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Digestive System
BY ALEX MUNOZ, CPC, NCICS
Digestive System
 Divided by anatomic site from
mouth to abdomen, peritoneum,
and omentum + organs that aid
digestive process
 Many bundled procedures
 Surgical procedures for open &
endoscopic:












Mouth & related structures
Pharynx
Adenoids
Tonsils
Esophagus
Stomach
Intestines
Appendix
Rectum and anus
Liver
Biliary tract
Pancreas
Lips (40490-40799)
 Vermilionectomy (40500) is shaving of lip
 Vermilion border: Area between lip and mucosal surface of
mouth
 Large defects (40510-40527)

Repaired with procedures such as transverse wedge excision
(40510)
 Cheiloplasty is lip repair
 Full thickness repair (40650-40654)
 Cleft lip repair (40700-40761)
Tongue and Floor of Mouth
(41000-41599)
 Incision and drainage codes based on:



Sublingual (under tongue)
Submandibular (under mandibular)
Masticator space (floor of mouth to
hyoid bone)
 Extraoral (outside mouth) I&D of abscess, cyst,
hematoma on floor of mouth
Dentoalveolar Structures and Palate/Uvula
 Dentoalveolar structures (41800-41899)
 Bone (osseous) and soft structures
of mouth
 Anchors teeth
 Palate/Uvula
(42000-42299)


_____ (roof of mouth)
_____ (pendulous
structure at back of throat)
Salivary Gland and Ducts
(42300-42699)
 Three salivary glands
 Parotid
 Submandibular
 Sublingual
 Codes divided initially by gland
Pharynx, Adenoids, and Tonsils (42700-42999)
 Incision codes 42700-42725 initially divided on
________


Intraoral
External
 Tonsillectomy and adenoidectomy
 42820-42836
 Based on gland removed and
___ of patient
Esophagus (43020-43499)
Approaches—Incision, Excision





Code esophageal dilation

1.
2.
3.

Cervical
Thoracic
Abdominal
Endoscopy
Know the device or method used
How each device works
Whether dilation was endoscopic or non-endoscopic
Diagnostic endoscopy always included in surgical
endoscopy
Esophagoscopy (43200-43232)
 Limited to esophagus only
 Scope may be advanced into stomach but is short of
pylorus.
 If scope transverses pyloric channel becomes an EGD
(43234-43259)
 If scope passes beyond second portion of duodenum,
report Endoscopy, Small Intestine codes 4436044379
Stomach (43500-43999)
 Gastric bypass performed for morbid obesity
 Many different types, such as RNY
 May be performed via laparoscope
 Bariatric surgery (43770-43775)
 Gastric restrictive device (such as band)
Intestines (Except Rectum)
(44005-44799)
 Separate procedures common
 Colostomies always bundled with major procedure
 Unless code states otherwise
 Small intestine extends for 20 feet from pyloric
sphincter to first part of large intestine
 Large intestine extends from end of ilium to anus, 4
parts (cecum, colon, Sigmoid colon,
and rectum)
Endoscopy, Small Intestine and Stomal (4436044397)
 Diagnostic bundled into Surgical endoscopic
 Code to furthest extent of procedure
 Notes define specific terminology
 Code descriptions are specific regarding:
 Technique and depth of scope
Esophagoscopy: Esophagus only
 Esophagogastroscopy: Esophagus to past diaphragm
 Esophagogastroduodenoscopy: Esophagus to beyond pyloric
channel

 Read notes preceding 45300-45392
Endoscopy Terminology
 Sigmoidoscopy:


Entire rectum, sigmoid colon, and
may include part of the descending colon (up to 26
inches or 26-60 cm is visualized)
Proctosigmoidoscopy: Rectum and sigmoid colon
(6.25 cm is visualized)
Colonoscopy: Entire colon, rectum to cecum, and
may include terminal ileum (more than 60 cm
visualized or 53 inches)
Laparoscopy
and Endoscopy
 Some subheadings have both laparoscopy (from
outside) and endoscopy (from inside) procedures

Example: Subheading Esophagus
Endoscopy views inside
 Laparoscopy inserted through umbilicus,
views from outside

 Laparoscopic bariatric surgery codes
(43770-43774)
 Use of gastric band and/or subcutaneous port
components
Hemorrhoidectomy and Fistulectomy Codes
(46221-46320)
 Divided by
 Anatomy
Subcutaneous: no muscle involvement
 Submuscular: sphincter muscle


Complex fistulectomy involves excision/incision of multiple
fistulas
Abdomen, Peritoneum, and
Omentum Subheading (49000-49999)
 Laparoscopy
 Diagnostic (49320)
 Surgical (49321-49323)
 Repair category contains hernia repair codes
Hernia Codes Divided on
1. Type
 Example: inguinal, femoral
2. Initial or subsequent repair
3. Age of patient
4. Clinical presentation:
 Strangulated: Blood supply cut off
 Incarcerated: Cannot be returned to cavity
(not reducible)

Implantation of mesh or prosthesis is reported separately
The End
REFERENCE:
BUCK, C. (2010) STEP BY STEP. ELSEVIER.