MEDICON

40,000 series Questions:

1. The global surgical period refers to:

A. All surgical procedures done in a 12 month calendar year

B. All surgical procedures done in a particular inpatient stay
C. All surgical procedures
D. The time frame during which, either prior to or after the primary surgical
procedure, other services are provided. These services may need to be assigned a
modifier to alert the payer that this was known.

2. When billing for a percutaneous radiofrequency (RF) ablation of a liver tumor,

the appropriate surgical code is:

A. 47370
B. 47382
C. 47380
D. Any of the above based upon the imaging modality used

3. Preoperative Diagnosis: Lower left inguinal pain Postoperative Diagnosis:

Inguinal hernia Procedure: This 30-year-old patient presented with lower left
inguinal pain and on examination was found to have a left inguinal hernia. The
decision to perform a left inguinal hernia repair was made. The procedure was
performed in the outpatient hospital surgery center. Risks and benefits of the
surgery were discussed with the patient and the patient decided to proceed with
the surgery. A skin incision was placed at the umbilicus where the left rectus

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fascia was incised anteriorly. The rectus muscle was retracted laterally. Balloon
dissector was passed below the muscle and above the peritoneum. Insufflation
and deinsufflation were done with the balloon removed. The structural balloon
was placed in the preperitoneal space and insufflated to 10 mm Hg carbon
dioxide. The other trocars were placed in the lower midline times two. The hernia
sac was easily identified and was well-defined. It was dissected off the cord
anteromedially. It was an indirect sac. It was taken back down and reduced into
the peritoneal cavity. Mesh was then tailored and placed overlying the defect,
covering the femoral, indirect, and direct spaces, tacked into place. After this was
completed, there was good hemostasis. The cord, structures, and vas were left
intact. The trocars were removed. The wounds were closed with 0 Vicryl for the
fascia, 4-0 for the skin. Steri-Strips were applied. The patient was awakened and
carried to the recovery room in good condition, having tolerated the procedure
well. What are the correct procedure and diagnostic codes?

A.49505-LT, K40.90
B.49505-LT, 49568, K40.90
C.49507-LT, 40.91
D.49501-LT, 49568, K40.91

4. Diagnostic upper GI endoscopy of the esophagus, stomach, and duodenum was

performed after esophageal balloon dilation (less than 30 mm diameter) was
done at the same operative session. Code the procedure(s).

A.43249, 43235-51
B.43249
C.43220, 43200-51
D.43220

5. 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
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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 codes?

A.42826, 42831-59
B.42826, 42831-51-59
C.42821-50, 42836-50-59
D.42821
A patient comes in for surgery today to address complications from his previous
partial enterectomy performed 5 months ago. Upon reopening the patient’s
previous incision the surgeon resected the ileum and a portion of the colon. An
ileocolostomy was performed to complete the procedure with no complications.
The appropriate CPT® code to report is:

A.44144
B.44160
C.44150
D.44205

6. A 30 year old patient underwent a cholecystectomy with exploration of comon duct with
biliary endoscopy. How should you report this procedure?

A.47610, 47550

B.47610, 47630-59, 47552-59

C.47600

D.475624, 47550

7. 43-year-old male developed a ventral hernia when lifting a 60 pound bag. The
patient is in surgery for a ventral herniorrhaphy. The abdomen was entered
through a short midline incision revealing the fascial defect. The hernia sac and
contents were able to easily be reduced and a large plug of mesh was placed into
the fascial defect. The edge of the mesh plug was sutured to the fascia. What
procedure code(s) should be used?

A.49560
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B.49561, 49568
C.49652
D.49560, 49568

8. 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.49653
C.49652
D.49653, 49568

9. The patient is a 40-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 5-mm 0- 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 procedure:

A.44970
B.44950
C.44960
D.44979
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10. ileocolostomy was performed to complete the procedure with no

complications. The appropriate CPT® code to report is:

A.44144
B.44160
C.44150
D.44205

11. A patient with esophageal cancer is brought to the OR for subtotal

esophagectomy. A thoracotomy incision is made and the esophagus is identified.
The tumor is carefully dissected free of the surrounding structures. No invasion of
the aorta or IVC is identified. The cervical esophagus is controlled with
pursestring sutures and then transected above the sternal notch. The esophagus
is then dissected free of the stomach and the entire specimen is removed from
the chest cavity and sent to pathology. The stomach is then pulled into the chest
cavity and anastomosed to the remaining cervical esophageal stump. The
anastomosis is tested for patency and no leaks are found. Hemostasis is assured.
The chest is examined for any signs of additional disease but is grossly free of
cancer. The chest is closed in layers and a chest tube is place through a separate
stab incision. The patient tolerated the procedure well and was taken to the
PACU in stable condition.

