Digestive

Question 1

Large lymphadenopathy in the right neck region was marked. Skin incision was made, and dissection was made down through the muscle where multiple lymphadenopathy was identified. Two representative nodes were removed.

Answer 1

38510 biopsy/excision lymph node deep cervical node

Question 2

Tonsillectomy and adenoidectomy was performed on a 17-year-old male. A McIvor mouth gag was placed and attention was focused on left tonsil. Tonsil was removed entirely and then similar procedure was performed on the right tonsil. Utilizing suction cautery, the adenoids were also removed.

Answer 2

42821 tonsillectomy and adenoidectomy 12>

Question 3

Coaxial biopsy needle was advanced right at the end of the lesion. Three 18-gauge core-needle liver biopsy samples were taken.

Answer 3

47000 biopsy liver needle percutaneous

Question 4

Endoscopic dilation of stricture of GE junction via balloon and EGD were completed to the second portion of the duodenum. Several ulcerations around the pylorus were biopsied.

Answer 4

43245 egd dilation gastric/duodenal stricture, 43239-59 egd transoral biopsy single/multiple

Question 5

A 2-year-old patient swallowed a marble that lodged in his esophagus. An esophagotomy through thoracic approach was completed for the removal of foreign body.

Answer 5

43045 esophagotomy thoracic approach w/foreign body removal

Question 6

Esophagoscopy with FB removal

Answer 6

43215 esophagoscopy flexible removal of foreign body

Question 7

A 13-year-old presents for removal of tonsils. Tonsils are grasped and removed

Answer 7

42826 tonsillectomy primary/secondary 12>

Question 8

The patient is a 58-year-old white female with morbid obesity who 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 small 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.

Answer 8

44120-78 resection small intestine 1 resection and anastomosis

Question 9

Hernia, initial, inguinal, age 4

Answer 9

49500 repair 1st inguinal hernia age 6mo-5yrs reducible

Question 10

A patient presented for screening colonoscopy. Positive for pertinent past family history of colon cancer. Scope was introduced, and the cecum was identified. A polyp in the rectosigmoid junction was ablated, two polyps in the sigmoid colon were excised utilizing snare, and an additional lesion in the sigmoid colon was biopsied.

Answer 10

45388 colonoscopy flexible ablation tumor/polyp/other lesion, 45385-51 colonoscopy flexible w/removal of tumor polyp lesion snare, 45380-59 colonoscopy w/biopsy single/multiple

Question 11

Examination under anesthesia with left lateral internal sphincterotomy. Examination of the anal canal demonstrates a posterior anal fissure. Left lateral mucosa over the internal sphincter was incised and hemostasis was achieved. Under direct vision, the sphincter was divided. The mucous membrane was then oversewn in a running locking fashion.

Answer 11

46200 fissurectomy including sphincterotomy

Question 12

Laparoscopic right inguinal hernia repair with laparoscopic umbilical hernia repair was performed during closing of inguinal hernia repair.

Answer 12

49650-RT laparoscopy surgical repair initial inguinal hernia

Question 13

Laparoscopy cholecystectomy

Answer 13

47562 laparoscopy surgery cholecystectomy

Question 14

Hernioplasty to repair a recurrent ventral incarcerated hernia 2 cm in length with implantation of mesh for closure. The surgeon completed debridement for necrotizing soft tissue due to infection at another site (intra-abdominal wall).

Answer 14

49614 repair hernia strangulated, 11005-59 debridement skin subcutaneous necrotic infection abdominal wall

Question 15

A 77-year-old presented to ED after feeling as though steak was stuck in the esophagus. Scope was passed into the esophagus, and there was a large amount of what appeared to be meat in the esophagus. The pelican forceps were used to remove the large amount of meat so the distal end of the esophagus and EG junction could be identified. Scope was removed.

Answer 15

43215 esophagoscopy flexible foreign body removal

Question 16

EGD. Scope was passed and visually guided into the esophagus, the stomach, and advanced all the way to the third part of the duodenum. A couple of biopsies were taken from the small bowel mucosa. An esophageal ulcer was examined and biopsy was taken as well.

Answer 16

43239 egd transoral biopsy single/multiple

Question 17

A 36-year-old presents for tonsillectomy. Tonsils were grasped with Allis forceps, and tonsil was bluntly dissected free. Identical procedure was performed on the other tonsil as well. The nasopharynx was viewed, and considerable amount of adenoidal tissue was also removed.

