1. BY ALEX MUNOZ, CPC, NCICS Digestive System

2. 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. 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  Full thickness repair (40650-40654)  Cleft lip  Cleft lip repair (40700-40761)

4. Tongue and Floor of Mouth (41000-41599) Incision and drainage codes based on:  Sublingual  Sublingual (under tongue)  Submandibular  Submandibular (under mandibular)  Masticator  Masticator space (floor of mouth to hyoid bone) Extraoral (outside mouth) I&D of abscess, cyst, hematoma on floor of mouth

5. Dentoalveolar Structures and Palate/Uvula Dentoalveolar structures (41800-41899)  Bone (osseous) and soft structures of mouth  Anchors teeth Palate/Uvula (42000-42299)  _____ (roof of mouth)  _____ (pendulous structure at back of throat)

6. Salivary Gland and Ducts (42300-42699) Three Three salivary glands  Parotid  Submandibular  Sublingual Codes divided initially by gland

7. 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

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. 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. 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)

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. Endoscopy, Small Intestine and Stomal (44360- 44397) Diagnostic bundled into Surgical endoscopic Code to furthest extent of procedure 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

13. Endoscopy Terminology 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)

14. 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

15. Hemorrhoidectomy and Fistulectomy Codes (46221-46320) Divided by  Anatomy  Subcutaneous  Subcutaneous: no muscle involvement  Submuscular  Submuscular: sphincter muscle  Complex fistulectomy involves excision/incision of multiple fistulas

16. Abdomen, Peritoneum, and Omentum Subheading (49000-49999) Laparoscopy  Diagnostic (49320)  Surgical (49321-49323) Repair category contains hernia repair codes

17. 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

18. REFERENCE: BUCK, C. (2010) STEP BY STEP. ELSEVIER. The End