A.43101
B.43117
C.43107
D.43112

12. 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
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the CPT® procedure(s).

A.45384
B.45384, 45384-51
C.45380, 45384
D.45378, 45383

13. Dr. Alex completed harvest and transfer for an extra-abdominal omental
flap procedure for correction of chest wall defect in an eight year old patient.
How does Dr. Alex report this procedure?

A.49904
B.44700, 49905
C.49904, 20926-59
D.44700, 49904, 20926-59

14. 12-year-old female is to have a tonsillectomy performed for chronic tonsillitis

and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue
was depressed. The nasopharynx was digitalized. No significant adenoid tissue
was felt. The tonsils were then removed bilaterally by dissection. The uvula was a
huge size because of edema, a part of this was removed and the raw surface
oversewn with 3-0 chromic catgut. Which CPT® code(s) should be used?

A.42821
B.42825, 42104-51
C.42826, 42106-51
D.42842

15. If Physician discontinued the procedure what is right way to submit claim.

A.Modifier -53 with appropriate documentation

B.Modifier-53 along with procedure
C.Procedure and appropriate documentation.
D.Procedure, Modifier-53, with appropriate documentation.

16. 42-year-old has a lesion on his pancreas. The physician passes the biopsy
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needle through the skin and removes tissue to be sent to pathology. Fluoroscopic
guidance is used to obtain the biopsy. Code this encounter.

A.48100, 77002
B.48102, 77002
C.48120, 76942
D.48102, 76942

17. Diagnostic upper GI endoscopy of the esophagus, stomach, and duodenum

was performed after esophageal balloon dilation (less than 30 mm diameter) was
done at the same operative session. Code the procedure(s).

A.43235
B.43249
C.43226, 43200
D.43220, 43235
18. Incidental appendectomy during an intra-abdominal surgery does not usually
warrant a separate identification. If it is necessary to report a separate
identification, what modifier should you add?

A. 52

B. 59

C. 51

D. 57

19. An ENT surgeon performed control of uncontrolled bleeding in a 14 yrs old

boy after 24 hrs of surgery by surgical intervention. The boy underwent
tonsillectomy, only for regrown tonsil after the initial tonsillectomy in 12 years of
age.

A.42970-58
B.42962-58
C.42962-78
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D.42826-52

20. Patient arrives at the hospital for a scheduled outpatient diagnostic

colonoscopy. During the pre-operative evaluation and prep, it’s determined the
patient’s procedure should be postponed as the patient is febrile and appears to
be suffering from a sinus infection. Which is the correct facility coding for these
services?
A.45378-52
B.45378-74
C.45378-73
D.45378-53

21. During ERCP, a surgeon places two stents in the common bile duct and a third
stent in the right hepatic duct. Which is the proper coding?

A.43274
B.43274 x 3
C.43274, 43274-59
D.43274, 43274-59 x 2

22. Which code describes removing all, or a portion, of the omentum?

A.44700
B.49255
C.49905
D.57270

23. A patient is scheduled for laparoscopic cholecystectomy; however, the

procedure is converted to open cholecystectomy with common bile duct
exploration. Which is the correct CPT® coding?

A.47562, 47600
B.47610
C.47999
D.47560, 47610

24. A patient is scheduled for laparoscopic cholecystectomy; however, the

procedure is converted to open cholecystectomy with common bile duct
exploration with biliary endoscopy. Which is the correct CPT® coding?

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A.47562, 47600
B.47610
C.47999
D.47610, 47550

25. A patient with a history of morbid obesity is taken to the operating room for a
laparoscopic gastric restrictive procedure with bypass and Roux-en-Y
gastroenterostomy. The primary surgeon’s documentation states, “Due to the
patient’s condition of morbid obesity and complexity of procedure, Dr. X assisted
during the entire procedure.” Which is the proper coding for the primary surgeon, as
well as Dr. X?

A.43644; 43644-80
B.43644; 43644-81
C.43644; 43644-82
D.Medicare does not allow payment for an assistant at surgery for code 43644
26. What modifier should be used for an incomplete colonoscopy when the
patient was prepared for a full colonoscopy?

A. 78
B. 52
C. 24
D. None of the above

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27.

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