Surgery Coding of Digestive

System

Rabina Chaudhary, CPC

 Disclaimer

This presentation is intended for Educational

purpose only.

The information shared here has been reviewed

completely for accuracy, the instructor does not
accept any responsibility or liability with regards to
errors or misinterpretation and it should not be
considered as legal advice.
 Learning Objectives

❖Digestive System - Anatomy and Physiology

❖Common Diseases of Digestive System
❖Frequently reported procedures
❖Structure of CPT code and Description
❖Difference between Diagnostic vs Surgical Procedure
❖Open Vs Laparoscopy
❖Hernia Repair
❖Modifiers Use
Introduction - Gastrointestinal tract (GIT)

Group of organs working together to convert

food into energy and basic nutrients to feed
the body

Mechanical and chemical Breakdown of food

Absorption of nutrients into the body and

blood
 Organs - Digestive System

• Mouth
• Esophagus
Alimentary • Stomach
Canal Organs • Small Intestine
• Large Intestine

• Liver
• Gallbladder
Accessory • Pancreas
Organs
Upper and Lower GI Tracts
Functions of Digestive System
INGESTION
• Taking food into mouth

SECRETION
• Release of water, acidic buffers and enzymes into lumen of GI tract

MIXING AND PROPULSION

• Churning and propulsion of food through GI tract

DIGESTION
• Mechanical and chemical breakdown of food

ABSORPTION
• Passage of digested products from GI tract into blood and lymph

DEFECATION
• Elimination of waste product from GI tract
Basic Process of Digestion
 Disease of Digestive System
Upper GI Illness Lower GI Illness

• GERD • Irritable bowel syndrome

• Gastroparesis • Inflammatory bowel diseases
• Gastritis (like Crohn’s and ulcerative
• Peptic and duodenal Ulcers colitis)
• Esophagitis • Infections within portions of the
• Swallowing disorders lower small intestine (known as
• Infections like the H-pylori diverticulitis)
bacteria • Hemorrhoids
 GERD
•

DIAGNOSTIC PROCEDURES
DEFINE

CAUSES

SIGN & SYMPTOMS

GERD Oesophageal • Upper
• Heartburn
Occurs when Sphincter doesn't • Regurgitation Endoscopy
stomach acid work • Nausea • Ambulatory
repeatedly flows • Gastric acid • Burping acid (pH) probe
back into the tube flowing from your test
connecting your • Bloating
mouth and stomach
stomach back up • Sour taste in the • X-ray of the
(esophagus) into your food mouth upper digestive
pipe system
 Irritable Bowel Syndrome(IBS)

DIAGNOSTIC PROCEDURES
DEFINE

CAUSES
IBS Muscle contractions Abdominal Pain, Colonoscopy

SIGN & SYMPTOMS

Common disorder • in the intestine
Muscle • Abdominal
cramping CT scan
that affects the Nervous system
contractions in Pain, cramping
Bloating Upper endoscopy
stomach and Severe infection • Bloating
Changes in
intestines, also the intestine appearance of bowel
Lactose intolerance
called the •
Early life stress
Nervous system • Changes
movement
in test
gastrointestinal tract appearance
Frequency ofof
Changes in gut Stool Test
• Severe
microbes infection bowel
• Early life stress bowel
• Changes in gut movement
microbes • Frequency of
bowel
 APPENDICITIS

DIAGNOSTIC PROCEDURES
CAUSES

SIGN & SYMPTOMS

DEFINE • Rt lower
Appendicitis is an • • Blockage in the
Muscle • Abdominal
abdominal pain
• Physical
lining of the Examination
inflammation of the
contractions Pain, cramping
appendix. The appendix in
appendix is a finger- the intestine • •Bloating
Nausea • Blood Test
shaped pouch that • • This blockage
Nervous system • Changes in
sticks out from the • Constipation or •
• can cause an
Severe infection appearance
diarrhea
of Urine Test
colon on the lower
infection bowel
right side of the • Early life stress • Imaging Test
belly, also called the •movement
Abdominal
abdomen. • Changes in gut
microbes • Frequency
bloating of
bowel
 HIATAL HERNIA