Answer 17

42821 tonsillectomy and adenoidectomy age 12>

Question 18

Scope was passed into the esophagus, stomach, and duodenum. On withdrawal, a 3-cm area resembling polyp was found and biopsied, and scope was removed.

Answer 18

43239 egd transoral biopsy single/multiple

Question 19

A patient was referred by primary care to GI for rectal bleeding. The colonoscope was advanced into the cecum. The patient had a polyp removed by snare, another polyp was hot biopsied, and a separate area of questionable inflammation was also biopsied. The base of the polyps was cauterized to control bleeding.

Answer 19

45385 colonoscopy flexible w/removal of tumor polyp lesion snare, 45380-59 colonoscopy w/biopsy single/multiple

Question 20

Infraumbilical incision was performed, peritoneum was insufflated, and trocar was introduced, and scope revealed that the liver, bowel, appendix, bladder, and uterus appeared normal. There were multiple cysts on the left ovary consistent with benign follicular cysts, which were aspirated. Bilateral chromotubation was then performed, and bilateral tubal patency was confirmed.

Answer 20

49322 laparoscopy surgery w/aspiration cavity/cyst single/multiple, 58350-50-51 chromotubation oviduct w/materials

Question 21

Scope was introduced into the esophagus and advanced into the stomach and duodenum. Multiple erosions were biopsied, remainder of EGD was normal. Scope was introduced into the rectum and advanced to the cecum. Patient requested that two lesions be excised at the time of the EGD: a 2 cm on the leg and a 1 cm on the arm were excised and sent to pathology.

Answer 21

43239 egd transoral biopsy single/multiple, 45378 colonoscopy flexible diagnostic w/collection of specimen when performed, 11402 excision benign lesion 1.1-2cm, 11401-51 excision benign lesion 0.6-1cm

Question 22

Attempted liver wedge biopsy. The right hepatic vein was cannulated using the catheter that was on the hepatic access tray. A very sharp angle is present, and the stiff metallic device could not be passed. Numerous attempts were made without success.

Answer 22

47100-52 biopsy liver wedge

Question 23

Patient with inguinal pain following inguinal hernia repair 2 years ago. Old incision was reopened, and dissection was completed down to external oblique. External ring was located, and the external oblique was opened in line with its fiber. Mesh that was placed previously was palpable and appeared intact. Patient was set upright, instructed to cough; however, no defects could be identified and the incision was closed.

Answer 23

49000 exploratory laparotomy celiotomy w wo biopsy

Question 24

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 24

43246 egd percutaneous placement of gastrostomy tube

Question 25

ERCP with removal of obstructed biliary stent, balloon of CBD stones and sludge, placement of biliary stent. Duodenoscopy was advanced through the esophagus, stomach, and pylorus into the duodenum. An obstructed biliary stent was snared and removed. Selective cannulation of the CBD was performed. Balloon of the CBD was performed by removing soft stones and sludge, followed by a new 10 French biliary stent being placed across the strictures.

Answer 25

43276 ercp biliary/pancreatic duct stent exchange w/dilation and wire, 43264-51ercp removal of calculi/debris biliary/pancreatic duct

Question 26

Appendectomy with a ruptured appendicitis. Right lower quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant, there was a large amount of pus consistent with a right lower quadrant abscess. Irrigation of the pus was performed until it was clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken down and tied using 0-Vicryl ties, and the appendix fell off completely since it was already ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using figure of 8-Vicryl sutures.

Answer 26

44960 appendectomy ruptured appendix abscess/pritonitis

Question 27

A 69-year-old male had a CT scan, which revealed evidence of a proximal small bowel obstruction. He 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. What code(s) would be assigned for this procedure?

Answer 27

44005 enterolysis freeing of intestinal adhesion

Question 28

Patient presented with cirrhosis with recurrent ascites requiring recurrent paracentesis. Area was prepped and a Seldinger needle was used. Needle catheter assembly was placed into the abdominal cavity, guidewire was placed, and a lavage catheter was placed over the wire. Wire was withdrawn and lavage catheter was attached to an evacuating bottle. Approximately 5 L of dark yellow ascitic fluid was removed and the catheter was withdrawn.

