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Hello CPT coders and welcome to part 2 of chapter 4 surgery! We're going to be
covering pages 132 through 187. We have a lot of topics that we are going to cover
this week, but they're pretty straightforward. So this lecture is going
to touch on the little nuances that we need to look out for in particular
subsections of this chapter, so I hope this helps with your studying and best
of luck, so let's get started!
Our first subsection is the digestive system. We need to know when the
digestive system begins in our body and ends in our body so we know where to
find these codes in the CPT book, so it's important to know that the digestive
system begins with the lips. It also includes the mouth and tongue, palette
and uvula, salivary glands and ducts, pharynx, adenoids and tonsils, the
esophagus, stomach, intestines, appendix, ***, biliary tract, abdomen, peritoneum,
and the omentum. Now let's talk about how the codes are categorized in the
alphabetic index of the CPT book. Codes are categorized by the body part
involved and then by it's a procedure, so when we're looking up a code in the
alphabetic index of the CPT book for the digestive system we usually want to
start with a body part first. However there are some acept,
exceptions to the rule and some code ranges can be located in the alphabetic
index under endoscopy, gastrointestinal, and upper. So every once in a while you
actually can find them under the procedure first. Now let's talk about our
first gastrointestinal/digestive system procedure, and that's the EGD, the
esophargogastroduodenoscopy, so we see it ends with -scopy, so we know that
it's an endoscopy, and as with other endoscopies we need to read the
operative report to determine what was performed during the scope. Was this a
biopsy? Was it a removal of foreign of foreign bodies? Was it done to complete a
dilation? But what I wanted to bring to your attention regarding EGDs is that
there is no alphabetic entry for the abbreviation EGD in the alphabetic
index of the CPT code book. We're going to use the code ranges located in the
alphabetic index under in coppy comma gastrointestinal comma upper,
so this is the exception to that rule that we discussed on the previous slide.
So when we're going to be coding EGDS we're going to be using the procedure first
instead of the body part or body system.
Another gastrointestinal procedure I would like to discuss is the ERCP, the
endoscopic retrograde cholangiopancreatography. We give you the
cpt code range it's four three two six zero through four three two seven eight.
I wanted to point out that the ERCP is used to diagnose and treat conditions
such as gallstones, strictures, and cancer, so it's utilized to visualize the liver,
the gallbladder, the bile ducts and the pancreas, but it combines the use of both
x-rays and an endoscope. But, I also wanted to point out that as a coder we
need to know if this was a complete ERCP or if this was an attempted ERCP. So when
the pancreatic or biliary ductal systems were not visualized successful
successfully visualized it's considered to be an attempted ERCP per cpt
guidelines. To report an attempted ercp we're gonna use codes four three two
three five through four three two five nine. We also have two codes outside of
that range that may be appropriate and those are codes for three two six six
and four three two seven zero, so we need to know that ERCPs combine the use of
x-rays and endoscopes but we also need to know what is an
attempted ERCP versus what is a completed ERCP and you can find that
information in your cpt code book on page 294. Now we're
going to talk about lower gastrointestinal system endoscopies you
need to know all the different types of endoscopies. We're not going to actually
touch on all the endoscopies in this lecture. I want to talk specifically
about colonoscopies, and that's code range for five three seven eight through
four five three nine eight and your book gives you a great decision tree for
colonoscopies so you need to be able to ask and answer these specific questions:
is the colonoscopy for diagnostic or therapeutic treatment, did the surgeon
reach the splenic flexure, and did the surgeon examine all the way to the cecum,
and the reason why we need to know these questions because we need to know
whether this was a completed colonoscopy or an incomplete colonoscopy. I want to
make sure you understand the difference between an incomplete colonoscopy that
we're coding for physician services and an incomplete colonoscopy that we're
coding for facility services. So this is where the different uses of different
modifiers comes into play. Modifiers used for physician services services differ
from modifiers used in facility services, so when circumstances prevent the entire
colon from being visualized when coding for physician services modifier 53
should be assigned along with the colonoscopy codes per cpt guideline. So
an incomplete colonoscopy for physician services equals modifier 53. Now let's
talk about incomplete colonoscopies for facility services when circumstances
prevent the entire colon from being visualized in a facility service we are
directed by the CMS Transmittal number four for to to append modifier 73
or modifier 74 as appropriate. So in the facility service we're using one of two
modifiers and that's modifier 73 or 74. Now this is why we have gone in-depth
over the differences between modifier 73 and modifier 74. If you remember we even
had a discussion post about this modifier so it might benefit you to go
back and look at that post and to go back and read the definitions of these
modifiers. so know that facility service coding for an incomplete colonoscopy we
use modifier 73 or 74 depending on the situation and then for physician
services we just used modifier 53, and as always the operative report should be
reviewed to determine the approach and if the procedure was diagnostic or
therapeutic.
Now let's discuss hemorrhoids. This is quick little subject, not too difficult.
The things you need to know about hemorrhoids are going to be is what was the
the technique determine the technique you should be able to get this
information from the OP report we're looking as it was an incisional, was it
destructive,was it a rubber band ligation, we need to know these
techniques, um, but what I wanted to point out in the hemorrhoids subsection is
that several of the codes are out of sequence so when we're looking in the
alphabetic index and then trying to find a code we need to make sure that we
recognize and understand that not all the codes for hemorrhoids are going to
be in sequence. Hernias, hernias are pretty straightforward as well. We're
going to abstract documentation from the health record to support coding. So the
information that we need as coders to code a hernia is we need to know which
type of hernia are we dealing with is it incisional is an inguinal, also we
need to know the type of diagnosis, is the hernia recurrent or initial we need
to know that as well what's the patient's age, what's the surgical treatment, also
what's the approach is it open or is it laparoscopic, um, and there's a reason why we
need to know this because there may be additional codes that we need to use
depending on how you answer those questions. But first I want to define a
recurrent hernia. And a recurrent hernia is a hernia that has been previously
surgically reduced. So it's been surgically treated prior and the reason
why we need to know what type of hernia repair that is taking place is because a
lot of times mesh is used to be placed in the body to help prevent the hernia
and get the hernia back in place. So when coding a mesh repair we're gonna use the
code four nine five six eight, that's the implementation of mesh or other
prosthesis for an open incisional or ventral hernia repair this code is gonna
be assigned in addition to the repair code but we're only gonna code mesh when
we're looking at incisional or ventral hernias because the use of mesh with
other hernia repairs is not coded so it's going to be included in the code so
there's only two types of hernias that we're gonna use that add-on code for the
use of mesh so it's the incisional and ventral hernia so when we see incisional
and ventral hernia we need to know that we're gonna go ahead and use an
additional code to address the mesh repair.