Digestive system CPT coding guidelines by bharath kumar medesun student

1. DIGESTIVE SYSTEM

2. DIGESTIVE SYSTEM

3. INTRODUCTION
 It is also known as alimentary system.
 The human digestive system consists of
the gastrointestinal tract plus the accessory
organs of digestion (the tongue, salivary
glands, pancreas, liver, and gallbladder).

4. DIGESTION
 The chemical breakdown of complex
biological molecules into their components
parts
lipids to fatty acids
proteins to amino acids
carbohydrates to simple sugars

5. FUNCTIONS OF STOMACH
 Produces various chemicals to break down
the food
 Filters out harmful substances
 Get rid of solid wastes

6. MECHANICAL ACTION OF DIGESTION
 Chew
 Tear
 Grind
 Mash
 mix

7. PHASES OF DIGESTION
 Ingestion
 Movement
 Digestion
 Absorption
 Further digestion

8. DIGESTIVE TRACT
 A long muscular tube with many sections and
areas
 Starts with mouth ends with anus
 Parts of digestive tract:
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small intestine
 Lrge intestine
 anus

9. ACCESSORY PARTS
These are not present in digestive tract but
helps in digestion of food
teeth
tongue
salivary glands
liver
gall bladder
pancreas

10. ENZYMES OF STOMACH
 PEPSIN: major enzyme converts protiens
into peptides
 mucus:lubricates food and protects from
strong digestive juices
 It converts blous into liquid form
 Chyme after 4 hrs of mechanical and
chemical digestion
 Chyme passes into small intestine through
sphincter

11. REMOVAL OF WASTE
 Two types of wastes
1. Solid waste-from the digestive system in
the form of feces
2. Metabolic waste:water, carbon di oxide,
urea,salts

12. ORGANS OF EXCRETION
 Skin
 liver
 Lungs
 kidneys

13. SURGERY OF DIGESTIVE SYSTEM
 Lips
 Vestible of mouth
 Tongue and floor mouth
 Dentoalveolar structures
 Palate and uvula
 Salivary glands and duct
 Pharynx,adenoids and tonsils

14.  Esophagus
 Stomach
 Intestines
 meckel’s diverticulam and the mesentry
 Appendix
 Colon and rectum

15.  Anus
 Liver
 Biliary tract
 Pancreas
 Abdomen,peritoneum,and omentum

16. TYPE OF SURGERIES
 General surgeries involved in digestive system
are
 Incision making a cut to drain the fluid
 Excision partial removal of a tissue
 Biopsy pathological examination of a removed
tissue
 Destruction Ablation of a tissue either it may be
benign,premalignant, or malignant tissue by any
method with or without curettement(scrapping).

17.  Repair :- after excision the resultant wound is
closed by repair
 Repair is performed by utilizing sutures,
staples, or tissue adhesives(ex,2-
cyanoacrylate)
 Repair can be done in 3 ways
a)Simple repair
b)Intermediate repair
c)Complex repair

18. LIPS
 Vermilionectomy: surgical procedure used to
remove a growth that can form at the border
where the lips meet the skin,it is also known
as lip shave.
 Cheiloplasty: is the technical term for surgery
of the lip.in this surgery size of the lip is
reduced
 Range of code(40490-40799)

19. VESTIBULE OF MOUTH
 Frenectomy is the removal of a frenulum, a
small fold of tissue that prevents an organ in
the body from moving too far
 Frenotomy incision into the frenulum
 Vestibuloplasty surgical modification of
ginginva
 Range of code(40800-40899)

20. TONGUE AND FLOOR OF MOUTH
 It includes various types of surgery procedures based
upon the type of surgery code range may varies.
 Glossectomy surgical removal of all or a portion of
the tongue
 Tracheostomy
creation of an opening into the TRACHEA through
the neck
 Micrognathia is a condition where abnormal
smallness of the jaws, especially the lower jaw.
 Frenoplasty surgery of frenum
 Range of code(41000-41599)

21. DENTOALVEOLAR STRUCTURES
 Gingivectomy surgery of gingiva
 Operculectomy surgical removal of the oper
culum, a flap of tissue over a partially erupte
d tooth.
 Alveolectomy
surgical excision of part of the alveolar proce
ss.
 Range of code(41800-41899)

22. PALATE AND UVULA
 Major function of this uvula is prevent food from
entering the nasal cavity.
 Uvulectomy excision of the uvula.
 Palatopharyngoplasty
a trimming back of excess palatal and pharynge
al tissue, done in order to widen the airway and
relieve obstructive sleep
apnea or severe snoring.
 Palatoplasty surgical reconstruction of the
palate
 Range of code(42000-42299)

23. SALIVARY GLAND AND DUCT
 Salivary gland(exocrine gland) which produces saliva.
 Sialolithotomy excision of a salivary calculus(stone
formation)
 Marsupialization
conversion of a closed cavity, such as an abscess or
cyst into an open pouch, by incising it and suturing t
he edges of its wall to the edges of the wound.
 Sialography study of salivary gland
 Salivary fistula
any abnormal passage within body tissue, usually be
tween two internal organs.
 range of code(42300-42699)