Answer 28

49082 abdominal paracentesis diagnostic/therapeutic wo imaging guidance

Question 29

Excision of lesion, buccal submucosa, right lower lip. A hard lesion measured 7 × 8 mm is felt under the submucosa of the right lower lip. After application of 1% Xylocaine with 1:1000 epinephrine, the lesion was completely excised. The lesion does not extend into the muscle layer. The 8-cm wound was closed with complex repair to the submucosal level and dressed in typical sterile fashion.

Answer 29

40814 excision lesion mucosa and submucosal vestibule complex repair

Question 30

Exploratory laparotomy with total abdominal hysterectomy

Answer 30

58150 total abdominal hysterectomy w wo removal tube ovary

Question 31

Duodenal arteriovenous malformation with bipolar thermal cauterization and ablation. Scope was introduced and advanced well into the jejunum. In the third portion of the duodenum, there was a bleeding AVM, approximately 3–4 mm in size. The probe was utilized to perform bipolar thermal ablation of the AVM.

Answer 31

44366 enteroscopy > 2nd portion w/control bleeding

Question 32

A 15-year-old male is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIvor 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 of a huge size because of edema and possible lesion, a part of this was removed and the raw surface was oversewn with 3-0 chromic catgut.

Answer 32

42826 tonsillectomy primary/secondary age 12>, 42106-52 excision lesion palate w/simple closure

Question 33

Tonsillectomy age 8

Answer 33

42825 tonsillectomy primary/secondary

Question 34

Colonoscopy with polypectomies and upper endoscopy with biopsy. Colonoscope was introduced all the way to the cecum. Two small polyps were identified that were hot biopsied and ablated. 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 CLO test biopsy.

Answer 34

45388 colonoscopy flexible ablation tumor polyp lesion, 45385-59 colonoscopy flexible w removal of tumor polyp lesion snare, 43239 egd transoral biopsy single/multiple

Question 35

Procedure: Removal of gallbladder. Indications: Trocar was placed, and CO2 was insufflated into the abdomen until an adequate pneumoperitoneum was achieved. A camera was placed at the umbilicus, and the gallbladder and liver bed were visualized. The gallbladder was enlarged and thickened, and there was evidence of chronic inflammatory changes. Two additional ports were placed, and graspers were used to free the gallbladder from the liver bed with a combination of sharp dissection and electrocautery. Several attempts were made before it was decided that additional exposure was needed and procedure was converted to an open approach. The trocars were removed, and a midline incision was made. The cystic duct was carefully ligated, and the gallbladder was carefully removed from the field. The area was copiously irrigated, and a needle biopsy of the liver was taken.

Answer 35

47600 cholecystectomy, 47001 biopsy liver needle

Question 36

Colonoscopy with polypectomy and electrocoagulation with bleeding arteriovenous malformation. Colonoscope was passed through the colon to the cecum. There were a couple of bleeding AVMs that were treated with BICAP probe. There was another one in the ascending colon that was also treated with electrocoagulation. There was also a 5-mm polyp removed by hot snare polypectomy.

Answer 36

45385 colonoscopy flexible w removal tumor polyp lesion snare, 45382-51 colonoscopy flexible control bleeding any method

Question 37

The abdomen was prepped, and a trocar was placed in the infraumbilical region through open cut down and abdomen insufflated with CO2. Laparoscopic exploration was performed as well as cholangiogram, which revealed free flow of contrast into the duodenum. Clips were placed on the cystic duct and artery, and the structure was divided. The gallbladder was taken down of its fossa, excised and placed in the Endocatch bag and pulled out through the umbilical port site.

Answer 37

47563 laparoscopic surgery cholecystectomy w/cholangiography

Question 38

Colonoscopy completed to cecum, visualizing the splenic flexure

Answer 38

45378 colonoscopy flexible diagnostic with collection of specimen when performed

Question 39

A patient was fully prepped for a diagnostic colonoscopy; however, an object was then shifted into the descending colon just below the splenic flexure. The physician was unable to advance the scope to the splenic flexure.

Answer 39

45330 sigmoidoscopy flexible diagnostic w/collection specimen

Question 40

Sigmoidoscopy with biopsy.

