© 2010 Delmar, Cengage Learning Chapter 14 CPT Surgery IV

© 2010 Delmar, Cengage Learning Mediastinum and Diaphragm Subsection Mediastinum –Space in thoracic cavity between lungs that contains aorta, esophagus, heart, and other structures Diaphragm –Thin muscle below heart and lungs that separates chest from abdomen

© 2010 Delmar, Cengage Learning Digestive System Organs

© 2010 Delmar, Cengage Learning Digestive Subsections Excision Incision Repair Excision/Destruction Introduction Manipulation (continued)

© 2010 Delmar, Cengage Learning Digestive Subsections Laparoscopy Endoscopy Enterostomy Liver Transplantation Pancreas Transplantation

© 2010 Delmar, Cengage Learning Large Intestine

© 2010 Delmar, Cengage Learning Digestive System Subsection 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

© 2010 Delmar, Cengage Learning Gastrostomy Surgical creation of artificial opening into the stomach

© 2010 Delmar, Cengage Learning Oral Cavity Lips Vestibule of mouth Tongue and floor of mouth Dentoalveolar structures Palate and uvula Salivary glands and ducts (continued)

© 2010 Delmar, Cengage Learning Oral Cavity

© 2010 Delmar, Cengage Learning 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

© 2010 Delmar, Cengage Learning Child with Cleft Palate Before and after treatment

© 2010 Delmar, Cengage Learning Vestibule of Mouth Incision Excision/Destruction Repair Other procedure (unlisted)

© 2010 Delmar, Cengage Learning Tongue and Floor of Mouth Incision Excision Repair Other procedure (unlisted) (continued)

© 2010 Delmar, Cengage Learning Tongue and Floor of Mouth When reporting codes for excision of tongue lesion, review operative note to identify: –Location of lesion –Type of lesion

© 2010 Delmar, Cengage Learning Dentoalveolar Structures reported for procedures on teeth or gums Most commonly performed dental procedures are found in Current Dental Terminology (CDT) and HCPCS level II

© 2010 Delmar, Cengage Learning Palate and Uvula reported for procedures on hard and soft palates Palatopharyngoplasty –Treat oropharyngeal obstruction to cure extreme cases of snoring with or without sleep apnea

© 2010 Delmar, Cengage Learning Pharynx, Adenoids, and Tonsils Pharynx contains three segments: –Nasopharynx –Oropharynx –Hypopharynx

© 2010 Delmar, Cengage Learning Tonsillectomy and 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 (continued)

© 2010 Delmar, Cengage Learning Tonsillectomy and Adenoidectomy Procedure: –Cryogenic –Electrocautery –Laser Report modifier -78 to indicate return to OR for related procedure performed during global period

© 2010 Delmar, Cengage Learning Esophagus reported for procedure on esophagus When assigning codes, review documentation to identify approach Endoscopy –Esophagogastroscopy –Esophagogastroduodenoscopy (EGD) –Endoscopic retrograde cholangiopancreatography (ERCP) (continued)

© 2010 Delmar, Cengage Learning Esophagus Endoscopic injection Ligation Manipulation

© 2010 Delmar, Cengage Learning Endoscopy Diagnostic 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

© 2010 Delmar, Cengage Learning EGD

© 2010 Delmar, Cengage Learning Laparoscopy Peritoneoscopy Closed laparoscopy Open laparoscopy

© 2010 Delmar, Cengage Learning Stomach Gastrostomy Bariatric surgery –Gastric restriction procedures Laparoscopic techniques –Roux-en-Y gastric bypass and small bowel restriction –Adjustable gastric band (continued)

© 2010 Delmar, Cengage Learning Stomach Gastrectomy –Remove all/part of the stomach to treat: Ulcers Malignancy of the stomach

© 2010 Delmar, Cengage Learning Gastrostomy Feeding

© 2010 Delmar, Cengage Learning 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

© 2010 Delmar, Cengage Learning Enterostomy -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) (continued)

© 2010 Delmar, Cengage Learning Enterostomy -stoma –Located at end of ureter, small intestine, or large intestine –Can be viewed as protruding through abdominal wall

© 2010 Delmar, Cengage Learning 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

© 2010 Delmar, Cengage Learning Endoscopy, Small Intestine and Stoma Endoscopy –Jejunal feeding –Endoscopy for small intestine pouch –Ileoscopy through stoma –Colonoscopy through stoma Introduction (continued)

