Medical Billing and Coding
Digestive System
Chapter 18
http://kidshealth.org/kid/cancer_center/HTBW/digestive_system.html
If you go to this website and roll over the labels, it tells you what each part of your digestive system
does.
Digestive System 40490 – 49999
Format: Divided according to anatomic site and procedure
Endoscopy coding – Choose the farthest extent to which the scope was passed and
then the procedure performed.
Lips 40490 – 40799 – pg 527 SBS TB
 Excision 40490 - 40530
 Terminology
 Vermilion Zone – Red part of the lips
o
The upper and lower lips include the vermillion border. This is the juncture between the lighter skin
and the redder tissue (vermillion) that we commonly call the lip. This tissue is red because the skin
is thin and there are many small blood vessels (capillaries) underneath it. The vermillion is different
than oral mucosa because it maintains an outer layer of cells (stratum corneum) and it does not
contain any salivary glands.

Vermilionectomy – shaving of the lip - 40500
 Transverse Wedge Resection – wedge of lip tissue is removed and tissue
flaps are used to repair the defect – 40510
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
Ex. Abbe-Estlander aka Abbe’ flap or cross flap – 40527
Medical Billing and Coding
Digestive System
Chapter 18
 Repair 40650 – 40761 (pg 529 SBS TB)
o Terminology
 Cheiloplasty – lip repair
 Watch for modifier -50
o Terminology

Cleft lip – a congenital defect in which the muscle and tissue of the lip did not close properly,
The word cleft means a gap or split between two things. A cleft lip is a split in the upper lip.
This can happen on one or two sides of the lip, creating a wider opening into the nose. A
cleft palate is a split in the roof of the mouth. This leaves a hole between the nose and the
mouth
http://kidshealth.org/kid/health_problems/birth_defect/cleft_lip_palate.html#

Rhinoplasty – plastic repair of the nose
Vestibule of Mouth – 40480 – 40899
Note: Watch for types of repairs, location, and sizes
 Incision 40800 - 40806
 Excision, Destruction 40808 - 40820
 Repair 40830 – 40845
Tongue and Floor of Mouth 41000 – 41599
Note: to code for a laceration repair of floor of mouth – Look under: Tongue, Repair,
Laceration – 41250 - 412525
 Incision 41000 – 41019
Terminology
o Based on the location
 Sublingual – under the tongue
 Submandibular – under the mandible
 Masticator space – within the space from the floor of the mouth to the hyoid bone
 Lingual frenum – flap of skin under the tongue
 Sublingual, submental – under the chin
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Limbal Tongue Tie Surgery - CPT 41115
Diagnosis: Limbal tongue tie Consent: This is an approximately 13-month-old female who has a lingula tongue tie that has affected
not only some swallowing, but potentially speech.
Operative Details: Patient brought to the operative suite, place supine on the operating table where
general anesthesia by mask was induced. As this point, approximately 1 mL of 1% Xylocaine with
1:1000,000 was injected unto the lingual frenulum, and while anesthetic and hemostatic effect took
place, the patient was draped in the usual fashion.
The patient underwent lingual frenuloplasty with a Z-plasty incision, excision of the lingual frenulum
and suture of the limbs of approximately 1 cm with 4-0 chromic. With hemostatis intact, the patient
was then fully awakened and taken to the recovery room in stable condition.
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Medical Billing and Coding
Digestive System
Chapter 18
ORAL CAVITY
Tongue, Floor of Mouth, Alveolar Ridge, Buccal Mucosa, & Palate
The oral cavity includes all the areas of the mouth in
front what would be considered the throat
(oropharynx), and is divided into multiple
components based on the anatomical area. They
include the tongue, floor of mouth, alveolar ridge,
buccal mucosa, and palate. These divisions have
important ramifications based on the important
structures that are within and adjacent to each area.
(Fig. 1a Oral Cavity Parts)
Tongue: There are two regions that comprise the
tongue: the oral part, found in the mouth (the front
2/3), and the base of the tongue, found in the throat
(the back 1/3). The tongue is made up mostly out of
muscle covered by mucosa that has taste buds
within it. The majority of oral cavity cancers occur
on the tongue, and they mostly arise from the
mucosal covering and not the muscle.
Floor of the mouth: This is the area at the bottom of the oral cavity, under the tongue, behind the gum line &
teeth. There are numerous saliva glands and their ducts that bring the saliva into the mouth in the floor of
the mouth. 30% of all oral cancers occur in this region.
Alveolar Ridge: This is includes the gums in front and behind the teeth. The mucosa or gums covering this
area lay immediately on the bone of the upper and lower jaw; as such cancers in this area immediately
grow into the bone. This is considered one of the more rare types of oral cancer.
