OST-249: Chapter 9 - Digestive System
(40000 Series) Study Guide with Actual
Answers.
Repair of umbilical hernia for a 62-year-old male. Incision was carried through subcutaneous
tissue to the fascia level. The hernia sac was opened and excised along the umbilicus, and the
incision was closed. - Answer 49585
(Open umbilical hernia repair is assigned code 49585 for 62 year old.)
Planned colonoscopy with biopsy is not completed to reach the cecum due to tortuous colon. -
Answer 45380-52
(Colonoscopy with biopsy was planned, code 45380. The procedure was not completed;
therefore, modifier-52 should be appended. Modifier-53 is assigned only when the procedure
cannot be completed due to the patient's condition and the physician's decision to terminate.)
WRONG
The practice performs both laparoscopic and open cholecystectomies. An internal review of
these procedures coded/billed by the practice indicated some of the codes were assigned as
open procedures not laparoscopic as performed. In an effort to train staff on the specifics of a
laparoscopic cholecystectomy, the practice management team decided to provide additional
training. The following documentation was provided: Procedure: Cholecystectomy. A
supraumbilical incision was made, a trocar was placed, and a pneumoperitoneum was
insufflated. Ports were placed, and the gallbladder was identified and dissected free from the
attachments with cautery. The gallbladder was brought out through the Endobag. What words
or phrases in this example are most beneficial for training staff to recognize a laparoscopic
cholecystectomy? - Answer Supraumbilical incision, trocar(s), pneumoperitoneum, Endobag
(When a laparoscopic procedure is performed, an incision is made above (supra) the umbilicus,
a pneumoperitoneum (inflating the abdomen with CO2) is made. Trocars are utilized during the
procedure, and an Endobag is utilized to remove any specimens or biopsies.)
Dilation of stricture of GE junction through guidewire and EGD were completed to the second
portion of the duodenum. Several ulcerations around the pylorus were biopsied. - Answer
43245, 43239-59
(EGD (esophagogastroduodenoscopy) was performed. Biopsies were taken (43239-59) distinct
and separate from the dilation of GE junction stricture, assigned 43245.) WRONG
Procedure: Esophagogastroduodenoscopy with biopsy, colonoscopy. Scope was introduced into
the oropharynx and then into the entire esophagus, stomach, and duodenum without difficulty.
Severe erosive gastritis was noted with long rows of striation. Biopsies were taken to rule out H.
pylori. A recital exam revealed mild hemorrhoids. Normal prostate. The scope was transversed
through entire colon to the ileocecal valve. An excellent prep was noted. There was no evidence
of pathology whatsoever. - Answer 43239, 45378
,(Both an EGD (esophagogastroduodenoscopy) and upper GI are performed with biopsy as well
as a colonoscopy with biopsy. Codes 45378 and 43239 are both assigned in this instance.)
Patient seen for follow-up anoscopy who previously had bleeding rectal polyps. The scope was
inserted, and a single polyp was removed by hot biopsy technique that required cauterization at
the base, and an additional flat polyp was ablated as it was not able to be removed by forceps. -
Answer 46615, 46612-51
(Only two techniques were utilized on separate lesions, hot biopsy polypectomy (46612-51) and
ablation of lesions (46615).)
Colonoscopy with polypectomy X 4 by snare - Answer 45385
(Colonoscopy was performed with four polypectomies all performed by snare. CPT guidelines
indicate that each technique is allowed only per encounter; therefore, 45385 only would be
assigned.)
Incidental appendectomy during an intra-abdominal surgery does not usually warrant a
separate identification. If it is necessary to report a separate identification, how should the
service be reported? - Answer Never appropriate if incidental
(An incidental appendectomy performed during the time of any intra-abdominal surgery is not
separately reportable.)
Upper endoscopy is performed. Following direct visualization of the esophagus, stomach, and
duodenum, a small cut is made to enter the stomach percutaneously. Guidewire was inserted,
and a #20 PEG tube was placed over the top of the guidewire and pulled into position. - Answer
43246
(When a PEG tube (feeding tube) is placed during an EGD over a guidewire, the
esophagogastroduodenoscopy section should be utilized. In this instance, 43246 would be
appropriate for placement of the PEG tube over the guidewire.)
Laparoscopic cholecystectomy with cholangiography - Answer 47563
(When gallbladder is excised laparoscopically with cholangiogram, assign code 47563.)
Anal fissure with anal stenosis. Anal dilator was placed with packing. A moderate-sized fissure
was visualized in the posterior column. Sphincterotomy was performed with dividing some of
the external anal sphincter muscle fibers. Mucosa was then closed with 3-0 Monocryl. - Answer
46080
(Assign code 46080 when sphincterotomy is performed with division of sphincter.)
Colonoscope was inserted, and examination was carried out to the cecum. At 25 cm from the
rectal opening, a 4 mm polyp was encountered. It was snared and cauterized at the base. -
Answer 45385
, (Snare polypectomy was performed; therefore, code 45385 only would be assigned.)
