CPT Module 5.docx - SURGERY Digestive Urogenital Nervous...

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SURGERY - Digestive, Urogenital, Nervous, Eye and Ear Key Points - Digestive System: The digestive system includes procedures performed on the mouth and tongue, palate and uvula, salivary glands and ducts, pharynx, adenoids, and tonsils, esophagus, stomach, intestines, appendix, rectum, biliary tract, abdomen, peritoneum and omentum. It includes endoscopic as well as open procedures. For endoscopy procedures, code the appropriate endoscopy of the anatomic site examined. Surgical endoscopy always includes diagnostic endoscopy. Whenever a diagnostic endoscopic procedure is performed, the collection of specimen(s) by brushing or washing is included. In removal of polyps, tumors or other lesions - selection of the correct code depends on the method of removal, including: a pedunculated polypoid lesion has a stalk and can be removed with a snare or hot biopsy forceps hot biopsy forceps simultaneously excise and fulgurate polyps. bipolar cautery is electrosurgery using a pair of electrodes. Tissue is placed between the electrodes, then coagulated by the flow of current from one to the other. Ablation involves the elimination or control of the hemorrhage of a tumor or mucosal lesion (e.g. - sessile polyps are smooth on the wall of the intestine and cannot be grasped, physician may use laser to cut out; or electrocautery or hot biopsy/fulguration). Upper gastrointestinal endoscopy or esophagogastroduodenoscopy (EGD) [43234 - 43259] involves inserting an endoscope through the patient's mouth and slowly advancing it through the esophagus, stomach and duodenum to examine any suspicious areas. When a percutaneous gastrostomy (PEG) tube is placed by EGD, assign code 43246. In such cases, the EGD is used to locate the area for placement of the PEG tube. Endoscopic retrograde cholangiopancreatography (ERCP) [43260 - 43272] is the radiographic examination of the pancreatic ducts and the hepatobiliary tree after injection of a contrast medium into the duodenal papilla to
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visualize the pancreatic and common bile ducts. The procedure involves an endoscope being inserted into the patient's mouth and advanced through the esophagus and stomach. When the endoscope reaches the duodenum, the patient is placed in a prone position, a cannula is passed through the endoscope, and contrast medium is instilled. X-rays are taken and other procedures may be performed (e.g. - biopsy, removal, of stones). When coding lower endoscopies, distinguish between the following: proctosigmoidoscopy (exam of the rectum and sigmoid colon) sigmoidscopy (exam of the rectum, sigmoid colon and part of the descending colon) colonoscopy (exam of the entire colon, from rectum to cecum and possible examination of the terminal ileum). If a colonoscopy is incomplete (perhaps due to poor bowel prep), the facility will code as far as it goes. For example, if the scope is advanced as far as the sigmoid, a sigmoidoscopy is coded. The physician would use the colonoscopy code with -52 modifier.
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