Buccal Mucosa: This refers to the area of the mouth on the inside surface of the cheek. There isn’t a lot of
substance to this tissue and tumors can readily grow into the overlying skin. The duct of one of the saliva
gland, the Parotid, is in this area.
Palate: There are two parts of the palate: the hard palate (the bony part on the roof of the mouth), and the
soft palate (further back, at the top of the throat). The soft palate is considered to be in the region of the
oropharynx, while the hard palate is considered to be part of the oral cavity. The tumors of the hard palate
can easily grow into the nose
http://www.advancedonc.com/oral-cavity.htm
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Medical Billing and Coding
Digestive System
Chapter 18
Tongue and Floor of Mouth 41000 – 41599, pg 530-531 SBS TB
Note: to code for a laceration repair of floor of mouth – Look under: Tongue, Repair, Laceration –
41250 – 412525, pg. 530-531 SBS TB
Terminology
 Sublingual – under the tongue
 Submandibular – under the mandible
o Mandible - the largest and strongest bone of the face. It forms the lower jaw and holds
the lower teeth in place.
 Lingual Frenum – flap of skin under the tongue
 Ankyloglossia – tongue tied
 Excision 41100 – 41155
o Oral biopsies, excision of oral lesions, and removal of part or all of the tongue
(glossectomy) 41100 - 41108
 Repair 41250 – 41252
o Based on size of repair
Dentoalveolar Structures – pg 531 SBS TB
 Bones and soft tissues of the mouth that anchor the teeth 41800 – 41899
 Incision – 41800 – 41806
 Excision – 41820 – 41850
 Other Procedures – 41870 - 41874
Palate and Uvula 42000 - 42299
Terminology
o Uvula – loose flap of skin you see dangling at the back of your throat
o Palate – roof of your mouth
o Incision 42000
o Excision, Destruction 42100 - 42160
o Other Procedures 42299
Ex. Bill has tried everything to stop snoring. Finally he went to the doctor, scheduled surgery and
had an uvulectomy. 42140
Salivary Gland and Ducts 42300 - 42699
 Incision 42300 – 4234
 Excision 42400 - 42450
 Repair – 42500 - 42510
 Other Procedures - 42550 - 42699
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Medical Billing and Coding
Digestive System
Chapter 18
Pharynx, Adenoids, and Tonsils
Terminology
o Branchial Cleft Cyst – congenital defect that appears as a fill and is located on the neck
 Incision 42700 – 72725
o Reported according to location and approach
 Excision, Destruction 42800 – 42894
o Tonsillectomy and adenoidectomy – 42820 – 42836
 Watch verbage. Either a tonsillectomy can be done, an adenoidectomy or both
 Repair 42900 – 42953
Bilateral tonsillectomy CPT 42826-50
Diagnosis: Asymmetric tonsils, Tonsilloliths, recurrent tonsillitis – 474.00
Findings: Asymmetric tonsils, right greater than left. Cryptic tonsils bilaterally. Arterial bleeding
from right tonsillar fossa, controlled with suction cautery and Bovie.
Indications for the Procedure: The patient is a young woman who is seen in clinic regarding her
asymmetric tonsils. She noted that she also experiences tonsilloliths as well as recurrent sore
throats. Given this picture, the patient was counseled about the benefits, risks, and alternatives of a
tonsillectomy. The patient consented.
Procedure: The patient was met in the preoperative staging area and last-minute questions were
answered. Consent, surgical indications, and patient identification were all confirmed. The patient
was transported to the operating room by the anesthesia care team. There the patient underwent
general endotracheal anesthesia. A time-out was conducted, appropriately identifying the patient and
surgical indications.
The procedure was started with head draping. The body was draped as well. A mouth gag was
placed in the patient’s mouth with care. Of note, the patient does have difficulty with
temporomandibular joint subluxation. Care was taken to gently retract her jaw open. This revealed
her asymmetric tonsils. The right tonsil was addressed first. A tonsil tenaculum was used to
medialize the tonsil. Bovie electrocautery was used to incise the mucosa and establish the
peritonsillar plane. The tonsil was resected with care taken to preserve the posterior tonsillar pillar.
Between the right and left tonsils, the tongue was let down for reperfusion.The left tonsil was then
addressed in a similar fashion. Care was taken to preserve the posterior tonsillar pillar on this side as
well. Some Marcaine-soaked tonsil sponges were placed to topically anesthetize the tonsillar fossae.
