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CPCSTUDY COURSEMy progress

CPC STUDY COURSE · 2026 EDITION

Gallbladder surgery and a separate planned umbilical-hernia repair

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-08 · Professional outpatient claim; Original Medicare unless stated otherwise

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Two established conditions

Fictional patient Casey Linden, age 60, is scheduled chiefly for treatment of symptomatic gallbladder stones. The surgeon confirms calculus without cholecystitis or obstruction. The same patient has a separate symptomatic, reducible primary umbilical hernia without obstruction or gangrene. Both conditions have been evaluated, and repair of the hernia is independently planned as medically necessary.

Gallbladder procedure

The surgeon performs laparoscopic cholecystectomy without cholangiography or bile-duct exploration. Access and extraction incisions are in the upper abdomen and do not use the umbilical defect. The report specifically documents that the hernia site is not an access or extraction incision for the gallbladder operation. The gallbladder procedure is completed without conversion.

Separate hernia work

Through a separate umbilical incision, the surgeon repairs the existing primary umbilical hernia. Before opening or enlarging the defect, the measured defect length is 3.0 cm. It is reducible, not incarcerated or strangulated, and has never been repaired before. The surgeon completes an open repair with mesh and closes that incision separately.

Completion and roles

The final diagnoses remain gallbladder calculus without cholecystitis or obstruction and umbilical hernia without obstruction or gangrene. A separate anesthesia professional supplied anesthesia. There is no incidental appendectomy, separately necessary bile-duct procedure or other abdominal operation. The surgeon assumes routine postoperative care.

Coding desk

The draft either drops the hernia because every same-day abdominal repair is assumed included or bills it separately plus an old mesh add-on without reviewing the current entry. Compare the documented separate site and medical purpose with the NCCI rule. Select the licensed cholecystectomy and current hernia entries, link each diagnosis to its service, and review current edits and modifier conditions before final submission.

Your coding worksheet

  1. Identify the reason for this encounter and the supported diagnoses.
  2. List the services actually completed and the applicable code sets.
  3. Use your books to select final codes, units and any supported modifiers.
  4. Sequence the diagnoses and explain the relevant instruction.
  5. Review included work and any separate coverage question. Explain why the strongest alternative does not fit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Write your answer

Use only this fictional record. Your entries stay on this page and disappear when you leave or reload. Do not enter real patient information.

Compare with the worked explanation
  1. The documented diagnoses are K80.20 and K42.9. Verify both Index/Tabular routes and preserve the explicitly absent inflammation, obstruction and gangrene. Gallbladder treatment is the stated chief reason; the independently treated hernia is also reported and linked to its service.
  2. Use the licensed laparoscopic cholecystectomy entry matching the completed work without cholangiography or bile-duct exploration. Do not add a study that was not performed.
  3. NCCI VI E.4 distinguishes an included repair at an abdominal procedure’s incision from a medically necessary repair at another site. This record explicitly documents a separate planned hernia site, outside the access and extraction incisions. That supports separate review for reporting the hernia procedure.
  4. The hernia lookup uses the current entry and its actual facts: primary rather than recurrent, reducible, 3.0 cm before manipulation, the documented site and technique. Do not reuse a retired entry or round the measurement into a different group.
  5. NCCI VI E.7 explains that mesh is included in most hernia repair entries unless a specific current instruction permits otherwise. Do not add the deleted historical mesh entry from an old charge list. Verify the complete selected entry.
  6. Separate reportability still requires the current edit and modifier review; a separate incision alone is not a blanket license for every extra procedure. This record also supplies independent medical necessity. Routine access closure and the other professional’s anesthesia are not added as separate surgeon services.

Reference sections: NCCI VI E.4,E.7; ACS pre-manipulation measurement; K80.20,K42.9

Practice the linked chart questions

Review the lesson

Sources

  1. CMS — Medicare NCCI 2026 Chapter VI: Digestive System. 2026. Accessed 2026-09-10.
  2. American College of Surgeons — Frequently Asked Questions about CPT Coding: Anterior Abdominal Hernia Documentation. December4/2024 explanatory article; current licensed entries required. Accessed 2026-09-10.
  3. CDC NCHS — ICD-10-CM April1,2026 Index and Tabular XML. April1–September30,2026. Accessed 2026-09-12.
  4. CDC/NCHS and CMS — ICD-10-CM April 1 2026 Guidelines. FY2026 April. Accessed 2026-09-10.

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