the correct ICD-10-CM coding for diverticulosis of the small intestine which has been present since birth?
A. K57.90
B. K57.90, Q43.8
C. Q43.8
D. K57.10

Answer 32

C. Q43.8

Rationale: If a condition has been present since birth, it is considered congenital. Look in the ICD-10-CM Alphabetic Index for Diverticulosis/small intestine which refers you to K57.10. Verification in the Tabular list has an Excludes1 note under category code K57 for a congenital diverticulum of intestine and directs you to code Q43.8. Congenital diverticulum is in the list of congenital malformations beneath code Q43.8

Question 33

In ICD-10-CM, how is Crohn’s disease of the small intestine with intestinal obstruction reported?
A. Crohn’s disease of the small intestine is reported first with intestinal obstruction reported as a secondary diagnosis.
B. Crohn’s disease of the small intestine is reported as regional enteritis of the small intestines
C. One combination code is reported to indicate Crohn’s disease of the small intestine with intestinal obstruction.
D. Intestinal obstruction is reported first with Crohn’s disease of the small intestine is reported as a secondary.

Answer 33

C. One combination code is reported to indicate Crohn’s disease of the small intestine with intestinal obstruction.

Rationale: In ICD-10-CM there are combination codes to include the anatomic site (i.e., small intestine, large intestine) as well as the associated complications of Crohn’s disease. Example: K50.012 Crohn’s disease of small intestine with intestinal obstruction.

Question 34

A 12-year-old patient had an adenoidectomy in 2013 and a second adenoidectomy this year. What CPT® code(s) is/are reported for the second adenoidectomy performed this year?
A. 42836
B. 42831
C. 42831, 42836
D. 42826

Answer 34

A. 42836

Rationale: Sometimes adenoid tissue, even after it has been removed, will grow back when a few cells are left behind. For the removal of the secondary adenoid tissue, report code 42836 which represents the secondary adenoidectomy. Look in the CPT® Index for Adenoids/Excision referring to 42830-42836. In this case, the patient is over 12 years of age upon presentation for the secondary adenoidectomy, further supporting the criteria for 42836.

Question 35

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?
A. 47562, K81.0
B. 47605, K81.2
C. 47600, K81.0
D. 47570, K81.9

Answer 35

A. 47562, K81.0

Rationale: In the CPT® Index, look for Cholecystectomy/Laparoscopic referring 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 36

A 33-year-old male patient presents to the endoscopy suite to determine if he has an ulcer. The physician performs a diagnostic scope through the esophagus, stomach and into the duodenum and jejunum. During the scope the patient has a severe drop in blood pressure and the physician discontinues the procedure, but not before observing and diagnosing a bleeding ulcer on the stomach lining as well a perforated ulcer in the jejunum. A repeat examination is planned.

What CPT® and ICD-10-CM codes are reported?
A. 43235-52, K25.4, K28.5
B. 43235-53, K25.4, K28.1
C. 43235-53, K25.4, K28.5
D. 43200-52, K25.5, K28.5

Answer 36

C. 43235-53, K25.4, K28.5

Rationale: Code 43235 represents an Upper GI down into the small intestine or esophagogastroduodenoscopy (EGD). In the CPT® Index, look for Endoscopy/Gastrointestinal/Upper/Exploration. We append modifier 53 since the procedure was terminated after anesthesia due to extenuating circumstances and a repeat examination is planned.

The first code reported is for the bleeding ulcer. Look in the ICD-10-CM Alphabetic Index for Ulcer/stomach/with/hemorrhage referring you to K25.4. The second code reported is for the jejunum perforated ulcer. Look in the ICD-10-CM Alphabetic Index for Ulcer/gastrojejunal/with/perforation referring you to K28.5. Verify all code selections in the Tabular List.

Question 37

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?
A. 43450-53, 43220
B. 43220
C. 43450, 43220
D. 43220, 43450-52

Answer 37

B. 43220

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 38

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?
A. 43634, 38115-51
B. 43634, 38102-51
C. 43622, 38102
D. 43622, 38100-51

Answer 38

C. 43622, 38102

Rationale: In the CPT® Index, look for Gastrectomy/Total referring you 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 referring you to 38102.

