CPC 2025 Test Chapter 9

Digestive System

Introduction

  • The digestive system consists of:
    • Alimentary or digestive tract.
    • Accessory organs.
  • Major function: To digest or break down foods.
  • Chapter objectives:
    • Define key terms.
    • Understand anatomy related to digestive system procedures.
    • Explain CPT® Surgery/Digestive System subsections.
    • Assign CPT® surgery codes from the Digestive System subsection.

Anatomy and Medical Terminology

  • Oral Cavity.
  • Salivary Glands.
  • Teeth.
  • Tongue.
  • Pharynx.
  • Esophagus.
  • Stomach.
  • Liver.
  • Gallbladder.
  • Pancreas.
  • Duodenum.
  • Jejunum.
  • Ileum.
  • Cecum.
  • Appendix.
  • Ascending colon.
  • Transverse colon.
  • Descending colon.
  • Sigmoid colon.
  • Rectum.
  • Anus.
  • Trachea.

Lips/Mouth

  • Lips form the entrance to the digestive tract.
  • Oral cavity includes:
    • Mouth.
    • Soft and hard palates.
    • Teeth.
    • Gums.
    • Tongue.
    • Salivary glands.
  • Teeth and tongue break food into small particles.
  • Salivary glands secrete saliva and enzymes to aid in digestion.
  • Tongue mixes saliva with food and keeps food pressed between teeth for chewing, then pushes it backward for swallowing.
  • Three categories of teeth:
    • Incisors:
      • Front of the mouth.
      • Shaped like chisels.
      • Useful for biting off large pieces of food.
      • Eight incisors (four on top and four on bottom).
    • Cuspids:
      • Pointy teeth immediately behind the incisors.
      • Also called canines.
      • Used for grasping or tearing food.
      • Four cuspids (two on top and two on bottom).
    • Molars:
      • Flat teeth used for grinding food.
      • Furthest back in the mouth.
      • Number varies among people.

Pharynx

  • Five-inch tube located immediately behind the mouth.
  • Aids in closure of the nasopharynx and larynx when swallowing.
  • Keeps food out of the respiratory tract and in the digestive tract.

Esophagus

  • Tube about 10 inches long.
  • Arises from the pharynx, passes through the diaphragm, and continues into the stomach.
  • Moves food into the stomach by peristalsis.

Stomach

  • Four parts: cardia, fundus, body, and antrum (pylorus).
  • Further digests food received from the esophagus.
  • Passes partially digested food, known as chyme, into the duodenum.

Small Intestine

  • Occupies the central and lower abdomen.
  • Duodenum:
    • First portion of the small intestine.
    • Connected to the stomach.
    • About 10 inches long.
    • Small ducts from the liver (hepatic ducts) and gallbladder (cystic duct) merge to form the bile duct.
    • The bile duct and the pancreatic duct together open into the duodenum via the hepatopancreatic ampulla (ampulla of Vater).
  • Jejunum:
    • Middle third of the small intestine.
    • About 7 ½ feet long.
    • Vigorous, peristaltic waves move fluid contents to the ileum.
  • Ileum:
    • Approximately 12 feet in length.
    • Last and longest section of the small intestine.
    • Most food absorption takes place in the ileum.
    • Connects to the large intestine.

Large Intestine

  • About five feet long.
  • Divided into the cecum, appendix, ascending colon, hepatic (right colic) flexure, transverse colon, splenic (left colic) flexure, descending colon, sigmoid colon, rectum, and anus.
  • Most of the colon is retroperitoneal, except the transverse colon and sigmoid colon, which are intraperitoneal.
  • Water is reabsorbed as food material travels through the large intestine and eventually is eliminated from the body.

Pancreas

  • Soft, oblong gland located beneath the great curvature of the stomach.
  • Consists of five parts: the head, neck, body, tail, and uncinate process.
  • Empties digestive fluid (mixture of enzymes) into the duodenum and insulin into the bloodstream.
  • Insulin is a hormone produced in the pancreas by the islands of Langerhans.
  • Lack of insulin not produced by the body is usually the key cause for Type I diabetes mellitus.
  • Many studies indicate that obesity is the key cause for Type II diabetes mellitus.

