[ Surgery - Digestive System }

Cod. Ran~ 40,000 S.ri•s - 10 Qµntions

The human dipstive system consists of the pstrointestinal tract plus the accessory orpns of
diaestion (the tonaue, salivary &lands, pancreas, liver, and pllbladder). Diaestion involves the
breakdown of food into smaller and smaller components, until they can be absorbed and
assimilated into the body.
Sul'Jlal procedures performed on the dtpsttv• system
• Ups, Mouth, Palate and uvula
• Salivary 1land and ducts
• Pharynx, adenoids, and tonsils
· Esophaaus
(-,) Stomach
(el lntnttnes
• Appendix
• lwctum,Anus
• Uver, Btltary Tract, PancrNS, Gallbladder
• Abdomen, peritoneum, and omentum
❖ Strodure of CPT rode and d~ptioo

❖ Diffe~nce betwttn Diagnostic \ 'S Surgical procedt1tt

❖ Surgical \ 'S Scopy (e.g. Surgical appendtttomy / apptndectomy by using laperosoopy)

❖ F.sophagosoopy

❖ F.sopbagogastroduodromcopy

❖ KRCP (Endoscopic r~trotrade cholanp)pMcrNtotfaphy)

❖ Transplant (U,-er, Pancreas)

-❖ Hernia repair
Difference between Diagnostic vs Surgical procedure
43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of
specimen(s) by brushina or washina, when performed (separate procedure)

43201 with directed submucosal injection(s), any substance

43202 with biopsy, singte or multiple

43215 with removal of foreian body(s)

Ex. The patient was experiencina difficulty in swallowina and fellina somethina
struck in throat. The physician has the doubt of foreian body in throat. He order
and done the Esophaaoscopy. No foreian body found in esophaaoscopy and fofliQn OC>,ICI ESOC)haOus
everything is normal.

@)
Endolcope
Slomxh
Ans:43200 I

~
Ex. The patient came for foreian body removal from throat. The physician was
removed the coin (Foreian body) by usina Esophaaoscopy.
Duodenum
Ans:43215
❖ Esophagoscopy

Esophagoscopy

Rigid (Trans-oral) Flexible

l
Trans-oral Trans-nasal

43180 Esophagoscopy, rigid, transoral; diagnostic (separate procedure)

43200 Esophagoscopy, flexible, transoral; diagnostic (separate procedure)

Ex. The patient was feelin1 somethln1 struck In throat. The physician was examined
the esopha1us by usin1 flexible esophqoscopy throuah transoral. Two Custard apple
seeds was found in esopha1us.
Ans:43200
❖ Esophagogastroduodenoscopy

Esophagogastroduodenoscopy

Repeat exam Repeat exam not

planned planned
(Use 53 modifier) (Use 52 modifier)

43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic (separate procedure)

43239 With biopsy, single or multiple

43247 With removal of foreign body(s)

Ex. The patient was feelina abdominal pain. The physician was examined esophaps,
stomach, but unable to see the duodenum due to stomach ulcer. The procedure was
stopped at stomach. How you report this services?
Ans: 43235 - 52
••
Normal Ulcer
 ❖ ERCP (Endoscopic retrograde cholangiopancreatography)

[ ERCP ]
J i
Balloon Dilation Stent

43260 ERCP; diagnostic (separate procedure)

43274 with placement of endoscopic stent into biliary or pancreatic duct, each stent

43277 with trans -endoscopic balloon dilation of biliary or pancreatic duct, each duct

Ex-1. The patient was present for stent placement at riaht and left hepatic duct. The
physician was placed the stent successfully. How you report this services?

Ans: 43274, 43274 - 59

 ❖ ERCP (Endoscopic retrograde cholangiopancreatography)

43260 ERCP; diagnostic (separate procedure)

43274 with placement of endoscopic stent into biliary or pancreatic duct, each stent

43277 with trans -endoscopic balloon dilation of biliary or pancreatic duct, each duct

Ex-2. The patient was present for balloon dilation and stent placement at ri1ht
hepatic duct. The physician was done balloon dilation and placed the stent
successfully. How you report this services?
Ans:43274

Ex-3. The patient was present for balloon dilation at pancreatic duct and stent
placement at ri1ht hepatic duct. The physician was done balloon dilation and placed
the stent successfully. How you report this services?

Ans:43274,43277
 Coch Rangn 40,000 S.rl•s - 10 Qjlntlons

❖ Transplant Transplant
(e.g. Liver, Pancreas )

Donor Backbench work Recipient

(Hepatectomy) (Surgial ~~tion) (Allo-transpw,ution)

Cadaver Living

Liver
r
~ 713~ [ 47140 - 47142 L
47143 - 47147 1 ◄7135 1

Pancreas

1 ◄8550 1 48551 - 48552 1 4855◄ ,

 CocJ. Rangfl 40,000 S.rln - 10 Qµntlons

❖ Transplant Transplant
(e.g. Liver, Pancreas)

Donor Backbench work Recipient

(~tectomy) (Suraial ~~tion) (Allo·tn~tation)

l
Cadaver Living

Liver

1 ◄1133 1 r 47140 - 47142 47143 - 47147 147135 1

Ex. The patient is here for liver transplant due to liver failure. The suraeon was prepared the patient for liver transplantation
where the patient liver was removed completely, followed by the cadaver liver was transplanted to the patient successfully.
How you report this services?

