AAPC Chapter 11 Quiz & Flashcards for Practical Applications

Preoperative and postoperative diagnosis: History of rectal carcinoma.
Procedure included closure of loop ileostomy, small bowel resection, enteroenterostomy, and intraoperative flexible sigmoidoscopy.
General anesthesia was used; the patient was positioned in supine modified lithotomy.
Surgical steps involved digital rectal examination, flexible sigmoidoscopy, parastomal incision, and 360-degree subfascial mobilization.
Verification of no enterotomies performed with insufflation of Betadine.
Used LigaSure Impact for vessel division, GIA stapler for bowel division and anastomosis.
Circumferential hemostasis achieved before closing using 3-0 PDS 2 sutures.
Codes: CPT® 44625, ICD-10-CM Z43.2, Z85.048.

Diagnosis: Right-sided colonic polyps.
Procedure involved laparoscopic right hemicolectomy with ileocolic anastomosis.
General anesthesia administered; patient positioned in supine modified lithotomy.
Supracolic vertical incision facilitated laparoscopic approach via Hasson technique.
High ligation of arteries and mesenteric structures completed using LigaSure Atlas.
Bowel resection performed using GIA stapling device.
A functional end-to-end anastomosis was created, ensuring healthy blood flow.
Codes: CPT® 44205, ICD-10-CM K63.5.

Diagnosis: Morbid obesity with BMI of 40 and sleep apnea.
Procedure combined laparoscopic sleeve gastrectomy with intraoperative endoscopy.
Access achieved with 1 cm supraumbilical incision; CO2 insulfated to 15 mmHg.
Gastric tube created using linear cutter; staple line reinforced.
Intraoperative endoscopy confirmed the integrity of the sleeve.
Codes: CPT® 43775, ICD-10-CM E66.01, Z68.41.

Diagnoses include cholelithiasis, chronic cholecystitis, and acute pancreatitis.
Procedure performed: laparoscopic cholecystectomy combined with intraoperative fluoroscopic cholangiography.
A vertical incision at the umbilicus was made for access; maintained CO2 pressure.
Gastrointestinal anatomy dissected carefully; cholangiography confirmed normal biliary flow.
Gallbladder removed under direct vision; minimal estimated blood loss.
Codes: CPT® 47563, ICD-10-CM K80.10, K85.90.

Diagnosis: Severe obesity and hypertension, BMI of 53.
Procedure: Laparoscopic antecolic Roux-en-Y gastric bypass performed under general anesthesia.
Access accomplished through a 1 cm supraumbilical incision; CO2 used for insufflation.
Pouch creation followed by side-to-side gastrojejunostomy.
Hemostasis achieved; drain placement over the anastomosis.
Codes: CPT® 43644, ICD-10-CM E66.01, I10, Z68.43.

Reason for examination: Gastroesophageal Reflux Disease (GERD).
Procedure performed under monitored anesthesia care; no abnormalities found in the esophagus, stomach, or duodenum.
Patient tolerated the procedure well without complications.
Codes: CPT® 43235, ICD-10-CM K21.9.

Reason for examination: Anemia due to iron deficiency.
Informed consent obtained prior to colonoscopy; no contraindications noted.
Monitored anesthesia care administered for patient comfort.### Case 9: Bowel Preparation and Findings
Bowel prepared with GoLYTELY prep; quality assessed by Ottawa bowel preparation quality scale, total score: 3/14.
Digital exam noted uncomplicated internal hemorrhoids; no bleeding observed.
Procedure performed in left lateral decubitus position, instrument advanced to terminal ileum.
Cecum identified by ileocecal valve and appendiceal orifice; retroflexion performed in the rectum.
Mild granularity and red spots found in the ascending colon and cecum, likely due to air insufflation; biopsies taken.
No friability, ulcerations, or bleeding observed; terminal ileum appeared normal.
CPT® Code: 45380, ICD-10-CM Codes: D50.9, K64.8.

Examination focused on proximal sigmoid colon; reason being proctitis with postoperative assessment.
Informed consent obtained; no contraindications noted; monitored anesthesia care (MAC) administered.
Quality of bowel preparation rated adequate; digital exam prior to procedure was unremarkable.
Procedure performed in left lateral decubitus position; sigmoidoscope inserted and studied the proximal sigmoid colon.
Withdrawal time from proximal sigmoid colon was 8 minutes; patient tolerated the procedure without complications.
Findings included mild segmental inflammation in the rectum; no mucosal bleeding observed.
CPT® Code: 45330, ICD-10-CM Code: K62.89.