International Classification of Diseases Tenth Revision Procedure Coding

International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10 -PCS): An Applied Approach 2012 Edition Chapter 12: Gastrointestinal and Hepatobiliary Systems © 2012

Gastrointestinal and Hepatobiliary System • Gastrointestinal system – body system D -Esophagus, stomach, intestines, anus and rectum -Mouth and throat introduced in Chapter 10 • Hepatobiliary system – body system F -Closely connected to the gastrointestinal system © 2012

Functions of the Gastrointestinal System • • • Ingestion of food Mechanical digestion Chemical digestion Mixing and propelling movements Absorption of nutrients and water Elimination of waste products © 2012

Organization of the Gastrointestinal System • Digestive System -See Figure 12. 1 for specific organs -Stomach – see figure 12. 2 -Mesentery and omentum – see figure 12. 3 • Peritoneum – double-layered covering of intraperitoneal organs that forms the mesentery • Hepatobiliary System -Liver, gallbladder, pancreas and ducts -See figure 12. 4 © 2012

Common Root Operations • Tubular body parts -Dilation -Occlusion -Restriction • Transplantation • Bypass – bariatric procedures - Restriction for gastric bands -Excision for sleeve gastrectomy © 2012

Multiple Procedures • See Coding Guideline B 3. 2 c – multiple procedure codes for multiple root operations with distinct objectives • Adjunct information for anastomotic technique for colectomy is not specified -E. g. side-to-end, end-to-end -Specific root operation is assigned -With root operation Bypass for the anastomoses © 2012

Myotomy • Myotomy -Esphagomyotomy – Index directs to Division of esophageal junction -Pyloromyotomy – no index entry • Dilation – to enlarge the diameter of tubular body part • Includes both intraluminal and extraluminal methods • Device placed to maintain new diameter is coded in the device value © 2012

Other Procedures • Volvulus -Reposition of body part involved • Fixation procedures -E. g. Reposition -rectopexy, proctopexy, gastropexy • Enterolysis -Release of body part being freed -See Coding Guideline B 3. 13 © 2012

Body Parts • Upper Intestinal Tract -Above the diaphragm • Lower Intestinal Tract -Below the diaphragm • Esophagus -Upper or cervical -Middle or thoracic -Lower or abdominal • See Table 12. 2 © 2012

Approaches • • • 0 – Open 3 – Percutaneous 4 - Percutaneous endoscopic 7 – Via natural or artificial opening 8 - Via natural or artificial opening endoscopic X - External © 2012

Devices • Intraluminal device, airway -Esophageal or gastric tube or obturator airways -Inserted through the mouth -Inflatable bulb blocks air entry and forces air into the trachea • Artificial anal sphincter -To restore bowel control -See Figure 12. 5 © 2012

Qualifiers • Bypass -See Coding Guideline B 3. 6 a- body part – bypassed from qualifier – bypassed to • • Transfer Transplantation Diagnostic – X No Qualifier - Z © 2012