AAPC Chapter 11: Digestive System Test with Verified Answers
Mechanical and chemical
Rationale: Digestion consists of two
processes, mechanical and chemical.
Mechanical digestion is chewing the food
What are the two processes of diges- and your stomach and smooth intestine
tion? churning the food, and chemical diges-
tion is the work the enzymes do by break-
ing large carbohydrate, lipid, protein and
nucleic acid molecules into their subcom-
ponents of nutrients.
Duodenum, jejunum, ileum
Rationale: The three sections of the
small intestine are the duodenum, je-
Name the three sections of the small
junum, and the ileum. The ilium (note
intestine.
spelling) is one of the bones located in
the pelvis. The sigmoid, rectum, and ce-
cum are parts of the large intestine.
5ft. long
Approximately how long is the large in-
Rationale: The large intestine is about
testine in normal anatomy?
five feet long.
K21.9
Rationale: GERD is the definitive diag-
nosis. Chest pain and a dry cough are
A 42-year-old patient visits his doctor
both symptoms of GERD and are not re-
for chest pain and a dry cough lasting
ported separately. GERD is an acronym
for two months. After evaluating the pa-
for Gastroesophageal Reflux Disease.
tient, the physician states the patient has
In the ICD-10-CM Alphabetic Index,
GERD. What is/are the correct diagnosis
look for Disease/gastroesophageal re-
code(s)?
flux (GERD) or look for GERD, and you
are guided to K21.9. There is no indica-
tion the patient has esophagitis.
K64.8
A patient with a large prolapsed hem-
Rationale: Hemorrhoids are dilated or
orrhoid arrives at the Emergency De-
enlarged varicose veins which occur
partment. After multiple attempts, the
in and around the anus and rectum.
provider is unable to reduce it. The physi-
The condition can be complicated by
cian applies granulated sugar to the he-
thrombosis, strangulation, prolapse, and
, AAPC Chapter 11: Digestive System Test with Verified Answers
ulceration. To find hemorrhoids in the
morrhoid and is able to reduce the he- ICD-10-CM Alphabetic Index, locate He-
morrhoid. What is the correct diagnosis morrhoids/Prolapsed directing you to
code? K64.8. Verify code selection in the Tabu-
lar List.
49505-LT
RATIONALE: In the CPT Index, look
for Hernia Repair/Inguinal/Initial, Child 5
Years or Older. You are referred to 49505
and 49507. Review the codes to choose
A 55-year-old patient underwent a repair
the appropriate service. 49505 is the cor-
of an initial left inguinal hernia. An inci-
rect code. The repair was through an inci-
sion was made at the groin. A hernia sac
sion (not by laparoscopy) on an initial in-
was readily identified and cleared from
guinal hernia on a patient over five years
the surrounding tissue, inverted into the
of age and the hernia was not incarcer-
preperitoneal space, and plugged. Mesh
ated or strangulated. According to CPT
was tacked to the surrounding muscle
guidelines, "With the exception of the
layers and then placed over the entire
incisional hernia repairs (49560-49566),
floor. What CPT code(s) is/are reported?
the use of mesh or other prosthesis is not
separately reported." It is inappropriate
to code the mesh in this scenario. Modi-
fier LT is appended to indicate the hernia
is on the left side.
41008
Rationale: CPT code 41008 is specifi-
cally for Intraoral incision and drainage
of abscess, cyst, or hematoma of
Code intraoral incision and drainage
tongue or floor of mouth; submandibu-
of hematoma of tongue, submandibular
lar space. Look in the CPT In-
space. What CPT code is reported?
dex for Drainage/Hematoma/Mouth/Sub-
mandibular Space. The code selection is
made because it is intraoral, not extrao-
ral.
48150
Code proximal subtotal pancreatectomy, Rationale: The CPT code 48150 is
with total duodenectomy, partial gastrec- specifically for pancreatectomy, proxi-
tomy, choledochoenterostomy, and gas- mal subtotal with total duodenectomy,
partial gastrectomy, choledochoenteros-
, AAPC Chapter 11: Digestive System Test with Verified Answers
tomy, and gastrojejunostomy (Whip-
trojejunostomy, with pancreatojejunosto- ple-type procedure); with pancreatoje-
my. What CPT code is reported? junostomy. Look in the CPT Index for
Pancreas/Excision/Partial.
44204
Rationale: A peritoneoscopy is a sep-
arate procedure and is not separately
reportable when it is performed with a
more extensive procedure. It is inciden-
tal to the laparoscopic partial collection
Code peritoneoscopy with laparoscop-
and anastomosis. Look in the CPT In-
ic partial colectomy and anastomosis.
dex for Colectomy/Partial/with Anasto-
What CPT code(s) is/are reported?
mosis/Laparoscopic. The code is select-
ed based on whether additional proce-
dures, such as a coloproctostomy, is per-
formed. There are no additional proce-
dures in this case making 44204 the cor-
rect code choice.
E11.43, K31.84
Rationale: Gastroparesis is also called
delayed gastric emptying. Gastropare-
sis may occur when the vagus nerve is
The patient is a 65-year-old female with
damaged and the muscles of the stom-
Type 2 diabetes. She is seen today by
ach and intestines do not work normally.
her primary care physician for extreme
Food then moves slowly or stops mov-
abdominal bloating and discomfort af-
ing through the digestive tract. The most
ter eating. The patient also complains
common cause of gastroparesis is di-
of constant heartburn. This occurrs fre-
abetes. In this case, the physician did
quently and is not relieved by anything
link the gastroparesis to the patient's di-
the patient has tried. The patient record-
abetes so we will use a diabetic com-
ed her blood sugar this morning as 178.
plication code. In ICD-10-CM Alphabet-
Her A1C taken in the office was 8.2.
ic Index look for Diabetes, diabetic/type
The physician diagnoses gastroparesis
2/with gastroparesis which directs you
due to the patient's diabetes. Code the
to E11.43. Even if the provider had not
ICD-10-CM diagnosis(es).
linked the gastroparesis with diabetes,
because it is listed under 'with' in the
Alphabetic Index, there is a presumed
causal relationship. In the Tabular List
, AAPC Chapter 11: Digestive System Test with Verified Answers
there is an instructional note for code
K31.84 that indicates to Code first under-
lying disease, if known and code E11.43
is listed. There is also an Excludes2 note
under category code K31 which indi-
cates that code E11.43 can be reported
with codes in category K31.
CASE 1
Preoperative Diagnosis: History of rectal
carcinoma.
Postoperative Diagnosis: History of rec-
tal carcinoma.
Procedure Performed: Closure of loop
ileostomy with small bowel resection
and enteroenterostomy with intraopera-
tive flexible sigmoidoscopy.
Description of Procedure: After induction
of adequate general endotracheal anes-
thesia, the patient was carefully posi-
tioned in the supine modified lithotomy
position in Allen stirrups. Great care was
taken to pad and protect all areas of
potential bodily injury. Digital rectal ex-
amination revealed a widely patent cir-
cumferentially intact pouch anal anasto-
mosis within 1 cm of the dentate line.
Flexible sigmoidoscopy was performed
revealing healthy pink mucosa. The ab-
domen was prepped and draped in the
usual sterile manner, and a parastom-
al incision was made and carried down
sharply into the peritoneal cavity. Meticu-
lous hemostasis was obtained with elec-
trocautery. A 360 degree subfascial mo-
bilization was undertaken until approxi-