After this, the tonsillar fossae were examined for any bleeding. The right tonsillar fossa in the
midportion revealed an artery that started bleeding at this point. This artery was grabbed with a
forceps and Bovie electrocautery was used to stop the bleeding. Further irrigation of this region
revealed no further bleeding. Hemostatis was achieved. The patient’s stomach was suctioned of any
secretions. The patient was awakened and extubated. She was transported to the PACU in stable
condition.
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Medical Billing and Coding
Digestive System
Chapter 18
o Pharyngoplasty – surgical repair of the pharynx and includes use of flaps fashion from
the skin, tongue, and/or tissue located near the area of the defect. 42950
 Other Procedures 42955 – 42999
o Pharyngostomy – procedure to create an opening for the insertion of a long-term
feeding tube. 42955
Esophagus 43020 - 43499
 Incision 43020 – 43045
o Watch for the type of approach
 Excision 43100 – 43135
o Watch for the type of approach
 Endoscopy 43200 – 43273
o This section is used for diagnosis and treatment
 ERCP (Endoscopic Retrograde Cholangiopancreatography) – endoscopic
procedure of the pancreatic ducts, hepatic ducts, common bile ducts, duodenal
papilla, and/or gallbladder. Codes used are 43260 – 43275
Procedure: Direct Laryngoscopy and Esophagoscopy – 31530, 43200
Diagnosis: Possible Airway Foreign Body – 933.0
Indications for Procedure: The patient is a 12-month old male who came into the emergency room
after the parents were concerned that the baby may have ingested some foreign body. The child was
quite fussy and sounded to have slightly more wheezing on the right side of his lungs, but it is
unknown whether or not the child had ingested anything as the parents were not present when this
happened. The patient was coughing up some bloody secretions. The patient was brought to the
emergency room and airway was stable. There was no evidence of any stridor or desaturations;
however, the patient was coughing and the parents felt that the child was drooling. For these
reasons, we brought the patient to the procedure bed, started to turn and assess the patient.
Description of Procedure: The patient was brought to the operating room, placed on the operating
table in the supine position. The patient was given mask anesthesia and IV was performed. General
anesthesia was administered via a 4.5 endotracheal tube. As the tube was being placed, anesthesia
noted a foreign body object, a plastic toy was removed with a Magill forceps. This was removed and
sent outside on the back table. We then proceeded with performing a direct laryngoscopy with a
Parsons largoscope as well as a rigid esophagoscopy scope exam. There was no other foreign body
noted. There were some mild blood secretions noted in the esophagus. Otherwise, the rest of the
exam was normal. The patient was then returned to anesthesia and extubated without difficulty. The
patient tolerated the procedure well and there were no apparent complications.
Operative Findings: Yellow plastic toy noted in the back of the oropharynx that anesthesia removed
with a Magill forceps. No other foreign bodies were noted.
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Medical Billing and Coding
Digestive System
Chapter 18




Laparoscopy 43279 – 43289
Repair 43300 – 43425
Manipulation 43450 - 43460
Other Procedures 43496 - 43499
Stomach 43500 – 43999
Note: Identify the method before assigning a code
 Incision 43500 – 43520
 Excision 43600 – 43641
o Roux-en-y (RNY) – Y-shaped connection in which the intestine is detached from its
original origin and reattached so as to bypass a part of the stomach and all of the
duodenum – 46321, 43644
 Laparoscopy 43644 – 43659
 Introduction 43752 – 43761
 Bariatric Surgery 43770 – 43775
o Laparoscopy 43770 – 43775
 Other Procedures 43800 – 43999
Intestines (Except Rectum) 44005 – 44799
22 Feet Isn't Small at All
The small intestine (say: in-tes-tin) is a long tube that's about 1½ inches to 2 inches (about 3.5 to 5
centimeters) around, and it's packed inside you beneath your stomach. If you stretched out an adult's
small intestine, it would be about 22 feet long (6.7 meters) — that's like 22 notebooks lined up end to
end, all in a row
That's One Large Intestine
At 3 or 4 inches around (about 7 to 10 centimeters), the large intestine is fatter than the small intestine and it's
almost the last stop on the digestive tract. Like the small intestine, it is packed into the body, and would
measure 5 feet (about 1.5 meters) long if you spread it out.