Liver

  • Lies in the upper abdomen on the right side under the diaphragm and above the duodenum.
  • The human liver has four lobes: the right lobe and left lobe, which may be seen in an anterior view, plus the quadrate lobe and caudate lobe on the visceral surface.
  • The liver converts ammonia into urea, which is then excreted by the kidney or the sweat glands.
  • The liver also converts excess glucose into glycogen or fat.
  • The liver produces bile salts.
  • When bile is secreted into the duodenum, fat is emulsified and absorbed by the intestines.
  • The liver is the only organ in the human body that can regenerate itself.

Gallbladder/Biliary System

  • The gallbladder is a sac-like structure that serves as a reservoir for bile.
  • Bile is produced by the liver and aids in the digestive process.
  • It periodically empties into the duodenum by way of the cystic ducts.

ICD-10-CM Coding Diagnostic

  • Diagnoses for diseases of the digestive system are found throughout ICD-10-CM:
    • Chapter 11, Diseases of the Digestive System (K00-K95).
    • Chapter 1, Certain Infectious and Parasitic Diseases (A00-B99).
    • Chapter 2, Neoplasms (C00-D49).
    • Chapter 17, Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00-Q99).
    • Chapter 18, Symptoms, Signs and Abnormal Clinical and Laboratory Findings (R00-R99).
    • Chapter 21, Factors Influencing Health Status and Contact with Health Services (Z00-Z99) section.

Esophageal and Swallowing Disorders

  • Barrett's Esophagus: Abnormal growth of stomach or intestinal cells at the distal end of the esophagus, which may develop because of chronic gastroesophageal reflux disease.
  • Esophagitis: An inflammation of the lining of the esophagus; can be caused by an infection or irritation in the esophagus.
  • Esophageal Varices: Extremely dilated sub-mucosal veins in the lower end of the esophagus.
  • Mallory-Weiss Tear: Occurs in the mucous membrane of the esophagus, where it connects to the stomach; usually caused by forceful or long-term vomiting, coughing, or epileptic convulsions.
  • Hiatal Hernia: Part of the stomach protrudes or herniates through the opening of the diaphragm, into the chest.
  • Swallowing Disorders/Dysphagia: Any condition that causes impairment of the movement of solids or fluids from the mouth, down the throat, and into the stomach.

Gastritis and Peptic Ulcer Disease

  • Gastritis is an acute or chronic inflammation of the stomach. A common cause of gastritis is a bacterium named Helicobacter pylori, or H. pylori.
  • Peptic ulcer disease is a sore or opening in the inner lining of the stomach or duodenum. The two most common causes of peptic ulcers are H. pylori infections and prolonged use of NSAIDS.

Gastrointestinal (GI) Bleeding

  • GI bleeding can range from microscopic bleeding, only detectable by a lab test, to massive bleeding.
  • It may be caused by esophageal varices, Mallory-Weiss tears, peptic ulcer disease, etc.

Gastroenteritis

  • Gastroenteritis is an infection or irritation of the digestive tract, particularly the stomach and intestines.
  • Symptoms include nausea and vomiting, diarrhea, and abdominal cramps.

Inflammatory Bowel Disease (IBD)

  • Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine.
  • The major types of IBD are Crohn's disease and ulcerative colitis.
    • Crohn's disease (regional enteritis) is a chronic, inflammatory bowel process that often leads to fibrosis and obstructive symptoms.
    • Ulcerative colitis is a chronic inflammatory disorder limited to the colon. It causes inflammation and sores in the lining of the colon and rectum.

Irritable Bowel Syndrome (IBS)

  • Irritable bowel syndrome (IBS)-also known as spastic colon, spastic colitis, and nervous or functional bowel-occurs when the colon contracts in a disorganized, violent manner.
  • These abnormal contractions result in changing bowel patterns, commonly with constipation and pain.

Foreign Bodies

  • Foreign bodies in the GI tract are typically swallowed and may cause perforation or obstruction.
  • Foreign bodies in the esophagus may be removed or manipulated endoscopically into the stomach.

