4 Series - Notes Need To Write

4 series (Digestive system)
Colon parts & sequence
Small intestine & sequence
Colon parts started with cecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Small Intestine
Duodenum
Jejunum
Ilium
Colonoscopy
Colonoscopic surgical
 Colonoscopic with biopsy (some time they mention cold biopsy) -> 45380
 Colonoscopic with removal of foreign body-> 45379
 Colonoscopic with submucosal insertion -> 45381
Colonoscopy with removal of tumors, polyps or other lesions 45379-45398
They are using 2 techniques
1. Hot biopsy forceps

2. Snare technique
Hot biopsy Forceps: 45384
Uses mono polar current requiring grounding pad paste somewhere on the patient. The use hot
forceps enables the provider to simultaneously excise the lesion and control bleeding.
Snare technique: 45385
A snare is a wire loop used to encircle tissue for removal rather than grasp tissue
Example:
1. Patient is having 3 colon polyps in ascending colon. Colon polyps removed by colonoscopy with hot
biopsy forceps?
2. Patient is having 5 colon polyps in transverse colon. First 3 colon polyps removed by hot biopsy
forceps and another 2 removed by snare tech?
3. Colonoscopy with cold biopsy?
 Esophagoscopy:
 Esophago gastroscopy:
 Esophagogastroduodenoscopy
Esophagoscopy:
 Trans oral rigid 43180-43196
 Trans oral flexible 43200-43232
 Trans nasal Esophagoscopy flexible 43197-43198
Example:
1. Esophagoscopy Trans oral rigid with balloon dilation 20 mm diameter?
2. Esophagoscopy Trans oral flexible with balloon dilation 30 mm diameter?
3. Esophagoscopy, flexible, transoral with removal of tumor/polyps, or other lesion(s) by hot biopsy
forceps
Esophagogastroduodenoscopy
 Repeat examination planned means: 53
 Repeat examination hot planned: 52
1. EGD diagnostic with repeat exam planned?
2. EGD diagnostic with repeat exam not planned?
3. EGD transoral with dilation of esophagus with balloon DILATION (30 mm) diameter?
4. Esophagogastroduodenoscopy, flexible, transoral with removal of tumor(s)/polyps (or other lesion(s)

by snare technique?
ERCP:
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Examination of the hepato biliary system (pancreatic ducts, hepatic ducts, common bile ducts,
duodenal papilla (Ampulla of rater) and gall bladder (if present) is performed through a side-
viewing flexible fibero optic endoscope
ERCP with stent
1. ERCP with stent placement
2. ERCP with stent removal
3. ERCP with stent exchange (replacement)
4. ERCP with 3 stent placement?
5. ERCP with 3 stent removal
6. ERCP with 3 stent exchange (Replacement)?
Tonsillectomy & adenoidectomy?
Coding points:
 First we have to look for what procedure MD performed

 Primary or secondary
 Age
Tonsillectomy & Adenoidectomy Both codes?
42820 -> Tonsillectomy & Adenoidectomy; younger than age 12
42821 -> age 12 or over
42825 -> Tonsillectomy, primary or secondary; younger than age 12
42826 -> age 12 or over
42830 -> Adenoidectomy, primary, younger than age 12
42831 -> age 12 or over
42835 -> Adenoidectomy, secondary, younger than age 12
42836 -> age 12 or over
1. Patient is having Adenoiditis MD performed removal of remaining portion of the adenoids age is 10?
Hemorrhoid:
Swollen or infected veins in the rectum and anus that cause discomfort and bleeding
1. Hemorrhoidectomy, internal by ligation other than rubber band; single hemorrhoid column
2. Hemorrhoidectomy, external, 3 columns
3. Hemorrhoidectomy, external, single columns
4. Hemorrhoidectomy, internal and external 2 column with fistulectomy along with fissurectomy
Hernia:
Protrusion (prolapse) of organ from its origin
Hernia repair:
Physician will replace that to its original place and physician will place mesh under that hernia part to
prevent recurrent hernia.
OPEN: 49491-49611,
LAP: 49650-49659
Non – Reducible/Incarcerated/Strangulated
 Hernia with Obstruction

 Hernia with adhesion
 Hernia with omentum
Mesh:
 Mesh is included in all procedures of hernia except open Incisional or ventral hernia
 49560, 49561, 49565, 49566 = +49568
Open code Laparoscopic code
Femoral Initial reducible
Ventral Initial reducible
Incisional Initial reducible
Inguinal Initial reducible

6yrs
Epigastric Initial reducible
1. Lumbar hernia with mesh initial reducible:

2. Spigelian hernia with mesh initial reducible:
3. Incisional hernia WITH ADHESION PRESENT with mesh PLACEMETN initial
4. Paraesophageal hernia with mesh by laparotomy:
5. Paraesophageal hernia with mesh by thoracotomy:
6. Paraesophageal hernia with mesh by thoracoabdominal:
General Questions:
1. Superficial abscess of anal region md performed I&D:
2. Inguinal strangulated hernia initial with mesh implantation? Pt. age is 7years:
3. Palatoplasty with cleft palate repair:
4. Biopsy of pancreas open:

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4 series (Digestive system)

Colon parts & sequence

Small intestine & sequence

Colon parts started with cecum

Colonoscopy with removal of tumors, polyps or other lesions 45379-45398

They are using 2 techniques

1. Hot biopsy forceps

Hot biopsy Forceps: 45384

Snare technique: 45385

3. Colonoscopy with cold biopsy?

1. Esophagoscopy Trans oral rigid with balloon dilation 20 mm diameter?

2. Esophagoscopy Trans oral flexible with balloon dilation 30 mm diameter?

1. EGD diagnostic with repeat exam planned?

2. EGD diagnostic with repeat exam not planned?

4. Esophagogastroduodenoscopy, flexible, transoral with removal of tumor(s)/polyps (or other lesion(s)

ERCP with stent

1. ERCP with stent placement

2. ERCP with stent removal

3. ERCP with stent exchange (replacement)

4. ERCP with 3 stent placement?

5. ERCP with 3 stent removal

6. ERCP with 3 stent exchange (Replacement)?

Tonsillectomy & adenoidectomy?

 First we have to look for what procedure MD performed

Tonsillectomy & Adenoidectomy Both codes?

42820 -> Tonsillectomy & Adenoidectomy; younger than age 12

42821 -> age 12 or over

42825 -> Tonsillectomy, primary or secondary; younger than age 12

42826 -> age 12 or over

42830 -> Adenoidectomy, primary, younger than age 12

42831 -> age 12 or over

42835 -> Adenoidectomy, secondary, younger than age 12

42836 -> age 12 or over

2. Hemorrhoidectomy, external, 3 columns

3. Hemorrhoidectomy, external, single columns

Protrusion (prolapse) of organ from its origin

 Hernia with Obstruction

Femoral Initial reducible

Ventral Initial reducible

Incisional Initial reducible

Inguinal Initial reducible

Epigastric Initial reducible

1. Lumbar hernia with mesh initial reducible:

1. Superficial abscess of anal region md performed I&D:

3. Palatoplasty with cleft palate repair:

4. Biopsy of pancreas open:

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