Digestive System Digestive System The digestive system is cmpsed f rgans that functin by digesting, absrbing, and eliminating fd and waste frm the bdy. The digestive system cnsists f the ral cavity (muth), thrat (pharynx), esphagus, stmach, small intestine, large intestine, liver, gallbladder, pancreas, rectum, and anus. Anatmy Oral Cavity Digestin begins with the ral cavity (r/ means muth). Fd is chewed (masticatin) and swallwed (deglutitin) t begin the digestive prcess. The fllwing structures are part f the ral cavity: Buccal cavity: Als called the vestibule f the muth Cheeks (bucc/): Inside the muth n bth sides Gums: Tissue surrunding the teeth Lips (labi/): Surrund the utside f the muth Palate (palat/): Rf f the muth Salivary glands: Excrine glands that surrund the ral cavity, which prduce saliva; saliva cntains enzymes that break dwn fd Teeth: 32 permanent teeth in the adult muth Tngue (lingu/): Muscular structure attached t the flr f the muth Tnsils: Masses f lymph tissue lcated in the back f the thrat Uvula (uvul/): Prjectin f tissue that hangs frm the palate 1
Pharynx (Thrat) The pharynx is a muscular tube that extends apprximately 5 t 6 inches, frm the muth t the esphagus, and serves as a passage fr air and fd. Epiglttis: Muscular flap (lid) that cvers the larynx when swallwing Esphagus The esphagus is a muscular tube that cntracts (peristalsis) and carries fd t the stmach. Stmach The stmach is a sac-like muscular rgan that lies just belw the diaphragm and t the right f the spleen. The stmach receives fd frm the esphagus. Small Intestine The small intestine is where a majrity f digestin and absrptin takes place. It is apprximately 20 feet lng and divided int three areas. Dudenum: Apprximately ne ft lng; first part f the small intestine Jejunum: Middle (secnd) part f the small intestine Ileum: Third part f the small intestine Large Intestine (Cln) The large intestine, als called the cln, includes the cecum, appendix, cln, and rectum. The large intestine begins at the end f the ileum and ends at the anus. The primary functin f the cln is t absrb large amunts f water and electrlytes and t mve feces tward the rectum. Liver Cecum: A small puch that jins the small and large intestines Appendix: (Appendage-hanging); A small tube that hangs frm the cecum in the RLQ f the abdmen; has n knwn purpse; if infected, it may lead t appendicitis requiring an appendectmy Cln: Main part f the large intestine; apprximately 5 feet lng; divided int fur areas 1. Ascending cln 2. Transverse cln 2 3. Descending cln 4. Sigmid cln Rectum: Last part f the large intestine that leads t the anus Anus: Opens t the utside f the bdy; expels feces The liver is lcated in the RUQ f the abdmen. The liver functins by making greenish fluid called bile and maintaining glucse levels in the bld. The liver releases bile thrugh ducts that lead t the gallbladder.
Gallbladder The gallbladder is a small pear-shaped sac that lies just belw the liver and stres bile. Pancreas The pancreas is a gland that lies behind the stmach, which functins by prducing insulin and enzymes. Surgery/Digestive System (40490-49999) The digestive system is divided by anatmy, beginning with the muth where fd enters and ending at the anus where feces is expelled. Lips (40490-40799) Vermilinectmy (40500): Shaving f the red part f the lips Repair (Cheilplasty)(Cleft lip and nasal defrmity, primary, tw stages) Cleft palate repairs: Partial, cmplete, unilateral r bilateral (use mdifier -50 fr bilateral) Vestibule f Muth (40800-40899) Incisin, excisin, destructin, repair, and ther Tngue and Flr f Muth (41000-41599) Frenum: A small flap f skin under the tngue Frentmy: Incisin perfrmed t allw mre mvement f the tngue Dentalvelar Structures (41800-41899) Prcedures n the bne (sseus) and sft structures f the muth Palate and Uvula (42000-42299) Uvula: Structure that hangs in the back f the thrat Salivary Gland and Ducts (42300-42699) Prcedures are divided by anatmy: Partid, submandibular, and sublingual 2015 Cding Alert! Cde 42508 has been deleted. 3