Diverticular Disease

  • Diverticulosis describes pockets or projections (diverticula) extending from the walls of the colon, which develop through weaknesses of muscle layers in the colon wall.
  • It can cause changes in bowel function, such as discomfort, diarrhea, or constipation.
  • Bacteria in the colon can cause infection of the diverticular pockets, referred to as diverticulitis.

Anorectal Disorders

  • Rectal prolapse can be partial or complete.
    • Partial rectal prolapse occurs when the mucous membrane lining the anal canal protrudes through the anus.
    • Complete rectal prolapse occurs when the whole thickness of the bowel protrudes though the anus.
  • Abscess is a localized pocket of pus caused by infection.
  • Hemorrhoids are dilated or enlarged varicose veins that occur in and around the anus and rectum.
    • They may be external (distal end of the anal canal) or internal (in the rectum) and slip to the outside of the anus (prolapsed).
  • Anal fissure is a tear in the mucosa and skin of the anal canal due to passing a large stool, straining during childbirth, and laceration from passing a foreign body.
  • Anal fistula is a tiny channel or tract that develops because of an infection, inflammation, or abscess. The channel has one opening in the anal canal and runs to the perianal skin, rectum, bladder, or vagina.

Pancreatitis

  • Pancreatitis is an (acute or chronic) inflammation of the pancreas.
  • The digestive enzymes of the pancreas break out into the tissues of the organ rather than staying within the tubes (ducts), which damages the pancreas.

Benign and Malignant Neoplasms of the GI Tract

  • Benign and malignant neoplasms can occur throughout the digestive tract.
  • Coding for neoplasms requires specific physician documentation regarding neoplasm behavior and exact location within the GI tract.
  • After locating the code in the ICD-10-CM Alphabetic Index or Table of Neoplasms, be sure to confirm the code found in the Tabular List.
  • Polyps are defined as an abnormal tissue growth projecting from a mucous membrane.
  • Coding for polyps can be accomplished by using the ICD-10-CM Alphabetic Index and confirming the code choice in the Tabular List.
  • Personal history and/or family history of neoplasm are significant and should be coded in addition to the reason for treatment.
    • Personal history of a malignant neoplasm in the GI tract is coded using Z85.0-.
    • Family history of a malignant neoplasm in the GI tract is coded using Z80.0.
  • Codes are available to report screening of malignant neoplasms for the digestive tract (Z12.1-); specific codes exist for the colon, rectum, and small intestine.
  • Screening for a malignant neoplasm for the oral cavity is reported with Z12.81.

Congenital Disorders

  • ICD-10-CM codes for a congenital disorder are found in Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00-Q99).
  • Cleft lip and palate are congenital conditions that result due to abnormal facial development during gestation. The deformity can affect the lip, soft palate, hard palate, and even the nasal cavities.
  • Meckel's diverticulum is a remnant of the connection from the yolk sac to the small intestine present during embryonic development; it normally remains asymptomatic.
  • Congenital megacolon is an abnormal dilation of the colon, often accompanied by paralysis of peristaltic bowel movements.
  • Redundant colon means the colon is longer than normal.
  • Imperforate anus or anal atresia is a malformed rectum. These defects need to be corrected surgically very soon after birth.