 Incision 44005 – 44055
 Excision 44100 – 44160
o See page 24 of CPT Book for Intestinal allotransplanation
 Laparoscopy 44180 – 44238
o Incision 44180
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 Enterostomy – External Fisulization of Intestines 44186 – 44188
o Excision 44202 – 44213
 3 types of anastomoses
 End to End
 End to side
 Side to side
o Repair 44227
o Other Procedures 44238
Medical Billing and Coding
Digestive System
Chapter 18
Op Report
Diagnosis: Leaking from intestinal anastomosis
Procedure: Proximal ileostomy for diversion of colon. Oversew of right colonic fistula
Op Note: This patient was taken back to the operating room from the ICU. She was having acute
signs of leakage from an anastomosis I performed 3 days previously. We took down some of the
sutures holding the wound together. We basically exposed all of this patient’s intestine. It was
evident that she was leaking from the small bowel as well as from the right colon. This was done in 2
layers, and then we freed up enough bowel to try to make an ileostomy proximal to the area of
leakage. We were able to do this with great difficulty, and there was only a small amount of bowel to
be brought out. We brought this out as an ileostomy stoma, realizing that it was of questionable
viability and that it should be watched closely. With that accomplishment, we then packed the wound
and returned the patient to the ICU.
A. 44310, 998.31
B. 44310-78, 997.4, E878.2 (Surgical operation with anastomosis, bypass or graft w/ natural or
artificial tissues used as implant) – pg 736 ICD-9
C. 45135, 996.5, E878.2
D. 45136-78, 998.32, E879.1 (kidney dialysis)
Meckel’s Diverticulum and the Mesentery 44800 – 44899
Terminology
o Meckel’s Diverticulum – congenital anomaly
 Excision 44800 - 44820
 Suture 44850
 Other Procedures 44899
Appendix 44900 – 44979
Note: Watch for the approach
 Incision 44900 – 44901
 Excision 44950 – 44960
 Laparoscopy 44970 – 44979
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Medical Billing and Coding
Digestive System
Chapter 18
Rectum 45000 – 45999
 Incision 45000 – 45020
 Excision 45100 – 45172
 Destruction 45190
 Endoscopy 45300 – 45392
o Protosignoidoscopy – exam of the rectum and the sigmoid colon
o Sigmoidoscopy – examination of the sigmoid colon and may include the descending
colon
o Colonoscopy – examination of the colon
 Laparoscopy 45395 – 45499
o Excision 45395 – 45397
o Repair 45400 – 45499
 Repair 45500 – 45825
 Manipulation 45900 – 45915
 Other Procedures 45990 – 45999
Anus 46020 – 46999
Terminology
o Seton – treatment for anal fistula
o Hemorrhoids – arises from an inflammation of the venous plexuses around the anus
and may be inside or outside of the anal canal
 Watch for the types of degrees
 Incision 46020 – 46083
 Excision 46200 – 46288
 Introduction 46500 – 46505
 Endoscopy 46600 – 44615
 Repair 46700 – 46947
 Destruction 46900 – 46942
 Other Procedures 46999
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Medical Billing and Coding
Digestive System
Chapter 18
Liver 47000 – 47399
 Incision 47000 – 47015
 Excision 47100 – 47130
 Liver Transplantation 47133 – 47147
 Repair 47300 – 47362
 Laparoscopy 47370 – 47379
 Other Procedures 47380 – 47399
Biliary Tract 47400 – 47999
Terminology
o Choledochotomy – incision into the bilary tract
o Cholecystostomy – formation of a stoma between the abdominal wall and the
gallbladder
 Incision 47400 – 47490
 Introduction 47500 – 47530
 Endoscopy 47550 – 47556
 Laparoscopy 47560 – 47579
 Excision 47600 – 47715
 Repair 47720 – 47900
 Other Procedures 47999
Pancreas 48000 – 48999
Note: The Pancreas is located behind (posterior to) the stomach and produces
enzymes and hormones. Controls your sugar levels. If diabetics have this removed,
they will no longer have diabetes.
 Incision 48000 – 48999
 Excision 48100 – 48160
 Introduction 48400
 Repair 48500 – 48548
 Pancreas Transplantation 48550 – 48556
 Other Procedures 48999
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Medical Billing and Coding
Digestive System
Chapter 18
Abdomen, Peritoneum, and Omentum 49000 – 49999
 Incision 49000 – 49081
 Excision, Destruction 49180 – 49255
 Laparoscopy 49320 – 49329
 Introduction, Revision, Removal 49400 – 49465
o Initial Placement 49440 – 49442
o Conversion 49446
o Replacement 49450 – 49452
o Mechanical Removal of Obstructive Material 49460
o Other 49465
 Repair 49491 – 49659
o Hernioplasty, Herniorrhaphy, Heriotomy 49491 – 49659
 Strangulated Hernia – blood supply is cut off
 Incarcerated Hernia – cannot be returned to the abdominal cavity
 Laparoscopy 49650 – 49659
http://www.bing.com/videos/watch/video/inguinal-hernia-surgeryrepair/f7c31a3e7b2fe41e1218f7c31a3e7b2fe41e1218-56008245912
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