1. Digestive System

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3. Digestive System Define and understand the key terms associated with the digestive tract and the procedures performed in this section Understand the anatomy associated with the procedures performed in this section Explain the organization and content of the CPT® Surgery/Digestive System subsections Learn to assign appropriately CPT® surgery codes from the digestive subsection Objectives 3

4. Digestive System 4

5. Gastroenterology Digestion Absorption Mastication Digestive System Terms 5

6. Digestive System Lips –Entrance to the oral cavity Teeth –Begin mechanical digestion via chewing –20 Deciduous teeth –32 Permanent teeth Gums Tongue –Muscle –Facilitates chewing and swallowing Digestive System 6

7. Pharynx –Conduit for respiration and digestion –Composed of: Nasopharynx Oropharynx Laryngopharynx Esophagus –Conducts food from the pharynx to the stomach –Peristaltic action moves the food Digestive System 7

8. Stomach: –Cardia (entrance) –Fundus (superior to cardia) –Pylorus (antrum) –Body Digestive System 8

9. Small Intestine (small bowel) –Duodenum –Jejunum –Ileum Large Intestine (large bowel) –Cecum (appendix attached) –Colon Ascending colon Transverse colon Descending colon Sigmoid colon Rectum Anus Digestive System 9

10. Spleen –Blood-forming early in life –Acts as a storage organ and filter for blood later in life Pancreas –Endocrine and exocrine organ –Secretes insulin into the bloodstream Digestive System 10

11. Digestive System Liver (Hepatic) –Largest organ and largest gland –Vital functions include: Storage of glucose as glycogen, fat-soluble vitamins, and vitamin B12 Making of plasma proteins Excretion of bilirubin, cholesterol and drugs Metabolism of carbohydrates, protein and fats Making of bile salts Detoxification of drugs and other harmful substances Gallbladder Digestive System 11

12. Digestive System Chapter 1 – Infectious and Parasitic Diseases Chapter 2 – Neoplasms Chapter 9 – Disease of the Digestive System Chapter 14 – Congenital Anomalies Chapter 16 – Signs, Symptoms, and Ill-Defined Conditions ICD-9-CM 12

13. Digestive System Dental Specialists: –General dentist –Periodontist –Endodontist –Orthodontist –Oral Surgeon Diseases of the Digestive System 13

14. Digestive System GERD Appendix –Appendicitis (540-543) –Peritonitis (540.0) –Abscess (540.1) Diseases of the Digestive System 14

15. Digestive System Hernia of the abdominal cavity (550-553) –Inguinal –Femoral –Umbilical –Abdominal –Diaphragmatic Diverticula of intestine (562) –Diverticulosis –Diverticulitis Fissures and fistulas Diseases of the Digestive System 15

16. Digestive System Hepatitis –Acute –Chronic –Classifications Cirrhosis –Hepatitis –Chronic Alcoholism Diseases of the Digestive System 16

17. Digestive System Cholelithiasis Cholecystitis Neoplasms Diseases of the Digestive System 17

18. Digestive System Organized by anatomic site and procedure Endoscopy –Visualization of a hollow viscus or canal by means of an endoscope or scope –Laparoscope is an endoscope CPT® - Digestive System 18

19. Digestive System Lips (40490-40799) –Vermilionectomy (40500) –Cheiloplasty (40650-40761) Vestibule of Mouth (40800-40899) –Vestibuloplasty (40840-40845) –Repair of lacerations –Frenectomy (40819) CPT® - Digestive System 19

20. Digestive System Incision –Intraoral I & D –Extraoral I & D –Frenotomy Excision (41100-41155) –Biopsy –Excision of Lesion –Removal of all or part of tongue Repair (41250-41252) CPT® - Tongue and Floor of Mouth 20

21. Digestive System Dentoalveolar Structures (41800-41899) –Gums (or soft tissue structures) –Bone that anchor the teeth Palate and Uvula (42000-42299) –Roof of the mouth –Uvula – posterior edge of the middle of the soft palate Salivary gland and ducts (42300-42699) –Codes based on gland CPT® - Digestive System 21

22. Digestive System Pharynx, Adenoids and Tonsils (42700-42999) –Tonsillectomy –Adenoidectomy –Biopsy –Pharyngoplasty –Pharyngostomy CPT® - Pharynx, Adenoids and Tonsils 22

23. Digestive System Incision –Esophagotomy – based on approach –Cricopharyngeal myotomy Excision (43100-43135) –Lesion excision – based on approach Endoscopy (43200-43273) –Include moderate sedation –Watch indented codes…brackets may be useful here –ERCP – Endoscopic Retrograde Cholangiopancreatography CPT® - Esophagus (43020-43499) 23

24. Digestive System Repair –Codes selected based on approach Manipulation (43450-43460) –Dilation of esophagus –Report S & I in addition –43460 – inpatient only CPT® - Esophagus 24

25. Digestive System Incision –Foreign body removal –Excision of stomach tumor Excision –Gastrectomy – inpatient only Introduction –Placement, changing and repositioning of feeding tubes Bariatric Surgery Other Procedures CPT® - Stomach (43500-43999) 25

26. Digestive System Incision (44005-44055) –Biopsy –Exploration Excision –Enterectomy Laparoscopy CPT® - Intestines (44005-44779) 26

27. Digestive System Enterostomy (44300-44346) –44186 – only procedure covered in outpatient hospital and ASC settings Endoscopy (44360–44397) –Include moderate sedation –Distinguish if performed through stoma Repair (44602-44680) CPT® - Intestines (44005-44779) 27

28. Digestive System Meckel’s Diverticulum and the Mesentery (44800- 44899) Appendix (44900-44979) CPT® - Digestive System 28

29. Digestive System Rectum (45000-45999) –Incision & drainage of abscesses –Excision Proctectomy – partial or complete –Endoscopy Proctosigmoidoscopy Sigmoidoscopy Colonoscopy Anus (46020-46999) CPT® - Digestive System 29

30. Digestive System Liver (47000-47399) Biliary Tract (47400-47999) Pancreas (48000-48999) CPT® - Digestive System 30

31. Digestive System Exploratory laparotomy (49000) Drainage of abscess – open or percutaneous Laparoscopy Hernia codes –Type of hernia –Strangulated or incarcerated –Initial or subsequent repair CPT® - Abdomen, Peritoneum, and Omentum (49000-49999) 31

32. Digestive System In the ASC, radiology services are only covered if integral to a surgical procedure. Digestive Radiology –Gastrointestinal tract studies (74210-74363) –Diagnostic ultrasound (76700-76776) –Nuclear Medicine studies (78201-78299) –Radiology of GI (74240-74249) –Radiology of colon (74261-74283) CPT ® – Radiology Section 32

33. Digestive System 91010-91013 Esophageal motility study 91065 Breath hydrogen test 91110 Capsule endoscopy 91120 Rectal sensation test 91122 Anorectal manometry CPT ® – Medicine Section 33

34. Digestive System Colorectal cancer screening –G0104-G0106 –G0120-G0122 HCPCS 34

35. Digestive System 50 – Bilateral 52 – Reduced services Modifiers 35

36. Digestive System The End