SURGERY
DIGESTIVE SYSTEM
Bucco……………buccal cavity
Chol/e or chol/o………bile or gall
Cholangio……bile duct
Cholecysto…..gall bladder
Choledocho……common bile duct
Entero…………intestine
Gastro……..stomach
Glosso ………..tongue
Hepato ……liver
Labio…..lip
Linguo…..tongue
Oro…mouth
Sialo…..salivary gland
Stoma or stomato…..mouth
Procto….rectum and anus
Uvulo…uvula
REPAIR
Cheiloplasty – repair of lip
Vestibuloplasty – Repair of vestibule ( part of oral cavity including
mucosal & submucosal tissue of lips & cheeks)
Frenoplasty – surgical revision of frenum (soft tissue between lips
& gums)
Gingivoplasty – surgical reshaping of gum
Alveoloplasty - surgical reshaping of jaw
Palatoplasty – surgical correction of palate
Pharyngoplasty - surgical correction of pharynx
ENDOSCOPY
When bleeding occur as a result of endoscopy during same
session, the control of bleeding is not reported separately
ESOPHAGOSCOPY
Esophagoscopy is a type of endoscopy that doesn’t require
incisions. The endoscope is inserted through your nose or mouth
into your esophagus.
This allows your doctor to see the inside of your upper
gastrointestinal (GI) tract. This includes your esophagus,
stomach, and the beginning of your small intestine.
Check flexible / rigid
transoral / transnasal
ESOPHAGOGASTRODUODENOSCOPY
Esophagogastroduodenoscopy (EGD) is a procedure during which
a small flexible endoscope is introduced through the mouth (or,
with smaller-caliber endoscopes, through the nose) and advanced
through the pharynx, esophagus, stomach, and duodenum.
If discontinued the procedure
repeat examination planned - Use modifier 53 (discontinued
procedure)
repeat examination not planned - use modifier 52 (reduced
services)
ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY
Endoscopic retrograde cholangiopancreatography, or ERCP, is a
procedure to diagnose and treat problems in the liver,
gallbladder, bile ducts, and pancreas.
It combines X-ray and the use of an endoscope—a long, flexible,
lighted tube.
ERCP WITH STENT PLACEMENT
ERCP with stent placement includes balloon dilation performed in that duct
ERCP with more than one stent in same day – use modifier 59 (distinct
procedural service) 43274-59
ERCP with more than 1 stent exchanged in same day – mod 59
43276-59
ERCP with balloon dilation of more than 1 duct in same day – mod 59
LAPAROSCOPY
Laparoscopy is an operation performed in the abdomen or pelvis
using small incisions with the aid of a camera.
The laparoscope aids diagnosis or therapeutic interventions with
a few small cuts in the abdomen.
Surgical laparoscopy include diagnostic laparoscopy ( don’t code
separately)
BARIATRIC SURGERY
Gastric bypass and other weight-loss surgeries — known
collectively as bariatric surgery — involve making changes to
your digestive system to help you lose weight.
It involve the stomach, duodenum, jejunum and ileum
INTESTINAL ALLOTRANSPLANTATION
1. Cadaver / living donor enterectomy – 44132/ 44133
2. Backbench work – 44715 or 44720, 44721
3. Recipient intestinal allotransplantation – 44135, 44136
ENDOSCOPY- SMALL INTESTINE
Small bowel/intestinal endoscopy, also known as deep
endoscopy, examines more of the small intestine using
balloons, fitted over an endoscope, to access hard-to-reach areas
of the small intestine.
-not including ileum (44360)
Including ileum (44376)
A stoma is an opening in your belly's wall that a surgeon makes
An ileoscopy detects causes of bleeding in the small intestine,
high ileostomy fluid output, and Crohn's disease.
Ileoscopy through stoma- endoscope into your ileum through your
stoma to take pictures of the lining of your ileum.(44380)
COLONOSCOPY THROUGH STOMA - is the examination of the
colon, from the colostomy stoma to the cecum or colon small
intestine anastomosis and may include terminal ileum/ small
intestine proximal to anastomosis (44388)
ENDOSCOPY – LARGE INTESTINE
PROCTOSIGMOIDOSCOPY – is the examination of the rectum and
may include also a portion of the sigmoid colon(45300)
SIGMOIDOSCOPY – is the examination of the entire rectum,
sigmoid colon and may include portion of the descending
colon(45330)
COLONOSCOPY – is the examination of the entire colon, from
rectum to cecum and may include terminal ileum/ small intestine
proximal to anastomosis
COLONOSCOPY DECISION TREE
Meckel's diverticulum
Meckel's diverticulum is an outpouching or bulge in the lower
part of the small intestine.
