Code Abdominal Surgery Procedures - Certified Professional Coder CPC

1. A trauma surgeon attempts splenorrhaphy for a lacerated spleen but ultimately performs an open total splenectomy when hemorrhage cannot be controlled. No other organ resections are performed. Which CPT® code is reported for the splenectomy?
   Answer: 38100 CPT® 38100 describes total splenectomy as a separate procedure — the correct code when the spleen is removed in its entirety through an open approach without accompanying en bloc resection of adjacent organs. Code 38120 describes laparoscopic total splenectomy; the approach here is open laparotomy. Code 38115 describes splenorrhaphy (attempted first in this case), but the final procedure is total splenectomy; splenorrhaphy is not additionally reportable when the surgeon proceeds to splenectomy. Code 38102 describes total splenectomy en bloc for extensive disease performed in conjunction with another procedure — no other organ was resected here. The open approach (38100) vs. laparoscopic approach (38120) is the key differentiator.
2. A surgeon performs a laparoscopic left inguinal hernia repair. The operative note confirms no prior hernia repairs on this side. Which CPT® code is reported?
   Answer: 49650 CPT® 49650 describes laparoscopic inguinal hernia repair for an initial (first-occurrence) hernia — the correct code for a minimally invasive inguinal repair when no prior repair has been performed on that side. Code 49651 describes laparoscopic inguinal hernia repair for a recurrent hernia; the note confirms no prior repairs, so 49651 is incorrect. Code 49505 describes open (not laparoscopic) initial inguinal hernia repair. Code 49520 describes open recurrent inguinal hernia repair. The approach (laparoscopic vs. open) and hernia status (initial vs. recurrent) together determine the correct inguinal hernia code.
3. A surgeon performs an open appendectomy via laparotomy for a ruptured appendix with generalized peritonitis and abscess formation. Which CPT® code is reported?
   Answer: 44960 CPT® 44960 describes open appendectomy for a ruptured appendix with abscess or generalized peritonitis — the correct code when the appendix is perforated and the clinical picture includes peritoneal contamination. Code 44950 describes open appendectomy for a simple, non-ruptured appendix; the presence of rupture and peritonitis requires 44960. Code 44970 describes laparoscopic appendectomy; the approach here is open laparotomy. Code 44140 describes open partial colectomy (large bowel resection), not appendectomy. The key upgrade from 44950 to 44960 is the documentation of rupture, abscess, or generalized peritonitis.
4. A surgeon performs an open repair of a recurrent anterior abdominal wall hernia at a previous midline incision site. The defect measures 5 cm and the hernia is reducible. Which CPT® code is reported?
   Answer: 49595 CPT® 49595 describes open repair of a reducible recurrent anterior abdominal hernia (e.g., incisional, ventral, epigastric, umbilical) with a defect measuring 3 to 10 cm — the 2023 code that replaced the deleted 49565. The two determining axes are hernia status (initial vs. recurrent) and defect size (<3 cm, 3-10 cm, or >10 cm). Code 49592 covers open initial (not recurrent) anterior hernia repair, 3-10 cm. Code 49594 covers open recurrent anterior hernia repair but for defects less than 3 cm. Code 49596 covers open recurrent anterior hernia repair for defects greater than 10 cm. A 5 cm recurrent defect falls in the 3-10 cm tier (49595).
5. A surgeon performs a laparoscopic 360-degree (Nissen) fundoplication for GERD with a sliding hiatal hernia. Which CPT® code is reported?
   Answer: 43280 CPT® 43280 describes laparoscopy, surgical, esophagogastric fundoplasty (e.g., Nissen, Toupet procedures) — the correct code for a laparoscopic 360-degree fundoplication performed for GERD with hiatal hernia. Code 43239 describes esophagogastroduodenoscopy (EGD) with biopsy — a diagnostic endoscopic procedure, not a surgical fundoplication. Code 43324 describes open esophagogastric fundoplasty via the Belsey Mark IV approach, which is performed through a thoracotomy — an open thoracic approach, not laparoscopic. Code 43325 describes open esophagogastric fundoplasty with diaphragmatic hernia repair — also open, not laparoscopic. The Nissen procedure performed laparoscopically is specifically captured by 43280.