Answer 40

45331 sigmoidoscopy flexible w/biopsy single/multiple

Question 41

Colostomy performed with colectomy.

Answer 41

44141 colectomy partial w/skin level colostomy

Question 42

After anesthesia, a left paramedian incision was made, and a mass was found in the left colon. Colon was divided in the left portion of the transverse colon. The inferior mesenteric vessels were ligated and divided, and the left hemicolon with the mesentery and the nodes were resected en bloc. The functional end-to-end anastomosis was carried out and reinforced with sutures. Two drains were brought out through a lateral stab wound incision, and the abdomen was closed.

Answer 42

44140 colectomy partial w/anastamosis

Question 43

Colonoscope was inserted, and examination of cecum was carried. At 25 cm from the rectal opening, a 4-mm polyp was encountered. It was snared and cauterized at the base.

Answer 43

45385 colonoscopy flexible removal tumor polyp lesion snare

Question 44

A semicircular incision of 12 cm was made in the margin of the umbilicus of a 6-year-old to repair a 12 cm umbillical hernia. Dissection was carried down to the fascia. Posterior part of the umbilical skin was detached, and examination showed pinpoint opening in which omentum was stuck. Opening was enlarged, and the omentum was adhesed to the umbilical opening. It was excised and the 11 cm hernia repaired

Answer 44

49596 repair hernia 1st > 10 cm necrotic/strangulated

Question 45

Appendectomy was performed laparoscopically.

Answer 45

44970 laparoscopic appendectomy

Question 46

EGD with dilation of esophagus over guidewire

Answer 46

43248 egd insertion of guide wire dilator passage esophagus

Question 47

Laceration repair, floor of the mouth

Answer 47

41250 repair laceration 2.5cm< mouth

Question 48

Subcutaneous anal fistulotomy. Metal probe was used to retract the course of the fistula, and a curette was used to remove granulation tissue at the base.

Answer 48

46270 surgical treatment anal fossils subcutaneous

Question 49

Colonoscopy with polypectomy × 4 by snare

Answer 49

45385 colonoscopy flexible removal tumor polyp lesion snare technique

Question 50

Colonoscope was introduced and advanced to the cecum. Beyond the cecal valve, there was an area with a cauliflower-like appearance. Several biopsies were taken, hot and cold, of the area in question. In the area of the sigmoid colon, an additional polyp was snared in toto.

Answer 50

45385, 45380-59

Question 51

EGD with biopsies and dilation over guidewire

Answer 51

43248 egd insertion of guide wire dilator passage esophagus, 43239-51 egd transoral biopsy single/multiple

Question 52

Scope was introduced through the rectum and advanced to the cecum. In the duodenum, an AVM was noted and gold probe was utilized to perform bipolar thermal ablation. Multiple biopsies of several small polyps were performed with hot biopsy forceps as the scope was withdrawn and sent for pathology.

Answer 52

45388 colonoscopy flexible ablation tumor polyp, 45380-59 colonoscopy with biopsy single/multiple

Question 53

Patient was 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 could not be removed by forceps.

Answer 53

46615 anoscopy ablation lesion, 46610-51 anoscopy with removal lesion cautery

Question 54

A patient with ongoing symptoms of weight loss, constipation, and blood in stool verified with occult testing underwent a rectal approach colonoscopy with snare removal of three colonic polyps. The pathology report, which was returned to the physician on the same day of the procedure, revealed benign colon polyps.

Answer 54

45385 colonoscopy flexible with removal tumor lesion polyp snare

Question 55

A 3-year-old swallowed a quarter, and X-ray confirms it to be in high esophagus. Endoscope was introduced through pharynx, and immediately upon entering esophagus, coin was noted. It was grasped with a tooth tenaculum and pulled intact from the esophagus.

Answer 55

43215 esophagoscopy with removal fb

Question 56

The colonoscope was advanced under direct visualization into the rectum and advanced without difficulty into the cecum, ileocecal valve, appendiceal orifice, and terminal ileum. Random biopsies were obtained throughout the colon. Withdrawal back into the ascending colon did reveal a 2-mm polyp, removed by hot biopsy polypectomy. Retroflex in the rectum revealed internal hemorrhoids along with a 4-mm polyp removed by hot snare method.

Answer 56

45385, 45384-51, 45380-59

Question 57

A 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.

