1.

A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic
cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to
the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope
was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the
gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were
taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried
out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once
distally and transected. The gallbladder was then taken down from the bed using electrocautery,
delivering it into an endobag and removing it from the abdominal cavity with the umbilical port. What
CPT and ICDIOCM codes should be reported?
A. 47564, K80.18
B. 47610, K80.64
C. 47562, K81.1
D. 47600, K81.9

2. A 70-year-old female who has a history of symptomatic ventral hernia was advised to undergo
laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried
down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant
and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the
area of the hernia where a small defect was clearly visualized. There was some omentum, which was
adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to
cover the defect. What procedure code(s) should be used?
A. 49560, 49568
B. 49652
C. 49653
D. 49653, 49568

3. The patient is a 50-year-old gentleman who presented to the emergency room with signs and symptoms
of acute appendicitis with possible rupture. He has been brought to the operating room. An
infraumbilical incision was made which a 5-mm VersaStep trocar was inserted. A 5mm O- degree
laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the
left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture
noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12-mm
defect was brought out. Select the appropriate code for this visit:
A. 44970
B. 44950
C. 44960
D. 44979

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4. An 82-year-old female had a CAT scan which revealed evidence of a proximal small bowel obstruction.
She was taken to the Operating Room where an elliptical abdominal incision was made, excising the skin
and subcutaneous tissue. There were extensive adhesions along the entire length of the small bowel: the
omentum and bowel were stuck up to the anterior abdominal wall. Time- consuming tedious lysis of
adhesions was performed to free up the entire length of the gastrointestinal tract from the ligament to
Treitz to the ileocolic anastomosis. The correct CPT code is:
A. 44005
B. 44180-22
C. 44005-22
D. 44180-59

5. 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a
catheter placement. The endoscope is passed through the cricopharyngeal muscle area without
difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted.
Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach at
least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged
due to high-grade narrowing in the pyloric channel. It seems to be a high grade outlet obstruction with a
superimposed volvulus. What code should be used for this procedure?
A. 43246-52
B. 43241-52
C. 43235
D. 43206

6. The patient is a 78-year-old white female with morbid obesity that presented with small bowel
obstruction. She had surgery approximately one week ago and underwent exploration, which required a
small bowel resection of the terminal ileum and anastomosis leaving her with a large inferior ventral
hernia. Two days ago she started having drainage from her wound which has become more serious. She
is now being taken back to the operating room. Reopening the original incision with a scalpel, the
intestine was examined and the anastomosis was reopened, excised at both ends, and further excision of
intestine. The fresh ends were created to perform another end- to-end anastomosis. The correct
procedure code is:
A. 44120-78
B. 44126-79
C. 44120-76
D. 44202-58

2
7. 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a
catheter placement. The endoscope is passed through the cricopharyngeal muscle area without
difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted.
Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach at
least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged
due to high grade narrowing in the pyloric channel. It seems to be a high grade outlet obstruction with a
superimposed volvulus. What code should be used for this procedure?
A. 43246-52
B. 43241-52
C. 43235
D. 43234

8. Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis. Postoperative Diagnosis: Same.

Procedure: Tonsillectomy and adenoidectomy. Patient is a 24-year old male who was taken to the
operating room and put under IV sedation by the anesthesia department. An initial curettage of
adenoids was done and packing was placed. The left tonsil was then identified and dissected out
extracapsular and removed with scissors. Hemostasis was maintained by packing the left tonsil. Next, the
right tonsil was identified and incision was made. Dissection was done extracapsular and the right tonsil
was then removed. Both the right and left tonsil were sent as specimens as well as adenoid tissue. What
are the procedure and diagnosis codes?
A. 42826, 42831-59
B. 42826, 42831-51-59, 42809
C. 42821-50, 42809-59
D. 42821

9. A patient has an adjustable gastric restrictive device component removed and replaced via a
laparoscopic procedure. How should you code this procedure?
A. 43773
B. 43772, 43773-51
C. 43888
D. 43845

10. Preoperative diagnosis: History of prior colon polyps Postoperative diagnosis: Colon polyps,
diverticulosis, hemorrhoids Procedure: A rectal exam was performed and revealed small external
hemorrhoids. The video colonoscope was passed without difficulty from anus to cecum. The colon was
well prepped. The instrument was slowly withdrawn with good views obtained throughout. There was a
3 mm polyp in the proximal ascending colon. This polyp was removed with hot biopsy forceps and
retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the proximal rectum. The polyp
was removed by hot biopsy forceps. There was also moderate diverticulosis extending from the hepatic
flexure to the distal sigmoid colon. Code the CPT@ procedure(s).
A. 45384
B. 45384, 45384-51
C. 45380, 45384
D. D. 45383