Pharynx, Adenids, and Tnsils (42700-42999) Cdes are based n surgical apprach Bipsy includes sample (des nt include the use f a scpe) Indirect laryngscpy: Viewing the larynx thrugh a reflectin Direct laryngscpy: Viewing the larynx directly thrugh a scpe Tnsillectmy and adenidectmy: Surgical remval f the tnsils and/r adenids; cde selectin based n age (yunger r lder than 12) Esphagus (43020-43499) Based n apprach: Cervical (neck) r thracic (chest) Endscpy cdes d nt include imaging guidance (cde frm the radilgy sectin). Mst f the cdes in this subheading include cnscius sedatin. 2015 Cding Alert! There are extensive changes in this subsectin, including new, deleted, and revised cdes. Be sure t read them thrughly. New guidelines added t Endscpy. Esphagscpy Cde 43180 (new) Cdes 43191-43193, 43195-43196, 43198-43206, 43211-43214, and 43217-43233 (new instructins and resequenced) Cdes 43194, 43197, and 43215-43216 (revised) Esphaggastrdudenscpy New guidelines added Cdes 43233-43249 and 43251-43270 (new instructins and resequenced) Cdes 43247 and 43250 (revised) Endscpic Retrgrade Chlangipancreatgraphy (ERCP) New guidelines added Cdes 43260-43265 and 43274-43278 (new instructins and resequenced) Manipulatin Cde 43460 (new instructins) 4
Stmach (43500-43999) Open incisin prcedures Rux-en-Y (RNY): Y shaped surgical cnnectin; used fr intestinal bypass prcedures Bariatric prcedures: Perfrmed t treat mrbidly bese patients 2015 Cding Alert! Cde 43640 cntains new instructins. Intestines (Except Rectum) (44005-44799) Clstmies are always bundled in a majr prcedure. Cde endscpic prcedure t the furthest extent that the scpe advances. Anastmses: Perfrmed by remving a diseased prtin f the intestine thrugh a stma (artificial pening) in the abdminal wall and rejining; there are three types: 1. End t end 2. End t side 3. Side t side Extensive add-n cdes in this sectin (add-n cdes may nt be cded alne) Cde 44500 is mdifier -51 exempt 2015 Cding Alert! There are extensive changes in this subsectin, including new and revised cdes as well as new guidelines. Be sure t read them thrughly. Endscpy, Small Intestine New guidelines Cdes 44360 and 44363 (revised) Cdes 44376-44379 (new instructins) Endscpy, Stmal New title and guidelines Cdes 44380, 44385-44388, and 44390-44392 (revised) Cdes 44382, 44389, and 44394 (new instructins) Cdes 44381, 44384, and 44401-44408 (new) Other Prcedures Cde 44799 (revised) Meckel s Diverticulum and the Mesentery (44800 44899) Meckel s diverticulum is a cngenital puch n the wall f the small intestine that may require surgical remval (44800) 5
Appendix (44900-44979) Appendicitis: Inflammatin f the appendix; usually affects yung adults; treatment is appendectmy; pen r thrugh a scpe When a healthy appendix is remved during anther pen prcedure, the prcedure is incidental and, therefre, is nt cded. Cde selectin is based n apprach (pen, percutaneusly, r thrugh a scpe). Cln and Rectum (45000-45999) Prcedures divided by anatmy: Rectum, sigmid cln, and cln. 2015 Cding Alert! There are extensive changes in this subsectin, including new and revised cdes as well as new guidelines. Be sure t read them thrughly. Endscpy Anus (46020-46999) New guidelines added Cdes 45330, 45332-45334, 45337, 45340, 45378-45382, 45384-45386, and 45391-45392 (revised) Cdes 45346-45347, 45349-45350, 45388-45390, 45393, and 45398 (new and resequenced) Hemrrhids: inflammatin arund the anus; may be inside r utside; cde based n extent 1. First degree: Bleeding, n prtrusin utside f the anus 2. Secnd degree: Prtrudes utside the anus ccasinally 3. Third degree: Prtrudes utside ften 4. Furth degree: Cannt be manually placed back inside the anus; may be strangulated 2015 Cding Alert! Cdes 46221, 46500, 46606, and 46762 cntain new instructins. Cde 46600 has been revised. Cdes 46601 and 46607 are new. Liver (47000-47399) Transplant is very cmplex; usually requires a team f surgens (use mdifiers) 2015 Cding Alert! Cde 47383 is new. Biliary Tract (47400-47999) Prcedures n the gallbladder 6
Pancreas (48000-48999) Prcedures perfrmed due t pancreatitis (inflammatin f the pancreas); diabetes patients. Abdmen, Peritneum, and Omentum (49000-49999) Use 49320 t reprt a diagnstic laparscpy. Hernia cdes are based n type f hernia. 2015 Cding Alert! Cdes 49323 and 49406 cntain new instructins. 7