Coders' Specialty Guide 2021: Gastroenterology

Gastroenterology Contents

Introduction ��3 General ��5 Respiratory System ��11 Hemic and Lymphatic Systems ��13 Digestive System ��14 Urinary System ��700 Operating Microscope ��702 Radiology ��703 Pathology and Laboratory ��736 Medicine ��765 Evaluation and Management ��802 Category III Codes ��894 HCPCS Codes •• Enteral and Parenteral Therapy ��900 •• Procedures/Professional Services ��901 •• Drugs Administered Other Than Oral Method ��916 •• Temporary National Codes (Non-Medicare) ��917 •• Hearing Services ��920 ICD-10 CrossRef Details ��921 Modifier Descriptors �� 1035 Terminology �� 1045 Code Index �� 1079 Digestive System Coders’ Specialty Guide 2021: Gastroenterology 40527 — 40527 40527 — Fee Schedule 40527 Medicare Fees National Conversion Factor: 36.0896, Facility: $573.10, Non Facility: $573.10, OPPS Facility: $278.61, OPPS Non Facility: $278.61 Excision of lip; full thickness, reconstruction with cross lip flap RVU Facility Work RVU: 7.72, PE RVU: 6.99, Malpractice RVU: 1.17, (Abbe-Estlander) Total RVU: 15.88 RVU Non-Facility Work RVU: 7.72, PE RVU: 6.99, Malpractice RVU: Clinical Responsibility 1.17, Total RVU: 15.88 When the patient is appropriately prepped and anesthetized, the Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: provider incises the full thickness lip area and mucosa often using 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic a V-shaped incision and removes the affected area and margins of Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: healthy tissue. He then creates a skin flap from the upper lip, and None, MUE: 2 cross transfers it, using sutures to close the wound. The provider Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, performs this procedure to repair large defects of the lips. 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU Fee Schedule CCI Alerts (version 25.3) Medicare Fees National Conversion Factor: 36.0896, Facility: $639.87, 0 0 0 0 0 1 1 1 Non Facility: $639.87, OPPS Facility: $336.36, OPPS Non Facility: 00170 , 0213T , 0216T , 0228T , 0230T , 11000 , 11001 , 11004 , $336.36 110051, 110061, 110421, 110431, 110441, 110451, 110461, 110471, 1 1 1 1 1 1 1 1 RVU Facility Work RVU: 9.32, PE RVU: 7.15, Malpractice RVU: 1.26, 11440 , 11441 , 11442 , 11443 , 11444 , 11446 , 11640 , 11641 , Total RVU: 17.73 116421, 116431, 116441, 116461, 120011, 120021, 120041, 120051, 1 1 1 1 1 1 1 1 RVU Non-Facility Work RVU: 9.32, PE RVU: 7.15, Malpractice RVU: 12006 , 12007 , 12011 , 12013 , 12014 , 12015 , 12016 , 12017 , 1.26, Total RVU: 17.73 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 1 1 1 1 1 1 1 1 Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: 12037 , 12041 , 12042 , 12044 , 12045 , 12046 , 12047 , 12051 , 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 1 1 1 1 1 1 1 1 Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: 13102 , 13120 , 13121 , 13122 , 13131 , 13132 , 13133 , 13151 , None, MUE: 2 131521 1 1 1 1 1 1 1 , 13153 , 36000 , 36400 , 36405 , 36406 , 36410 , 36420 , Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 405001, 1 1 1 1 1 1 0 0 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, 40510 , 40527 , 43752 , 51701 , 51702 , 51703 , 62320 , 62321 , QJ, XE, XP, XS, XU 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, CCI Alerts (version 25.3) 0 0 0 0 0 0 0 0 64448 , 64449 , 64450 , 64461 , 64462 , 64463 , 64479 , 64480 , 0 0 0 0 0 1 1 1 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 00170 , 0213T , 0216T , 0228T , 0230T , 11000 , 11001 , 11004 , 110051 1 1 1 1 1 1 1 644920, 644930, 644940, 644950, 645050, 645100, 645170, 645200, , 11006 , 11042 , 11043 , 11044 , 11045 , 11046 , 11047 , 114401 1 1 1 1 1 1 1 645300, 699900, 920121, 920141, 925020, 930001, 930051, 930101, , 11441 , 11442 , 11443 , 11444 , 11446 , 11640 , 11641 , 116421 1 1 1 1 1 1 1 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, , 11643 , 11644 , 11646 , 12001 , 12002 , 12004 , 12005 , 120061 1 1 1 1 1 1 1 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, , 12007 , 12011 , 12013 , 12014 , 12015 , 12016 , 12017 , 120181 1 1 1 1 1 1 1 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, , 12020 , 12021 , 12031 , 12032 , 12034 , 12035 , 12036 , 120371 1 1 1 1 1 1 1 963681, 963721, 963741, 963751, 963761, 963771, 965230, 975971, , 12041 , 12042 , 12044 , 12045 , 12046 , 12047 , 12051 , 120521 1 1 1 1 1 1 1 975981, 976021, 991550, 991560, 991570, 992111, 992121, 992131, , 12053 , 12054 , 12055 , 12056 , 12057 , 13100 , 13101 , 131021 1 1 1 1 1 1 1 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, , 13120 , 13121 , 13122 , 13131 , 13132 , 13133 , 13151 , 131521 1 1 1 1 1 1 1 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, , 13153 , 36000 , 36400 , 36405 , 36406 , 36410 , 36420 , 364251 1 1 0 0 1 1 1 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, , 36430 , 36440 , 36591 , 36592 , 36600 , 36640 , 40500 , 405101 1 1 1 1 1 0 0 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, , 40520 , 43752 , 51701 , 51702 , 51703 , 62320 , 62321 , 623220 0 0 0 0 0 0 0 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, , 62323 , 62324 , 62325 , 62326 , 62327 , 64400 , 64402 , 644050 0 0 0 0 0 0 0 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, , 64408 , 64410 , 64413 , 64415 , 64416 , 64417 , 64418 , 644200 0 0 0 0 0 0 0 993771, 993781, 994460, 994470, 994480, 994490, 994510, 994520, , 64421 , 64425 , 64430 , 64435 , 64445 , 64446 , 64447 , 644480 0 0 0 0 0 0 0 994950, 994960, G04631, G04711, J20011 , 64449 , 64450 , 64461 , 64462 , 64463 , 64479 , 64480 , 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645100, 645170, 645200, 0 0 1 1 0 1 1 1 ICD-10 CrossRef 64530 , 69990 , 92012 , 92014 , 92502 , 93000 , 93005 , 93010 , Dig 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, C00.0-C00.9, C43.0, C44.00-C44.09, C76.0, D03.0, D04.0, D10.0, 1 1 1 1 1 1 1 1 94680 , 94681 , 94690 , 94770 , 95812 , 95813 , 95816 , 95819 , es D22.0, D23.0, D37.01, K13.0, T81.40XA-T81.40XS 1 1 1 1 1 1 1 1 95822 , 95829 , 95955 , 96360 , 96361 , 96365 , 96366 , 96367 , tiv 963681, 963721, 963741, 963751, 963761, 963771, 965230, 975971, 975981, 976021, 991550, 991560, 991570, 992111, 992121, 992131, e S