© 2010 Delmar, Cengage Learning Endoscopy, Small Intestine and Stoma Repair Other procedure –Implanting mash

© 2010 Delmar, Cengage Learning Meckel’s Diverticulum and Mesentery Diverticula –Small pouches (herniations) in colon Diverticulosis –Presence of diverticula in mucosa and submucosal –Almost always in sigmoid colon (continued)

© 2010 Delmar, Cengage Learning Meckel’s Diverticulum and Mesentery Meckel’s Diverticulum –Common congenital abnormality of gastrointestinal (GI) tract that results in pouch in wall of small bowel –Excision is one of the treatments

© 2010 Delmar, Cengage Learning 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.

© 2010 Delmar, Cengage Learning Rectum Proctosigmoidoscopy Sigmoidoscopy Colonoscopy

© 2010 Delmar, Cengage Learning Removal of Polyps Hot biopsy forceps Bipolar cautery Electrocautery snare Cold biopsy forceps Laser technique (e.g., YAG laser)

© 2010 Delmar, Cengage Learning Anus Hemorrhoidectomy –Identify: Approach Location of hemorrhoids (e.g., internal, external) Whether fissurectomy also was performed (continued)

© 2010 Delmar, Cengage Learning Anus Fistulectomy –Subcutaneous fistulectomy –Submuscular fistulectomy –Complex fistulectomy –Second stage

© 2010 Delmar, Cengage Learning Hemorrhoids: Internal and External

© 2010 Delmar, Cengage Learning Digestive Accessory Organs Liver Gallbladder Bile ducts inside liver Bile ducts outside liver Hepatic ducts (continued)

© 2010 Delmar, Cengage Learning Digestive Accessory Organs Common bile ducts Cystic ducts Pancreas (continued)

© 2010 Delmar, Cengage Learning Digestive Accessory Organs Liver, gallbladder, and pancreas

© 2010 Delmar, Cengage Learning Cholecystectomy Open versus laparoscopically When attempted laparoscopically and converted to open procedure, report code for open procedure only

© 2010 Delmar, Cengage Learning Hernia Repair Determine: –Hernia site (e.g., inguinal, femoral) –Patient’s age –Type of hernia Initial Recurrent –Clinical presentation of hernia –Use of mesh

© 2010 Delmar, Cengage Learning Inguinal and Umbilical Hernias

© 2010 Delmar, Cengage Learning Hernia Repair Includes: –Traditional/Conventional –Mesh –Laparoscopic

© 2010 Delmar, Cengage Learning Urinary Subsection Kidneys Ureters Urinary bladder Urethra

© 2010 Delmar, Cengage Learning Male Urinary System

© 2010 Delmar, Cengage Learning Female Urinary Systems

© 2010 Delmar, Cengage Learning Urodynamic Procedures Cystometrogram Uroflowmetry Urethral pressure profile (UPP) Neuromuscular studies Void pressure (VP) studies

© 2010 Delmar, Cengage Learning Endoscopy of the Urinary System Cystoscopy Urethroscopy Cystourethroscopy

© 2010 Delmar, Cengage Learning Kidney Nephrectomy –Type of procedure Partial Total –Surgical approach Laparoscopic Open –Other structures removed

© 2010 Delmar, Cengage Learning Nephrolithotomy Removal of urinary calculi (stones) Code for site: –Renal pelvis –Bladder –Urethra (continued)

© 2010 Delmar, Cengage Learning Nephrolithotomy Code for approach: –Open incision –Percutaneous –Endoscopic –Extracorporeal shock wave lithotripsy (ESWL)

© 2010 Delmar, Cengage Learning Locations of Renal Calculi Common locations of renal calculi (stone) formation

© 2010 Delmar, Cengage Learning EWSL

© 2010 Delmar, Cengage Learning Ureter Procedures performed on ureters Open endoscopic or urethroscopy Laparoscopic

© 2010 Delmar, Cengage Learning Cystourethroscopy Diagnostic procedure –Bladder biopsy Therapeutic procedure –Removal of foreign body, calculus, and ureteral stent –Transurethral resection of the prostate (TURP)

© 2010 Delmar, Cengage Learning Use of a Cystoscope