6. A surgeon performs a laparoscopic cholecystectomy and obtains an intraoperative cholangiogram to evaluate the bile ducts. Which CPT® code is reported?
   Answer: 47564 CPT® 47564 describes laparoscopic cholecystectomy with intraoperative cholangiography — the correct code when a laparoscopic approach is used and fluoroscopic imaging of the bile ducts is obtained during the same session. Code 47563 describes laparoscopic cholecystectomy without cholangiography; since a cholangiogram was explicitly performed here, 47563 is incorrect. Code 47605 describes open cholecystectomy with cholangiography (not laparoscopic). Code 47600 describes open cholecystectomy without cholangiography. The two axes — approach (laparoscopic vs. open) and cholangiography (with vs. without) — create four distinct cholecystectomy codes.
7. A surgeon performs a laparoscopic right hemicolectomy for ascending colon cancer, removing the right colon segment laparoscopically with anastomosis. Which CPT® code is reported?
   Answer: 44204 CPT® 44204 describes laparoscopic colectomy, partial — the correct code for any laparoscopic segmental colon resection including right hemicolectomy, left hemicolectomy, or sigmoid resection. Code 44140 describes open partial colectomy; the approach here is laparoscopic, not open. Code 44210 describes laparoscopic total colectomy, which removes the entire colon — only the right colon is removed here. Code 44150 describes open total abdominal colectomy — also incorrect on both approach and extent. The combination of laparoscopic approach and partial (not total) colon resection identifies 44204 as the correct code.
8. A surgeon performs a laparoscopic left inguinal hernia repair. The patient's history documents a prior open repair on the same side 3 years ago. Which CPT® code is reported?
   Answer: 49651 CPT® 49651 describes laparoscopic inguinal hernia repair for a recurrent hernia — the correct code when a laparoscopic approach is used to repair an inguinal hernia that has recurred after a prior repair. Code 49650 describes laparoscopic inguinal hernia repair for an initial hernia; since this is a documented recurrence, 49650 is incorrect. Code 49520 describes open repair of a recurrent inguinal hernia; the extent (recurrent) is correct, but the approach is laparoscopic, not open. Code 49505 describes open initial inguinal hernia repair — wrong on both recurrence status and approach. Identifying both the hernia status (initial vs. recurrent) and approach (laparoscopic vs. open) is essential for accurate inguinal hernia code selection.
9. A surgeon performs a laparoscopic cholecystectomy for symptomatic cholelithiasis. The operative note states no cholangiogram was performed. Which CPT® code is reported?
   Answer: 47563 CPT® 47563 describes laparoscopic cholecystectomy without intraoperative cholangiography — the correct code because the approach is laparoscopic and the operative note explicitly states that no cholangiogram was performed. Code 47564 describes laparoscopic cholecystectomy with intraoperative cholangiography; since no cholangiogram was obtained, 47564 is incorrect. Code 47600 describes open cholecystectomy without cholangiography — correct on cholangiography status but wrong approach. Code 47605 describes open cholecystectomy with cholangiography — wrong on both counts. The surgeon's decision not to perform a cholangiogram, combined with the laparoscopic approach, makes 47563 the only correct selection.
10. A colorectal surgeon performs an open total abdominal colectomy for refractory ulcerative colitis, removing the entire colon via an open laparotomy incision. Which CPT® code is reported?
    Answer: 44150 CPT® 44150 describes open total abdominal colectomy — the appropriate code when the entire colon is removed via an open laparotomy incision. Code 44140 describes open partial colectomy, which resects only a segment of the colon, not the entire organ. Code 44204 describes laparoscopic partial colectomy; this case is both open and total. Code 44210 describes laparoscopic total colectomy; while the extent is correct, the approach is open, not laparoscopic. Both the extent of resection (partial vs. total) and the surgical approach (open vs. laparoscopic) must be identified to select the correct colectomy code.