992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, ys 1 1 1 1 1 1 1 1 99223 , 99231 , 99232 , 99233 , 99234 , 99235 , 99236 , 99238 , t

1 1 1 1 1 1 1 1 e

99239 , 99241 , 99242 , 99243 , 99244 , 99245 , 99251 , 99252 , m

Modiier: 0 = not allowed, 1 = allowed CPT® is a registered trademark of the American Medical Association. 17 CPT © 2020 American Medical Association. All rights reserved. Coders’ Specialty Guide 2021: Gastroenterology Digestive System 40530 — 40650

992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 645200, 645300, 699900, 920121, 920141, 925020, 930001, 930051, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 993771, 993781, 994460, 994470, 994480, 994490, 994510, 994520, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 994950, 994960, G04631, G04711 963671, 963681, 963721, 963741, 963751, 963761, 963771, 965230, 975971, 975981, 976021, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, ICD-10 CrossRef 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 40530 — 40650 C00.0-C00.9, C43.0, C44.00-C44.09, C76.0, D03.0, D04.0, D10.0, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, D22.0, D23.0, D37.01, K13.0, T81.40XA-T81.40XS 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994510, 40530 994520, 994950, 994960, G04631, G04711, J06701, J20011

Resection of lip, more than one-fourth, without reconstruction ICD-10 CrossRef C00.0-C00.9, C43.0, C44.00-C44.09, C47.0, C49.0, C76.0, D03.0, Clinical Responsibility D04.0, D10.0, D22.0, D23.0, D37.01, K13.0 When the patient is appropriately prepped and anesthetized, the provider incises a patient's lip and resects the diseased or damaged area and surrounding tissue excising more than one fourth of the lip. He closes the area and repairs the incision 40650 in layers using sutures but does not reconstruct surrounding structures. Repair lip, full thickness; vermilion only Fee Schedule Clinical Responsibility Medicare Fees National Conversion Factor: 36.0896, Facility: $414.67, When the patient is appropriately prepped and anesthetized, the Non Facility: $563.36, OPPS Facility: $199.94, OPPS Non Facility: provider closes a full thickness tear of the vermilion using sutures. $199.94 The vermilion is the external red area of the upper and lower lips RVU Facility Work RVU: 5.54, PE RVU: 5.16, Malpractice RVU: 0.79, that extends from where the surrounding facial skin connects on Total RVU: 11.49 the exterior of the lip to the labial mucosa, or the inside lining of RVU Non-Facility Work RVU: 5.54, PE RVU: 9.28, Malpractice RVU: the lips. He closes the incision with sutures and applies a dressing 0.79, Total RVU: 15.61 as necessary. Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Coding Tips Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: Code 40650 identifies the repair of a laceration that involves the None, MUE: 2 full thickness of the lip and the vermilion border. 40652, Repair lip, Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, full thickness; up to half vertical height, involves a laceration or 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, surgical wound that extends through the full thickness of the lip, XS, XU including the vermilion border, whose size extends up to one half of the vertical height of the lip. So report 40652 for a repair that CCI Alerts (version 25.3) extends beyond the vermilion. 001700, 0213T0, 0216T0, 0228T0, 0230T0, 110001, 110011, 110041, 110051, 110061, 110421, 110431, 110441, 110451, 110461, 110471, Fee Schedule 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, Medicare Fees National Conversion Factor: 36.0896, Facility: $317.23, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, Non Facility: $478.91, OPPS Facility: $136.42, OPPS Non Facility: 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, $136.42 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, RVU Facility Work RVU: 3.78, PE RVU: 4.33, Malpractice RVU: 0.68, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, Total RVU: 8.79 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 1 1 1 1 1 1 1 0 RVU Non-Facility Work RVU: 3.78, PE RVU: 8.81, Malpractice RVU: m 36405 , 36406 , 36410 , 36420 , 36425 , 36430 , 36440 , 36591 , e 0 1 1 1 1 1 1 0 0.68, Total RVU: 13.27 t 36592 , 36600 , 36640 , 43752 , 51701 , 51702 , 51703 , 62320 , Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, ys 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic S 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, e e Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 0 0 0 0 0 0 0 0 None, MUE: 2 tiv 64447 , 64448 , 64449 , 64450 , 64461 , 64462 , 64463 , 64479 , 0 0 0 0 0 0 0 0 Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78,

es 64480 , 64483 , 64484 , 64486 , 64487 , 64488 , 64489 , 64490 , 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, 644910, 644920, 644930, 644940, 644950, 645050, 645100, 645170, QJ, XE, XP, XS, XU Dig

18 CPT® is a registered trademark of the American Medical Association. Modiier: 0 = not allowed, 1 = allowed CPT © 2020 American Medical Association. All rights reserved. Digestive System Coders’ Specialty Guide 2021: Gastroenterology 41009 — 41010 41009 — 41010 ICD-10 CrossRef 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 410181, 437521, 491851, 494241, E08.638, E09.638, K08.89, K09.8, K09.9, K12.2, K13.1-K13.4, K13.6, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, K13.70, K13.79, K14.6, K14.8, K91.61, K91.62, K91.840, K91.841, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, K91.870, K91.871, L03.211, L03.212, M27.2, Q38.3, R22.0, R22.1, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, Z86.003 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645100, 645170, 645200, 645300, 699900, 920121, 41009 920141, 925020, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, Intraoral incision and drainage of abscess, cyst, or hematoma of 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, tongue or floor of mouth; masticator space 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 965230, 991550, 991560, 991570, 992111, Clinical Responsibility 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, When the patient is appropriately prepped and anesthetized, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, the provider makes an intraoral incision over the abscess, cyst, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, or hematoma in the masticator space. The incision goes into the 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, floor of the mouth near the back to reach the space containing the 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, masticator muscles and the ramus, which is the angled portion 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, of the lower jaw near the hinge. He reaches the abscess, cyst, or 994510, 994520, 994950, 994960, G04631, G04711, J06701, J20011 hematoma. The provider drains the abscess, cyst, or hematoma. He then applies sterile saline solution and closes the incision. ICD-10 CrossRef Coding Tips E08.638, E09.638, K04.6, K04.7, K05.20, K08.81-K08.89, K09.8, K09.9, K12.2, K13.1-K13.4, K13.6, K13.70, K13.79, K14.6, K14.8, K68.11, Before choosing your final code, review 41000 to 41009 to be sure K91.870, K91.871, L02.01, L03.211, L03.212, M79.11, M79.18, Q38.6, you've chosen the most appropriate code for the intraoral incision R22.0, R22.1, Z86.003 with drainage of the abscess, cyst, or hematoma based on the different spaces in the mouth.