Answer 57

47562 laparoscopy surg cholecystectomy

Question 58

An otherwise healthy 22-year-old patient was scheduled for repair of an incarcerated bilateral recurrent inguinal hernia. The surgeon created the incision and started the procedure. At this point, the patient went into shock due to the surgery and the procedure was halted. The patient was stabilized and returned to the recovery room.

Answer 58

49521-50-53 repair recurrent inguinal hernia any age incarcerated

Question 59

Planned colonoscopy with biopsy was not completed to the cecum due to tortuous colon; however, splenic flexure was successfully passed

Answer 59

45380-52 colonoscopy with biopsy single/multiple

Question 60

A 3.4-cm tumor at the base of the tongue. Physician places needles under fluoroscopic guidance for subsequent interstitial radioelement application.

Answer 60

41019 placement needle head/neck radioelement application

Question 61

The colonoscope was advanced to the cecum. In the ascending colon, there was a flat polyp. Saline lift was performed by submucosal injection after which the polyp was removed in a piecemeal fashion by snare. Random biopsies were performed on other colonic mucosa to rule out microscopic colitis.

Answer 61

45385, 45381-51 colonoscopy flexible with directed submucosal injection any substance, 45380-59

Question 62

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 purse string 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. The chest is closed in layers, and a chest tube is placed through a separate stab incision.

Answer 62

43112 total esophagectomy with thoracotomy w/wo pylorplasty

Question 63

Laparoscopy, right subcutaneous inguinal hernia. A Veress needle was inserted, and a pneumoperitoneum was introduced. Indirect inguinal hernia was visualized, and open repair was determined to be appropriate. Incision was made in the right groin and dissected down to the indirect sac seen bulging at the internal ring. Sac was excised, and a medium size mesh was used to plug the ring.

Answer 63

49505-RT repair 1st inguinal hernia 5yrs> reducible

Question 64

Postoperative diagnosis: Initial inguinal hernia, 35-year-old male. A skin incision was placed at the umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle was retracted laterally. 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.

Answer 64

49505-LT

Question 65

A 67-year-old male patient with a history of carcinoma of the sigmoid colon is referred for a diagnostic colorectal cancer screening. The physician performed a diagnostic flex sigmoidoscopy examination to screen for recurrent colon cancer and examine the anatomic site. During the examination, the physician found three polyps in the rectosigmoid junction. They were removed by hot biopsy forceps. The path report indicated that the polyps were benign.

Answer 65

45333 sigmoidoscopy flexible w removal tumor by hot biopsy forceps

Question 66

Patient is scheduled for a screening colonoscopy. During the procedure, three polyps were discovered and removed through hot biopsy forceps technique. The polyps were reported as benign

Answer 66

45384 colonoscopy with lesion removal hot biopsy forceps

Question 67

Screening colonoscopy. Colonoscope was inserted and passed through all flexures to the cecum. The patient had diverticulosis in the sigmoid colon, and a small sessile polyp in the distal sigmoid was removed by snare.

Answer 67

45385

Question 68

Anal fissure with anal stenosis. Anal dilator was placed with packing. A moderate-sized fissure was visualized in the posterior column. Sphincterotomy was performed by dividing some of the external anal sphincter muscle fibers. Mucosa was then closed with 3-0 Monocryl.

Answer 68

46080 sphincterotomy anal division

Question 69

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 rectal exam revealed mild hemorrhoids and a 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 69

43239 egd transoral biopsy single/multiple, 45378 colonoscopy flexible diagnostic with collection specimen when performed

Question 70

Liver biopsy due to elevated liver enzymes. The area of biopsy site was chosen and a small nick was made on the skin and advanced to the liver capsule. Patient was told to hold her breath, biopsy gun was inserted into the liver, and the obtained biopsy was sent to pathology.

Answer 70

47399 unlisted procedure liver

Question 71

A patient diagnosed with GERD presents to the same day surgery department for an upper GI endoscopy. The procedure is done in order to treat the GERD by delivering thermal energy to the muscle of the gastric cardia and lower esophageal sphincter. Anesthesia was administered and as the physician begins the procedure, the patient's blood pressure drops to a dangerously low level. The physician decides not to finish the procedure due to the risk it may cause to the patient.

