CPT 40000DIGESTIVE SYSTEM By Panny Lewis, CPC-A

TOPICS COVERED•Anatomy and terminology•Procedures•Helpful tips•Practice exam samples

ANATOMY

The codes start with the mouth and end with the anus.

ANATOMY Know the order:1. Duodenum2. Jejunum3. Ileum4. Ascending5. Transverse6. Descending7. Sigmoid8. Rectum

ANATOMY• Flexures: where the colon bends.

•You can draw/mark it in your book

ANATOMYCheiloplasty and vermillion relate to lips.

ANATOMY Know this order from outer to inner:1. serosa2. smooth muscle3. submucosa4. mucosa.

TERMINOLOGY•43235: also called Upper GI or EGD•EGD: esophago/gastro/duodeno/scopy• Esophagus•Gastronomus•Duodunum•An endoscope that goes to the sigmoid is procto/sigmoido/scopy•An endoscope that goes to the anus is ano/scopy.

PROCEDURES 43220• Upper GI with dilation•a balloon is passed through the scope and inflated to open up a narrowed section of the tract.

BACKBENCH PREP

Backbench Prep:Any kind of procedure done to an organ to prepare it before transplant: freezing, dissecting, accessing the veins and arteries.

BACKBENCH PREP•Indexed as “preparation for transplant”•Intestines and pancreas are from cadavers only•Liver can be from living or cadaver donors so highlight the difference.

HIGHLIGHTS

Tonsillectomy: highlight 42820 (tonsillectomy with adenoidectomy) and 42825 (tonsillectomy only); notice the age group.

HIGHLIGHTSHighlight using different colors for internal and external hemorhoidectomy.

HIGHLIGHTS

Draw a vertical line from code 43200 all the way down to code 43234

ENDOSCOPY

PRACTICE QUESTIONSDiagnostic upper GI endoscopy of the esophagus, stomach, and duodenum was performed after esophageal balloon dilation (less than 30 mm diameter) was done at the same operative session. Code the procedure(s). A. 43249, 43235-51 under same indent B. 43249 Upper GI C. 43220, 43200-51 under same indent D. 43220 Eshophagoscopy Watch out for indentations and look back for main headings.

PRACTICE QUESTIONSA patient comes in for surgery today to address complications from his previous partial enterectomy performed 5 months ago. Upon reopening the patient’s previous incision the surgeon resected the ileum and a portion of the colon. An ileocolostomy was performed to complete the procedure with no complications. The appropriate CPT® code to report is: A. 44144 no mucofistula B. 44160 open surgery C. 44150 not total D. 44205 this is laparoscopy

PRACTICE QUESTIONSPREOPERATIVE DIAGNOSIS: History of prior colon polyps POSTOPERATIVE DIAGNOSIS: Colon polyps, diverticulosis, hemorrhoids PROCEDURE: A rectal exam was performed and revealed small external hemorrhoids. The video colonoscope was passed without difficulty from anus to cecum. The colon was well prepped. The instrument was slowly withdrawn with good views obtained throughout. There was a 3 mm polyp in the proximal ascending colon. This polyp was removed with hot biopsy forceps and retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the proximal rectum. The polyp was removed by hot biopsy forceps. There was also moderate diverticulosis extending from the hepatic flexure to the distal sigmoid colon. Code the CPT® procedure(s). A. 45384 B. 45384, 45384-51 not done twice C. 45380, 45384-51 same indent D. 45378, 45383-51 same indent

PRACTICE QUESTIONSPreoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis. Postoperative Diagnosis: Same. Procedure: Tonsillectomy and adenoidectomy. Patient is a 24-year old male who was taken to the operating room and put under IV sedation by the anesthesia department. An initial curettage of adenoids was done and packing was placed. The left tonsil was then identified and dissected out extracapsular and removed with scissors. Hemostasis was maintained by packing the left tonsil. Next, the right tonsil was identified and incision was made. Dissection was done extracapsular and the right tonsil was then removed. Both the right and left tonsil were sent as specimens as well as adenoid tissue. What are the procedure and diagnosis codes?A. 42826, 42831-59, 474.01 tonsillectomy onlyB. 42826, 42831-51-59, 474.02 tonsillectomy onlyC. 42821-50, 42836-50-59, 474.00, 474.01 adenoidectomy is already includedD. 42821, 474.02  

PRACTICE QUESTIONS Patient with RUQ pain and nausea suspected of having a stone or other obstruction in the biliary tract is brought in for ERCP under radiologic guidance. Procedure: The patient was brought to the hospital outpatient endoscopy suite and placed supine on the table. The mouth and throat were anesthetized. Under radiologic guidance, the scope was inserted through the oropharynx, esophagus, stomach, and into the small intestine. The ampulla of Vater was cannulated and filled with contrast. It was clear that there was an obstruction in the common bile duct. The endoscope was advanced retrograde to the point of the obstruction, which was found to be a stone that was removed with a stone basket. The rest of the biliary tract was visualized and no other obstructions or anomalies were found. The scope was removed without difficulty. The patient tolerated the procedure well.

A. 47554, 74363-26 Endoscopy

B. 43264, 74328-26 ERCP

C. 43265, 74328 missing modifier

D. 43269, 74329 missing modifier

Good Luck!

• Very helpful: AAPC Practice Exam Online• Peruse quickly through the test booklet• If all the easy questions are in the back then

start there• Mark and put off all the hard questions for last• Find the correct answer by eliminating the

incorrect ones• Write formulas, abbreviations, notes, diagrams

in your books• Add extra tabs and labels to move faster around

your books• Bring some candy and bottle of water• Stop fast food/dining/eating out 1 week before

exam