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Digestive System, Chapter 23

Chapter 23 Step-by-Step
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Digestive system subsection divided according to:
anatomic site and procedure
What is included in digestive system CPT codes?
sites beginning with the mouth and ending with the anus; internal organs that aid in digestive process including pancreas, liver and gallbladder; also codes for procedures of abdomen, peritoneum, omentum, and hernia repairs.
Where are endoscopic codes located in the digestive system CPT coding manual?
throughout the subsection on the basis of anatomical site
vermilionectomy
shaving of the lip;Depending on size of repair: surgeon removes an area of tissue and repairs the defect by moving the mucosal surface to reconnect the lip, therby forming a new vermilion border. (CPT code 40500)
vermilion zone
red part of the lips
transverse wedge excision
a wedge of lip tissue is removed and tissue flaps are placed to repair the defect (see CPT code 40510)
Abbe-Estlander
Abbe flap or cross flap is a reconstructive procedure in which a graft is taken from a portion of the lip and the non-defective area above lip is used to repair the area of the defect
lip resection
if more than 1/4 of lip surface is removed, procedure considered resection and reported with 40530)
complex repair of lip and face
CPT codes 13131-13153
cheiloplasty
lip repair
two types of lip repair codes
full-thickness repair of lip or cleft lip repair
cleft lip
congenital defect in which the muscle and tissue of the lip did not close properly
coding cleft lip repair with rhinoplasty
rhinoplasty may be required if nasal deformity has occurred with the cleft lip defect, rhinoplasty coded separately.
-
unilateral or bilateral cleft palate repair codes
if bilateral procedure performed and code description does not indicate bilateral procedure, add modifier-50.
coding cleft lip repair with palatoplasty
palate repair reported separately
palatoplasty
palate repair
vestibule of mouth CPT codes
part of the oral cavity incisions, excision/destruction/repair.
Do not include codes for service of the tongue and floor of the mouth or dentoalveolar structures.
Tongue and floor of mouth CPT codes
...
sublingual
under the mouth
submandibular
under the mandible
masticator space
space from floor of mouth to the hyoid bone
lingual frenum
flap of skin under the tongue
ankyloglossia
tongue tie due to tight lingual frenum
frenotomy
incision in the lingual frenum
frenectomy
excision of the lingual frenum
frenoplasty
lingual frenum surgically repaired (code from Other procedures category)
Extraoral incision and drainage
I & D performed on abscess, cyst or hematoma located outside the mouth and coding based on location of sublingual, submental, submandiublar or msticator space
oral biopsy
coding based on location from which biopsy obtained.
glossectomy
removal of all or part of the ginue
Excision coding for tongue and floor of mouth
if local tongue flap is required to repair excisonal defect, report repair with 41114 in addition to primary incision procedure
repair of tongue coding
based on size of repair 2.5 cm or less; over 2.6 cm, and in additon based on location of repair
Dentoalveolar structures
bone (osseous) and soft structures of the mouth that anchor the teeth. Codes report incision, excision/destruction and other types of procedures performed.
Dentoalveolar quadrants
...
gingivectomy
excision of the gingiva
palate and uvula coding
...
palatopharyngoplasty
palate and pharynx repair procedure which may be performed to OSA patients not responding to CPAP or other conservative measures
OSA
obstructive sleep apnea
hypnopnea
shallow breathing
salivary gland and ducts - CPT coding
parotid, submandibular and sublingual salivary glands, coding may be divided by gland
sialography
x-ray of salivary gland
parotid duct
Steno's or Stensen's duct
pharynx, adenoids and tonsil's CPT coding
incision codes based on location,(
surgical approach: intraoral or external)
branchial cleft cyst
congenital defect that appears as a gill located on the neck
tonsillectomy and / or adenoidectomy coding
performed bilaterally:
If procedure reported with -50 modifier, or with modifieres-RT and -LT, the 3rd party payer will usually not recognize modifier's and pay based on amount for a single procedure
IF ONE SIDE ONLYis removed, modifier -52 (reduced service) must be appended to the cpT code
pharyngoplasty
surgical repair of pharynx and includes the use of flaps fashioned form skin, tongue, and/or tissue located near area of defect used in repair procdure
pharyngostomy
procedure to create an opening for insertion fo a long-term feeding tube. incision made below jaw line on skin and incision is carred down to the parynx.
NGT
nasogastric feeding tube
oropharyngeal
between softr palate and the epiglottis
nasopharyngeal
above the soft palate
esophagotomy or myotomy
coded based on whether the procedure is prinmary or secondary and level of complexity
myotomy
surgical incision or division of a muscle
1) A _____is shaving of the lip.
vermilionectomy
2) In addition to the sites from the mouth to the anus, the Digestive System codes include codes for the pancreas, liver and _______.
...
3) How many centimeters are there in 4 inches (round to the nearest tenth)?
...
4) An Abbe-Estlander reconsgtruction for cleft lip.