11. A general surgeon performs a laparoscopic appendectomy for acute, non-ruptured appendicitis. Which CPT® code is reported?
    Answer: 44970 CPT® 44970 describes laparoscopic appendectomy — the correct code for any laparoscopic removal of the appendix, whether performed for simple or complicated appendicitis. Code 44950 describes open (not laparoscopic) appendectomy for a simple, non-ruptured appendix. Code 44960 describes open appendectomy for a ruptured appendix with abscess or generalized peritonitis; the case here has neither rupture nor peritonitis, and the approach was laparoscopic. Code 44150 describes open total abdominal colectomy, which involves removal of the colon — an entirely different organ. Approach (laparoscopic vs. open) is the primary axis for appendectomy coding.
12. A hepatic surgeon performs a total right hepatic lobectomy, removing segments V through VIII of the right lobe for hepatocellular carcinoma. Which CPT® code is reported?
    Answer: 47130 CPT® 47130 describes total right hepatic lobectomy — the correct code when the entire right lobe of the liver (segments V through VIII) is removed. Code 47120 describes partial hepatectomy, which is used for resections of less than a full anatomic lobe; removal of the entire right lobe requires the total lobectomy code. Code 47125 describes total left hepatic lobectomy (segments II, III, and IV); the right lobe, not the left, is removed here. Code 47122 describes trisegmentectomy (extended resection involving three or more segments from both lobes), which applies when the resection crosses beyond one anatomic lobe. When a complete, single anatomic lobe is removed, the total lobectomy code (47130 for right, 47125 for left) is correct.
13. A colorectal surgeon performs an open sigmoid colectomy for diverticular disease, resecting the sigmoid segment of the colon with primary anastomosis via open laparotomy. Which CPT® code is reported?
    Answer: 44140 CPT® 44140 describes open partial colectomy — the correct code for any open resection of a segment of the large bowel (including sigmoid colectomy, right or left hemicolectomy) with anastomosis. Code 44204 describes laparoscopic partial colectomy; the approach here is open laparotomy. Code 44150 describes open total abdominal colectomy, which removes the entire colon from cecum to rectum — only the sigmoid colon is removed here. Code 44210 describes laparoscopic total colectomy — incorrect on both approach and extent. The distinction between total (44150) and partial (44140) colectomy, and between open (44140) and laparoscopic (44204) approach, determines the correct code.
14. A surgeon performs an open resection of a segment of the jejunum for a small bowel obstruction with primary anastomosis. Which CPT® code is reported?
    Answer: 44120 CPT® 44120 describes open resection of the small intestine (single resection) with anastomosis — the correct code for an open small bowel resection when the gastrointestinal tract is restored in the same operation. Code 44202 describes laparoscopic small intestine resection; the note specifies an open laparotomy. Code 44140 describes open partial colectomy (resection of the large intestine, not small intestine); the jejunum is small bowel. Code 44205 describes laparoscopic colectomy, partial — also incorrect on both organ (colon vs. small bowel) and approach. Distinguishing between small bowel (44120) and large bowel (44140) resection is fundamental to abdominal surgery coding.
15. A hepatic surgeon performs an open partial hepatic lobectomy, resecting segment VI of the right lobe while preserving the remaining hepatic parenchyma. Which CPT® code is reported?
    Answer: 47120 CPT® 47120 describes hepatectomy with partial lobectomy — the correct code for any open resection of less than an entire lobe, including single-segment or limited resections that preserve the remaining hepatic parenchyma. Code 47125 describes total left hepatic lobectomy, which removes the entire left lobe — not applicable here. Code 47130 describes total right hepatic lobectomy, removing the entire right lobe — the right lobe is preserved except for segment VI in this case. Code 47122 describes trisegmentectomy (three-segment resection); only one segment is resected here. Partial lobectomy (47120) is appropriate whenever less than a complete anatomic lobe is removed.
16. A surgeon performs an open right inguinal hernia repair in a 45-year-old patient. This is the patient's first inguinal hernia repair on this side. Which CPT® code is reported?