Colonoscopy with polypectomies and upper endoscopy with biopsy. Colonoscope was
introduced all the way to the cecum. Two small polyps were identified which were hot biopsied
and totally fulgurated. Another large pedunculated polyp was identified and a small biopsy was
taken and then the polyp was snared in toto. Following withdrawal of the colonoscope, the
mouth was sprayed with Cetacaine and the scope was passed through the mouth into the
duodenum. Biopsies were taken of several polyps as well as CLOtest biopsy. - Answer 45388,
45385-59, 43239
(Two methods were utilized for removing/destroying polyps, namely fulguration (after biopsy
which would be included) 45388, and snare, code 45385-59 to indicate the snare polypectomy
was performed to a distinct and separate site than the fulguration. In addition, biopsies were
performed during an EGD (esophagogastroduodenoscopy) which codes to 43239.)
Hernia, initial, inguinal, age 4 - Answer 49500
(Repair of an initial inguinal hernia on a 4-year-old is coded to 49500 as assumed reducible.)
Exploratory laparotomy - Answer 49000
(When exploratory laparotomy only is performed, it is assigned code 49000.)
A 46-year-old taken to OR. Left tonsil was grasped with Allis forceps. Tonsil was dissected free
from the fossa, resected by snare. Right tonsil was excised in a similar fashion. - Answer
42826
(Tonsils only were excised; therefore, code 42826 would be appropriate for patients over 12.)
Patient had an exploratory laparotomy that revealed cholecystitis, and cholecystectomy was
performed. - Answer 47600
(Exploratory laparotomy is the approach by which the procedure was performed and, therefore,
is not separately reported. Therefore, code 47600 for the open cholecystectomy only would be
appropriate.)
A 7-year-old was brought to the OR. Mouth retractor was used for good visualization of the
posterior pharynx. Enlarged adenoid tissue was discarded, and tonsil pack was placed and the
tonsil grasper was used to grasp the entire right and left tonsillar tissue from the tonsillar fossa.
- Answer 42820
(Both tonsils and adenoids were excised; therefore, code 42820, for patients under 12 would be
assigned.)
A patient presents for upper GI endoscopy for possible esophageal dilation and polyps. Scope
was introduced into the esophagus, visualizing an esophageal polyp that was removed through
snare technique. At the gastroesophageal junction, an extreme narrowing occurred and unable
(40000 Series) Study Guide with Actual
Answers.
Repair of umbilical hernia for a 62-year-old male. Incision was carried through subcutaneous
tissue to the fascia level. The hernia sac was opened and excised along the umbilicus, and the
incision was closed. - Answer 49585
(Open umbilical hernia repair is assigned code 49585 for 62 year old.)
Planned colonoscopy with biopsy is not completed to reach the cecum due to tortuous colon. -
Answer 45380-52
(Colonoscopy with biopsy was planned, code 45380. The procedure was not completed;
therefore, modifier-52 should be appended. Modifier-53 is assigned only when the procedure
cannot be completed due to the patient's condition and the physician's decision to terminate.)
WRONG
The practice performs both laparoscopic and open cholecystectomies. An internal review of
these procedures coded/billed by the practice indicated some of the codes were assigned as
open procedures not laparoscopic as performed. In an effort to train staff on the specifics of a
laparoscopic cholecystectomy, the practice management team decided to provide additional
training. The following documentation was provided: Procedure: Cholecystectomy. A
supraumbilical incision was made, a trocar was placed, and a pneumoperitoneum was
insufflated. Ports were placed, and the gallbladder was identified and dissected free from the
attachments with cautery. The gallbladder was brought out through the Endobag. What words
or phrases in this example are most beneficial for training staff to recognize a laparoscopic
cholecystectomy? - Answer Supraumbilical incision, trocar(s), pneumoperitoneum, Endobag
(When a laparoscopic procedure is performed, an incision is made above (supra) the umbilicus,
a pneumoperitoneum (inflating the abdomen with CO2) is made. Trocars are utilized during the
procedure, and an Endobag is utilized to remove any specimens or biopsies.)
Dilation of stricture of GE junction through guidewire and EGD were completed to the second
portion of the duodenum. Several ulcerations around the pylorus were biopsied. - Answer
43245, 43239-59
(EGD (esophagogastroduodenoscopy) was performed. Biopsies were taken (43239-59) distinct
and separate from the dilation of GE junction stricture, assigned 43245.) WRONG
Procedure: Esophagogastroduodenoscopy with biopsy, colonoscopy. Scope was introduced into
the oropharynx and then into the entire esophagus, stomach, and duodenum without difficulty.