Ans:47133,47143,47135
❖ Surgical vs Scopy
<•·•· 5urwtcal ~ o m y I ~ o m y by ustna laparoscopy) Surgical
44950 Appendectomy;

+ 44955 when done for indicated purpose at time of other major procedure

(not as separate procedure) (List separately in addition to code for

~ ~4,.
---
-- -~~
primary procedure) /
44970 l..1paroscopy, surgical, appendectomy
I
44979 Unlisted laparoscopy procedure, appendix

Ex. The patient has Appendicitis. The surseon removed the appendix
(Appendectomy) by usin1 laparoscopy.
Ans: 44970
 ❖ Hernia repair

Hernia repair

Reducible Iincarcerated / Strangulated I

Coding Tips:
❖ Check whether it ts open or ~paroscoptc
❖ Types of hem~ (lncisioNl, Umbilial, Epig1stric hemi1)
❖ lc:t.ntify whether it is reducible or lnar~ted / S ~ t e d
❖ Check whether mesh/other prosthesis is included or not

49580 Repair of umbilical hernia, (< 5 years of age); Reducible

49582 Incarcerated or Str,mgulated

495 70 Repair of epigastric hernia; Reducible

495 72 Incarcerated or Strangulated
Endoscopy
Deflnltionl

Practattsa1wMwopy ts the examination of the rectum and may Include examination of a

portion of the slsmold colon..
SW;1wldoleopy ls the examination of the entire rectum. slsmold colon and may indude
~ination of• portion of the de~ndi"I colon.
Colonolcopy Is the eamlnatJon of the ~tire colon. from the rectum to the cecum, and may
tndude eumlnation of the terminal i~um or srMII intMtine Pf•oximal to an ..,,,tomosis..
Colo.-..copv throush IIOff'8 Is the examination of ttw colon_ from the colostomy stoma to the
CKUm CK coion--small inte-sti~ anastomosJs.. and may include f!Dmination of the terminal
Ileum or sman Intestine prodmat to an 1nastomosb.

rw,po,t i~opy through stoma t44380, 44381, 44382. 44384) fo, f'ndoscopic examination of 1
pet~t who h1s an lleostomy. ~ Chipter 8 for the detalls.

4S300 Proctoslpnoidoscopy, rigid; dla~tk. with or without cofl@ctlon of speclmNt(s) bv

°'
brushJnc washlna heparate procedure)

4S303 Proctoslpnoidoscopy, rigJd; with dilation (f'I, balloon, guide- wire. bout~)
 CPT CODING GUIDELINES
i .

• Control of bleeding is not separately billable: it's included in biopsy and most
other endoscopic procedures except when the patient presented with a GI
bleed and the physician performs the procedure to control bleeding.
• Polyps of various sizes can be removed using different techniques and also by
different method of removal (ex. Hot bx, cold bx, cold forceps, snare etc.)
a) Multiple polyps removed by the same technique, code only once.
b) 2 separate polyps: if one polyp is removed using cold forceps biopsy and a
separate polyp is removed by code snare technique, then you code both
with modifier 59 attached to the biopsy code.
c) 1 polyps removed by both cold biopsy and snare technique, code it as
snare polypectomy.
 UPPER GI
r
• 43209 Esophagoscopy, rigid or flexible, diagnosis
• 43235 EGO, diagnostic

LOWER GI
- - - -

• 45300 Proctosigmoidoscopy, rigid, diagnostic

• 45330 Sigmoidoscopy, flexible, diagnostic
• 45355 Colonoscopy, rigid or flexible, transabdominal via colostomy
• 45378 Colonoscopy, flexible, diagnostic.
• Indication for procedure: Hema positive stool on fecal occult blood test ]
• The CFQ-160L Video colonoscopy wa ~ inserted into the rectum]and under
direct vision was carefully and[advanced to the cecunj. There was an excellent
prep. The cecum was identify by transillumination of light in the right lower
abdomen and the ileo-cecal folds. The mucosa was normal except for[internal )
[hemorrhoids and scattered [left side diverticulosis.]Patient tolerated procedure
without difficulty. How would you code this procedure?

CPT 45378: Colonoscopy, flexible, diagnostic, with or w/o collection of specimen

R19.S Other fecal abnormalities
K64.8 Internal hemorrhoids, unspecified
K57.30 (.)iverticulosis of large intestine
 • Preoperative diagnosis:[Screenlng colonoscopyl
• Postoperative diagnosis:-[S_m_m
_ s-es_s_,,il_
e_p_o_lys
_ ln_t_,.h_e_r_e_
ct_o_si_l _m_o_id- iu_n_cti
__o_n_)
[4mm sessile polyp In the distal sigmoid]
Description of procedure: Under conscious sedation, the Olympus coloscopy was
I advance Into the----rectilmJ No ulcer or masses were seen. The rectosigmoid junction
we saw 5mm sessile polyps and tHis was biopsied, At
12cm from the anus was saw
a 4mm sessile polyp, this(was biopsied and Mte advanced the colonoscope into the
ascending colon up to the cecum and the mucosa looked normal and no ulcers or
masses were seen. The patient tolerated the procedure well. How would you code
this procedure?
CPT 45380 Colonoscopy, flexible, with biopsy, single or multiple
212.11 Encounter for screening for malignant neoplasm of colon
K63.S Polys of colon
• Indication : [Dysphagia, Gastro-esophageal reflux disease]
Description of procedure: After obtaining informed consent, the endoscope was
passed under direct vision. This was introduced[through the mouth,] and advanced
to the second part o~duodenum.]The upper GI endoscopy was accomplished
without difficulty. The patient tolerate the procedure well.

1
Findings: A few semi sessile polyps }Nith no bleedings and no stigmata of recent
bleeding were found in t he gastric body; not manipulated.
The duodenal bulb, second portion of the duodenum and major papilla were
normal. How would you code this procedure?
CPT 43235 Diagnostic EGO
R13.1O Oysphagia, unspecified
K21.9 GERO, unspecified
K3 +.7 Polyp of stomach