See 41015 to 41018 when the provider performs extraoral incision and drainage of an abscess, cyst, or hematoma by advancing into 41010 different spaces in the mouth. Incision of lingual frenum (frenotomy) Fee Schedule Clinical Responsibility Medicare Fees National Conversion Factor: 36.0896, Facility: $295.57, Non Facility: $426.22, OPPS Facility: $133.89, OPPS Non Facility: When the patient is appropriately prepped and anesthetized, the $133.89 provider makes an incision in the lingual frenum, which is the RVU Facility Work RVU: 3.71, PE RVU: 4.10, Malpractice RVU: 0.38, band connecting the floor of the mouth to the alveolar ridge and Total RVU: 8.19 the bottom of the tongue. After the incision, the provider may RVU Non-Facility Work RVU: 3.71, PE RVU: 7.72, Malpractice RVU: place sutures, but he does not suture the incised frenum ends 0.38, Total RVU: 11.81 together because the goal is to free the frenum to allow increased Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: movement of the tongue. 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: Coding Tips None, MUE: 2 Be sure to distinguish lingual frenectomy from frenotomy. Use Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 41115 for frenectomy, which is excision of the frenum. Use 41010 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, if the provider performs only an incision or clipping of the frenum, QJ, XE, XP, XS, XU which is frenotomy.

Use 41520 if the provider performs frenoplasty. Dig CCI Alerts (version 25.3)

001700, 0213T0, 0216T0, 0228T0, 0230T0, 100301, 100601, 100611, es

101601, 120011, 120021, 120041, 120051, 120061, 120071, 120111, tiv 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 1 1 1 1 1 1 1 1 e

12031 , 12032 , 12034 , 12035 , 12036 , 12037 , 12041 , 12042 , S 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, ys

120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, t 1 1 1 1 1 1 1 1 e 13122 , 13131 , 13132 , 13133 , 13151 , 13152 , 13153 , 36000 , m

Modiier: 0 = not allowed, 1 = allowed CPT® is a registered trademark of the American Medical Association. 45 CPT © 2020 American Medical Association. All rights reserved. Coders’ Specialty Guide 2021: Gastroenterology Digestive System 41015 — 41015

Illustration ICD-10 CrossRef

Lingual frenulum M26.03, M26.74, Q38.3

41015

41015 — Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual

Incision site Clinical Responsibility 41010 When the patient is appropriately prepped and anesthetized, the provider makes an extraoral incision into the tissue near the lower border of the mandible, which is the lower jaw. He goes Fee Schedule through the space under the chin, dissecting muscle such as the suprahyoid to reach the sublingual space beneath the tongue. The Medicare Fees National Conversion Factor: 36.0896, Facility: $111.52, provider drains the abscess, cyst, or hematoma. He then may place Non Facility: $215.45, OPPS Facility: $40.06, OPPS Non Facility: a drain at the site of incision and sutures the incision. $40.06 RVU Facility Work RVU: 1.11, PE RVU: 1.83, Malpractice RVU: 0.15, Total RVU: 3.09 Coding Tips RVU Non-Facility Work RVU: 1.11, PE RVU: 4.71, Malpractice RVU: Before choosing your final code, review 41015to 41018 to be sure 0.15, Total RVU: 5.97 you've chosen the most appropriate code for the incision and Indicators Preoperative: 10.00, Intraoperative: 80.00, Postoperative: drainage of the abscess, cyst, or hematoma based on the different 10.00, Total RVU: 100, Global Period: 010, Radiology Diagnostic spaces in the mouth. Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1 See 41000 to 41009 when the provider performs intraoral incision Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, and drainage of an abscess, cyst, or hematoma by advancing into 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, different spaces in the mouth. QJ, XE, XP, XS, XU Illustration CCI Alerts (version 25.3) 0 0 0 0 0 1 1 1 00170 , 0213T , 0216T , 0228T , 0230T , 11000 , 11001 , 11004 , Hematoma 110051, 110061, 110421, 110431, 110441, 110451, 110461, 110471, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, Sublingual 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, space 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645100, 645170, 0 0 0 1 1 0 1 1 64520 , 64530 , 69990 , 92012 , 92014 , 92502 , 93000 , 93005 , Mylohyoid 1 1 1 1 1 1 1 1 93010 , 93040 , 93041 , 93042 , 93318 , 93355 , 94002 , 94200 , muscle 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 1 1 1 1 1 1 1 1 95819 , 95822 , 95829 , 95955 , 96360 , 96361 , 96365 , 96366 , Tube 963671, 963681, 963721, 963741, 963751, 963761, 963771, 965230, 1 1 1 0 0 0 1 1 m 97597 , 97598 , 97602 , 99155 , 99156 , 99157 , 99211 , 99212 , e 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, t 41015 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, ys 1 1 1 1 1 1 1 1

S 99238 , 99239 , 99241 , 99242 , 99243 , 99244 , 99245 , 99251 , 1 1 1 1 1 1 1 1 e e 99252 , 99253 , 99254 , 99255 , 99291 , 99292 , 99304 , 99305 , Fee Schedule 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, tiv 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, Medicare Fees National Conversion Factor: 36.0896, Facility: $321.92, 1 1 1 0 0 0 0 0 es 99375 , 99377 , 99378 , 99446 , 99447 , 99448 , 99449 , 99451 , Non Facility: $418.64, OPPS Facility: $147.25, OPPS Non Facility: 994520, 994950, 994960, G04631, G04711, J06701, J20011 $147.25 Dig

46 CPT® is a registered trademark of the American Medical Association. Modiier: 0 = not allowed, 1 = allowed CPT © 2020 American Medical Association. All rights reserved. Digestive System Coders’ Specialty Guide 2021: Gastroenterology 41530 — 41599 41530 — 41599 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 645050, 645100, 645170, 645200, 645300, 699900, 920121, 920141, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, GA, GC, GJ, GR, KX, PD, Q5, Q6, 925020, 930001, 930051, 930101, 930401, 930411, 930421, 933181, QJ, XE, XP, XS, XU 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, CCI Alerts (version 25.3) 963761, 963771, 965230, 975971, 975981, 976021, 991550, 991560, 001700, 0213T1, 0216T1, 120011, 120021, 120041, 120051, 120061, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 994480, 994490, 994510, 994520, 994950, 994960, G04631, G04711, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, J06701, J20011 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644151, 644161, 644171, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644501, 644610, ICD-10 CrossRef 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, K14.8, M26.03, M26.04, Q38.1, Q38.3 644880, 644890, 644901, 644910, 644920, 644931, 644940, 644950, 645050, 645100, 645170, 645200, 645300, 699900, 920121, 920141, 925021, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 41530 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 1 1 0 0 0 0 1 1 Submucosal ablation of the tongue base, radiofrequency, 1 or 96376 , 96377 , 96523 , 99155 , 99156 , 99157 , 99211 , 99212 , 1 1 1 1 1 1 1 1 more sites, per session 99213 , 99214 , 99215 , 99217 , 99218 , 99219 , 99220 , 99221 , 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, Clinical Responsibility 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, During this procedure, the physician ablates submucosal 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, tissue of the tongue base using radiofrequency to reduce tissue 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, volume, often on more than one site. This procedure may also 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994510, be referred to as radiofrequency tissue volume reduction (RTVR) 994520, 994950, 994960, G04631, G04711, J06701, J20011 and is often used to treat obstructive sleep apnea. The physician utilizes radiofrequency waves to destroy diseased submucosal tissue beneath the tongue. This code should be reported for each ICD-10 CrossRef session. C01, C02.1-C02.4, C02.8, C02.9, C79.89, D00.00-D00.08, D10.1, D37.02-D37.05, D37.09, G47.30, G47.33, K14.8, Q38.2, Q38.3 Coding Tips This procedure is performed in an outpatient setting under local anesthesia. It has a postoperative period that includes the duration of pain and swelling. CPT® 41530 includes removal of obstructive 41599 tissues in multiple sites at the base of the tongue and may need several sessions to complete. This procedure should only be Unlisted procedure, tongue, floor of mouth reported once per session. Clinical Responsibility Fee Schedule The provider performs a procedure on the tongue or floor of the mouth that is not represented by any of the standard and active Medicare Fees National Conversion Factor: 36.0896, Facility: $385.08, CPT® codes available. Consult the provider, if possible, to ensure Non Facility: $978.75, OPPS Facility: $126.31, OPPS Non Facility: that proper documentation has been done before billing for an $126.31 unlisted procedure. RVU Facility Work RVU: 3.50, PE RVU: 6.69, Malpractice RVU: 0.48, Dig Total RVU: 10.67 Coding Tips es RVU Non-Facility Work RVU: 3.50, PE RVU: 23.14, Malpractice RVU: 0.48, Total RVU: 27.12 CPT® guidelines instruct that you should not choose a code that tiv