CPT code:
5) A complex, full-thickness repair of the vermilion after resection of bucall-mucosal squamous cell carcinoma of upper lip.
CPT code
6) Simple drainage of a hematoma of the vestibule of the mouth
CPT code
7) Repair of a laceration of the tongue, measuring 1.5 inches.
CPT code
Pharynx, Adenoids and tonsils
codes 42700-42999
Incision category codes (42700-42725)
based on location and the approach utilized (intraoral or external)
peritonsillar
around the tonsils
retropharyngeal
behind the pharynx
parapharyngeal
adjacent to the pharynx
biopsy category codes (42800-42806)
include obtaining biopsy sample but does not include use of a scope. If laryngoscopic biopsy is performed, the service is reported with code from Respiratory system
Procedures of the esophagus
Codes 43020-43499, performed by incision, excision, endoscopy, repair and manipulation. APPROACH determines code.
types of esophagus procedures
diagnostic endoscopy, injection, biopsy, removal of foreign body, insertion of plastic tube/stent, dilation, and hemorrhage control.
diagnostic esophagoscopy with endoscopic ultrasound examination
43231 include imaging guidance
excision codes (43100-43135
include cervical, thoracic and abdominal approaches
pylorus
stricture at end of stomach
esophageal endoscopy
codes 43200-43232
diagnostic esophagoscopy
using either rigid or flexible scope, used with or without collection of specimen(s)
0 global days
procedure includes all preoperative and postoperative care related to performing the procedure on the day of the procedure; but before on after the day of the procedures, any services related to procedure are reported separately
esophagoscopy with submucosal injections of any substance of any substance
code substance injected
esophagoscopy (rigid or flexible) with biopsy (single or multiple)
code 43202 once (one unit) regardless of number of biopsies taken
diagnosis must support the medical necessity of procedure
TRUE
radiology used during esophagoscopy
code separately
removal of ablation of esophageal polyp, tumor or othe rlesion
coded with 43216 or 43217 according to technique of removal
EGD
esophagogastroduodensocopy, procedure performed to examine esophagus, stomach, duodenum, and sometimes jejunum for signs of bleeding, tumors, erosion, ulcers, or other abnormalties
EGD code 43259 assigned when an endoscopic ultrasound examination is performed,
radiological supervision and interpretation is not reported separately
ERCP
endoscopic retrograde cholangiopancreatography, procedure of the pancreatic ducts, hepatic ducts, common bile ducts, duodenal papilla, and/or gallbladder (Hepatobiliary system) primiarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (due to trauma or surgery), and cancer
ERCP coding
based on purpose of procedure: diagnostic or therapeutic, codes do not include radiological superivsion and interpretation, so when perform code 74328 (biliary ductal system), 74329 (pancreatic ductal system) and 74330 (biliary and pancreatic ductal systems)failed ERCP
Failed ERCP
coded 43260-52 indicating a service that was reduced at physician's discretion
laparoscopy (43279-43289)
surgical laporoscopy is a procedure to examine organs of the abdominal cavity and always includes diagnostic laparoscopy
laparoscope
thin flexible tube containing a camera, placed through a small incision in the abdomen
Stomach codes 43500-43999
...
gastric bypass surgery
outcome of decreasing size of stomach and/or intestines to aid with weight loss
Roux-en-Y (RNY)
Y-shaped surgical connecdtion in which the intestine is detached from its original origin an dreattached so as to bypass a part of the stomach and the entire duodenum
bariatric surgery
codes 43770-43775, gastric restrictive procedures
intestines
codes 44005-44799
colostomies
creation of an artificial opening, always bundled into a more major procedure
resection of intestines
taking out a portion of intestine and joining the remaining ends (anastomosis) directly or developing an artifical opening (exteriorizing) through the abdominal wall
stoma
artifical opening
openings to the outside of the body are named for the part of the intestine from which they are formed
colostomy, ileostomy, gastrostomy
1. The first step to choosing the correct GI endoscopic code is to determine the _____to which the scope was passed.
extent
if exploratory procedure progressed to surgical treatment
code the definite treatment
Sigmoidoscopy
endoscopic examination of the entire rectum and sigmoid colon and may include part of the descending colon
if a definitive diagnosis has not been documented
report the documented signs/symptoms
diagnostic colonoscopy
endoscopic examination fo the colon from rectum to cecum. Coded based on extent and purpose of procedure
modifier -53
discontinued procedure, with documentation
colonoscopy
endoscope is advanced to the proximal colon (past the splenic flexure) to the cecum or into a protion of the terminal ileum (most distant part of the small intestine)
cold biopsy
use of forceps to grasp and remove a small piece of tissue without the application of cautery.
snare procedure
wire loop is placed around the lesion and the wire is ten heated to shave off the lesion. Report only one technique for each lesion or polyp.