24. PHARYNX,ADENOIDS AND TONSILS
 Adenoids are located in nasopharynx.
 Never assign modifier 50 for surgical
procedures.
 Tonsillectomy sugery of tonsils
 Adenoidectomy surgery of adenoids.
 Range of code(42700-42999)

25. ESOPHAGUS
 It is also known as food pipe or gullet through
which food is passed
 Esophagotomy creation of an artificial
opening into the esophagus.
 Thoracotomy incision into the pleural space
of the chest
 Range of code(43020-43135)

26. ENDOSCOPY
 It is an instrument used to examine the interior of a
hollow organ or cavity of the body. Unlike most
other medical imaging techniques, endoscopes are
inserted directly into the organ.
 Endoscopy is used to study various organic systems
like
a) Gi tract
b) Respiratory tract
c) Urinory tract
d) Reproductive system
e) Laproscopy

27. ESOPHAGOSCOPY
 Esophagoscopy includes examination from the cricopharyngeus
muscle(upper esophageal sphincter) to and including the
gastroesophageal junction. It may also includes examination of
the proximal region of the stomach via retroflexion when
performed
 Diverticulectomy surgical removal of abnormal pouch of the small
intestine
 Band ligation is used to treat enlarged veins in the esophagus
 Snare technique used for surgical extraction and cauterization
 Esophagus stricture narrowing of esophagus in such conditions
dilation of esophagus is required.
 Range of code(43180-43233)

28. ESOPHAGOGASTRODUODENOSCOPY
 for examination of the cricopharyngeus muscle(upper
esophageal sphincter) to and including the
gastroesophageal junction. It may also includes
examination of the proximal region of the stomach via
retroflexion when performed and finally upto
duodenum.
 gastrointestinal tract down to the duodenum.
 If repeat exam is not planned use modifier-52
 If repeat exam is planned due to incomplete evaluation
use modifier-53
 Range of code(43235-43210)

29. ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY
 ERCP is a procedure that enables
your physician to examine the
pancreatic and bile ducts.
 If ERCP is attempted but with
unsuccessful cannulation use codes
43235-443259,43266,43270
 For percutaneous biliary catheter
procedures see 47490-47544

30.  If more than one stent placed during the
same session reported with 43274 and
modifier 59
 Sphincteroplasty reconstruction of anal
sphincter
 Range of code(43260-43278)

31. LAPAROSCOPIC FUNDOPLASTY
 Nissen fundoplication, or laparoscopic
Nissen fundoplication when performed
via laparoscopic surgery, is a surgical
procedure to treat gastroesophageal reflux
disease(GERD) and hiatal hernia.
 Esophagoplasty repair and reconstruction of
esophagus
 Range of code(43280-43499)

32. STOMACH
 Gastrotomy creation of an artificial opening
into the stomach
 Laprotomy incision into the abdominal wall
 Vagotomy surgical removing part of vagous
nerve
 Range of code(43500-43641)

33. GASTRIC INTUBATION
 is a medical process involving the insertion of a
plastic tube (nasogastric tube or NG tube)
through the nose, past the throat, and down into
the stomach
 Two types of intubation
Orogastric tube(through mouth)
Nasogastric tube(through nose)
 This technique is used to aspire the gastric
contents as well injecting
 Range of code(43753-43761)

34. BARIATRIC SURGERY
 In simple words it is a weight loss surgery.
Weight loss is achieved by reducing the size
of the stomach or removal of a portion of
the stomach or by resecting and re-routing
the small intestine to a small stomach pouch.
 It may involve the stomach
duodenum,jejunam,and the ileum
 Range of code(43770-43846)

35. MECKEL’S DIVERTICULAM
 is a slight bulge in the small
intestine present at birth. It is the most
common malformation of the gastrointestinal
tract.
 Range of code(44800-44899)

36. APPENDIX
 The is a blind-ended tube connected to
the cecum, from which it develops in the
embryo.
 Appendicitis is the common condition of
appendix
 Range of code(44900-44979)

37. COLON AND RECTUM
 Proctosigmoidoscopy is the examination of
rectum and may include portion of the sigmoid
colon
 Sigmoidoscopy examination of the entire
rectum,sigmoid colon and may include a portion
of the descending colon
 Colonoscopy examination of entire colon from
the rectum to the cecum and may include
terminal ileum or small intestine proximal to an
anastomosis

38.  Colonoscopy through stoma examination of
the colon from the colostomy stoma to the
cecum,and may include terminal ileum or
small intestine proximal to an anastomosis.
 physician is performing total colonoscopy if
the physician is unable to perform to cecum
report 45378 with modifier 53.
 Range of code(45300-45999)

39. ANUS
 Fistulotomy surgical removal of anal fistula
 Seton Placement
 A seton (silk string or rubber band) is used to either:
 Create scar tissue around part of the sphincter
muscle before cutting it with a knife
 Allow the seton to slowly cut all the way through the
muscle over the course of several weeks
 The seton may also aid in the drainage of the fistula.
 Hemorrhoidectomy surgical removal of hemorrhoids
 Range(46020-46999)

40. ABDOMEN,PERITONEUM, AND OMENTUM
 Hernioplasty surgical operation for the
correction of hernia
 Herniorrhaphy suture repair of hernia
 Herniotomy surgical incision of hernia
 Omentum is a fold of peritonium connecting
the stomach and the abdominal viscera.
 Range of code(49000-49999)
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