Digestive System CPT copyright 2012 American Medical Association

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Digestive System

Digestive System

CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units,

CPT® copyright 2012 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. 2 Digestive System 2

Objectives • Define and understand the key terms associated with the digestive tract and

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 appropriately CPT® surgery codes from the digestive subsection Digestive System 3

Digestive System 4

Digestive System 4

Digestive System Terms • Gastroenterology • Digestion • Absorption • Mastication Digestive System 5

Digestive System Terms • Gastroenterology • Digestion • Absorption • Mastication Digestive System 5

Digestive System • Lips – Entrance to the oral cavity • Teeth – Begin

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 System 6

Digestive System • Pharynx – Conduit for respiration and digestion – Composed of: •

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 System 7

Digestive System • Stomach: – – Cardia (entrance) Fundus (superior to cardia) Pylorus (antrum)

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

Digestive System • Small Intestine (small bowel) – Duodenum – Jejunum – Ileum •

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 System 9

Digestive System • Spleen – Blood-forming early in life – Acts as a storage

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 System 10

Digestive System • Liver (Hepatic) – Largest organ and largest gland – Vital functions

Digestive System • Liver (Hepatic) – Largest organ and largest gland – Vital functions include: • Storage of glucose as glycogen, fat-soluble vitamins, and vitamin B 12 • 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 System 11

ICD-9 -CM • • • Chapter 1 – Infectious and Parasitic Diseases Chapter 2

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 – Signs, Symptoms, and Ill-Defined Conditions Digestive System 12

Diseases of the Digestive System • Dental Specialists: – – – General dentist Periodontist

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

Diseases of the Digestive System • GERD • Appendix – Appendicitis (540 -543) –

Diseases of the Digestive System • GERD • Appendix – Appendicitis (540 -543) – Peritonitis (540. 0) – Abscess (540. 1) Digestive System 14

Diseases of the Digestive System • Hernia of the abdominal cavity (550 -553) –

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 Digestive System 15

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

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

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

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

CPT® - Digestive System • Organized by anatomic site and procedure • Endoscopy –

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 System 18

CPT® - Digestive System • Lips (40490 -40799) – Vermilionectomy (40500) – Cheiloplasty (40650

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 System 19

CPT® - Tongue and Floor of Mouth • Incision – Intraoral I & D

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 System 20

CPT® - Digestive System • Dentoalveolar Structures (41800 -41899) – Gums (or soft tissue

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 ducts (42300 -42699) – Codes based on gland Digestive System 21

CPT® - Pharynx, Adenoids and Tonsils • Pharynx, Adenoids and Tonsils (42700 -42999) –

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

CPT® - Esophagus (43020 -43499) • Incision – Esophagotomy – based on approach –

CPT® - Esophagus (43020 -43499) • Incision – Esophagotomy – based on approach – Cricopharyngeal myotomy • Excision (43100 -43135) – Lesion excision – based on approach • Endoscopy (43200 -43273) – Include moderate sedation – Watch indented codes…brackets may be useful here – ERCP – Endoscopic Retrograde Cholangiopancreatography Digestive System 23

CPT® - Esophagus • Repair – Codes selected based on approach • Manipulation (43450

CPT® - Esophagus • Repair – Codes selected based on approach • Manipulation (43450 -43460) – Dilation of esophagus – Report S & I in addition – 43460 – inpatient only Digestive System 24

CPT® - Stomach (43500 -43999) • Incision – Foreign body removal – Excision of

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 System 25

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

CPT® - Intestines (44005 -44779) • Incision (44005 -44055) – Biopsy – Exploration • Excision – Enterectomy • Laparoscopy Digestive System 26

CPT® - Intestines (44005 -44779) • Enterostomy (44300 -44346) – 44186 – only procedure

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 • Repair (44602 -44680) Digestive System 27

CPT® - Digestive System • Meckel’s Diverticulum and the Mesentery (4480044899) • Appendix (44900

CPT® - Digestive System • Meckel’s Diverticulum and the Mesentery (4480044899) • Appendix (44900 -44979) Digestive System 28

CPT® - Digestive System • Rectum (45000 -45999) – Incision & drainage of abscesses

CPT® - Digestive System • Rectum (45000 -45999) – Incision & drainage of abscesses – Excision • Proctectomy – partial or complete – Endoscopy • Proctosigmoidoscopy • Sigmoidoscopy • Colonoscopy • Anus (46020 -46999) Digestive System 29

CPT® - Digestive System • Liver (47000 -47399) • Biliary Tract (47400 -47999) •

CPT® - Digestive System • Liver (47000 -47399) • Biliary Tract (47400 -47999) • Pancreas (48000 -48999) Digestive System 30

CPT® - Abdomen, Peritoneum, and Omentum (49000 -49999) • • Exploratory laparotomy (49000) Drainage

CPT® - Abdomen, Peritoneum, and Omentum (49000 -49999) • • Exploratory laparotomy (49000) Drainage of abscess – open or percutaneous Laparoscopy Hernia codes – Type of hernia – Strangulated or incarcerated – Initial or subsequent repair Digestive System 31

CPT ® – Radiology Section • In the ASC, radiology services are only covered

CPT ® – Radiology Section • 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 studies (78201 -78299) Radiology of GI (74240 -74249) Radiology of colon (74261 -74283) Digestive System 32

CPT ® – Medicine Section • • • 91010 -91013 Esophageal motility study 91065

CPT ® – Medicine Section • • • 91010 -91013 Esophageal motility study 91065 Breath hydrogen test 91110 Capsule endoscopy 91120 Rectal sensation test 91122 Anorectal manometry Digestive System 33

HCPCS • Colorectal cancer screening – G 0104 -G 0106 – G 0120 -G

HCPCS • Colorectal cancer screening – G 0104 -G 0106 – G 0120 -G 0122 Digestive System 34

Modifiers • 50 – Bilateral • 52 – Reduced services Digestive System 35

Modifiers • 50 – Bilateral • 52 – Reduced services Digestive System 35

The End Digestive System

The End Digestive System