question

A patient with Crohn's disease has been on drug therapy to treat the condition. She is now seen for extreme pain. An x-ray is taken, showing small bowel obstruction. The patient is taken immediately to surgery and a partial colectomy is performed with an end-to-end anastomosis. Which code(s) should be reported?

answer

44120

question

Which code(s) should be assigned for esophagoscopy with dilation of the esophagus using a balloon of 36 mm with radiological guidance for achalasia?

answer

43214

question

A female patient is admitted with hematemesis. She is alcohol-dependent and has liver cirrhosis. She has an EGD which demonstrates an oozing gastric varix as well as esophageal varices that aren't bleeding at the present time; however, because of their size and likelihood of bleeding, they were injected. The physician performs a transjugular intrahepatic portosystemic shunt (TIPSS) procedure. Which codes should be assigned?

answer

43243, 37182

question

A 62-year-old patient recently diagnosed with adenocarcinoma of the sigmoid colon is admitted for resection of the sigmoid colon with anastomosis of the colon to the rectum. A liver biopsy is also performed. Which code(s) should be assigned?

answer

44140, 47001

question

A patient with Crohn's disease and enterocutaneous fistula is admitted for surgery. The patient undergoes Gastrografin evaluation of the enterocutaneous fistula and closure with Tisseel fibrin glue. A catheter is inserted into the fistula measuring 3 mm-4 mm in size. GASTRO-VUE water-soluble contrast is injected. Under image intensifier evaluation, a small pinpoint enterocutaneous fistula is tracted. Irrigation and suction is performed, removing all contrast. Next, Tisseel is injected with the catheter, starting with the entry point of the fistula and slowly withdrawing out the length of the tract. The glue is set and a pressure dressing is applied. Which code should be assigned?

answer

44640

question

A physician performs a laparoscopic liver biopsy on a 48-year-old male with suspected primary biliary stenosis. How is this service coded?

answer

47379

question

A patient presented to the hospital with upper gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) with biopsy was performed, which was positive for chronic duodenal ulcer. On day three of admission, the patient required BiCap cautery of her ulcer to control the bleeding. Which code(s) will the endoscopy doctor report?

answer

43239, 43255-78

question

A 70-year-old patient was admitted to the hospital with a history of bloody diarrhea for 2 days. The admitting physician evaluated the patient and requested that a gastroenterologist see the patient for an opinion on what was causing the problem. As a result of her discussion with the patient, the gastroenterologist obtained an extended history of the present illness an extended system review; and a complete past, family, and social history, and documented a detailed history. Her examination of the patient was detailed and the resulting medical decision making was moderate. The diagnosis is acute diverticulitis with hemorrhage. A colonoscopy with biopsy confirmed the diagnosis. Which codes need to be reported?

answer

45380, 99253-57

question

A patient has been experiencing gastroesophageal reflux. The physician does an endoscopic diagnostic evaluation of the patient's esophagus and stomach. The scope does not go beyond the cardia of the stomach. Assign the diagnosis and CPT code for the physician.

answer

43200

question

After a month of ignoring the bulge in his left abdomen, a patient is seen by his family doctor and sent to a surgeon for evaluation. The surgeon's diagnosis is incarcerated left inguinal hernia. The patient then undergoes an indirect hernia repair. How is this service reported?

answer

49507

question

A 12-year-old boy has had chronic adenotonsillitis for the past 16 months. He was seen earlier today at the ASC. The boy was scheduled for T&A under general anesthesia. The physician used a laser to excise both the tonsils and adenoids and to control bleeding. Which of the following codes is appropriate for the procedure?

answer

42821

question

Indications: Colon cancer screening. The patient is a 66-year-old Medicare patient with no GI complaints present for screening colonoscopy. A colonoscope is inserted into the rectum and then advanced without any difficulty to the cecum, which is verified by the presence of the ileocecal valve and appendiceal orifice. Careful inspection following withdrawal is performed, with polyps noted in both the mid-descending colon and in the rectum (at about 15 cm). Three diminutive polyps all measuring 1 to 2 mm in the rectum, which were removed with cold biopsy forceps. Two diminutive polyps measuring about 3 mm are seen in the descending colon also removed with biopsy forceps. Which code should be assigned?