DIAGNOSTIC PROCEDURES
DEFINE

CAUSES

SIGN & SYMPTOMS

HERNIA • Heartburn
Occurs when the • • Age-related
Muscle • Abdominal • Xray
changes in your
upper part of
contractions •Pain, cramping of
Regurgitation
stomach bulges diaphragm in • Upper endoscopy
through the large the intestine • Bloating
food or liquids
muscle separating • • Injury to
Nervous the area
system • Changes
into theinmouth • Oesophageal
abdomen and chest appearance of manometry
• Severe infection • Acid Reflux
• Being born with bowel
• Early
an life stress
unusually
•movement
Difficulty
• Changes in gut
large hiatus
microbes • Frequency
swallowing of
bowel
 Types of Hernia

UMBILICAL HERNIA INGUINAL HERNIA VENTRAL HERNIA

HIATAL HERNIA SPIGELIAN HERNIA FEMORAL HERNIA

LUMBAR HERNIA INCISIONAL EPIGASTRIC

HERNIA HERNIA
 Surgery - Oral cavity

EXCISION 40490-40530

REPAIR
LIPS 40650-40761
(Cheiloplasty)

OTHER 40799
PROCEDURES
 Surgery - Vestibule of Mouth
INCISION 40800-40806

EXCISION,
40808-40820
DESTRUCTION
VESTIBULE OF
MOUTH
REPAIR 40830-40845

OTHER
40899
PROCEDURES
 Digestive System Surgery
❖ Structure of CPT code and Description

❖ Diagnostic vs Surgical Procedure

❖Surgical vs Scopy

❖Esophagoscopy

❖Esophagogastroduodenoscopy

❖ERCP (Endoscopic retrograde cholangiopancreatography)

❖Transplant (Liver, Pancreas)

❖Hernia Repair

❖Modifiers Use
Structure of CPT code and Description

43200 - Esophagoscopy, flexible, transoral; diagnostic,

including collection of specimen(s) by brushing or washing,
when performed (separate procedure)
• Cells are collected for specimen by brushing or washing
and/or aspirating the Esophageal lining

43201- Esophagoscopy, flexible, transoral; with directed

submucosal injection(s), any substance

• The physician injects any substance into a specific area

through the scope while viewing the esophagus
Structure of CPT code and Description

43202 - Esophagoscopy, flexible, transoral; with biopsy,

single or multiple

• Biopsy forceps are used to obtain samples of the

Esophageal mucosa

43204 - Esophagoscopy, flexible, transoral; with injection

sclerosis of Esophageal varices

• The physician injects any substance into a specific area

through the scope while viewing the esophagus
Structure of CPT code and Description

43206 - Esophagoscopy, flexible, transoral; with optical

endomicroscopy

• Use of endomicroscope

43235 - Esophagogastroduodenoscopy, flexible, transoral;

diagnostic, including collection of specimen(s) by brushing or
washing, when performed (separate procedure)
• Specimens may be obtained by brushing or washing the
Esophageal lining with saline, followed by aspiration
 Surgery - Esophagus
Incision
Esophagoscopy

Excision

Endoscopy
Esophagogastroduodenoscopy
Laproscopy
Esophagus

Repair
Endoscopic retrograde
cholangiopancreatography
Manipulation

Other Procedures
 Esophagoscopy
Esophagoscopy

Rigid(Trans-oral) Flexible

Trans - oral Trans - nasal

 Esophagoscopy

Difference between Diagnostic vs Surgical procedure

43200 Esophagoscopy, flexible, transoral; diagnostic, including

collection of specimen(s) by brushing or washing, when performed
(separate procedure)

