40,000 series

1.d - The global surgical period refers to the time frame during which, either prior to or after
the primary surgical procedure, other services were provided. These services may need to be
assigned a modifier to alert the payer that this was known.

2.b - Report code 47382 as this specifically states percutaneous in its definition. Also report the
appropriate 7XXXX series guidance code based upon the modality utilized.

3.a – (49505) 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. Your fifth digit
is 0 since there is no indication in the op note that the hernia is recurrent or bilateral.

4.b - (43249) Patient is having an Upper GI endoscopy, eliminating multiple choice answers C
and D, which report an esophagoscopy. Your key terms to look for are
balloon dilation which is in code description 43249. Code 43235 is noted as a separate
procedure and a diagnostic procedure which means it is included in a surgical endoscopy
(43249) when performed at the same time, not coded separately. Also 43235 is stand-alone
code, whereas 43249 is an indented code of 43235.

5.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. It is not appropriate to report two separate
procedure codes for a tonsillectomy and adenoidectomy, since there is combination procedure
code that reports the removal of both in one According to CPT® guidelines the codes for
tonsillectomy and adenoidectomy (42820-42836) are intended to represent bilateral
procedures. It is not appropriate to append the 50 modifier when performed bilaterally.
6.b - (44160) Documentation supports the physician removing portion of the colon (partial
colectomy), the ileum and an ileocolostomy through an incision not laparoscopically.

7.d - (43112) 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).

8.a - polyp was removed by hot biopsy forceps (45384). This colonoscopy involved two 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. According to
CPT® guidelines a surgical endoscopy always includes diagnostic colonoscopy. The diagnostic
colonoscopy is not reported separately.

9.a - Extra-abdominal omental flap (49904).

10.a - cholecystectomy with exploration of common duct (47610) with biliary endoscopy
(47550). Read the parenthetical notes below code 47610.

11.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.

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 - The age of this patient is 12, 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.

15.d - Procedure, Modifier-53, with appropriate documentation.

16 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 D12.1 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.

17.b - The physician inserts the needle through the skin which indicates this is a percutaneous
approach and not an open procedure. Answer options A and C can be eliminated. Fluoroscopic
guidance was used, which is reported with 77002 for this type of procedure.

18.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.

19.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 reportsa therapeutic procedure with removal of the polyps

20.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.
surgical intervention
21.b - Control oropharyngeal hemorrhage (post tonsillectomy), with secondary (42962-58) as
related procedure was done.

22.c - Because the procedure was not started, appending modifier 73 Discontinued services
prior to anesthesia administration to the procedure code would be appropriate for facility
billing.

23.c - When reporting endoscopic retrograde cholangiopancreatography (ERCP), if two stents

are placed in a single duct, regardless of their position, report 43274 Endoscopic retrograde
cholangiopancreatography (ERCP); with endoscopic retrograde insertion of tube or stent into
bile or pancreatic duct only once. The two stents placed in the common bile duct must be
reported as a single unit only. When multiple units of 43274 are performed in anatomically
different sites, append modifier 59 Distinct procedural service to the second unit, to alert the
payer that the second procedure occurred at a distinct, separate anatomical location.
Documentation should reflect this, as well.

24.b - removing all, or a portion, of the omentum (49255 - Omentectomy).

25.a - Per the Centers for Medicare & Medicaid Services (CMS), when a laparoscopic procedure
is converted to an open procedure, only the open procedure is reported. Do not report any
additional procedures for the diagnostic laparoscopy because CPT® guidelines specify, diagnostic
is always included in the therapeutic procedure. In ICD-10-CM, Closed surgical procedure
converted to open procedure is an additional diagnosis to identify that the procedure began
using a different approach. It’s identified as an unacceptable principal (first-listed)diagnosis.

26.b - cholecystectomy with common bile duct exploration (47610).

27.d - cholecystectomy with common bile duct exploration with biliary endoscopy (47610,
47550).

