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Chapter 14

Chapter 14. CPT Surgery IV. Mediastinum and Diaphragm Subsection. Mediastinum Space in thoracic cavity between lungs that contains aorta, esophagus, heart, and other structures Diaphragm Thin muscle below heart and lungs that separates chest from abdomen. Digestive System Organs.

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Chapter 14

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  1. Chapter 14 CPT Surgery IV

  2. Mediastinum and Diaphragm Subsection • Mediastinum • Space in thoracic cavity between lungs that contains aorta, esophagus, heart, and other structures • Diaphragm • Thin muscle below heart and lungs that separates chest from abdomen

  3. Digestive System Organs Delmar/Cengage Learning

  4. Digestive Subsections • Excision • Incision • Repair • Excision/destruction • Introduction • Manipulation (continued)

  5. Digestive Subsections • Laparoscopy • Endoscopy • Enterostomy • Liver transplantation • Pancreas transplantation

  6. Large Intestine Delmar/Cengage Learning

  7. Digestive System Subsection • Procedures classified first by anatomic site and then by type • Codes reported for open, endoscopic, and laparoscopic procedures • CPT Medicine section contains codes for digestive system procedures

  8. Gastrostomy Surgical creation of artificial opening into the stomach Delmar/Cengage Learning

  9. Oral Cavity • Lips • Vestibule of mouth • Tongue and floor of mouth • Dentoalveolar structures • Palate and uvula • Salivary glands and ducts (continued)

  10. Oral Cavity Delmar/Cengage Learning

  11. Cleft Palate and Nasal Deformities • Review operative record to identify whether procedure is: • Primary or secondary • One-stage or two-stage • More complicated plastic repair of cleft lip or nasal using cross-lip pedicle flap

  12. Child with Cleft Palate Before and after treatment Delmar/Cengage Learning

  13. Vestibule of Mouth • Incision • Excision/destruction • Repair • Other procedure (unlisted)

  14. Tongue and Floor of Mouth • Incision • Excision • Repair • Other procedure (unlisted) (continued)

  15. Tongue and Floor of Mouth • When reporting codes for excision of tongue lesion, review operative note to identify: • Location of lesion • Type of lesion

  16. Dentoalveolar Structures • 41800-41899 reported for procedures on teeth or gums • Most commonly performed dental procedures found in Current Dental Terminology (CDT) and HCPCS level II

  17. Palate and Uvula • 42000-42299 reported for procedures on hard and soft palates • Palatopharyngoplasty • Treat oropharyngeal obstruction to cure extreme cases of snoring with or without sleep apnea

  18. Pharynx, Adenoids, and Tonsils • Pharynx contains three segments • Nasopharynx • Oropharynx • Hypopharynx

  19. Tonsillectomy and Adenoidectomy • Code determined by: • Type of procedure • e.g., primary, secondary • Age of patient • Separate codes included to report hemorrhage control following tonsillectomy and adenoidectomy procedures (continued)

  20. Tonsillectomy and Adenoidectomy • Procedure: • Cryogenic • Electrocautery • Laser • Add modifier -78 to indicate return to OR for related procedure performed during global period

  21. Esophagus • 43020-43499 reported for procedure on esophagus • When assigning codes, review documentation to identify approach (continued)

  22. Esophagus • Endoscopy • Esophagogastroscopy • Esophagogastroduodenoscopy (EGD) • Endoscopic retrograde cholangiopancreatography (ERCP) • Endoscopic injection • Ligation • Manipulation

  23. Endoscopy • Diagnostic • Performed to visualize abnormality or determine extent of disease • Surgical • Performed when anything in addition to visualization performed (continued)

  24. Endoscopy • When both procedures performed, report code for surgical endoscopy only

  25. EGD Delmar/Cengage Learning

  26. Laparoscopy • Peritoneoscopy • Closed laparoscopy • Open laparoscopy

  27. Stomach • Gastrostomy • Bariatric surgery • Gastric restriction procedures • Laparoscopic techniques • Roux-en-Y gastric bypass and small bowel restriction • Adjustable gastric band (continued)

  28. Stomach • Gastrectomy • Remove all/part of stomach to treat: • Ulcers • Malignancy of the stomach

  29. Gastrostomy Feeding Delmar/Cengage Learning

  30. Intestines • Incision • Excision • Colectomy • Remove all/part of right colon • Remove all/part of left colon • Remove all/part of rectosigmoid colon, rectum, and anus

  31. Enterostomy • -ostomy • Surgically creating opening for discharge of body wastes • Classified according to portion of digestive tract brought to surface • May be permanent or temporary (continued)

  32. Enterostomy • -ostomy • Types: • Colostomy • Ileostomy • Continent ileostomy (Kock pouch) (continued)

  33. Enterostomy • -stoma • Located at end of ureter, small intestine, or large intestine • Can be viewed as protruding through abdominal wall

  34. Coding Tips • Add modifier -52 when patient underwent full preparation and incomplete colonoscopy was performed • When multiple endoscopies performed during same operative session, report code for most extensive procedure

  35. Endoscopy, Small Intestine, and Stoma • Endoscopy • Jejunal feeding • Endoscopy for small intestine pouch • Ileoscopy through stoma • Colonoscopy through stoma • Introduction (continued)

  36. Endoscopy, Small Intestine, and Stoma • Repair codes (44602-44680) are reported for procedures performed to repair small intestine • Other procedures • Implanting mesh or other prosthesis (44700)

  37. Meckel’s Diverticulum and Mesentery • Diverticula • Small pouches (herniations) in colon • Diverticulosis • Presence of diverticula in mucosa and submucosal • Almost always in sigmoid colon (continued)

  38. Meckel’s Diverticulum and Mesentery • Meckel’s Diverticulum • Common congenital abnormality of gastrointestinal (GI) tract that results in pouch in wall of small bowel • Excision • One of the treatments

  39. Coding Tips • Surgical endoscopy always includes diagnostic endoscopy • When multiple services provided during endoscopic procedure, report code for each • Multiple services reimbursed according to multiple endoscopic payment rules

  40. Rectum • Proctosigmoidoscopy • Sigmoidoscopy • Colonoscopy

  41. Removal of Polyps • Hot biopsy forceps • Bipolar cautery • Electrocautery snare • Cold biopsy forceps • Laser technique • e.g., YAG laser

  42. Anus • Hemorrhoidectomy • Identify: • Approach • Location of hemorrhoids • e.g., internal, external • Whether fissurectomy also was performed (continued)

  43. Anus • Fistulectomy • Subcutaneous fistulectomy • Submuscular fistulectomy • Complex fistulectomy • Second stage

  44. Hemorrhoids: Internal and External Delmar/Cengage Learning

  45. Digestive Accessory Organs • Liver • Gallbladder • Bile ducts inside liver • Bile ducts outside liver • Hepatic ducts (continued)

  46. Digestive Accessory Organs • Common bile ducts • Cystic ducts • Pancreas (continued)

  47. Digestive Accessory Organs Liver, gallbladder, and pancreas Delmar/Cengage Learning

  48. Cholecystectomy • Open versus laparoscopically • When attempted laparoscopically and converted to open procedure, report code for open procedure only

  49. Hernia Repair • Determine: • Hernia site • e.g., inguinal, femoral • Patient’s age • Type of hernia • Initial • Recurrent (continued)

  50. Hernia Repair • Determine: • Clinical presentation of hernia • Use of mesh

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