1. Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 23 DIGESTIVE SYSTEM

2. Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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. Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Lips (40490-40799) Vermilionectomy (40500) is shaving of __ –Vermilion border: Area between lip and mucosal surface of mouth –Large defects (40510-40527) Repaired with procedures such as transverse wedge excision (40510) _____plasty is lip repair –___ thickness repair (40650-40654) –_______ repair (40700-40761) lip Cheilo Full Cleft lip

4. Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Tongue and Floor of Mouth (41000-41599) Incision and drainage codes based on: –________ (under tongue) –____________ (under mandibular) –________ space (floor of mouth to hyoid bone) Extraoral (outside mouth) I&D of abscess, cyst, hematoma on floor of mouth Sublingual Submandibular Masticator

5. Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Dentoalveolar Structures and Palate/Uvula Dentoalveolar structures (41800-_____) –Bone (osseous) and soft structures of mouth –Anchors teeth Palate/Uvula (42000-_____) –_____ (roof of mouth) –_____ (pendulous structure at back of throat) 42299 Palate Uvula 41899 Alveolar mucosa. (From Liebgott B: The Anatomical Basis of Dentistry, ed 3, St. Louis, 2011, Mosby, Inc.) Figure: 23.6

6. Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Salivary Gland and Ducts (42300-42699) ____ salivary glands –Parotid –Submandibular –Sublingual Codes divided initially by gland Three

7. Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Pharynx, Adenoids, and Tonsils (42700-42999) Incision codes 42700-42725 initially divided on ________ –Intraoral –External Tonsillectomy and adenoidectomy –42820-42836 –Based on gland removed and ___ of patient approach age Figure: 23.9, A & B

8. Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Esophagus (43020-43499) Approaches—Incision, Excision –Cervical –Thoracic –Abdominal –__________ 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 Endoscopy

9. Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Esophagoscopy (43191-43233) Limited to esophagus only Scope may be advanced into stomach but is short of ______ If scope transverses pyloric channel becomes an EGD (43235-43259) If scope passes beyond second portion of _________, report Endoscopy, Small Intestine codes 44360-44379 pylorus duodenum

10. Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Stomach (43500-43999) Gastric bypass performed for morbid obesity –Many different types, such as RNY –May be performed via laparoscope Bariatric surgery (43770-_____) –Gastric restrictive device (such as band) 43775 Figure: 23.12

11. Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Intestines (Except Rectum) (44005-44799) Separate procedures common __________ 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, ___________, and rectum) Colostomies sigmoid colon

12. Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endoscopy, Small Intestine and Stomal (44360-44397) Diagnostic bundled into ______ endoscopic Code to furthest _____ of procedure surgical extent

13. Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endoscopy Terminology Notes define specific terminology Code descriptions are specific regarding: –Technique and depth of scope _____________: Esophagus only __________________: Esophagus to past diaphragm _________________________: Esophagus to beyond pyloric channel Read notes preceding 45300-45392 Esophagoscopy Esophagogastroscopy Esophagogastroduodenoscopy (Cont’d…)

14. Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endoscopy Terminology (…Cont’d) ____________: Entire rectum, sigmoid colon, and may include part of the descending colon (up to 26 inches or 26-60 cm is visualized) _________________: Rectum and sigmoid colon (6.25 cm is visualized) ___________ : Entire colon, rectum to cecum, and may include terminal ileum (more than 60 cm visualized or 53 inches) Sigmoidoscopy Proctosigmoidoscopy Colonoscopy

15. Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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. Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Laparoscopy and Endoscopy Some subheadings have both __________ (from outside) and _________ (from inside) procedures –Example: Subheading Esophagus Endoscopy views inside Laparoscopy inserted through umbilicus, views from outside Laparoscopic bariatric surgery codes (_____-43774) Use of gastric band and/or subcutaneous port components laparoscopy endoscopy 43770

17. Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Hemorrhoidectomy and Fistulectomy Codes (46200-46320) Divided by –Anatomy ____________: no muscle involvement ___________: sphincter muscle –Complex fistulectomy involves excision/incision of multiple fistulas Subcutaneous Submuscular

18. Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Abdomen, Peritoneum, and Omentum Subheading (49000-49999) Laparoscopy –Diagnostic (49320) –_______ (49321-49323) Repair category contains hernia repair codes Surgical

19. Slide 19 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Hernia Codes Divided on 1.Type –Example: inguinal, femoral 2.Initial or __________ repair 3.Age of patient 4.Clinical presentation: –__________: Blood supply cut off –__________: Cannot be returned to cavity (not reducible) Implantation of mesh or prosthesis is reported separately subsequent Strangulated Incarcerated

20. Slide 20 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 23 DIGESTIVE SYSTEM