    Answer: 49505 CPT® 49505 describes open repair of an initial (not recurrent) inguinal hernia in a patient older than 5 years — the standard code for a first-time open inguinal hernia repair in an adult. Code 49520 describes open repair of a recurrent inguinal hernia; the case specifies this is a first occurrence, making 49520 incorrect. Code 49507 describes open bilateral inguinal hernia repair (initial); only the right side is repaired here, not both sides. Code 49650 describes laparoscopic inguinal hernia repair (initial); the approach here is open, not laparoscopic. The three differentiating axes are laterality (unilateral vs. bilateral), recurrence (initial vs. recurrent), and approach (open vs. laparoscopic).
17. A surgeon creates a diverting sigmoid colostomy as a separate, staged procedure for a patient with obstructing rectal cancer. No bowel resection is performed at this session. Which CPT® code is reported?
    Answer: 44320 CPT® 44320 describes creation of a colostomy or skin-level cecostomy as a separate procedure — the correct code when a diverting stoma is constructed without concurrent bowel resection. Code 44140 describes open partial colectomy (resection with anastomosis), which involves removing a segment of bowel — not performed here. Code 44143 describes partial colectomy with end colostomy and closure of the distal segment (Hartmann's procedure), which includes a simultaneous bowel resection — no colonic resection was performed. Code 44204 describes laparoscopic partial colectomy; the approach here was open. When only a stoma is created without resection, 44320 is the correct code.
18. A surgeon performs a laparoscopic repair of an initial anterior abdominal hernia at a previous trocar site. The defect measures 6 cm and is reducible. Which CPT® code is reported?
    Answer: 49653 CPT® 49653 describes laparoscopic or robotic repair of a reducible initial anterior abdominal hernia with a defect measuring 3 to 10 cm — the correct code for a minimally invasive initial repair of this size. Under the 2023 anterior abdominal hernia framework, the approach (open vs. laparoscopic/robotic), hernia status (initial vs. recurrent), and defect size (<3 cm, 3-10 cm, or >10 cm) determine code selection. Code 49652 covers laparoscopic initial anterior hernia repair for defects less than 3 cm. Code 49592 covers open (not laparoscopic) initial anterior hernia repair, 3-10 cm. Code 49655 covers laparoscopic recurrent (not initial) anterior hernia repair, 3-10 cm. A 6 cm initial trocar-site hernia repaired laparoscopically falls in 49653.
19. A surgeon performs a laparoscopic total splenectomy for immune thrombocytopenic purpura (ITP) refractory to medical management. Which CPT® code is reported?
    Answer: 38120 CPT® 38120 describes laparoscopic total splenectomy — the correct code for minimally invasive removal of the entire spleen, which is the standard surgical treatment for ITP when medical therapy fails. Code 38100 describes open total splenectomy (not laparoscopic) as a separate procedure. Code 38102 describes open total splenectomy en bloc for extensive disease, performed in conjunction with another procedure — the additional complexity and open approach make this incorrect. Code 38115 describes splenorrhaphy (repair of a ruptured spleen), not removal. The laparoscopic approach is the critical differentiator between 38120 and the open codes 38100/38102.
20. A surgeon simultaneously repairs bilateral inguinal hernias via an open approach in a 60-year-old patient. Both hernias are first-occurrence. Which CPT® code is reported?
    Answer: 49507 CPT® 49507 describes open repair of bilateral initial inguinal hernias — the specific code for simultaneous bilateral open inguinal hernia repair at the first occurrence. Code 49505 describes open unilateral initial inguinal hernia repair; when both sides are repaired at the same session, the bilateral code (49507) is used rather than reporting 49505 twice with a modifier. Code 49650 describes laparoscopic (not open) initial inguinal hernia repair, unilateral. Code 49520 describes open recurrent inguinal hernia repair; both hernias here are first-occurrence. CPT® provides specific bilateral codes for common hernia procedures; 49507 should be used rather than 49505 with modifier -50 for bilateral open inguinal repairs.

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