1. Digestive System

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3. Digestive System Objectives 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 appropriate CPT® surgery codes from the digestive subsection 2/17/20162/17/20162/17/2016 3

4. Digestive System

5. Digestive System Terms Gastroenterology Digestion Absorption Mastication

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

7. Digestive System 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

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

9. Digestive System 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

10. Digestive System 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

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

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

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

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

15. Digestive System Diseases of the Digestive System Hernia of the abdominal cavity (550-553) –Inguinal –Femoral –Umbilical –Abdominal –Diaphragmatic Diverticula of intestine (562) –Diverticulosis –Diverticulitis Fissures and fistulas (565)

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

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

18. Digestive System CPT® - 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

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

20. Digestive System CPT® - Tongue and Floor of Mouth 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)

21. Digestive System CPT® - 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

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

23. Digestive System CPT® - Esophagus (43020-43499) Incision (43020-43045) –Esophagotomy – based on approach –Cricopharyngeal myotomy Excision (43100-43135) –Lesion excision – based on approach

24. Digestive System Endoscopy (43191-43278) –Esophagoscopy includes examination from cricopharyngeus muscle to and including the gastroesophageal junction. May include proximal region of the stomach via retroflexion when performed. –Surgical endoscopy includes diagnostic endoscopy –Some codes include moderate sedation –Watch for type of esophagoscopy: rigid transoral flexible transnasal flexible transoral. –Watch indented codes…brackets may be useful here CPT® - Esophagus (43020-43499) 24

25. Digestive System Endoscopy (43191-43278) continued –Esophagogastroduodenoscopy Report modifier 52 when duodenum is deliberately not examined –Endoscopic Retrograde Cholangiopancreatography (ERCP) (43260-43278) One or more ducts must be visualized Report 43235-43259 for unsuccessful cannulation of any ductal system ERCP with stent placement includes balloon dilation ERCP with more than one stent placement is reported with modifier 59 CPT® - Esophagus (43020-43499) 25

26. Digestive System CPT® - Esophagus Laparoscopy (43279-43289) Repair (43300-43425) –Codes selected based on approach Manipulation (43450-43460) –Dilation of esophagus –Report S & I in addition –43460 – inpatient only

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

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

29. Digestive System CPT® - Intestines (44005-44779) Enterostomy (44300-44346) –44186 – only procedure covered in outpatient hospital and ASC settings Endoscopy (44360–44397) –Include moderate sedation –Distinguish if performed through stoma Introduction (44500) Repair (44602-44680)

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

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

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

33. Digestive System CPT® - Abdomen, Peritoneum, and Omentum (49000-49999) Exploratory laparotomy (49000) Drainage of abscess – open Excision, Destruction Laparoscopy

34. Digestive System Introduction, Revision, Removal –Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst; visceral (eg, kidney, liver, spleen, lung/mediastinum (49405) Peritoneal or retroperitoneal, percutaneous (49406) Peritoneal or retroperitoneal, transvaginal or transrectal (49407) CPT® - Abdomen, Peritoneum, and Omentum (49000-49999) 34

35. Digestive System Hernia codes –Type of hernia –Strangulated or incarcerated –Initial or subsequent repair CPT® - Abdomen, Peritoneum, and Omentum (49000-49999) 35

36. 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 Diagnostic Studies (78201-78299) –Radiology of GI Tract (74210-74363) CPT ® – Radiology Section 36

37. Digestive System 91010-91013 Esophageal motility study 91065 Breath hydrogen test 91110 Capsule endoscopy 91120 Rectal sensation test 91122 Anorectal manometry CPT ® – Medicine Section 37

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

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

40. Digestive System The End 2/17/20162/17/20162/17/2016 40