Digestive System
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Transcript Digestive System
Digestive System
BY ALEX MUNOZ, CPC, NCICS
Digestive System
Divided by anatomic site from
mouth to abdomen, peritoneum,
and omentum + organs that aid
digestive process
Many bundled procedures
Surgical procedures for open &
endoscopic:
Mouth & related structures
Pharynx
Adenoids
Tonsils
Esophagus
Stomach
Intestines
Appendix
Rectum and anus
Liver
Biliary tract
Pancreas
Lips (40490-40799)
Vermilionectomy (40500) is shaving of lip
Vermilion border: Area between lip and mucosal surface of
mouth
Large defects (40510-40527)
Repaired with procedures such as transverse wedge excision
(40510)
Cheiloplasty is lip repair
Full thickness repair (40650-40654)
Cleft lip repair (40700-40761)
Tongue and Floor of Mouth
(41000-41599)
Incision and drainage codes based on:
Sublingual (under tongue)
Submandibular (under mandibular)
Masticator space (floor of mouth to
hyoid bone)
Extraoral (outside mouth) I&D of abscess, cyst,
hematoma on floor of mouth
Dentoalveolar Structures and Palate/Uvula
Dentoalveolar structures (41800-41899)
Bone (osseous) and soft structures
of mouth
Anchors teeth
Palate/Uvula
(42000-42299)
_____ (roof of mouth)
_____ (pendulous
structure at back of throat)
Salivary Gland and Ducts
(42300-42699)
Three salivary glands
Parotid
Submandibular
Sublingual
Codes divided initially by gland
Pharynx, Adenoids, and Tonsils (42700-42999)
Incision codes 42700-42725 initially divided on
________
Intraoral
External
Tonsillectomy and adenoidectomy
42820-42836
Based on gland removed and
___ of patient
Esophagus (43020-43499)
Approaches—Incision, Excision
Code esophageal dilation
1.
2.
3.
Cervical
Thoracic
Abdominal
Endoscopy
Know the device or method used
How each device works
Whether dilation was endoscopic or non-endoscopic
Diagnostic endoscopy always included in surgical
endoscopy
Esophagoscopy (43200-43232)
Limited to esophagus only
Scope may be advanced into stomach but is short of
pylorus.
If scope transverses pyloric channel becomes an EGD
(43234-43259)
If scope passes beyond second portion of duodenum,
report Endoscopy, Small Intestine codes 4436044379
Stomach (43500-43999)
Gastric bypass performed for morbid obesity
Many different types, such as RNY
May be performed via laparoscope
Bariatric surgery (43770-43775)
Gastric restrictive device (such as band)
Intestines (Except Rectum)
(44005-44799)
Separate procedures common
Colostomies always bundled with major procedure
Unless code states otherwise
Small intestine extends for 20 feet from pyloric
sphincter to first part of large intestine
Large intestine extends from end of ilium to anus, 4
parts (cecum, colon, Sigmoid colon,
and rectum)
Endoscopy, Small Intestine and Stomal (4436044397)
Diagnostic bundled into Surgical endoscopic
Code to furthest extent of procedure
Notes define specific terminology
Code descriptions are specific regarding:
Technique and depth of scope
Esophagoscopy: Esophagus only
Esophagogastroscopy: Esophagus to past diaphragm
Esophagogastroduodenoscopy: Esophagus to beyond pyloric
channel
Read notes preceding 45300-45392
Endoscopy Terminology
Sigmoidoscopy:
Entire rectum, sigmoid colon, and
may include part of the descending colon (up to 26
inches or 26-60 cm is visualized)
Proctosigmoidoscopy: Rectum and sigmoid colon
(6.25 cm is visualized)
Colonoscopy: Entire colon, rectum to cecum, and
may include terminal ileum (more than 60 cm
visualized or 53 inches)
Laparoscopy
and Endoscopy
Some subheadings have both laparoscopy (from
outside) and endoscopy (from inside) procedures
Example: Subheading Esophagus
Endoscopy views inside
Laparoscopy inserted through umbilicus,
views from outside
Laparoscopic bariatric surgery codes
(43770-43774)
Use of gastric band and/or subcutaneous port
components
Hemorrhoidectomy and Fistulectomy Codes
(46221-46320)
Divided by
Anatomy
Subcutaneous: no muscle involvement
Submuscular: sphincter muscle
Complex fistulectomy involves excision/incision of multiple
fistulas
Abdomen, Peritoneum, and
Omentum Subheading (49000-49999)
Laparoscopy
Diagnostic (49320)
Surgical (49321-49323)
Repair category contains hernia repair codes
Hernia Codes Divided on
1. Type
Example: inguinal, femoral
2. Initial or subsequent repair
3. Age of patient
4. Clinical presentation:
Strangulated: Blood supply cut off
Incarcerated: Cannot be returned to cavity
(not reducible)
Implantation of mesh or prosthesis is reported separately
The End
REFERENCE:
BUCK, C. (2010) STEP BY STEP. ELSEVIER.