Severe erosive gastritis was noted with long rows of striation. Biopsies were taken to rule out H.
pylori. A recital exam revealed mild hemorrhoids. Normal prostate. The scope was transversed
through entire colon to the ileocecal valve. An excellent prep was noted. There was no evidence
of pathology whatsoever. - Answer 43239, 45378
,(Both an EGD (esophagogastroduodenoscopy) and upper GI are performed with biopsy as well
as a colonoscopy with biopsy. Codes 45378 and 43239 are both assigned in this instance.)
Patient seen for follow-up anoscopy who previously had bleeding rectal polyps. The scope was
inserted, and a single polyp was removed by hot biopsy technique that required cauterization at
the base, and an additional flat polyp was ablated as it was not able to be removed by forceps. -
Answer 46615, 46612-51
(Only two techniques were utilized on separate lesions, hot biopsy polypectomy (46612-51) and
ablation of lesions (46615).)
Colonoscopy with polypectomy X 4 by snare - Answer 45385
(Colonoscopy was performed with four polypectomies all performed by snare. CPT guidelines
indicate that each technique is allowed only per encounter; therefore, 45385 only would be
assigned.)
Incidental appendectomy during an intra-abdominal surgery does not usually warrant a
separate identification. If it is necessary to report a separate identification, how should the
service be reported? - Answer Never appropriate if incidental
(An incidental appendectomy performed during the time of any intra-abdominal surgery is not
separately reportable.)
Upper endoscopy is performed. Following direct visualization of the esophagus, stomach, and
duodenum, a small cut is made to enter the stomach percutaneously. Guidewire was inserted,
and a #20 PEG tube was placed over the top of the guidewire and pulled into position. - Answer
43246
(When a PEG tube (feeding tube) is placed during an EGD over a guidewire, the
esophagogastroduodenoscopy section should be utilized. In this instance, 43246 would be
appropriate for placement of the PEG tube over the guidewire.)
Laparoscopic cholecystectomy with cholangiography - Answer 47563
(When gallbladder is excised laparoscopically with cholangiogram, assign code 47563.)
Anal fissure with anal stenosis. Anal dilator was placed with packing. A moderate-sized fissure
was visualized in the posterior column. Sphincterotomy was performed with dividing some of
the external anal sphincter muscle fibers. Mucosa was then closed with 3-0 Monocryl. - Answer
46080
(Assign code 46080 when sphincterotomy is performed with division of sphincter.)
Colonoscope was inserted, and examination was carried out to the cecum. At 25 cm from the
rectal opening, a 4 mm polyp was encountered. It was snared and cauterized at the base. -
Answer 45385
, (Snare polypectomy was performed; therefore, code 45385 only would be assigned.)
Colonoscopy with polypectomies and upper endoscopy with biopsy. Colonoscope was
introduced all the way to the cecum. Two small polyps were identified which were hot biopsied
and totally fulgurated. Another large pedunculated polyp was identified and a small biopsy was
taken and then the polyp was snared in toto. Following withdrawal of the colonoscope, the
mouth was sprayed with Cetacaine and the scope was passed through the mouth into the
duodenum. Biopsies were taken of several polyps as well as CLOtest biopsy. - Answer 45388,
45385-59, 43239
(Two methods were utilized for removing/destroying polyps, namely fulguration (after biopsy
which would be included) 45388, and snare, code 45385-59 to indicate the snare polypectomy
was performed to a distinct and separate site than the fulguration. In addition, biopsies were
performed during an EGD (esophagogastroduodenoscopy) which codes to 43239.)
Hernia, initial, inguinal, age 4 - Answer 49500
(Repair of an initial inguinal hernia on a 4-year-old is coded to 49500 as assumed reducible.)
Exploratory laparotomy - Answer 49000
(When exploratory laparotomy only is performed, it is assigned code 49000.)
A 46-year-old taken to OR. Left tonsil was grasped with Allis forceps. Tonsil was dissected free
from the fossa, resected by snare. Right tonsil was excised in a similar fashion. - Answer
42826
(Tonsils only were excised; therefore, code 42826 would be appropriate for patients over 12.)
Patient had an exploratory laparotomy that revealed cholecystitis, and cholecystectomy was
performed. - Answer 47600
(Exploratory laparotomy is the approach by which the procedure was performed and, therefore,
is not separately reported. Therefore, code 47600 for the open cholecystectomy only would be
appropriate.)
A 7-year-old was brought to the OR. Mouth retractor was used for good visualization of the
posterior pharynx. Enlarged adenoid tissue was discarded, and tonsil pack was placed and the
tonsil grasper was used to grasp the entire right and left tonsillar tissue from the tonsillar fossa.
- Answer 42820
(Both tonsils and adenoids were excised; therefore, code 42820, for patients under 12 would be
assigned.)
A patient presents for upper GI endoscopy for possible esophageal dilation and polyps. Scope
was introduced into the esophagus, visualizing an esophageal polyp that was removed through
snare technique. At the gastroesophageal junction, an extreme narrowing occurred and unable