43201 Esophagoscopy, flexible, transoral; with directed submucosal

injection(s), any substance

43202 Esophagoscopy, flexible, transoral; with biopsy, single or

multiple

43215 Esophagoscopy, flexible, transoral; with removal of foreign

body(s)
 Esophagoscopy

43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical

esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of
telescope or operating microscope and repair, when performed

43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s)

by brushing or washing, when performed (separate procedure)
 Test Your Knowledge

1. Patient is having difficulty in swallowing and has a feeling that something

is stuck in his throat. Physician wants to evaluate for foreign body in
throat. He orders and performs the Esophagoscopy. No foreign body is
found during esophagoscopy, and everything is normal.

a 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of

specimen(s) by brushing or washing, when performed (separate procedure)
b 43201 with directed submucosal injection(s), any substance
c 43202 with biopsy, single or multiple
Ans: (a)43200 Esophagoscopy, flexible, transoral; diagnostic, including collection
of specimen(s) by brushing or washing, when performed (separate procedure
 Test Your Knowledge

2. Foreign body is removed form throat of a 5 years old boy. The physician
has removed a coin by using Esophagoscopy.

a 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of

specimen(s) by brushing or washing, when performed (separate procedure)
b 43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s)
c 43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps

Ans: (b) 43215 Esophagoscopy, flexible, transoral; with removal of

foreign body(s)
 Test Your Knowledge

3.The patient was feeling something is stuck in throat, Esophagus was examined
by Physician using Flexible esophagoscopy trans orally. 2 pearl beads were found
in esophagus.

a 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of

specimen(s) by brushing or washing, when performed (separate procedure)
b 43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s)
c 43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps

Answer: (a) 43200 (Esophagoscopy, flexible, transoral; diagnostic, including

collection of specimen(s) by brushing or washing, when performed (separate
procedure)
 Appendectomy
44950 Appendectomy;

+44955 when done for indicated purpose at time of other major procedure
(not as separate procedure) (List separately in addition to code for primary
procedure)

44960 for ruptured appendix with abscess or generalized peritonitis

44970 Laparoscopy, surgical, appendectomy

44979 Unlisted laparoscopy procedure, appendix

Coding Tip : Use modifier 52 for incidental

appendectomy
 Test Your Knowledge

1. Patient is admitted for Appendicitis. The surgeon removed the appendix

(Appendectomy) by using laparoscopy.

a 44950 Appendectomy;
b 44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis
c 44970 Laparoscopy, surgical, appendectomy

Ans: (c) 44970 (Laparoscopy, surgical, appendectomy)

ERCP(Endoscopic retrograde cholangiopancreatography)

Procedure that combines upper gastrointestinal (GI)

endoscopy and x-rays to treat problems of the bile and
pancreatic ducts.
ERCP(Endoscopic retrograde cholangiopancreatography)

ERCP

Balloon Dilation Stent

43260 ERCP; diagnostic (separate procedure)

43274 ERCP; with placement of endoscopic stent into biliary or pancreatic duct, include
sphincterotomy each stent

43277 ERCP ; with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of

ampulla (sphincteroplasty), include sphincterotomy each duct
 ERCP(Endoscopic retrograde cholangiopancreatography)

Example 1 : The patient was present for balloon dilation and stent placement at right
hepatic duct. Physician has done balloon dilation and placed the stent successfully.
How do you report this service?

Answer: 43274 ERCP; with placement of endoscopic stent into biliary or pancreatic duct,
including pre- and post-dilation and guide wire passage, when performed, including
sphincterotomy, when performed, each stent

Example 2 : The patient was present for balloon dilation at pancreatic duct and
stent placement in right hepatic duct. Physician has done balloon dilation and
placed the stent successfully. How do you report this service?