Indicators Preoperative: 0.00, Intraoperative: 0.00, Postoperative: merely approximates the service provided. You should report the e 0.00, Total RVU: 0, Global Period: 000, Radiology Diagnostic Test: 99, service using only the appropriate unlisted procedure code if no S ys Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, such specific procedure or service code exists. t

MUE: 1 e m

Modiier: 0 = not allowed, 1 = allowed CPT® is a registered trademark of the American Medical Association. 67 CPT © 2020 American Medical Association. All rights reserved. Coders’ Specialty Guide 2021: Gastroenterology Digestive System 41800 — 41800

You must report a Category III code when available in place of an Use 41806 if the provider removes embedded foreign bodies from unlisted procedure code. the bone in dentoalveolar structures.

When reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes and Illustration compare your service to those codes to justify the claim amount you are billing. Also include the operative notes and/or other

41800 — relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case-by-case basis, and they will determine payment based on the documentation you provide.

Fee Schedule Inflamed pulp tissue Infected pulp tissue Medicare Fees National Conversion Factor: 36.0896, Facility: $0.00, Non Facility: $0.00, OPPS Facility: $0.00, OPPS Non Facility: $0.00 RVU Facility Work RVU: 0.00, PE RVU: 0.00, Malpractice RVU: 0.00, Decay Total RVU: 0.00 RVU Non-Facility Work RVU: 0.00, PE RVU: 0.00, Malpractice RVU: 0.00, Total RVU: 0.00 Indicators Preoperative: 0.00, Intraoperative: 0.00, Postoperative: 0.00, Total RVU: 0, Global Period: YYY, Radiology Diagnostic Test: 99, Code Status: C, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1 Infected Modifier Allowances 51, 52, 53, 59, 62, 78, 79, 80, 81, 82, AR, AS, GY, pulp GZ, KX, XE, XP, XS, XU

Abscess CCI Alerts (version 25.3) 965230 41800

ICD-10 CrossRef Fee Schedule C01, C02.0-C02.3, C02.8, C02.9, C04.0-C04.9, D00.06, D00.07, D10.1, Medicare Fees National Conversion Factor: 36.0896, Facility: $157.71, D10.2, D37.02, K13.21, K13.29, K14.1-K14.5, K14.8, K14.9, Q38.3, Non Facility: $302.43, OPPS Facility: $45.83, OPPS Non Facility: S00.502D, S00.502S, S00.512D, S00.512S, S00.522D, S00.522S, $45.83 S00.532D, S00.532S, S00.542D, S00.542S, S00.552D, S00.552S, RVU Facility Work RVU: 1.27, PE RVU: 2.88, Malpractice RVU: 0.22, S00.562D, S00.562S, S00.572D, S00.572S, Z85.810, Z86.005 Total RVU: 4.37 RVU Non-Facility Work RVU: 1.27, PE RVU: 6.89, Malpractice RVU: 0.22, Total RVU: 8.38 Indicators Preoperative: 10.00, Intraoperative: 80.00, Postoperative: 41800 10.00, Total RVU: 100, Global Period: 010, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: Drainage of abscess, cyst, hematoma from dentoalveolar None, MUE: 2 structures Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, Clinical Responsibility XS, XU When the patient is appropriately prepped and anesthetized, the provider identifies the site of the abscess, hematoma, or cyst. In a CCI Alerts (version 25.3) typical procedure, he uses a scalpel to make an incision at the root 001700, 0213T0, 0216T0, 0228T0, 0230T0, 100301, 100601, 100611, of the tooth to reach the abscess, hematoma, or cyst and allows it 101601, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 1 1 1 1 1 1 1 1 m to drain. The provider may use a drain to help remove the abscess, 12013 , 12014 , 12015 , 12016 , 12017 , 12018 , 12020 , 12021 , e hematoma, or cyst. After the procedure, he covers the site with an 1 1 1 1 1 1 1 1 t 12031 , 12032 , 12034 , 12035 , 12036 , 12037 , 12041 , 12042 , antibiotic filling, possibly leaving the drain in place. 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, ys

S 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, e e Coding Tips 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 1 1 1 1 1 1 1 1

tiv 36400 , 36405 , 36406 , 36410 , 36420 , 36425 , 36430 , 36440 , Use 41805 if the provider removes embedded foreign bodies from 365910, 365920, 366001, 366401, 437521, 491851, 494241, 517011, es the soft tissues in dentoalveolar structures. 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, Dig