CPT® Coding

  • The digestive system subsection is arranged first by anatomic region, and then by the procedure.
Lips
  • The lips are composed of skin, muscle, and mucosa, which are then divided into three main regions: cutaneous, vermilion, and mucosal.
  • If a procedure is performed on the skin of the lips, do not code from this section; choose a code from the Integumentary System instead.
  • Biopsy of the lip (40490) is performed on any portion of the lip. A biopsy would be performed when there is a concern for malignancy.
  • Vermilionectomy (40500) is shaving or excision of the vermilion border of the lip, including repair of the excisional area by mucosal advancement. If more tissue is excised or removed from the lip area, choose a code from range 40510-40530.
  • Wedge resections or full thickness excisional codes include reconstructions.
  • Cheiloplasty (40650-40761) is plastic surgery of the lips. These procedures can be cosmetic, or to repair congenital conditions (e.g., cleft lip), injury, or disease.
Mouth
  • The space between the cheek, lips, and teeth is referred to as the vestibule of the mouth, or buccal cavity.
  • Vestibuloplasty (40840-40845) is a repair in the vestibule of the mouth.
  • Glossectomy (41120-41155) is surgical removal of all or part of the tongue. Codes are selected based on the extent of the procedure performed.
  • Palatoplasty is a surgical procedure to reconstruct the palate or roof of the mouth. A palatoplasty with bone graft to alveolar ridge includes obtaining the bone graft.
  • There are three salivary glands (parotid, submandibular, and sublingual).
  • Codes 42300-42699 describe treatment of abscesses, cysts, tumors, fistulas, and stones of the salivary glands and ducts.
Pharynx, Adenoids, and Tonsils
  • Tonsillectomy is removal of the tonsils (located at the back of the throat); adenoidectomy is removal of the adenoids (located at the back of the nose). Coding is based on the tissue removed, patient age, and whether the procedure is primary (initial procedure performed to remove tissue) or secondary (previously-excised tissue has grown back).
Esophagus
  • Codes 43100-43135 report the removal of all or part of the esophagus, according to approach (cervical, thoracic, or thoracic with abdominal incision) and if reconstruction is performed.
  • Endoscopic procedures (43191-43278) visualize the digestive organs, via either a flexible fiber-optic tube or ridged instruments.
  • Select and report an appropriate code for each anatomic site examined.
  • According to National Correct Coding Initiative (NCCI) policy, if the provider converts a laparoscopic procedure to an open procedure, only report the open procedure.
  • On the CPC® exam, the NCCI policy is followed for laparoscopic procedures converted to open procedures.
  • Esophagoscopy (43191-43232) is direct visualization of the esophagus that does not extend into the stomach. In this section, it is important to pay attention to the parent codes for each code. For example, code 43191 is the parent code to codes 43192-43198.
  • Esophagogastroduodenoscopy (EGD) procedures (43233-43259, 43210) include visualization of the esophagus, stomach, and proximal duodenum or jejunum.
  • If the physician does not report an exam of the proximal duodenum or jejunum, append modifier 52 Reduced procedure to the appropriate code if repeat examination is not planned, or modifier 53, Discontinued procedure if repeat examination is planned.
  • Endoscopic retrograde cholangiopancreatography (ERCP), 43260-43278, uses a combination of endoscopy and fluoroscopy to diagnose and/or treat the biliary or pancreatic ductal systems for problems such as gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and malignancies.
  • Laparoscopy (43279-43289) includes surgical esophagogastric fundoplasty, paraesophageal herniorrhaphy, and esophageal lengthening procedures.
  • Repair (43300-43425) includes open procedures like the laparoscopic procedures listed above.
  • Manipulation (43450-43460) includes various types of esophageal dilation procedures, and esophagogastric tamponade.
Stomach
  • Gastrectomy (43620-43634) is removal of all or part of the stomach. Code according to the amount of stomach removed and reconstruction type.
  • Several different surgical techniques can be used to attach the remaining portion of the stomach to the small intestine. These range from a simple anastomosis of the duodenum (43631) or the jejunum (43632) to more complex reconstructions such as a Roux-en-Y (43633).
  • Code 43634 Gastrectomy, partial, distal; with formation of intestinal pouch describes reconstruction where the distal end of the jejunum is folded in upon itself to form a pouch, the bottom of which is connected to the remaining portion of the small intestine.
  • If the surgeon performs these procedures laparoscopically, report 43659 Unlisted laparoscopy procedure, stomach.
  • Bariatric surgery and gastric bypass are performed to treat morbid obesity. There are several procedures (Roux-en-Y, banding, etc.) and approaches.
  • Laparoscopic gastric restrictive procedures are reported using 43644-43647 and 43770-43775.
  • Open gastric restrictive procedures and bypass surgeries are reported using 43842-43848.
  • The endoscopic procedures of the stomach are reported using 43235-43259.
Nasogastric and Gastrostomy Tubes
  • For nasogastric/orogastric intubation that requires the skill of a surgeon and fluoroscopic guidance, report 43752.
  • Gastric intubation and aspiration procedures are reported with a code from range 43753-43755.
  • Highlight codes 43191, 43197, 43200, 43235, and 43260 in this section to indicate these are separate procedures that should not be billed with a surgical endoscopy. When both are performed at the same time, only report the surgical endoscopy.
Intestines
  • Intestinal procedures begin with code 44005 and end with 44799; these codes represent the different procedures performed on the intestines, except the rectum, which is covered with the code range 45000-45999.
  • The code description sounds similar from one code to the next; carefully review the note and the code description to assure correct coding.
  • CPT code 44005 describes enterolysis (freeing of intestinal adhesion).
  • This procedure is listed as a separate procedure. When it is performed alone and is not related to another, more extensive procedure performed at the same time, it may be reported.
  • Excision codes include enterectomies and colectomies.
    • An enterectomy is a resection of a portion of the intestines.
    • A colectomy is the excision of a portion or the entire colon.