polypectomy
surgical removal of a polyp
if single lesion is biopsied, but not entirely removed
only biopsy code assigned
if biopsy obtained and lesion is also excised
only excision of lesion coded
with or without biopsy
biopsy not reported separately
screening
no presenting symptoms or disease is present
ablation of lesion
destroy entire lesion
colonsocopy injection
code 45381 when polyp is injected with saline to lift polyp prior to removal by another technique
other injection services
placement of tattoo with India ink for later identificaion of the area during a surgical procedure
AVM
angiodysplasia
bleeding caused by the procedure and controlled by any method is considered part of the therapeutic procedure and not coded separately
TRUE
multiple lesions removed from colon using same technique (snare)
use only one code to report the service, colon is considered on anatomical location. If procedure is prolonged or extensive, report modifier -22 and include time procedure extned beyond usual time with documentation with claim form to support assignment of modifier
VC
virtual colonoscopy utilizes x-rays and computer to produce a 2 and 3-D image of the colon used to diagnose colon and bowel disease. Performed without sedation and in radiology department. Also used as a technique for screening.
Virtual colonoscopy
can be performed with CT, MRI
ANGIODYSPLASIA
acquired malformation of mucosal and submucosal capillary beds, usually arises in cecum and right colon due to high wall tension, rupture classically presents as hematochezia in an older adult
HEMATOCHEZIA
passage of stools containing bright red blood
1) Appendectomy on a patient with a ruptured appendix
CPT code:
2) Flexible sigmoidoscopy with 3 biopsies
CPT code
3) Colonscopy with removal of polyp by a snare
CPT code
4) The patient presents for removal of a sigmoid and rectal polyps. The Pentax video sigmoidoscope was inserted and four polyps were seen scattered between the rectum and proximal sigmoid colon. The largest measured about 1.5 cm in diameter. The others were diminuitve, about 4 of 5 mm in diameter. Biopsies were taken of 2 of these polyps. The pathology report indicated benign polyps.
CPT code:
seton
treatment for anal fistula
anal fistula
abnormal passage between anus and skin which is usually the result of a previous abscess that has drained but not completely healed.
Fissure
cleft or a groove, normal or otherwise
anal fissure
painful ulcer usually located at the margin of the anus
fissurectomy
excision of the fissure
sphincterotomy
surgical incision of a sphincter
anoscope
instrument inserted a short distance into the anal canal, procedures using anoscope are reported with endoscopy codes 46600-46615
destruction of anal lesions
methods include chemical, eletrodessication, cryosurgery, laser surger and surgical excision
hemorrhoids
(piles) from an inflammation of the venous plexuses (congregation of vessels) around the anus and may be inside or outside of anal canal. classifed into four degrees
The dentate line is the line where the anal mucosal lining meets the skin (mucocutaneous junction or anal verge).
used to measure degree of hemorrhoid
Liver biopsy
may be performed percutaneously using imaging guidance that is reported separtely, if biopsy is performed at the time of a more major surgery, reported with add-on code 47001.
wedge biopsy
involves removal through incision of a small fan-shaped section of tissue for examination
liver transplant
each component of the transplant is reported separately
backbench work
special preparation of the graft before tranplntation
biliary tract
gallbladder connected the liver and small intestine by biliary tract
hepaticotomy
incisional procedure of gallbladder
hepaticostomy
exploration of the tract to determine cause of obstruction and may include removal of calculus or drainage of bile from tract
choledochotomy
incision into the biliary tract
cholecystomstomy
formation of a stoma between abdominal wall and gallbladder
biliary tract stents
47511
laparoscopic cholecystectomy
placement of ports through the abdominal wall into the laparoscope and instrumentation are inserted to remove the gallbladder
When procedure begun but converted to another technique during same operative session
code only the successful approach
pancreatitis
inflamed pancreas
pancreatectomies
total or partial pancreas removalstranglated
strangulated
hernia cutting of blood supply
incarcerated hernia
cannot be returned to abdominal cavity
hernorrhaphy
surgical repair of hernia
1) exploratory laparotomy with cholecystectomy
CPT code
2) cholecystotomy with exploration and removal of calculus by means of an open procedure
CPT code:
3) repair of recurrent reducible incisional hernia, with implantation of a mesh graft, abdominal approach
CPT code
4) Repair of an initial incarcerated inguinal hernia in a 5-1/2 year old
CPT code
5) total pancreatectomy
CPT code
6) Sphincterotomy and one quadrant hemorrhoidectomy for an anal fissure is performed. During the procedure an enlarged hemorrhoid/sentinel tag was noted at the 10 o'clock postion and a fissure right at the base of this. Anoscope and a Kelly clamp were placed, and a sentinel tag excised. The defet was closed with sutures.
CPT code.
excrescence
Abnormal growth or outgrowth
exenteration
wide resection involving removal of the tumor, its organ of origin, and all surrounding tissue in the body space
code 45126 complex code increase the potential for unintenional unbundling
true
Colorectal cancer screening
pg 692,693,694
EGD with biopsy and dilation of gastric outlet for obstruction
43245, 43239
dilaton of gastric outlet
balloon, guide wire, bougie