68 CPT® is a registered trademark of the American Medical Association. Modiier: 0 = not allowed, 1 = allowed CPT © 2020 American Medical Association. All rights reserved. Digestive System Coders’ Specialty Guide 2021: Gastroenterology 42955 — 42960 42955 — 42960 Modifier Allowances 22, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, RVU Non-Facility Work RVU: 8.01, PE RVU: 12.60, Malpractice RVU: 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ, 1.09, Total RVU: 21.70 XE, XP, XS, XU Indicators Preoperative: 9.00, Intraoperative: 81.00, Postoperative: 10.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: CCI Alerts (version 25.3) None, MUE: 1 001700, 0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, Modifier Allowances 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, QJ, XE, XP, XS, XU 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, CCI Alerts (version 25.3) 1 1 1 1 1 1 1 1 13151 , 13152 , 13153 , 36000 , 36400 , 36405 , 36406 , 36410 , 0 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 00170 , 0213T , 0216T , 0228T , 0230T , 12001 , 12002 , 12004 , 36420 , 36425 , 36430 , 36440 , 36591 , 36592 , 36600 , 36640 , 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 12005 , 12006 , 12007 , 12011 , 12013 , 12014 , 12015 , 12016 , 43752 , 51701 , 51702 , 51703 , 62320 , 62321 , 62322 , 62323 , 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 12017 , 12018 , 12020 , 12021 , 12031 , 12032 , 12034 , 12035 , 62324 , 62325 , 62326 , 62327 , 64400 , 64402 , 64405 , 64408 , 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 12036 , 12037 , 12041 , 12042 , 12044 , 12045 , 12046 , 12047 , 64410 , 64413 , 64415 , 64416 , 64417 , 64418 , 64420 , 64421 , 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 12051 , 12052 , 12053 , 12054 , 12055 , 12056 , 12057 , 13100 , 64425 , 64430 , 64435 , 64445 , 64446 , 64447 , 64448 , 64449 , 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 13101 , 13102 , 13120 , 13121 , 13122 , 13131 , 13132 , 13133 , 64450 , 64461 , 64462 , 64463 , 64479 , 64480 , 64483 , 64484 , 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 13151 , 13152 , 13153 , 36000 , 36400 , 36405 , 36406 , 36410 , 64486 , 64487 , 64488 , 64489 , 64490 , 64491 , 64492 , 64493 , 1 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 36420 , 36425 , 36430 , 36440 , 36591 , 36592 , 36600 , 36640 , 64494 , 64495 , 64505 , 64510 , 64517 , 64520 , 64530 , 69990 , 1 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 43752 , 51701 , 51702 , 51703 , 62320 , 62321 , 62322 , 62323 , 92012 , 92014 , 92502 , 93000 , 93005 , 93010 , 93040 , 93041 , 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 62324 , 62325 , 62326 , 62327 , 64400 , 64402 , 64405 , 64408 , 93042 , 93318 , 93355 , 94002 , 94200 , 94250 , 94680 , 94681 , 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 64410 , 64413 , 64415 , 64416 , 64417 , 64418 , 64420 , 64421 , 94690 , 94770 , 95812 , 95813 , 95816 , 95819 , 95822 , 95829 , 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 64425 , 64430 , 64435 , 64445 , 64446 , 64447 , 64448 , 64449 , 95955 , 96360 , 96361 , 96365 , 96366 , 96367 , 96368 , 96372 , 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 64450 , 64461 , 64462 , 64463 , 64479 , 64480 , 64483 , 64484 , 96374 , 96375 , 96376 , 96377 , 96523 , 99155 , 99156 , 99157 , 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 64486 , 64487 , 64488 , 64489 , 64490 , 64491 , 64492 , 64493 , 99211 , 99212 , 99213 , 99214 , 99215 , 99217 , 99218 , 99219 , 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 64494 , 64495 , 64505 , 64510 , 64517 , 64520 , 64530 , 69990 , 99220 , 99221 , 99222 , 99223 , 99231 , 99232 , 99233 , 99234 , 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 92012 , 92014 , 92502 , 93000 , 93005 , 93010 , 93040 , 93041 , 99235 , 99236 , 99238 , 99239 , 99241 , 99242 , 99243 , 99244 , 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 93042 , 93318 , 93355 , 94002 , 94200 , 94250 , 94680 , 94681 , 99245 , 99251 , 99252 , 99253 , 99254 , 99255 , 99291 , 99292 , 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 94690 , 94770 , 95812 , 95813 , 95816 , 95819 , 95822 , 95829 , 99304 , 99305 , 99306 , 99307 , 99308 , 99309 , 99310 , 99315 , 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 95955 , 96360 , 96361 , 96365 , 96366 , 96367 , 96368 , 96372 , 99316 , 99334 , 99335 , 99336 , 99337 , 99347 , 99348 , 99349 , 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 96374 , 96375 , 96376 , 96377 , 96523 , 99155 , 99156 , 99157 , 99350 , 99374 , 99375 , 99377 , 99378 , 99446 , 99447 , 99448 , 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 1 99211 , 99212 , 99213 , 99214 , 99215 , 99217 , 99218 , 99219 , 99449 , 99451 , 99452 , 99495 , 99496 , G0463 , G0471 , J0670 , 1 1 1 1 1 1 1 1 J20011 99220 , 99221 , 99222 , 99223 , 99231 , 99232 , 99233 , 99234 , 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, ICD-10 CrossRef 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, S01.502A, S01.512A, S01.532A, S01.542A, S01.552A, S10.0XXD, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, S10.0XXS, S10.10XD, S10.10XS, S10.11XD, S10.11XS, S10.12XD, 994490, 994510, 994520, 994950, 994960, G04631, G04711, J06701, S10.12XS, S10.14XD, S10.14XS, S11.20XA, S11.21XA, S11.22XA, J20011 S11.23XA, S11.24XA, S11.25XA, S17.0XXA, S17.8XXA, S17.9XXA, S19.80XA, S19.83XA, S19.85XA, S19.9XXA, S27.812A, S27.813A, S27.818A, S27.819A, T17.208A, T17.218A ICD-10 CrossRef C09.0, C09.1, C10.2-C10.4, C10.8, C10.9, C11.3, C11.9, C12, C13.8, C15.3, C78.7, C78.80, C78.89, C79.89, C79.9, D10.5, D10.6, D10.9, 42955 Z85.818, Z85.819, Z97.4 Pharyngostomy (fistulization of pharynx, external for feeding) 42960 Clinical Responsibility Control oropharyngeal hemorrhage, primary or secondary (eg, The physician creates an artificial opening through skin of the neck post-tonsillectomy); simple for inserting an esophagostomy tube for feeding purpose. Clinical Responsibility Dig

Fee Schedule The patient continues to bleed or rebleeds following a prior es Medicare Fees National Conversion Factor: 36.0896, Facility: $783.14, surgical procedure, such as a tonsillectomy. Following application tiv of local anesthesia, the provider controls bleeding in the mouth

Non Facility: $783.14, OPPS Facility: $289.08, OPPS Non Facility: e

$289.08 and throat using simple techniques like bipolar electrocautery S RVU Facility Work RVU: 8.01, PE RVU: 12.60, Malpractice RVU: 1.09, (using high-frequency electric current to cauterize, or destroy, ys lesions or to stop bleeding by burning the tissue) or hot water t

Total RVU: 21.70 e

irrigation with saline (salt water). Once hemostasis (control of m

Modiier: 0 = not allowed, 1 = allowed CPT® is a registered trademark of the American Medical Association. 139 CPT © 2020 American Medical Association. All rights reserved. Coders’ Specialty Guide 2021: Gastroenterology Digestive System 42960 — 42960

bleeding) is assured and the patient has recovered, he discharges Fee Schedule the patient from the outpatient facility. Medicare Fees National Conversion Factor: 36.0896, Facility: $170.70, Coding Tips Non Facility: $170.70, OPPS Facility: $85.89, OPPS Non Facility: $85.89 For the same procedure requiring hospitalization because closure RVU Facility Work RVU: 2.38, PE RVU: 2.03, Malpractice RVU: 0.32, is more complicated, see 42961. Total RVU: 4.73 For control of bleeding requiring surgical intervention, see 42962. RVU Non-Facility Work RVU: 2.38, PE RVU: 2.03, Malpractice RVU:

42960 — 0.32, Total RVU: 4.73 For control of post-op nasopharyngeal bleeding, such as after an adenoidectomy, see 42970 to 42972. Indicators Preoperative: 10.00, Intraoperative: 80.00, Postoperative: 10.00, Total RVU: 100, Global Period: 010, Radiology Diagnostic Each of these codes crosses to anesthesia code 00170, Anesthesia Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: for intraoral procedures, including biopsy; not otherwise specified. None, MUE: 1 Because Medicare bundles all care of post-operative complications Modifier Allowances 22, 47, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, that do not require a return to the operating room into the 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, original procedure, you should not report 42960 for control of QJ, XE, XP, XS, XU post-op oropharyngeal bleeding or 42970 for control of post-op nasopharyngeal bleeding for Medicare payers. These are simple procedures, usually performed in the surgeon's office (and CCI Alerts (version 25.3) therefore not generally billed in an ASC in the first place). 001700, 0213T0, 0216T0, 0228T0, 0230T0, 110001, 110011, 110041, Although the descriptors for codes 42960 to 42962 give the 110051, 110061, 110421, 110431, 110441, 110451, 110461, 110471, example of post-tonsillectomy bleeding and 42970 to 42972 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, suggests post-adenoidectomy bleeding, all these codes represent 1 1 1 1 1 1 1 1 control of the hemorrhage by location and can therefore be 12014 , 12015 , 12016 , 12017 , 12018 , 12020 , 12021 , 12031 , 1 1 1 1 1 1 1 1 used to report control of bleeding in these areas following other 12032 , 12034 , 12035 , 12036 , 12037 , 12041 , 12042 , 12044 , types of procedures, such as surgery for resection of cancer. 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, The parenthetical references in the descriptors are merely 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, examples and do not exclude other causes of bleeding in the 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, areas defined by the descriptors. The abbreviation e.g. in (e.g., 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, post-tonsillectomy) and (e.g., postadenoidectomy) is for the Latin 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, exempli gratia, "for example." 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, If the complication occurrs during the global period of the original 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, procedure and the otolaryngologist had to return the patient to 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, the operating room, you should append modifier 78 (Return to the 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, operating room for a related procedure during the postoperative 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, period) to 42962 and 42972. Without the modifier, the insurer may 644910, 644920, 644930, 644940, 644950, 645050, 645100, 645170, bundle 42962 into the procedures global period. 645200, 645300, 699900, 920121, 920141, 925020, 930001, 930051, Be sure to link 42962 to 42972 to the hemorrhage complication 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, through the diagnosis code you select, not to the reason for the 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, original surgery. 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 965230, Illustration 975971, 975981, 976021, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, Control of oropharyngeal 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, hemorrhage 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994510, 994520, 994950, 994960, G04631, G04711

ICD-10 CrossRef C09.0-C09.9, C10.0-C10.9, C14.2, D37.05, J95.61, J95.62, J95.830, J95.831, R04.1, S01.502A, S01.512A, S01.532A, S01.542A, S01.552A, m e S11.20XA, S11.21XA, S11.22XA, S11.23XA, S11.24XA, S11.25XA, t S19.80XA, S19.83XA, S19.85XA, S19.9XXA ys

S Tonsils e e tiv Back third of tongue es 42960, 42961 Dig

140 CPT® is a registered trademark of the American Medical Association. Modiier: 0 = not allowed, 1 = allowed CPT © 2020 American Medical Association. All rights reserved. A 00.0 — ICD-10 CrossRef Details A

A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae A17.0 Tuberculous meningitis 24.9 A00.1 Cholera due to Vibrio cholerae 01, biovar eltor A17.1 Meningeal tuberculoma A00.9 Cholera, unspecified A17.81 Tuberculoma of brain and spinal cord A01.09 Typhoid fever with other complications A17.82 Tuberculous meningoencephalitis A02.0 Salmonella enteritis A17.83 Tuberculous neuritis A02.1 Salmonella sepsis A17.89 Other tuberculosis of nervous system A02.22 Salmonella pneumonia A17.9 Tuberculosis of nervous system, unspecified A03.0 Shigellosis due to Shigella dysenteriae A18.01 Tuberculosis of spine A03.1 Shigellosis due to Shigella flexneri A18.02 Tuberculous arthritis of other joints A03.2 Shigellosis due to Shigella boydii A18.03 Tuberculosis of other bones A03.3 Shigellosis due to Shigella sonnei A18.09 Other musculoskeletal tuberculosis A03.8 Other shigellosis A18.10 Tuberculosis of genitourinary system, unspecified A03.9 Shigellosis, unspecified A18.11 Tuberculosis of kidney and ureter A04.0 Enteropathogenic Escherichia coli infection A18.12 Tuberculosis of bladder A04.1 Enterotoxigenic Escherichia coli infection A18.13 Tuberculosis of other urinary organs A04.2 Enteroinvasive Escherichia coli infection A18.14 Tuberculosis of prostate A04.3 Enterohemorrhagic Escherichia coli infection A18.15 Tuberculosis of other male genital organs A04.4 Other intestinal Escherichia coli infections A18.16 Tuberculosis of cervix A04.5 Campylobacter enteritis A18.17 Tuberculous female pelvic inflammatory disease A04.6 Enteritis due to Yersinia enterocolitica A18.18 Tuberculosis of other female genital organs A04.71 Enterocolitis due to Clostridium difficile, recurrent A18.2 Tuberculous peripheral lymphadenopathy A04.72 Enterocolitis due to Clostridium difficile, not specified as A18.31 Tuberculous peritonitis recurrent A18.32 Tuberculous enteritis A04.8 Other specified bacterial intestinal infections A18.39 Retroperitoneal tuberculosis A04.9 Bacterial intestinal infection, unspecified A18.4 Tuberculosis of skin and subcutaneous tissue A05.0 Foodborne staphylococcal intoxication A18.50 Tuberculosis of eye, unspecified A05.1 Botulism food poisoning A18.51 Tuberculous episcleritis A05.2 Foodborne Clostridium perfringens [Clostridium welchii] A18.52 Tuberculous keratitis intoxication A18.53 Tuberculous chorioretinitis A05.3 Foodborne Vibrio parahaemolyticus intoxication A18.54 Tuberculous iridocyclitis A05.4 Foodborne Bacillus cereus intoxication A18.59 Other tuberculosis of eye A05.5 Foodborne Vibrio vulnificus intoxication A18.6 Tuberculosis of (inner) (middle) ear A05.8 Other specified bacterial foodborne intoxications A18.7 Tuberculosis of adrenal glands A05.9 Bacterial foodborne intoxication, unspecified A18.81 Tuberculosis of thyroid gland A06.0 Acute amebic dysentery A18.82 Tuberculosis of other endocrine glands A06.1 Chronic intestinal amebiasis A18.83 Tuberculosis of digestive tract organs, not elsewhere A06.2 Amebic nondysenteric colitis classified A06.3 Ameboma of intestine A18.84 Tuberculosis of heart A06.4 Amebic liver abscess A18.85 Tuberculosis of spleen A06.5 Amebic lung abscess A18.89 Tuberculosis of other sites A06.6 Amebic brain abscess A19.0 Acute miliary tuberculosis of a single specified site A06.7 Cutaneous amebiasis A19.1 Acute miliary tuberculosis of multiple sites A06.81 Amebic cystitis A19.2 Acute miliary tuberculosis, unspecified A06.82 Other amebic genitourinary infections A19.8 Other miliary tuberculosis A06.89 Other amebic infections A19.9 Miliary tuberculosis, unspecified A06.9 Amebiasis, unspecified A20.0 Bubonic plague A07.0 Balantidiasis A20.1 Cellulocutaneous plague A07.1 Giardiasis [lambliasis] A20.2 Pneumonic plague A07.2 Cryptosporidiosis A20.3 Plague meningitis A07.3 Isosporiasis A20.7 Septicemic plague A07.4 Cyclosporiasis A20.8 Other forms of plague A07.8 Other specified protozoal intestinal diseases A21.1 Oculoglandular tularemia A07.9 Protozoal intestinal disease, unspecified A21.2 Pulmonary tularemia A08.0 Rotaviral enteritis A21.3 Gastrointestinal tularemia A08.11 Acute gastroenteropathy due to Norwalk agent A21.7 Generalized tularemia A08.19 Acute gastroenteropathy due to other small round viruses A21.8 Other forms of tularemia ICD-10 Cross A08.2 Adenoviral enteritis A22.0 Cutaneous anthrax A08.31 Calicivirus enteritis A22.1 Pulmonary anthrax A08.32 Astrovirus enteritis A22.2 Gastrointestinal anthrax A08.39 Other viral enteritis A22.7 Anthrax sepsis A08.4 Viral intestinal infection, unspecified A22.8 Other forms of anthrax A08.8 Other specified intestinal infections A23.0 Brucellosis due to Brucella melitensis A09 Infectious gastroenteritis and colitis, unspecified A23.1 Brucellosis due to Brucella abortus R