answer

45385

question

A patient is known to have obstructed gallbladder and bile duct stones with chronic cholecystitis. The patient was also found to have pancreatic duct obstruction not due to calculus. ERCP is performed with removal of a stone from the bile duct, sphincterotomy, and insertion of stents into the bile and pancreatic ducts. Which codes should be assigned?

answer

43274, 43274-59, 43264, 43262

question

A patient with a history of colon cancer is admitted for closure of her colostomy, which was performed under general anesthesia. The surgeon reported code 44620.

answer

True

question

If an endoscopic procedure is performed as a diagnostic procedure upon which the decision to perform the open procedure is made, the procedure may be reported separately with a -58 modifier.

answer

True

question

If multiple biopsies are performed from the same and different lesions, yet none of the lesions are excised, multiple biopsy codes may be reported with a -59 modifier on the second code.

answer

False

question

A surgical procedure using a rigid instrument to examine the rectum and distal colon that includes dilation would be assigned code 45303.

answer

True

question

snare

answer

A wire loop with an electric current

question

cleft lip

answer

A type of birth defect involving a separation of the lip

question

A twisting of the intestines - volvulus, Surgical removal of the gallbladder

answer

cholecystectomy

question

diagnostic

answer

The type of endoscopy that is included in a surgical endoscopy

question

esophagoscopy

answer

Placing a scope into the esophagus

question

incidental appendectomy

answer

May or may not be separately reportable from other intra-abdominal procedures

question

polyp

answer

tumor on a pedicle

question

bariatric surgery

answer

A gastric restrictive procedure

question

colonoscopy

answer

Scope placement from the anus to the cecum

question

EGD is the abbreviation for esophagogastrodilation.

answer

False

question

With respect to polyps, biopsy and polypectomy are synonymous.

answer

False

question

If an esophageal dilation using a Savary dilator was performed, the dilation was carried out using a guidewire.

answer

True

question

If a screening colonoscopy is scheduled but during the procedure a polyp is found and removed, a code for the screening should still be submitted because this was why the case was originally scheduled.

answer

False

question

To report a colonoscopy, the physician passes the scope beyond 50 cm of the large intestine

answer

True

question

An EGD with Maloney dilation is reported with 43235 and 43450.

answer

False

question

An incidental appendectomy is coded separately when performed with other abdominal procedures on the digestive system.

answer

True

question

Placement of an anal seton cannot be reported separately from other rectal procedures.

answer

True

question

The use of hot biopsy forceps does not constitute ablation technique.

answer

False

question

Medicare accepts either the diagnostic colonoscopy CPT code or the HCPCS code for screening colonoscopies.

answer

False

question

Suture of diaphragm due to traumatic multiple stab wounds is assigned to 39501.

answer

True

question

Inflammation of the bile ducts is referred to as cholangitis

answer

True

question

A patient is seen for a screening colonoscopy. The patient is 75 years old and has a family history of colon cancer. During the colonoscopy, a polyp is discovered in the proximal sigmoid. The polyp is snared with cold biopsy forceps. Which code(s) should be reported?

answer

45385

question

Colonoscopy is performed in a 46-year-old patient. Biopsy was taken of the terminal ileum. A scope was withdrawn into the cecum and multiple biopsies were taken of several suspicious-looking areas. At the area of the hepatic flexure, a polyp was removed with snare technique. Which code(s) should be reported?

answer

45385, 45380-59

question

A 53-year-old patient exhibits hernias of the left inguinal canal and of the umbilicus. The inguinal canal was repaired 5 years ago. At this episode, the physician uses mesh to repair the inguinal hernia. Both hernias are repaired laparoscopically under general anesthesia. Which codes should be reported?

answer

49651, 49652

question

A 47-year-old patient complaining of persistent right upper quadrant nagging pain undergoes an ERCP with removal of stent and sphincterotomy. Which code(s) should be reported?