Question 39

A patient with hypertension is scheduled for same day surgery for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery.
What ICD-10-CM codes are reported by the cardiologist?
A. I10, Z01.818, K80.20
B. K80.20, I10, Z01.810
C. Z01.810, K80.20, I10
D. K80.21, Z01.89, I10

Answer 39

C. Z01.810, K80.20, I10

Rationale: In the ICD-10-CM Alphabetic Index look for Examination/preoperative – see Examination, pre-procedural. Look for Examination/pre-procedural/cardiovascular referring you to Z01.810. Next, look for Calculus/gallbladder K80.20 and Hypertension referring you to I10. Verify all code selections in the Tabular List. Correct codes and sequencing are Z01.810, K80.20 and I10. Sequencing of preoperative clearance first (the reason for the visit), then the reason for the surgery, and last, any other findings or diagnoses. (Sequencing rule from Official Coding Guidelines of ICD-10-CM Section IV.M.)

Question 40

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?
A. 42215-76, Q35.7, R56.9
B. 42220-52, Q35.7, R56.9
C. 42215-53, Q35.9, R56.9
D. 42220-53, Q35.9, R56.9

Answer 40

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

Rationale: In the CPT® Index, look for Palatoplasty 42145, 42200-42225. An alternate path is Cleft Palate/Repair referring 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 41

Margaret has a cholecystoenterostomy with a Roux-en-Y. Five hours later, she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and was demonstrating early signs of peritonitis. What is the correct coding for the subsequent services on this date of service? (The same surgeon took her back to the OR as the one who performed the original operation.)
A. 49000-58
B. 49402-77
C. 49402-78
D. 49000-77

Answer 41

C. 49402-78

Rationale: CPT® code 49402 represents the removal of a foreign body (sponge from previous surgery) from the peritoneal cavity. In the CPT® Index, look for Removal/Foreign Body/Peritoneum. Modifier 78 indicates this was an unplanned return to the OR by the same physician for a related procedure following an initial procedure during the initial procedures postoperative period.

Question 42

A 45-year-old patient with liver cancer is scheduled for a liver transplant. The patient’s brother is a perfect match and will be donating a portion of his liver for a graft. Segments II and III will be taken from the brother and then the backbench reconstruction of the graft will be performed, both a venous and arterial anastomosis. The orthotopic allotransplantation will then be performed on the patient.
What CPT® codes are reported?
A. 47141, 47146, 47399
B. 47140, 47146, 47147, 47135
C. 47140, 47147, 47146, 47399
D. 47141, 47146, 47135

Answer 42

B. 47140, 47146, 47147, 47135

Rationale: In the CPT® Index, look for Hepatectomy/Partial/Donor referring you to 47140-47142. Code 47140 represents the portion of the liver taken from the donor. Next, look in the CPT® Index for Transplantation/Liver/Allograft Preparation referring you to 47143 - 47147. Segments II and III are to be allotransplanted. Codes 47146 and 47147 represent the backbench work with venous and arterial anastomosis. A vein and an artery are anastomosed so only report each of these codes one time. For the final code, look in the CPT® Index for Transplantation/Liver/Allotransplantation referring you to 47135; this represents the orthotopic allotransplantation into the patient.

Question 43

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?
A. 44960-22, K35.200
B. 44950-22, R10.9, R11.2, D72.829
C. 44960-22, R10.9, R11.2, D72.829, K35.30
D. 44005, 44955, R10.9, R11.2, K35.209

Answer 43

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

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. 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 44

A 56-year-old patient complains of occasional rectal bleeding. His physician decides to perform a rigid proctosigmoidoscopy. During the procedure, two polyps are found in the rectum. The polyps are removed by a snare. What CPT® and ICD-10-CM codes are reported?
A. 45309, 45309, K63.5
B. 45315, K62.1
C. 45385, K63.5
D. 45320, K62.1

Answer 44

B. 45315, K62.1

Rationale: In the CPT® Index, look for Proctosigmoidoscopy/Removal/Polyp referring you to 45308-45315. During the proctosigmoidoscopy, polyps were removed by snare technique. 45315 is the correct code for the removal of more than one polyp by snare technique.

The polyps are located in the rectum. In the ICD-10-CM Alphabetic Index, look for Polyp, polypus/rectum, referring to K62.1. Verify code selection in the Tabular List. The other code, K63.5, is for polyps that are located in the large intestine and would be inappropriate in this case.

Question 45

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?
A. 45305, K92.1
B. 45330, 45331, K62.5
C. 45331, K92.1
D. 45333, Z12.11, K62.5

Answer 45

45331, K92.1

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) 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.