Answer: 43274, 43277 ERCP; with trans-endoscopic balloon dilation of biliary/pancreatic

duct(s) or of ampulla (sphincteroplasty),
including sphincterotomy, when performed, each duct
 Esophagogastroduodenoscopy(EGD)

EGD is a diagnostic endoscopic procedure that

includes visualization of the oropharynx,
esophagus, stomach, and proximal duodenum.
 Esophagogastroduodenoscopy(EGD)
43235 - Esophagogastroduodenoscopy, flexible, transoral; diagnostic (separate procedure);
including collection of specimen(s) by brushing or washing, when performed (separate
procedure)

43239 with biopsy, single or multiple

43247 with removal of foreign body(s)

Example : Patient is having abdominal pain, Physician has examined esophagus, stomach, but
unable to see the duodenum due to stomach ulcer. The procedure was stopped at stomach. How you
report this service?

Answer : 43235 - 52
 Hernia Repair
Clinical Considerations for Coding Changes

TYPE
SIZE NUMBER (Reducible or
Incarcerated)
 Hernia Repair- Hybrid Procedures
Prior to 2023
• Coding did not differentiate
Small vs Large Hernia Repair
• Coding did not allow
differential reporting for
“Swiss cheese” defects
• Coding for Incisional and
ventral hernia repair was not
consistent
• Coding for parastomal hernia
repair was confusing
Effective in 2023
• Size of hernias matters
• Number of hernias matters
• Type of abdominal hernia
(e.g., ventral, incisional,
spigelian) matters less than
size and number
• Parastomal hernia repair can
include mesh
Coding Change
Action
• Create codes that combine
any type of anterior
abdominal hernia, but
differentiate work based on
size of all hernias repaired
• Create code for parastomal
hernia repair
 Mesh Implantation
Prior to 2023 Effective in 2023 Coding Change
Action

• Only laparoscopic codes

include mesh as inherent

• Implantation of mesh as now

• Revise codes to include mesh
typical for both open and
implantation, when performed
laparoscopic hernia repairs
• Add-on code 46958(mesh
implant) could only be
reported with
incisional/ventral hernia codes
 Mesh Removal
Prior to 2023 Effective in 2023 Coding Change
Action

• No code to report work of

removing old mesh at the time
of hernia report
• Create a new add-on code for
• Mesh is typically places for
total or near total mesh
many hernia repair operations
removal to be reported with all
and may need removal at
abdominal hernia repair
• Reporting modifier 22 subsequent operations
codes
(increased services) was
often rejected for additional
payment
 Hernia Repair

Open Hernia Repair Codes DELETED for 2023

 Hernia Repair
Laparoscopic Hernia Repair Codes DELETED for 2023
 Hernia Repair

NEW Codes for 2023

CPT DESCRIPTOR GLOBAL

49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, 000
umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial,
including implantation of mesh or other prosthesis when performed, total
length of defect(s); less than 3 cm, reducible
49592 less than 3 cm, incarcerated or strangulated 000

49593 3 cm to 10 cm, reducible 000

49594 3 cm to 10 cm, incarcerated or strangulated 000

49595 greater than 10 cm, reducible 000

49596 greater than 10 cm, incarcerated or strangulated 000

 Hernia Repair

NEW Codes for 2023

CPT DESCRIPTOR GLOBAL

49613 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, 000
umbilical, spigelian), any approach (ie, open, laparoscopic, robotic),
recurrent, including implantation of mesh or other prosthesis when
performed, total length of defect(s); less than 3 cm, reducible
49614 less than 3 cm, incarcerated or strangulated 000

49615 3 cm to 10 cm, reducible 000

49616 3 cm to 10 cm, incarcerated or strangulated 000

49617 greater than 10 cm, reducible 000

49618 greater than 10 cm, incarcerated or strangulated 000

 Measuring Hernia Defects

Cpt codes 49591-49596(initial) and 49613-49618 (recurrent) :

➢ Reported only once based on the total defect size for one or more anterior abdominal hernia(s)

➢ Measured as the maximal craniocaudal or transverse distance between the outer margins of all
defects repaired