  • Understanding the anatomy of the gastrointestinal system will be key in determining the correct codes.
  • Endoscopic procedures are divided by small intestines (44360-44379), beyond the second portion of the duodenum, and stoma endoscopy (44380-44384), where the scope is inserted through an existing ileostomy. Colonoscopies performed via the stoma can be found in this section, as well, with codes 44388-44408.
  • Enterostomy is the creation of external stomas, or openings in the body for the discharge of body waste. Codes are chosen by the portion of the digestive tract brought to the surface of the abdomen (this assumes the ostomy is not included in a more extensive procedure).
  • Appendectomies may be open (44950-44960) or laparoscopic (44970). Unless performed by itself, or for an indicated purpose (rupture, fecalith, and intussusception), an appendectomy is incidental to other intra-abdominal procedures.
Colon and Rectum
  • Proctosigmoidoscopy (45300-45327) examines the rectum and sigmoid colon.
  • Sigmoidoscopy (45330-45350) involves the entire rectum and sigmoid colon and may include the descending colon.
  • Colonoscopy (45378-45398) visualizes the entire colon from the rectum to cecum and might include the terminal ileum.
  • Colonoscopy procedures (45378-45398) are the visual examination of the entire colon, from the rectum to cecum, and might include the terminal ileum. According to CPT®, for a diagnostic or screening colonoscopy that does not reach the splenic flexure, you report flexible sigmoidoscopy code 45330.
  • For a diagnostic or screening colonoscopy that passes the splenic flexure but does not go all the way to the cecum you report code 45378 with modifier 53.
  • When the diagnostic or screening colonoscopy goes all the way to the cecum you report code 45378 with no modifier.
  • For therapeutic or surgical colonoscopy that does not reach the splenic flexure you report code flexible sigmoidoscopy codes 45331-45347.
  • For therapeutic or surgical colonoscopy that passes the splenic flexure but does not go all the way to cecum you report codes 45379-45398 with modifier 52.
  • For therapeutic or surgical colonoscopy that goes all the way to the cecum report codes 45379-45398 with no modifier.
  • Refer to the CPT subsection guidelines for Endoscopy and read all parenthetical notes in this series of codes.
  • Techniques via scope to remove lesions, polyps, or tumors include hot biopsy forceps (tweezer-like forceps connected to a monopolar electrocautery unit and a grounding pad), cold biopsy forceps (the provider simply grasps the polyp and pulls it from the colon wall), electrocautery snare (a wire loop encircles the specimen), or laser.
  • Many of the code descriptions indicate specimen(s), biopsy(s), polyp(s), tumor(s), and lesion(s).
  • The letters in parenthesis indicates the code is reported once if more than one specimen, polyp, tumor, and lesion are removed by the same method. For example, four polyps are removed during a colonoscopy by snare technique. You report code 45385 once, NOT 45385 x 4.
  • NOTE-When multiple specimens are removed during the same proctosigmoidoscopy, report procedure code 45315.
  • For sigmoidoscopies and colonoscopies, report each removal procedure with different methods and sequence codes from highest to lowest value.
Anus
  • Hemorrhoids are common diagnoses for anal procedures.
  • There are two types: internal (occur above the anal verge) and external (occur below the anal verge).
  • If left untreated, hemorrhoids can become prolapsed or strangulated.
  • Thrombosis of an external hemorrhoid occurs when a vein ruptures or a blood clot develops.
  • Treatments for hemorrhoids range from hemorrhoidectomy by banding or ligation via a rubber band (46221) to complete hemorrhoid excisions with treatment for anal fissures and/or fistulas (46945-46946 and 46320-46262).
  • When multiple methods are used to remove multiple hemorrhoids, use a separate code for each removal method.
  • Codes 46250-46260 apply to removing single or multiple hemorrhoids during the same operative session.
  • Documentation needs to include how many columns/groups of external or internal hemorrhoids are excised. For example, if the surgeon excises two internal hemorrhoids and one external hemorrhoid single column/group during the same operation, you should report only a single unit of 46255.
Liver, Biliary Tract, and Pancreas
  • Hepatectomy is removal of a portion of the liver. A partial lobectomy (47120) removes a single tumor from a lobe of the liver. The liver is made up of four lobes, the left, right, caudate, and quadrate lobes. It is also separated into eight segments, the caudate (1), lateral (2, 3), medial (4a, 4b) and right (5, 6, 7, 8). Code 47120 should be reported for each tumor, if removed from different lobes of the liver.
  • Liver injuries can result from trauma, such as stabbing, gunshot wounds, and blunt traumas. To report repairs, choose 47300-47362, depending on the extent of the wound and hemorrhaging involved.
  • The biliary tract includes the liver, gallbladder, and pancreas.
  • The most common procedure performed on the biliary tract is a cholecystectomy (removal of gallbladder), which can be performed laparoscopically (47562-47570) or open (47600-47620). Additional procedures can be performed during a cholecystectomy, such as a cholangiography or an exploration of the common bile duct.
  • Pancreas procedures are coded from range 48000-48999.
  • A Whipple procedure (pancreaticoduodenectomy or pancreatoduodenectomy) is performed to treat malignancies in the head of the pancreas, or malignant tumors involving the common bile duct or duodenum near the pancreas. Coding depends on how much of the duodenum is removed, whether a partial gastrectomy is performed, and whether pancreatojejunostomy is performed.
Abdomen, Peritoneum, and Omentum
  • Hernia repairs, reported with 49491-49659, are performed due to a protrusion of internal organs (e.g., intestines or omentum) through a weakening in the abdominal wall. Herniorrhaphies are repaired by the physician, who reduces bulging tissue back into the abdominal cavity and sutures the abdominal wall back into place. To determine which code is appropriate, you need to know the type of hernia (inguinal, femoral, lumbar, omphalocele, anterior abdominal, or parastomal).
  • For some hernia types, you will also need to know the patient's age, whether the hernia is initial or recurrent, and clinical presentation of the hernia (for example, reducible, incarcerated, strangulated, or recurrent). For anterior abdominal hernias, you will also need to know the total defect size.

