UNIT 8 Final Exam Coding Review CPT Surgery IV Digestive System HI250 Medical Coding II UNIT 8 Final Exam Coding Review CPT Surgery IV Digestive System

Unit 8 Assignments – Due 5/17/11 In 3-2-1 Code It!, Green textbook: Read chapters 14 Participate in the discussion (graded) Complete practice exercises – Chapter 14 Green, Chapter 14, Review p588-90 & Practice p590-93 Complete the Learning Activities (graded) Scott, Coding Case 1 p160-62 Scott, Coding Case 2, p163-66

Scott, Coding Case 2, pp. 163-166 (Inpatient) Seminar Coding Review Scott, Coding Case 2, pp. 163-166 (Inpatient)

Final Exam Review Guide Theory

Digestive System Subsections Excision Incision Repair Excision/Destruction Introduction Manipulation

Digestive Procedures Laparoscopy Endoscopy Enterostomy Liver Transplantation Pancreas Transplantation

Digestive System Procedures classified first by anatomic site and then by type Codes are reported for open, endoscopic, and laparoscopic procedures CPT Medicine section contains codes for digestive system procedures

Vestibule of Mouth Incision Excision/Destruction Repair Other procedure (unlisted)

Tongue and Floor of Mouth When reporting codes for excision of tongue lesion, review operative note to identify: Location of lesion Type of lesion

Dentoalveolar Procedures 41800-41899 reported for procedures on teeth or gums Most commonly performed dental procedures are found in Current Dental Terminology (CDT) and HCPCS level II

Palate and Uvulva 42000-42299 reported for procedures on hard and soft palates Palatopharyngoplasty Treat oropharyngeal obstruction to cure extreme cases of snoring with or without sleep apnea

Tonsillectomey & Adenoidectomy Code determined by: Type of procedure (e.g., primary, secondary) Age of patient Separate codes are included to report hemorrhage control following tonsillectomy and adenoidectomy procedures

Cleft Palate and Nasal Deformities Review operative record to identify whether procedure is: Primary or secondary One-stage or two-stage More complicated plastic repair of cleft lip or nasal using cross-lip pedicle flap

Surgical Package Tonsillectomy and Adenoidectomy Procedure: Cryogenic Electrocautery Laser Report modifier -78 to indicate return to OR for related procedure performed during global period

Esophagus 43020-43499 reported for procedure on esophagus When assigning codes, review documentation to identify approach Endoscopy Esophagogastroscopy Esophagogastroduodenoscopy (EGD) Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopy Diagnostic endoscopy Surgical endoscopy Performed to visualize abnormality or determine extent of disease Surgical endoscopy Performed when anything in addition to visualization is performed When both procedures performed, report code for surgical endoscopy only

Laparoscopy Peritoneoscopy Closed laparoscopy Open laparoscopy

Stomach Gastrostomy Bariatric surgery Laparoscopic techniques Gastric restriction procedures Laparoscopic techniques Roux-en-Y gastric bypass and small bowel restriction Adjustable gastric band

Intestines Incision Excision Colectomy Remove all/part of right colon Remove all/part of left colon Remove all/part of rectosigmoid colon, rectum, and anus

Enteroscopy -ostomy Surgically creating opening for discharge of body wastes Classified according to portion of digestive tract brought to the surface May be permanent or temporary Types: Colostomy Ileostomy Continent ileostomy (Kock pouch)

Coding Tips Add modifier -52 when patient underwent full preparation and an incomplete colonoscopy was performed When multiple endoscopies were performed during same operative session, report code for most extensive procedure

Meckel’s Diverticulum and Mesentery Diverticula Small pouches (herniations) in colon Diverticulosis Presence of diverticula in mucosa and submucosal Almost always in sigmoid colon

Meckel’s Diverticulum and Mesentery Common congenital abnormality of gastrointestinal (GI) tract that results in pouch in wall of small bowel Excision is one of the treatments

Coding Tips Surgical endoscopy always includes diagnostic endoscopy. When multiple services are provided during an endoscopic procedure, report a code for each. Multiple services are reimbursed according to multiple endoscopic payment rules.

Removal of Polyps Hot biopsy forceps Bipolar cautery Electrocautery snare Cold biopsy forceps Laser technique (e.g., YAG laser)

Anus Hemorrhoidectomy Identify: Approach Location of hemorrhoids (e.g., internal, external) Whether fissurectomy also was performed

Anus Fistulectomy Subcutaneous fistulectomy Submuscular fistulectomy Complex fistulectomy Second stage

Digestive Accessory Organs Liver Gallbladder Bile ducts inside liver Bile ducts outside liver Hepatic ducts

Digestive Accessory Organs Common bile ducts Cystic ducts Pancreas

Cholecystectomy Open versus laparoscopically When attempted laparoscopically and converted to open procedure, report code for open procedure only

Hernia Repair Determine: Hernia site (e.g., inguinal, femoral) Patient’s age Type of hernia Initial Recurrent Clinical presentation of hernia Use of mesh

Hernia Repair Includes: Traditional/Conventional Mesh Laparoscopic

Urodynamic Procedures Cystometrogram Uroflowmetry Urethral pressure profile (UPP) Neuromuscular studies Void pressure (VP) studies

Endoscopy of the Urinary System Cystoscopy Urethroscopy Cystourethroscopy

Kidney Nephrectomy Type of procedure Surgical approach Partial Total Surgical approach Laparoscopic Open Other structures removed

Nephrolithotomy Removal of urinary calculi (stones) Code for site: Renal pelvis Bladder Urethra

Nephrolithotomy Code for approach: Open incision Percutaneous Endoscopic Extracorporeal shock wave lithotripsy (ESWL)

Ureter Procedures performed on ureters Open endoscopic or urethroscopy Laparoscopic

Cystourethroscopy Diagnostic procedure Therapeutic procedure Bladder biopsy Therapeutic procedure Removal of foreign body, calculus, and ureteral stent Transurethral resection of the prostate (TURP)

Conclusion Questions / Concerns