answer

43275, 43262-51

question

A 56-year-old patient complaining of difficulty swallowing and persistent indigestion undergoes an endoscopy with biopsies and dilation of an esophageal stricture. The physician inserted the scope into the esophagus and at 20 cm noted esophagitis. The scope was advanced into the stomach and to the second portion of the duodenum. Biopsies were taken of the stomach and esophagus. A 20-mm balloon was used to dilate the esophagus. Which codes should be reported?

answer

43249, 43239-51

question

A 47-year-old with a 10-year history of chronic alcoholism reported to the physician-owned endoscopy suite with abnormal liver function tests and vomiting blood. The physician performed an endoscopy with injection of esophageal varices. Once the endoscopy procedure was completed, under fluoroscopic guidance, a hollow-bore needle was inserted between the ribs on the patient's right side and the liver was biopsied. Which codes should be reported?

answer

43204, 47000, 77002

question

A patient had a right recurrent ventral hernia repaired with Marlex mesh. Which codes should be reported?

answer

49565, 49568

question

A patient is seen in follow-up for polypectomy. A polyp was removed 1.5 years ago. She is scheduled for a colonoscopy. A scope was inserted and at about 38 cm a polyp was found. It was removed with a snare. Which code should be reported?

answer

45385

question

An elderly patient has a history of pancreatic cancer and now needs an ERCP procedure to place a biliary stent due to recurrent jaundice 4 months after a previous ERCP procedure. Which code(s) should be reported?

answer

43274

question

A 41-year-old female patient has been experiencing right flank pain radiating to the shoulder and irregular bowel movements. Ultrasound showed a 4+ gallbladder with two large stones. The patient undergoes a laparoscopic cholecystectomy with common bile duct exploration. Which code should be reported?

answer

47564

question

A patient presents with long-standing history of abdominal pain and now presents with acute rebound tenderness of the right lower quadrant. Exploratory laparotomy with appendectomy is performed. Which code(s) should be reported?

answer

44950

question

A 4-year-old boy presents with a bulge in the left inguinal area and an associated hydrocele on examination. The surgeon performs an open inguinal hernia repair with hydrocelectomy. Which code(s) should be reported?

answer

49500

question

This 4-year-old swallowed a small toy that got stuck in her throat. A flexible esophagoscopy was performed to remove the toy. Which code should be reported?

answer

43215

question

Assign the appropriate code(s) for EGD with biopsies of the stomach and duodenum and injection of implant material into the muscle of the lower esophageal sphincter. Which code(s) should be reported?

answer

43239, 43236

question

A 40-year-old male has had severe GERD for almost a year. After a previous endoscopy of the esophagus and a barium swallow, the physician determines that he will perform a laparoscopic Nissen procedure. Code for the Nissen procedure. Which code(s) should be reported?

answer

43280

question

A 48-year-old man went to the ED complaining of vomiting coffee-ground material several times within the past hour. He had abdominal pain and had been unable to eat for the past 24 hours. He was dizzy and light-headed. His stools today have been black and tarry. While in the ED he vomited bright red blood and some coffee-ground material. After evaluating the patient, a consult was requested. The GI physician took the patient to the endoscopy suite and performed an upper GI endoscopy for diagnostic purposes. Which code(s) should be reported?

answer

43235

question

An endoscope was inserted into the esophagus, and the stomach was entered. The pyloric channel was traversed, showing a pyloric stenosis. The endoscopy was then introduced into the second portion of the duodenum, which showed normal mucosa. A 15-mm balloon was placed across the stenosis and dilated and then withdrawn. Which code should be reported?

answer

43245

question

A diagnostic colonoscopy and a diagnostic EGD are performed on the same patient by the same physician on the same day but not during the same session. Code for both procedures.

answer

45378, 43235-51

question

A child's gestational age at birth was 34 weeks. Fourteen weeks later she had an initial inguinal hernia repair done. Which code should be reported?

answer

49491

question

A patient with Crohn's disease has been on drug therapy to treat the condition. She is now seen for extreme pain. An x-ray is taken, showing small-bowel obstruction. The patient is taken immediately to surgery and a partial colectomy is performed with an end-to-end anastomosis. Which code(s) should be reported?

answer

44120

CPT: Digestive System – Chapter 21 – Flashcards

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