Radiology Section

  • Digestive radiology codes include 74210-74363 (GI tract, gastric emptying, colon), 76700-76776 (diagnostic ultrasound studies of the abdomen and retroperitoneum), 78201-78299 (nuclear medicine studies of the GI tract).
  • Diagnostic ultrasound is an imaging technique that uses sound waves to display real-time scanning images and movement; for example, a patient undergoing an ultrasound, real time, of a transplanted kidney with duplex Doppler scan including image documentation (76776 Ultrasound, transplanted kidney, real time, and duplex Doppler with image documentation).
  • Nuclear medicine makes use of radioactive elements for diagnostic imaging and radiopharmaceutical therapy to destroy diseased tissue and can diagnose other diseases or anomalies.
  • Gastric emptying is a radiologic exam to aid in diagnosing neoplasms, ulcers, obstructions, and other diseases. Several of these procedures include kidneys, ureter, and bladder (KUB).
  • Computed tomographic (CT) colonography or virtual colonoscopy (74261) provides detailed, cross-sectional views of the colon using an X-ray machine linked to a computer. CT pneumocolon is a variation that uses thicker collimation and intravenous contrast without 3-D reconstruction.
  • Radiology procedures often include both a technical and professional component.
    • To report only the professional component, append modifier 26.
    • To report only the technical component, append modifier TC.
    • To report the complete procedure, submit the claim without a modifier.
  • All permanent images must be saved in the patient's medical record.
  • Make sure to read all parenthetical notes in this section, to know what codes should or should not be reported with radiology codes.