• The total length of the defects corresponds to the maximum width or height of an oval drawn to
encircle the outer perimeter of all repaired defects

• If the defects are not contiguous and are separated by greater than or equal to 10 cm of intact fascia,
total defect size is the sum of each defect measured individually
Measuring Hernia Defects
 Hernia- Other coding Instructions
Mesh Removal Facility E/M Work Office E/M Work

IMPORTANT: Report all IMPORTANT: Report all appropriate

E/M visits starting the day after
appropriate E/M visits starting
+49623 Removal of total or discharge.
the day after surgery.
near total non-infected mesh
or other prosthesis at the time All in-person office E/M visits, when
If the pt is admitted for several performed: 99212-99215
of initial or recurrent anterior
days, report 99231-99233 daily
abdominal hernia repair or Report all appropriate telehealth
as appropriate.
parastomal hernia repair, any E/M services, for example:
approach (ie, open, Telephone services 99441-99443
For discharge on a day after
laparoscopic, robotic)
inpatient stay, report Online digital services 99421-
99238/99239. 99423

Virtual check-in G2010-G2012

 Hernia - Clinical Scenario 1

A 55-year-old male presents with a painful mass through the umbilicus that disappears in supine position. He
undergoes open hernia repair of a defect that is less than 3 cm with placement of mesh and is discharged the
same day.

Answer : 49591
 Hernia - Clinical Scenario 2

A 60-year-old obese male with a prior laparotomy has developed an incisional hernia in the midline
incision. Over the past few months, the defect has become chronically protuberant. He reports increasing
pain and discomfort. Physical examination revealed a hernia that is tender and nonreducible by manual
manipulation. He undergoes laparoscopic hernia repair of a defect that is 6 cm with placement of mesh and
got discharged next day.

Answer : 49594 on the day of surgery

99238 or 99239 on Postop Day1

 Hernia - Clinical Scenario 3

A 70-year-old male with history abdominoperineal resection and end colostomy presents with a worsening
reducible bulge around his stoma when coughing. He has pain and discomfort around the stoma, and
difficulty keeping the stoma appliance in place due to leakage. CT scan revealed small bowel in the hernia
sac. He undergoes parastomal hernia repair with placement of mesh. He is discharged on postop day 4

Answer : 49621

Postop Day1-3 99231-99233

Postop Day 4 99238-99239
 Procedures - Upper GIT
Oral cavity • Stomach
• Mouth – lesion excision • Gastrotomy
• Lip- lesion excision and biopsy • Gastrectomy
• Tongue-glossectomy • Vagotomy
• Palatoplasty • Laparoscopy, surgical, gastric restrictive procedure;
• Salivary glands procedures • implantation or replacement of gastric neurostimulator
electrodes
• Adenoidectomy and tonsillectomy
• Gastric intubation and aspiration
Esophagus
• sleeve gastrectomy
• Esophagotomy /ectomy /scopy
• Gastrostomy
• Esophagogastroduodenoscopy
• Naso- or oro-gastric tube placement
• Laparoscopy, surgical,
esophagomyotomy • Replacement of gastrostomy tube
 Procedures - Intestine
Small intestine Large intestine
• Duodenotomy • Colectomy, partial
• Enterotomy • Colectomy, total, abdominal
• Enterectomy • Adhesiolysis
• Ileostomy or jejunostomy
• Colostomy
• Ileoscopy
• Closure of enterostomy
• Excision of Meckel's diverticulum
• Incision and drainage of appendiceal abscess
• Proctectomy
• Excision of rectal tumor
 Procedures - Liver
• Liver
• Biopsy of liver
• Hepatectomy
• Hepatectomy
• aspiration cyst(s) or abscess(es) in
liver
• Biopsy of liver, wedge
• Donor hepatectomy
• Backbench reconstruction of
cadaver or living donor liver graft
prior to allotransplantation
Modifiers - Digestive System Surgical Procedures
22-Increased Procedural Services
47-Anesthesia by Surgeon
51-Multiple procedures
52-Reduced services
53-Discontinued service
59-Distinct procedural services
78-Unplanned Return to the Operating/Procedure Room by the Same Physician or Other
Qualified Health Care Professional ,Following Initial Procedure for a Related Procedure During
the Postoperative Period
79-Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care
Professional During the Postoperative Period
 Real Time Scenario - 1
A 70-year-old female who has a history of ventral hernia and now presents with a recurrent symptomatic ventral hernia
and is advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection
was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and
one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia
where a small 2 cm defect was clearly visualized. There was some omentum, which was adhered to the hernia and this
was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code is
reported? 49591

Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach
a) 49591 (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed,
b) 49613 total length of defect(s); less than 3 cm, reducible
c) 49614
d) 49592 49613
recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less
than 3 cm, reducible
49614
recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less
than 3 cm, incarcerated or strangulated
Answer : (b) 49613
49592
initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less
than 3 cm, incarcerated or strangulated
 Real Time Scenario - 2
Preoperative Diagnosis: Chronic cholecystitis
Postoperative Diagnosis: Chronic cholecystitis
Procedure: Laparoscopic Cholecystectomy
Procedure Description: A transverse infraumbilical incision was made sharply dissecting to the subcutaneous tissue
down to the fascia using access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three
other ports were inserted under direct vision. The fundus of the gallbladder was grasped through the lateral port, where
multiple adhesions to the gallbladder were taken down sharply and bluntly: The gallbladder appeared chronically
inflamed. Dissection was carried out to the right of this identifying a small cystic duct and artery, was clipped twice
proximally, once distally and transected. The gallbladder was then taken down from the bed using electrocautery,
delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port.
47564
Laparoscopy, surgical; cholecystectomy with exploration of common duct
a) 47564, K81.2
b) 47562, K81.1 47562
Laparoscopy, surgical; cholecystectomy
c) 47610, K81.2 47610
Cholecystectomy with exploration of common duct;
d) 47600, K81.1
47600
Cholecystectomy;
Answer : (b) 47562, K81.1 K81.1
Chronic cholecystitis
K81.2
Acute cholecystitis with chronic cholecystitis
 Real Time Scenario - 3
55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a catheter placement.
The endoscope is passed through the cricopharyngeal muscle area without difficulty. Esophagus is normal, some chronic
reflux changes at the esophagogastric junction noted. Stomach significant distention with what appears to be multiple
encapsulated tablets in the stomach at least 20 to 30 of these are noted. Some of these are partially dissolved.
Endoscope could not be engaged due to high grade narrowing in the pyloric channel, the duodenum was not examined.
It seems to be a high grade outlet obstruction with a superimposed volvulus. A repeat examination is not planned at this
time. What coding is reported for this procedure?
43246
Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy
a) 43246-52 tube
b) 43241-52
43241
c) 43235 Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter
d) 43191
43235
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by
brushing or washing, when performed (separate procedure)

Answer : (b) 43241 - 52 43191

Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing
when performed (separate procedure)

52 Reduced Services
 Real Time Scenario - 4
The patient is a 78-year-old white female with morbid obesity that presented with small bowel obstruction. She had
surgery approximately one week ago and underwent exploration, which required a small bowel resection of the terminal
ileum and anastomosis leaving her with a large inferior ventral hernia. Two days ago she started having drainage from
her wound which has become more serious. She is now being taken back to the operating room. Reopening the original
incision with a scalpel, the intestine was examined and the anastomosis was reopened , excised at both ends, and
further excision of intestine. The fresh ends were created to perform another end- to-end anastomosis. The correct
procedure code is: 44120Enterectomy, resection of small intestine; single resection and anastomosis
44126
a) 44120-78 Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal
segment of intestine; without tapering
b) 44126-79
c) 44120-76 44202
Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis
d) 44202-58
76
Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Answer : (a) 44120
- 78 78 Repeat Procedure by Another Physician or Other Qualified Health Care Professional
79
Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care
Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
 Real Time Scenario - 5
PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula

POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula

PROCEDURE: Hartmann procedure, which is a sigmoid resection with Hartmann pouch and colostomy.

DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in the supine position under general
anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and Rocephin IV piggyback. A lower midline incision
was made, abdomen was entered. Upon entry into the abdomen, there was an inflammatory mass in the pelvis and there
was a large abscessed cavity, but no feces. The abscess cavity was drained and irrigated out. The left colon was
immobilized, taken down the lateral perineal attachments. The sigmoid colon was mobilized.
There was an inflammatory mass right at the area of the sigmoid colon consistent with a diverticulitis or perforation with
infection. Proximal to this in the distal left colon, the colon was divided using a GIA stapler with 3.5 mm staples. The
sigmoid colon was then mobilized using blunt dissection. The proximal rectum just distal to the inflammatory mass was
divided using a GIA stapler with 3.5 mm staples. The mesentery of the sigmoid colon was then taken down and tied
using two 0 Vicryl ties. Irrigation was again performed and the sigmoid colon was removed with inflammatory mass.
 Real Time Scenario - 5

The wall of the abscessed cavity that was next to the sigmoid colon where the inflammatory mass was, showed no leakage of stool, no
gross perforation, most likely there is a small perforation in one of the diverticula in this region. Irrigation was again performed throughout
the abdomen until totally clear. All excess fluid was removed. The distal descending colon was then brought out through a separate
incision in the lower left quadrant area and a large 10 mm 10 French JP drain was placed into the abscessed cavity. The sigmoid colon or
the colostomy site was sutured on the inside using interrupted 3-0 Vicryl to the peritoneum and then two sheets of film were placed into the
intra- abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and intermittently a #2 nylon retention suture
was placed. The colostomy was matured using interrupted 3-0 chromic sutures. I palpated the colostomy; it was completely patent with no
obstructions. Dressings were applied. Colostomy bag was applied.
a) 44140
44140
b) 44143 Colectomy, partial; with anastomosis
44143
c) 44160
Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
d) 44208

Answer : (b) 44143
44160
Colectomy, partial, with removal of terminal ileum with ileocolostomy
44208
Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic
anastomosis) with colostomy
November- HBM AAPC
Ask and learn Hernia Repair Codes
 Resources
• https://greaterorlandogi.com/2022/02/21/upper-gi-issues-versus-lower-gi-issues-whats-the-
difference/

• https://www.intechopen.com/chapters/80141

• https://www.asahq.org/madeforthismoment/preparing-for-surgery/procedures/hernia-surgery/
 Inguinal Hernia
• An inguinal hernia is often called a groin hernia due to the occurrence of a hernia
in the groin area.
• It is characterised by the bulging of abdominal contents through the weak regions
of the abdominal wall.
• Groin hernias may happen at two passages, either through the inguinal or femoral
canals
 Spigelian Hernia
• A spigelian hernia is a rare ventral hernia that is defined as herniation of
abdominal contents or peritoneum through a defect.
• The Spigelian fascia which is comprised of the transversus abdominis and the
internal oblique aponeuroses.
 Femoral Hernia
• A femoral hernia is a protrusion of a loop of the intestine through a weakened abdominal wall,
located in the lower abdomen near the thigh.
 Umbilical Hernia
• An umbilical hernia occurs when part of the intestine bulges through the opening in the
abdominal muscles near bellybutton (navel).
 Hiatal Hernia
A hiatal hernia occurs when the upper part of the stomach bulges through the
large muscle separating your abdomen and chest (diaphragm).
 Ventral Hernia
• A ventral hernia occurs when a weak spot in the abdomen enables
abdominal tissue or an organ (such as an intestine) to protrude through a
cavity muscle area.
• These hernias are visibly identified by a bulge in the belly area.