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Digestive SystemDigestive System

Digestive System

Digestive SystemDigestive System

CPT® copyright 2013 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.  CPT® is a registered trademark of the American Medical Association.

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Digestive SystemDigestive 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

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Digestive SystemDigestive System

Digestive SystemDigestive System

Digestive System Terms• Gastroenterology

• Digestion

• Absorption

• Mastication

Digestive SystemDigestive System

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 SystemDigestive System

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

Digestive SystemDigestive System

Digestive SystemStomach:– Cardia (entrance)– Fundus (superior to cardia)– Pylorus (antrum)– Body

Digestive SystemDigestive System

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

Digestive SystemDigestive System

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

Digestive SystemDigestive System

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 SystemDigestive 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

Digestive SystemDigestive System

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

Digestive SystemDigestive System

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

Digestive SystemDigestive 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)

Digestive SystemDigestive System

Diseases of the Digestive System• Hepatitis– Acute– Chronic– Classifications

• Cirrhosis– Hepatitis– Chronic Alcoholism

Digestive SystemDigestive System

Diseases of the Digestive System• Cholelithiasis

• Cholecystitis

• Neoplasms

Digestive SystemDigestive 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

Digestive SystemDigestive 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)

Digestive SystemDigestive 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)

Digestive SystemDigestive 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

Digestive SystemDigestive System

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

Digestive SystemDigestive System

CPT® - Esophagus (43020-43499)• Incision (43020-43045)

– Esophagotomy – based on approach– Cricopharyngeal myotomy

• Excision (43100-43135)– Lesion excision – based on approach

Digestive SystemDigestive 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)

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Digestive SystemDigestive 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)

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Digestive SystemDigestive 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

Digestive SystemDigestive 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

Digestive SystemDigestive System

CPT® - Intestines (44005-44779)• Incision (44005-44055)– Biopsy– Exploration

• Excision– Enterectomy

• Laparoscopy

Digestive SystemDigestive 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)

Digestive SystemDigestive System

CPT® - Digestive System• Meckel’s Diverticulum and the Mesentery

(44800-44899)

• Appendix (44900-44979)

Digestive SystemDigestive System

CPT® - Digestive System• Rectum (45000-45999)

– Incision & drainage of abscesses– Excision

• Proctectomy – partial or complete– Endoscopy

• Proctosigmoidoscopy• Sigmoidoscopy• Colonoscopy

• Anus (46020-46999)

Digestive SystemDigestive System

CPT® - Digestive System• Liver (47000-47399)

• Biliary Tract (47400-47999)

• Pancreas (48000-48999)

Digestive SystemDigestive System

CPT® - Abdomen, Peritoneum, and Omentum (49000-49999)

• Exploratory laparotomy (49000)• Drainage of abscess – open• Excision, Destruction• Laparoscopy

Digestive SystemDigestive 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)

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Digestive SystemDigestive System

• Hernia codes– Type of hernia– Strangulated or incarcerated– Initial or subsequent repair

CPT® - Abdomen, Peritoneum, and Omentum (49000-49999)

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Digestive SystemDigestive 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

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Digestive SystemDigestive System

• 91010-91013 Esophageal motility study• 91065 Breath hydrogen test• 91110 Capsule endoscopy• 91120 Rectal sensation test• 91122 Anorectal manometry

CPT ® – Medicine Section

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Digestive SystemDigestive System

HCPCS• Colorectal cancer screening

– G0104-G0106

– G0120-G0122

Digestive SystemDigestive System

Modifiers• 50 – Bilateral

• 52 – Reduced services

Digestive SystemDigestive System

The End

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