The bulge is congenital (present at birth) and is a leftover of the
umbilical cord
The mesentery is a fold of membrane that attaches the intestine
to the abdominal wall and holds it in place.
Appendectomy
An incidental appendectomy is the removal of the appendix during
another procedure, such as a cholecystectomy use modifier 52
When an open appendectomy is performed and the appendix has not
ruptured, assign 44950.
When an open appendectomy is performed for a ruptured appendix
with abscess or generalized peritonitis, assign 44960.(sub code)
When an open appendectomy is done for an indicated reason at the
same time as another major surgery, assign the add-on code 44955.
For a laparoscopic appendectomy, assign 44970.
LIVER TRANSPLANTATION
1. Cadaver / living donor hepatectomy – 47133/ 47140-47142
2. Backbench work – 47143- 47147
3. Recipient liver allotransplantation - 47135
HERNIA
A hernia is the abnormal exit of tissue or an organ, such as the bowel,
through the wall of the cavity in which it normally resides.
A reducible hernia is a hernia with a bulge that flattens out when you
lie down or push against it gently.
An incarcerated hernia is a part of the intestine or abdominal tissue
that becomes trapped in the sac of a hernia—the bulge of soft tissue
that pushes through a weak spot in the abdominal wall. If part of the
intestine is trapped, stool may not be able to pass through the
intestine.
A strangulated hernia is a hernia that is cutting off the blood supply to
the intestines and tissues in the abdomen.
HERNIA - TYPES
An inguinal hernia occurs when a small portion of the bowel bulges out through the
inguinal canal-a passage or opening through the muscles of the abdominal (belly) wall-
into the groin.
A femoral hernia occurs when tissue bulges from the lower belly into the upper thigh,
just below the groin crease.
An incisional hernia can occur after surgery in the belly. It can happen months or even
years after surgery. Most of the time, it occurs along a vertical (up and down) incision.
An umbilical hernia occurs when intestine, fat, or fluid pushes through a weak spot in
the belly. This causes a bulge near the belly button, or navel.
An epigastric hernia occurs when fat pushes through a weak part of the belly wall. It
occurs in the middle of the belly between the breastbone and the belly button, or navel.
A hiatal hernia occurs when part of your stomach bulges up through your diaphragm and
into your chest.
INITIAL / RECURRENT HERNIA
If the hernia repair fails and the hernia reappears, this is referred
to as a recurrent hernia.
A recurrent hernia is recognized as a bulge, sometimes painful,
that appears at or near the site of the original hernia
CHECK :
Initial/recurrent
Defect length
Incarcerated / Reducible
*All include mesh or other prosthesis
1) Diagnostic upper GI endoscopy of the
esophagus, stomach, and duodenum was
performed after esophageal balloon dilation (less
than 30 mm diameter) was
done at the same operative session. Code the
procedure(s).
A.43249, 43235-51
B.43249
C.43220, 43200-51
D.43220
.:
2) A patient comes in for surgery today to address
complications from his previous partial
enterectomy performed 5 months ago. Upon
reopening the patient’s previous incision, the
surgeon resected the ileum and a portion of the
colon. An ileocolostomy was performed to
complete the procedure with no complications.
A.44144
B.44160
C.44150
D.44205
3)A 30-year-old patient underwent a cholecystectomy
with exploration of common duct
with biliary endoscopy. How should you report this
procedure?
A.47610, 47550
B.47610, 47552
C.47600
D.47562, 47550
4)The patient is a 40-year-old gentleman who presented to the
emergency room with signs and symptoms of acute appendicitis with
possible rupture. He has been brought to the operating room. An
infraumbilical incision was made which a 5-mm VersaStep trocar was
inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-
mm trocar was placed suprapubically and a 12-mm trocar in the left
lower quadrant. A window was made in the mesoappendix using
blunt dissection with no rupture noted. The base of the appendix
was then divided and placed into an Endo-catch bag and the 12-mm
defect was brought out. Select the appropriate code for this
procedure:
A.44970
B.44950
C.44960
D.44979
1)B
2)B
3)A
4)A
2025 additional codes:
49186 : Excision or destruction, open, intra-
abdominal (i.e., peritoneal, mesenteric,
retroperitoneal), primary or secondary tumor(s)
or cyst(s), sum of the maximum length of
tumor(s) or cyst(s); 5 cm or less
49187 : 5.1 to 10 cm
49188 : 10.1 to 20 cm
49189 : 20.1 to 30 cm
49190 : Greater than 30 cm
