1. 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

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

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

4. Final Exam Review Guide
Theory

5. Digestive System Subsections Excision Incision Repair
Excision/Destruction
Introduction
Manipulation

6. Digestive Procedures Laparoscopy Endoscopy Enterostomy
Liver Transplantation
Pancreas Transplantation

7. 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

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

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

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

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

12. 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

13. 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

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

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

16. 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

17. Laparoscopy
Peritoneoscopy
Closed laparoscopy
Open laparoscopy

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

19. 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

20. 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)

21. 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

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

23. 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

24. 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.

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

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

27. Anus Fistulectomy Subcutaneous fistulectomy Submuscular fistulectomy
Complex fistulectomy
Second stage

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

29. Digestive Accessory Organs
Common bile ducts
Cystic ducts
Pancreas

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

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

32. Hernia Repair
Includes:
Traditional/Conventional
Mesh
Laparoscopic

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

34. Endoscopy of the Urinary System
Cystoscopy
Urethroscopy
Cystourethroscopy

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

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

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

38. Ureter Procedures performed on ureters Open endoscopic or urethroscopy
Laparoscopic

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

40. Conclusion
Questions / Concerns