28.a - laparoscopic gastric restrictive procedure with bypass and Roux-en-Y gastroenterostomy
(43644; 43644-80). Dr.X assisted during the entire procedure so modifier 80 was appended.

29.b - The patient is 50-years-old and has never undergone a colonoscopy procedure. His only
relevant history is a brother with adenomatous polyps (family history). ICD-10-CM guidelines
allow the use of Z12.11 Screening Colonoscopy NOS with Z83.71 Family history of colonic
polyps. CPT® 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or
without collection of specimen(s) by brushing or washing, with or without colon decompression
(separate procedure) accurately reports the procedure. HCPCS Level II code G0121 Colorectal
cancer screening; colonoscopy on individual not meeting criteria for high risk would be reported
for a Medicare patient with no family history of colorectal cancer or adenomatous polyps.
 30.a - The patient is 45-years-old. He had a polyp of unknown pathology removed five years
ago, and a brother with a history of diverticulitis. His physician is recommending a colonoscopy
at age 45, five years after his last colonoscopy, due to his history of polyps of unknown
pathology. This is a surveillance colonoscopy. Z86.010 Personal history of colon polyps and
Z83.79 Family history of other digestive disorders cover the personal and family histories,
respectively. ICD-10- CM guidelines do not allow the use of Z12.11 Screening colonoscopy NOS
with Z86.010

31. C. 48155 identifies the total pancreatectomy. 48100-51 indicates an open wedge biopsy of the
pancreas with the -51 modifier to indicate a multiple procedure.
RATIONALE:
A. 48100 reports only the open wedge biopsy and does not report the pancreatectomy.
B. 48155 reports only the pancreatectomy and does not report the biopsy procedure. Remember,
on the certification exam third-party payer guidelines are NOT followed, so the biopsy is reported
separately.D. 48155 correctly reports the pancreatectomy. 48100-51 correctly reports the open
wedge biopsy, but 88309 reports the pathology service, and the directions stated to code only the
operative procedure(s).

32. A. 49521 identifies a recurrent inguinal hernia that is strangulated.

RATIONALE:
B. 49520 is a repair of a recurrent inguinal hernia that was reducible, which is one that the
surgeon is able to return to the normal anatomic location. The hernia in the report is
strangulated, not reducible or able to be returned to the original location.
C. 49492 reports an initial repair of an inguinal hernia that is strangulated, and the report
indicated a recurrent repair.
D. 49521-78. Although the code is correct, the return to the operating room during the
postoperative period is not indicated in the report.

33. B. 42700 indicates the incision and drainage of a peritonsillar abscess; no approach is
mentioned. J36 is the correct diagnosis code for the peritonsillar abscess.

34. D. 45315 identifies the rigid proctosigmoidoscopy with the removal of the polyps using the
correct technique (snare).
RATIONALE:
A. 45320 reports the ablation (removal by cutting) of polyps that could not be removed by snare
technique, but the technique specified in the case was a snare technique.
B. 45383 is for colonoscopic ablation of tumors (not snare technique) from the colon (not the
sigmoid).
C. 45309 is the removal of a single polyp, and two polyps were removed; but there is a specific
code to report multiple polyp removal.

35.a. Look for a coding tip in CPT® Professional Edition located just above code 49568 and a
parenthetical note located below the code. Being aware of and reading parenthetical notes when
selecting and reporting procedure codes is important.

36.d

37. A. Code 43280 describes the laparoscopic fundoplasty Nissen procedure. Code 43324 describes
an open esophagogastric fundoplasty Nissen procedure. Diagnostic laparoscopy procedures are
included with the surgical procedure.

38. a. 43274 includes the sphincterotomy therefore only one code is necessary.

39. B. The physician inserts the needle through the skin which indicates this is a percutaneous
approach and not an open procedure. Answer options A and C can be eliminated.
Fluoroscopic guidance was used, which is reported with 77002 for this type of procedure.

40. 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.