1. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 23 DIGESTIVE SYSTEM

2. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Digestive System Divided by anatomic site from mouth to abdomen, peritoneum, and omentum + organs that aid digestive process Many bundled procedures Surgical procedures for open & endoscopic: –Mouth & related structures –Pharynx –Adenoids –Tonsils –Esophagus –Stomach –Intestines –Appendix –Rectum and anus –Liver –Biliary tract –Pancreas

3. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Lips (40490-40799) Vermilionectomy (40500) is shaving of lip –Vermilion border: Area between lip and mucosal surface of mouth –Large defects (40510-40527) Repaired with procedures such as transverse wedge excision (40510) Cheiloplasty is lip repair –Full thickness repair (40650-40654) –Cleft lip repair (40700-40761)

4. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Tongue and Floor of Mouth (41000-41599) Incision and drainage codes based on: –Sublingual (under tongue) –Submandibular (under mandibular) –Masticator space (floor of mouth to hyoid bone) Extraoral (outside mouth) I&D of abscess, cyst, hematoma on floor of mouth

5. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Dentoalveolar Structures and Palate/Uvula Dentoalveolar structures (41800-41899) –Bone (osseous) and soft structures of mouth –Anchors teeth Palate/Uvula (42000-42299) –Palate (roof of mouth) –Uvula (pendulous structure at back of throat) Alveolar mucosa. (From Liebgott B: The Anatomical Basis of Dentistry, ed 2, St. Louis, 2001, Mosby, Inc.) Figure: 23.6

6. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Salivary Gland and Ducts (42300-42699) Three salivary glands –Parotid –Submandibular –Sublingual Codes divided initially by gland

7. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Pharynx, Adenoids, and Tonsils (42700-42999) Incision codes 42700-42725 initially divided on approach –Intraoral –External Tonsillectomy and adenoidectomy –42820-42836 –Based on gland removed and age of patient Figure: 23.10, A & B

8. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Esophagus (43020-43499) Approaches—Incision, Excision –Cervical –Thoracic –Abdominal –Endoscopy Code esophageal dilation 1.Know the device or method used 2.How each device works 3.Whether dilation was endoscopic or non-endoscopic Diagnostic endoscopy always included in surgical endoscopy

9. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Esophagoscopy (43200-43232) Limited to esophagus only Scope may be advanced into stomach but is short of pylorus If scope transverses pyloric channel becomes an EGD (43234-43259) If scope passes beyond second portion of duodenum, report Endoscopy, Small Intestine codes 44360-44379

10. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Stomach (43500-43999) Gastric bypass performed for morbid obesity –Many different types, such as RNY –May be performed via laparoscope Bariatric surgery (43770-43775) –Gastric restrictive device (such as band) Figure: 23.13

11. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Intestines (Except Rectum) (44005-44799) Separate procedures common Colostomies always bundled with major procedure –Unless code states otherwise Small intestine extends for 20 feet from pyloric sphincter to first part of large intestine Large intestine extends from end of ilium to anus, 4 parts (cecum, colon, sigmoid colon, and rectum)

12. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Endoscopy, Small Intestine and Stomal (44360-44397) Diagnostic bundled into surgical endoscopic Code to furthest extent of procedure

13. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Endoscopy Terminology Notes define specific terminology Code descriptions are specific regarding: –Technique and depth of scope Esophagoscopy: Esophagus only Esophagogastroscopy: Esophagus to past diaphragm Esophagogastroduodenoscopy: Esophagus to beyond pyloric channel Read notes preceding 45300-45392 (Cont’d…)

14. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Endoscopy Terminology (…Cont’d) Sigmoidoscopy: Entire rectum, sigmoid colon, and may include part of the descending colon (up to 26 inches or 26-60 cm is visualized) Proctosigmoidoscopy: Rectum and sigmoid colon (6.25 cm is visualized) Colonoscopy: Entire colon, rectum to cecum, and may include terminal ileum (more than 60 cm visualized or 53 inches)

15. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Colon Procedures & Screening For colonoscopy procedures determine how it was performed: 1.Through a colostomy 2.Through a colotomy 3.Through the rectum For Colorectal Cancer Screening see HCPCS Level II codes: –G0104 –G0105 –G0106 –G0120 –G0121 –G0122

16. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Laparoscopy and Endoscopy Some subheadings have both laparoscopy (from outside) and endoscopy (from inside) procedures –Example: Subheading Esophagus Endoscopy views inside Laparoscopy inserted through umbilicus, views from outside Laparoscopic bariatric surgery codes (43770-43774) Use of gastric band and/or subcutaneous port components

17. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Hemorrhoidectomy and Fistulectomy Codes (46221-46320) Divided by –Anatomy Subcutaneous: no muscle involvement Submuscular: sphincter muscle –Complex fistulectomy involves excision/incision of multiple fistulas

18. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Abdomen, Peritoneum, and Omentum Subheading (49000-49999) Laparoscopy –Diagnostic (49320) –Surgical (49321-49323) Repair category contains hernia repair codes

19. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Hernia Codes Divided on 1.Type –Example: inguinal, femoral 2.Initial or subsequent repair 3.Age of patient 4.Clinical presentation: –Strangulated: Blood supply cut off –Incarcerated: Cannot be returned to cavity (not reducible) Implantation of mesh or prosthesis is reported separately

20. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Conclusion CHAPTER 23 DIGESTIVE SYSTEM