Answer 71

43257-53 egd deliver thermal energy sphincter/cardia gerd

Question 72

Ventral hernia 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 visible. There was some omentum, which was incarcerated and adhered to the hernia, and this was resected and the remainder delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect.

Answer 72

49592 repair hernia 1st <3cm necrotic/strangulated

Question 73

Preoperative diagnosis: Chronic tonsillitis, chronic adenoiditis. Postoperative diagnosis: Same. Procedure: Tonsillectomy and adenoidectomy. The 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 an incision was made. Dissection was done extracapsular, and the right tonsil was then removed. Both the right and left tonsils were sent as specimens as well as adenoid tissue.

Answer 73

42821 tonsil & adenoidectomy 12>

Question 74

An 18-gauge catheter was introduced into the peritoneal cavity after ultrasonic guidance. A guidewire was then advanced, a small transverse incision was made, a catheter was advanced over the guidewire, and a total of 6 L of peritoneal fluid was removed.

Answer 74

49083 abdominal paracentesis w imaging guidance

Question 75

Screening colonoscopy was performed revealing two colon polyps, which were removed by hot biopsy forceps and additional biopsy of a suspicious area in the rectum.

Answer 75

45384, 45380-59

Question 76

Sphincterotomy and an ERCP with a stent placed into the bile duct.

Answer 76

43274 ercp stent placement biliary/pancreatic duct

Question 77

Colonoscopy, diagnostic with EGD, four biopsies

Answer 77

45378, 43239

Question 78

Under fluoroscopic guidance, a feeding gastrostomy was performed percutaneously by placing two rows of purse string 2-0 silk sutures in the anterior wall of the stomach.

Answer 78

49440 insertion gastrostomy tube percutaneous

Question 79

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 79

42826 tonsillectomy primary/secondary 12>

Question 80

Colonoscopy with lesion removal by snare X2, an additional lesion excised by hot biopsy forceps X1, biopsy additional lesion

Answer 80

45385, 45384-51, 45380-59

Question 81

A patient with rectal bleeding undergoes a proctosigmoidoscopy. During the proctosigmoidoscopy, the physician identifies internal hemorrhoids. The proctoscope was withdrawn, and the anus was prepped and draped. There was a prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by applying two bands. In the posterior midline, there was another hemorrhoid that was banded in the same manner.

Answer 81

46221 hemorrhoidectomy internal rubber band ligations, 45300-51 proctosigmoidoscopy

Question 82

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 the scope could not be advanced further. Guidewire was placed over which dilation of the esophagus was successfully performed.

Answer 82

43251-52 egd removal tumor polyp lesion snare, 43248-51 egd insertion guide wire dilator passage esophagus

Question 83

Laparoscopic umbilical hernia repair 2.5 cm, age 37

Answer 83

49591 repair hernia 1st <3cm reducible

Question 84

Removal of foreign body from esophagus by scope

Answer 84

43215 esophagoscopy removal foreign body

Question 85

Patient had an exploratory laparotomy that revealed cholecystitis, and cholecystectomy was performed.

Answer 85

47600 cholecystectomy

Question 86

A 36-year-old female presents for laparoscopic bilateral inguinal hernia repair and open umbilical hernia 4 cm repair was also performed.

Answer 86

49650-50 laparoscopy surg repair initial inguinal hernia, 49591 repair hernia 1st <3cm reducible

Question 87

Laparoscopic ventral herniorrhaphy with patch. A small incision was made, and the trocar was introduced. In the left lower quadrant, two trocars were placed, and the hernia was easily visualized. The herniated area was removed, and the area was covered with an oval mesh patch measuring approximately 8 × 10 cm. Trocars were removed, the excess CO2 was allowed to escape, and the skin was closed.

Answer 87

49591

Question 88

Diagnostic Colonoscopy performed was not completed due to inability of the physician to reach the splenic flexure or cecum.

Answer 88

45330 sigmoidoscopy

Question 89

Exploratory laparotomy

Answer 89

49000 exploratory laparotomy celiotomy w/wo biopsy

Question 90

Cholecystectomy, open

Answer 90

47600 cholecystectomy

Question 91

For a 35-year-old female, repair of reducible 7 cm umbilical hernia was performed.

Answer 91

49593 repair hernia 3-10cm reducible