Medicine Section

  • Codes 91010-91013 are used to report esophageal motility or manometry studies to determine how well the esophagus or gastroesophageal junction are functioning.
  • Code 91020 describes gastric motility study, and 91022 reports duodenal motility study.
  • Code 91117 describes a colon motility study.

HCPCS Level II Coding

  • Use codes G0104-G0106 and G0120-G0122 when performing a sigmoidoscopy, colonoscopy, or barium enema when screening for GI malignancies for Medicare patients.

Modifiers

  • Common modifiers to the digestive system include:
    • Modifier 22 Increased procedural service-Use when significant additional work is required for extensive lysis of adhesions, or due to obesity.
    • Modifier 51 Multiple procedures-Use when multiple procedures are performed during the same session by the same provider.
    • Modifier 53 Discontinued procedure-Use when there is too much undigested food in the area to work effectively.
    • Modifier 58 Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period-Use when the procedure can only be accomplished in staged fashion during the global period of another procedure performed by the same provider.
    • Modifier 78 Unplanned return to the operating room by the same physician or other qualified healthcare professional-Use when the patient is returned to the operating room for a related procedure (especially work on the intestines) such as internal bleeding, or repair of a suture that rips apart internally (complications).
  • Other less commonly used modifiers are 80 Assistant surgeon, 62 Two surgeons (two surgeons of equal stature and responsibility perform the procedure), and 66 Surgical team, generally used with liver and pancreatic transplants.

Glossary

  • Anastomosis-Surgical connection of two tubular structures.
  • Anoscopy-Procedure using a scope to examine the anus.
  • Bariatric Surgery-Gastric restrictive procedures that are used to treat morbid obesity.
  • Barium Enema-Radiographic contrast medium enhanced examination of the colon.
  • Biliary-Gallbladder, bile, or bile duct.
  • Bypass-To go around.
  • Calculus-Concretion of mineral salts, also known as a stone.
  • Cholangiography-Radiographic recording of the bile ducts.
  • Cholangiopancreatography-Radiographic recording of the biliary system and pancreas.
  • Cholecystectomy-Surgical removal of the gallbladder.
  • Cholecystoenterostomy-Creating a connection between the gallbladder and intestine.
  • Cholecystography-Radiographic recording of the gallbladder.
  • Colonoscopy-Endoscopic examination of the entire colon that may include part of the terminal ileum.
  • Colostomy-Artificial opening between the colon and the abdominal wall.
  • Congenital-Existing from birth.
  • Conscious (moderate) Sedation-A decreased level of consciousness in which the patient is not completely asleep.
  • Crohn's Disease-Regional enteritis.
  • Diaphragm-Muscular wall that separates the thoracic and abdominal cavities.
  • Diaphragmatic Hernia-Hernia of the diaphragm.
  • Dilatation-Expansion.
  • Diverticulum-Protrusion of the intestinal wall.
  • Duodenography-Radiographic recording of the duodenum, or the first part of the small intestine.
  • Dysphagia-Difficulty swallowing.
  • Endoscopy-Inspection of body organs or cavities through an existing opening or through a small incision.
  • Enterolysis-Releasing of adhesions of intestine.
  • Epiglottidectomy-Excising the covering of the larynx.
  • Eventration of Intestines-Intestinal protrusion of the intestines through the abdominal wall.
  • Evisceration-Pulling the viscera outside of the body through an incision.
  • Exenteration-Major operation during which an organ and its adjacent structures are removed.
  • Exstrophy-Condition in which an organ is turned inside out.
  • Exteriorization-Exposing an internal structure outside the body for observation, surgery, or experimentation, such as creating a passage from the bladder to the abdominal wall.
  • Fistula-Abnormal opening from one area to another area in the body or outside of the body.
  • Fluoroscopy-Procedure for viewing the interior of the body using X-rays and projecting the image onto a television screen.
  • Fulguration-Use of electric current to destroy tissue.
  • Fundoplasty-Repair of the bottom of an organ or muscle.
  • Gastrointestinal-Pertaining to the