Digestive System
Digestive System
CPT® copyright 2013 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
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 appropriate CPT® surgery codes from the
digestive subsection
3
Digestive System
3/1
8/2
016
Digestive System
Digestive System Terms
• Gastroenterology
• Digestion
• Absorption
• Mastication
Digestive System
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
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
Digestive System
Stomach:
–
–
–
–
Cardia (entrance)
Fundus (superior to cardia)
Pylorus (antrum)
Body
Digestive System
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
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
Digestive System
• Liver (Hepatic)
– Largest organ and largest gland
– Vital functions include:
•
•
•
•
•
•
Storage of glucose as glycogen, fat-soluble vitamins, and vitamin B12
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
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 – Symptoms, Signs and Ill-Defined Conditions
Digestive System
Diseases of the Digestive System
• Dental Specialists:
–
–
–
–
–
General dentist
Periodontist
Endodontist
Orthodontist
Oral Surgeon
Digestive System
Diseases of the Digestive System
• GERD
• Appendix
– Appendicitis (540-543)
– Peritonitis (540.0)
– Abscess (540.1)
Digestive System
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 (565)
Digestive System
Diseases of the Digestive System
• Hepatitis
– Acute
– Chronic
– Classifications
• Cirrhosis
– Hepatitis
– Chronic Alcoholism
Digestive System
Diseases of the Digestive System
• Cholelithiasis
• Cholecystitis
• Neoplasms
Digestive System
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
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
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
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 and Ducts (42300-42699)
– Codes based on gland
Digestive System
CPT® - Pharynx, Adenoids and Tonsils
• Pharynx, Adenoids and Tonsils (42700-42999)
–
–
–
–
–
–
Tonsillectomy
Adenoidectomy
Biopsy
Limited pharyngectomy
Pharyngoplasty
Pharyngostomy
Digestive System
CPT® - Esophagus (43020-43499)
• Incision (43020-43045)
– Esophagotomy – based on approach
– Cricopharyngeal myotomy
• Excision (43100-43135)
– Lesion excision – based on approach
Digestive System
CPT® - Esophagus (43020-43499)
• Endoscopy (43191-43278)
– Esophagoscopy includes examination from cricopharyngeus
muscle to and including the gastroesophageal junction. May include
proximal region of the stomach via retroflexion when performed.
– Surgical endoscopy includes diagnostic endoscopy
– Some codes include moderate sedation
– Watch for type of esophagoscopy:
• rigid transoral
• flexible transnasal
• flexible transoral.
– Watch indented codes…brackets may be useful here
Digestive System
24
CPT® - Esophagus (43020-43499)
• Endoscopy (43191-43278) continued
– Esophagogastroduodenoscopy
• Report modifier 52 when duodenum is deliberately not examined
– Endoscopic Retrograde Cholangiopancreatography (ERCP)
(43260-43278)
•
•
•
•
One or more ducts must be visualized
Report 43235-43259 for unsuccessful cannulation of any ductal system
ERCP with stent placement includes balloon dilation
ERCP with more than one stent placement is reported with modifier 59
Digestive System
25
CPT® - Esophagus
• Laparoscopy (43279-43289)
• Repair (43300-43425)
– Codes selected based on approach
• Manipulation (43450-43460)
– Dilation of esophagus
– Report S & I in addition
– 43460 – inpatient only
Digestive System
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
CPT® - Intestines (44005-44779)
• Incision (44005-44055)
– Biopsy
– Exploration
• Excision
– Enterectomy
• Laparoscopy
Digestive System
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
• Introduction (44500)
• Repair (44602-44680)
Digestive System
CPT® - Digestive System
• Meckel’s Diverticulum and the Mesentery (4480044899)
• Appendix (44900-44979)
Digestive System
CPT® - Digestive System
• Rectum (45000-45999)
– Incision & drainage of abscesses
– Excision
• Proctectomy – partial or complete
– Endoscopy
• Proctosigmoidoscopy
• Sigmoidoscopy
• Colonoscopy
• Anus (46020-46999)
Digestive System
CPT® - Digestive System
• Liver (47000-47399)
• Biliary Tract (47400-47999)
• Pancreas (48000-48999)
Digestive System
CPT® - Abdomen, Peritoneum, and Omentum
(49000-49999)
•
•
•
•
Exploratory laparotomy (49000)
Drainage of abscess – open
Excision, Destruction
Laparoscopy
Digestive System
CPT® - Abdomen, Peritoneum, and Omentum
(49000-49999)
• Introduction, Revision, Removal
– Image-guided fluid collection drainage by catheter
(eg, abscess, hematoma, seroma, lymphocele, cyst;
visceral (eg, kidney, liver, spleen, lung/mediastinum
(49405)
• Peritoneal or retroperitoneal, percutaneous (49406)
• Peritoneal or retroperitoneal , transvaginal or transrectal
(49407)
Digestive System
34
CPT® - Abdomen, Peritoneum, and Omentum
(49000-49999)
• Hernia codes
– Type of hernia
– Strangulated or incarcerated
– Initial or subsequent repair
Digestive System
35
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 Diagnostic Studies (78201-78299)
Radiology of GI Tract (74210-74363)
Digestive System
36
CPT ® – Medicine Section
•
•
•
•
•
91010-91013 Esophageal motility study
91065 Breath hydrogen test
91110 Capsule endoscopy
91120 Rectal sensation test
91122 Anorectal manometry
Digestive System
37
HCPCS
• Colorectal cancer screening
– G0104-G0106
– G0120-G0122
Digestive System
Modifiers
• 50 – Bilateral
• 52 – Reduced services
Digestive System
The End
40
Digestive System
3/1
8/2
016