A15.0 Tuberculosis of lung A23.2 Brucellosis due to Brucella suis ef Deta A15.4 Tuberculosis of intrathoracic lymph nodes A23.3 Brucellosis due to Brucella canis A15.5 Tuberculosis of larynx, trachea and bronchus A23.8 Other brucellosis A15.6 Tuberculous pleurisy A24.0 Glanders A15.7 Primary respiratory tuberculosis A24.2 Subacute and chronic melioidosis i

A15.8 Other respiratory tuberculosis A24.3 Other melioidosis ls A15.9 Respiratory tuberculosis unspecified A24.9 Melioidosis, unspecified

921 Coders’ Specialty Guide 2021: Gastroenterology ICD-10 CrossRef Details A25.1 — A51.2

A25.1 Streptobacillosis A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus A26.7 Erysipelothrix sepsis A41.1 Sepsis due to other specified staphylococcus

51.2 A26.8 Other forms of erysipeloid A41.2 Sepsis due to unspecified staphylococcus

A A26.9 Erysipeloid, unspecified A41.3 Sepsis due to Hemophilus influenzae A28.0 Pasteurellosis A41.4 Sepsis due to anaerobes A28.1 Cat-scratch disease A41.50 Gram-negative sepsis, unspecified A28.2 Extraintestinal yersiniosis A41.51 Sepsis due to Escherichia coli [E. coli] A28.8 Other specified zoonotic bacterial diseases, not elsewhere A41.52 Sepsis due to Pseudomonas

25.1 — classified A41.53 Sepsis due to Serratia

A A28.9 Zoonotic bacterial disease, unspecified A41.59 Other Gram-negative sepsis A30.0 Indeterminate leprosy A41.89 Other specified sepsis A30.1 Tuberculoid leprosy A41.9 Sepsis, unspecified organism A30.2 Borderline tuberculoid leprosy A42.0 Pulmonary actinomycosis A30.3 Borderline leprosy A42.1 Abdominal actinomycosis A30.4 Borderline lepromatous leprosy A42.2 Cervicofacial actinomycosis A30.5 Lepromatous leprosy A42.81 Actinomycotic meningitis A30.8 Other forms of leprosy A42.82 Actinomycotic encephalitis A30.9 Leprosy, unspecified A42.89 Other forms of actinomycosis A31.0 Pulmonary mycobacterial infection A42.9 Actinomycosis, unspecified A31.1 Cutaneous mycobacterial infection A43.0 Pulmonary nocardiosis A31.2 Disseminated mycobacterium avium-intracellulare complex A43.1 Cutaneous nocardiosis (DMAC) A43.8 Other forms of nocardiosis A31.8 Other mycobacterial infections A43.9 Nocardiosis, unspecified A31.9 Mycobacterial infection, unspecified A44.0 Systemic bartonellosis A32.0 Cutaneous listeriosis A44.1 Cutaneous and mucocutaneous bartonellosis A32.11 Listerial meningitis A44.8 Other forms of bartonellosis A32.12 Listerial meningoencephalitis A44.9 Bartonellosis, unspecified A32.7 Listerial sepsis A46 Erysipelas A32.81 Oculoglandular listeriosis A48.0 Gas gangrene A32.82 Listerial endocarditis A48.1 Legionnaires' disease A32.89 Other forms of listeriosis A48.2 Nonpneumonic Legionnaires' disease [Pontiac fever] A32.9 Listeriosis, unspecified A48.8 Other specified bacterial diseases A34 Obstetrical tetanus A49.01 Methicillin susceptible Staphylococcus aureus infection, A35 Other tetanus unspecified site A36.0 Pharyngeal diphtheria A49.02 Methicillin resistant Staphylococcus aureus infection, A36.1 Nasopharyngeal diphtheria unspecified site A36.2 Laryngeal diphtheria A49.2 Hemophilus influenzae infection, unspecified site A36.3 Cutaneous diphtheria A49.3 Mycoplasma infection, unspecified site A36.81 Diphtheritic cardiomyopathy A49.8 Other bacterial infections of unspecified site A36.82 Diphtheritic radiculomyelitis A49.9 Bacterial infection, unspecified A36.83 Diphtheritic polyneuritis A50.01 Early congenital syphilitic oculopathy A36.84 Diphtheritic tubulo-interstitial nephropathy A50.02 Early congenital syphilitic osteochondropathy A36.85 Diphtheritic cystitis A50.03 Early congenital syphilitic pharyngitis A36.86 Diphtheritic conjunctivitis A50.04 Early congenital syphilitic pneumonia A36.89 Other diphtheritic complications A50.05 Early congenital syphilitic rhinitis A37.00 Whooping cough due to Bordetella pertussis without A50.06 Early cutaneous congenital syphilis pneumonia A50.07 Early mucocutaneous congenital syphilis A37.01 Whooping cough due to Bordetella pertussis with A50.08 Early visceral congenital syphilis pneumonia A50.09 Other early congenital syphilis, symptomatic A37.10 Whooping cough due to Bordetella parapertussis without A50.1 Early congenital syphilis, latent pneumonia A50.2 Early congenital syphilis, unspecified A37.11 Whooping cough due to Bordetella parapertussis with A50.30 Late congenital syphilitic oculopathy, unspecified pneumonia A50.31 Late congenital syphilitic interstitial keratitis A37.80 Whooping cough due to other Bordetella species without A50.32 Late congenital syphilitic chorioretinitis pneumonia A50.39 Other late congenital syphilitic oculopathy A37.81 Whooping cough due to other Bordetella species with A50.40 Late congenital neurosyphilis, unspecified pneumonia A50.41 Late congenital syphilitic meningitis A37.90 Whooping cough, unspecified species without pneumonia A50.42 Late congenital syphilitic encephalitis A37.91 Whooping cough, unspecified species with pneumonia A50.43 Late congenital syphilitic polyneuropathy A38.8 Scarlet fever with other complications A50.44 Late congenital syphilitic optic nerve atrophy A39.0 Meningococcal meningitis A50.45 Juvenile general paresis A39.1 Waterhouse-Friderichsen syndrome A50.49 Other late congenital neurosyphilis ls

