ANSWERS
1. “b” This answer must have the diagnosis codes and procedure code. The diagnoses codes report
special screening for the colonoscopy, family history of colon cancer, and benign polyps of the colon. The
procedure code 45384 reports a therapeutic procedure with removal of the polyps.
2. “d” You can find this answer in the index of the CPT Professional Edition under Suture, Abdomen.
3. “d” You can find this answer in the index of the CPT Professional Edition under Vestibuloplasty. You can
find the definition of the vestibule of the mouth at the beginning of the digestive system above code
40800. Modifier -50 isn’t necessary because the code description states “bilateral.”
4. “a” You should append modifier -26 to the radiology code to indicate the professional portion of this
procedure. You can find this procedure in the index of the CPT Professional Edition under Placement,
Needle, Interstitial Radioelement Application, Head.
5. “c” This is a replacement procedure via the same access site. The same provider who does the
procedure reports the moderate sedation codes.
6. “a” Use add-on code 49568 to report the implantation of the mesh in addition to debridement and
hernioplasty. Modifier -51 is not attached to add-on codes (see Appendix A).
7. “c” The code 45320 includes moderate sedation.
8. “a” direct code 43274.
9. “a” Report modifier -52. This statement is printed in the CPT Professional Edition under the code
44950. You can find this answer by looking up appendectomy in the index and cross referencing the
codes.
1O.“c” Always review how the procedure is being performed – laparoscopy, excision, etc. This is a key to
finding and reporting the correct code.
11. B One way to narrow down your choices is by the diagnosis. The patient has chronic cholecystitis. In
the ICD-10-CM manual, look under cholecystitis/chronic, referring you to code K81.1. Verify code in the
tabular section for accuracy. The patient had a laparoscopic cholecystectomy, eliminating multiple choice
answers C and D. An examination of the bile duct was not performed, eliminating multiple choice answer
A.
12. B The patient is having a laparoscopic ventral hernia repair, eliminating multiple choice answers A.
The hernia is incarcerated as the report states that omentum was adhered to the hernia and was
delivered back into the peritoneal cavity, eliminating multiple choice answer C. A parenthetical note in
the code descriptive for the laparoscopic hernia repair codes state, that mesh insertion is included when
reporting these codes when performed, eliminating multiple choice answer D
13. A Patient is having the surgery performed by a laparoscope, eliminating multiple choice answers B
and C. The surgical procedure performed was an appendectomy, eliminating multiple choice D.
14. 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 the adhesions were “extensive” and the procedure
was “time consuming” 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.
15. B The endoscopy was performed along with a placement of a catheter, eliminating multiple choice
answers C and D. Since the placement was a catheter, multiple choice answer A is eliminated. The
correct answer is 43241 with modifier -52 appended to indicate that the endoscope did not pass into the
duodenum and/or jejunum.
16. A The surgery was not performed with a laparoscope, eliminating multiple choice answer D. The
patient did not have a diagnosis of congenital atresia, eliminating multiple choice answer B. This was an
unplanned return to the operating room due to the patient having a complication from the original
surgery that was performed a week ago, eliminating multiple choice answer C.
17. B The surgery was not performed by a laparoscope, eliminating multiple choice answer D. The
patient had a colostomy (Artificial surgical opening anywhere along the length of the colon to the skin
surface for the diversion of feces) done, not an anastomosis (surgically creating a connection between
bowel segments to allow flow from one to the other), eliminating multiple choice answer A. The op note
documents that the distal left colon was divided and the sigmoid colon excised, eliminating multiple
choice answer C.
18.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. The diagnosis is indexed under
Appendicitis/with peritoneal abscess, referring you to code K35.3. Verify code in the tabular section for
accuracy.
19. C The age of this patient is 15, eliminating multiple choice answer B. The patient only had tonsils
removed eliminating multiple choice A. Part of the uvula was removed, eliminating multiple choice
answer D.
20. D The surgery was not performed by a laparoscope, eliminating multiple choice answer C. There is no
mention of the hernia being incarcerated or strangulated, eliminating multiple choice answer B.
According to CPT guidelines in the hernia repair section, codes 49560-49566 can be reported with mesh
add-on code, 49568.
21. A A sigmoidoscopy is performed for a diagnostic colorectal cancer screening since the patient has a
history of colon cancer. During the procedure the removal of three polyps are done by hot biopsy
forceps. The correct procedure is 45333. Since the patient has a history of colon cancer, the Z85.038 is
coded. This is indexed in you ICD-10-CM manual, History/malignant neoplasm (of)/colon. Code D12.6 is
coded since polyps were found. According to ICD-10-CM guidelines, when the patient is coming in for a
screening exam only and a condition is discovered during the screening then the code for the condition is
assigned as an additional diagnosis. So for this procedure, the polyps were discovered during the
screening, not before, and can only be assigned as an additional diagnosis.
22. B. The removal of the gallbladder (cholecystecomy) was begun as a laparoscopic procedure. During
the procedure, the surgeon decides that additional exposure is needed to complete the procedure. The
procedure is converted to an open approach. When a laparoscopic approach is converted to an open
approach, you code for the approach used to complete the surgery. You cannot code for both. Modifier
22 is appropriate for the additional work involved in the case. 47001 is coded to report the needle liver
biopsy that was performed during this open procedure.
23. B. Hemorrhoids were removed by rubber band ligation, eliminating C and D. There were two
different scopes used to indentify the internal hemorrhoids. Only code 45300 (Proctosigmoidoscopy) will
be billed. 46600 (Anoscopy) is a “separate procedure,” meaning this is only coded when it is not an
integral part of the another procedure performed at the same time. For this procedure, the doctor is
removing the hemorrhoids while performing the anoscopy, making the anoscopy an integral component
(included) in the procedure code for removal of the hemorrhoids. The 51 modifier is appended to the
second procedure code since there was an additional procedure performed in the surgery.
24 .D. 43257 is the correct procedure for the Upper GI Endoscopy delivering thermal energy, eliminating
multiple choice answer B. Modifier 73 and 74 are reported for the facility codes which eliminates
answers A and C. The correct modifier for the physician’s service is 53. For the diagnosis codes GERD is
indexed in the ICD-10-CM manual under Reflux/Gastroesophageal, you are referred to code K21.9. is
indexed under Hypotension/postoperative. Z53.09 is reported to indicate the surgery was not carried
out.
25. A. This colonoscopy involved polyps being removed by hot biopsy forceps which leads to code 45384.
This is only coded once regardless of the number of polyps that was removed with this one technique.
26. D. You first need to look at the approach of the surgery, which is the physician incising the chest
(thoracotomy) to expose the esophagus, eliminating multiple choice answer C. The physician is not
removing a lesion from the esophagus; the physician is removing the esophagus (esophagectomy) and
replacing it with the stomach, eliminating multiple choice answer A. The next key term to help you
choose between procedure code 43112 and 43117 is “cervical”. 43112 is the correct code since the
stomach is pulled through the middle of the chest into the neck and the stomach is connected to the
stump of the esophagus in the neck (cervical).
27. B. Radiological guidance was used for this procedure; there are parenthetical notes that inform you
for each of these ECRP procedure codes to use 74328 or 74329 for radiological supervision and
interpretation, eliminating multiple choice answer C. Since the surgery is being performed in an
outpatient hospital, the physician does not own the equipment so modifier 26 needs to be appended to
radiology code eliminating multiple choice answer D. 43264 is the correct code since there was a
removal of a calculus (stone) from the common bile duct.
28. A .To start narrowing down your choices, you need to identify the type of hernia. The operative note
indicates that it is an inguinal hernia. Next does the op not mention if the hernia is incarcerated or
strangulated? No, so this eliminates multiple choice answers C and D. Code 49568 (Mesh) would not be
coded. According to CPT® guidelines the mesh is only coded for incisional hernia repairs. This statement
is found in the subsection above the hernia repair codes. In the ICD-10-CM index, look up,
Hernia/inguinal referring you to K40.90.
29. D. One way to narrow down your choices is by looking up the diagnosis first. In the ICD-10-CM index,
look up Adenoiditis/with chronic tonsillitis, referring you to code J35.03. This eliminates multiple choice
answers A and C. The patient is having a tonsillectomy and an adenoidectomy, which leads to code
42821.
30. B. Patient is having an Upper GI endoscopy, eliminating multiple choice answers C and D, which
report esophagoscopy. Your key terms to look for are “balloon dilation” which is in code description
43249.
31. d. The definitive diagnosis of benign colon polyps should be reported, not the signs and symptoms
for this question. The signs and symptoms would be appropriate if there was not a definitive diagnosis
available for the study. The diagnostic colonoscopy is included with the surgical colonoscopy; therefore,
only code 45385 is required for correct procedure reporting.
32. c. The CPT® Professional Edition includes a definition of colonoscopy and coding tips. In the coding
tip for colonoscopy, modifier -53 is appropriate with documentation regarding non-advancement of the
scope beyond the splenic flexure.
33. a. One way to find this procedure in the index of the CPT® Professional Edition is under the main
term “Esophagus,” “Removal,” and “Foreign Bodies.” In this question, an esophagotomy was
completed;therefore, you should not report a code for an endoscopic approach.
34. a. This question indicates anesthesia was started and then the condition of the patient changed.
Modifier -74 indicates a discontinued procedure after administration of anesthesia and is appended to
the surgery code.
35. c. The complex repair is included with this excision code and should not be reported separately. The
diagnosis in this question is a lesion, not a neoplasm.
36. b. Code 43242 includes the ultrasound. Review the parenthetical notes with this code to help
determine correct reporting.
37. d. One way to find this procedure in the index of the CPT® Professional Edition is under the main
term “Laparoscopy,” then “Esophagogastric Fundoplasty” and/or “Esophageal Lengthening.” Review the
definition for modifier -51 in Appendix A of the CPT® Professional Edition to help determine placement
of this modifier.
38. d. The add-on code 44121 is reported for each additional resection and anastomosis of the small
intestine. In this case, four total resections and anastomoses were completed; therefore, report the
add-on code with three units.
39. a. The diagnostic procedure is included with the surgical procedure and should not be reported
separately.
40. a. One way to locate this answer in the index of the CPT® Professional Edition is under the main
term“Laparoscopy,”then “Gastric Restrictive Procedures.” Once the code range is located,
cross-reference for correct code selection.