i A39.2 Acute meningococcemia A50.51 Clutton's joints A39.3 Chronic meningococcemia A50.52 Hutchinson's teeth A39.4 Meningococcemia, unspecified A50.53 Hutchinson's triad A39.50 Meningococcal carditis, unspecified A50.54 Late congenital cardiovascular syphilis A39.51 Meningococcal endocarditis A50.55 Late congenital syphilitic arthropathy ef Deta ef A39.52 Meningococcal myocarditis A50.56 Late congenital syphilitic osteochondropathy R A39.53 Meningococcal pericarditis A50.57 Syphilitic saddle nose A39.81 Meningococcal encephalitis A50.59 Other late congenital syphilis, symptomatic A39.82 Meningococcal retrobulbar neuritis A50.6 Late congenital syphilis, latent A39.83 Meningococcal arthritis A50.7 Late congenital syphilis, unspecified A39.84 Postmeningococcal arthritis A50.9 Congenital syphilis, unspecified A39.89 Other meningococcal infections A51.0 Primary genital syphilis A40.3 Sepsis due to Streptococcus pneumoniae A51.1 Primary anal syphilis A40.9 Streptococcal sepsis, unspecified A51.2 Primary syphilis of other sites ICD-10 Cross ICD-10

922 22 — A Modifier Descriptors I

Modifier Description Modifier Description CPT® Modifiers 79 Unrelated Procedure or Service by the Same 22 Increased Procedural Services Physician or Other Qualified Health Care Professional During the Postoperative Period 23 Unusual Anesthesia 80 Assistant Surgeon 24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care 81 Minimum Assistant Surgeon Professional During a Postoperative Period 82 Assistant Surgeon (when qualified resident surgeon 25 Significant, Separately Identifiable Evaluation and not available) Management Service by the Same Physician or 90 Reference (Outside) Laboratory Other Qualified Health Care Professional on the 91 Repeat Clinical Diagnostic Laboratory Test Same Day of the Procedure or Other Service 92 Alternative Laboratory Platform Testing 26 Professional Component 95 Synchronous Telemedicine Service Rendered 27 Multiple Outpatient Hospital E/M Encounters on Via a Real-Time Interactive Audio and Video the Same Date Telecommunications System 32 Mandated Services 96 Habilitative Services 33 Preventive Services 97 Rehabilitative Services 47 Anesthesia by Surgeon 99 Multiple Modifiers 50 Bilateral Procedure Category II Modifiers 51 Multiple Procedures 1P Performance Measure Exclusion Modifier due to 52 Reduced Services Medical Reasons 53 Discontinued Procedure 2P Performance Measure Exclusion Modifier due to 54 Surgical Care Only Patient Reasons 55 Postoperative Management Only 3P Performance Measure Exclusion Modifier due to System Reasons 56 Preoperative Management Only 8P Performance Measure Reporting Modifier - Action Not 57 Decision for Surgery Performed, Reason Not Otherwise Specified 58 Staged or Related Procedure or Service by the HCPCS Modifiers Same Physician or Other Qualified Health Care Professional During the Postoperative Period A1 Dressing for one wound 59 Distinct Procedural Service A2 Dressing for two wounds 62 Two Surgeons A3 Dressing for three wounds 63 Procedure Performed on Infants less than 4 kg A4 Dressing for four wounds 66 Surgical Team A5 Dressing for five wounds 73 Discontinued Out-Patient Hospital/Ambulatory A6 Dressing for six wounds Surgery Center (ASC) Procedure Prior to the A7 Dressing for seven wounds Administration of Anesthesia A8 Dressing for eight wounds 74 Discontinued Out-Patient Hospital/Ambulatory A9 Dressing for nine or more wounds Surgery Center (ASC) Procedure After Administration of Anesthesia AA Anesthesia services performed personally by Modifier anesthesiologist 76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional AD Medical supervision by a physician: more than four concurrent anesthesia procedures 77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional AE Registered dietician D escriptors 78 Unplanned Return to the Operating/Procedure AF Specialty physician Room by the Same Physician or Other Qualified AG Primary physician Health Care Professional Following Initial Procedure AH Clinical psychologist for a Related Procedure During the Postoperative Period AI Principal physician of record

CPT® is a registered trademark of the American Medical Association. All rights reserved. 1035 CPT © 2020 American Medical Association. All rights reserved. Coders’ Specialty Guide 2021: Gastroenterology Modifier Descriptors AJ — ED

Modifier Description Modifier Description ED AJ Clinical social worker CE AMCC test has been ordered by an ESRD facility AK Non participating physician or MCP physician that is a composite rate test but

AJ — is beyond the normal frequency covered under AM Physician, team member service the rate and is separately reimbursable based on AO Alternate payment method declined by provider of medical necessity service CF AMCC test has been ordered by an ESRD facility AP Determination of refractive state was not or MCP physician that is not part of the composite performed in the course of diagnostic rate and is separately billable ophthalmological examination CG Policy criteria applied AQ Physician providing a service in an unlisted health CH 0 percent impaired, limited or restricted professional shortage area (HPSA) CI At least 1 percent but less than 20 percent AR Physician provider services in a physician scarcity area impaired, limited or restricted AS Physician assistant, nurse practitioner, or clinical CJ At least 20 percent but less than 40 percent nurse specialist services for assistant at surgery impaired, limited or restricted AT Acute treatment (this modifier should be used CK At least 40 percent but less than 60 percent when reporting service 98940, 98941, 98942) impaired, limited or restricted AU Item furnished in conjunction with a urological, CL At least 60 percent but less than 80 percent ostomy, or tracheostomy supply impaired, limited or restricted AV Item furnished in conjunction with a prosthetic CM At least 80 percent but less than 100 percent device, prosthetic or orthotic impaired, limited or restricted AW Item furnished in conjunction with a surgical CN 100 percent impaired, limited or restricted dressing CO Outpatient occupational therapy services furnished in AX Item furnished in conjunction with dialysis services whole or in part by an occupational therapy assistant AY Item or service furnished to an ESRD patient that is CQ Outpatient physical therapy services furnished in not for the treatment of ESRD whole or in part by a physical therapist assistant AZ Physician providing a service in a dental health CR Catastrophe/disaster related professional shortage area for the purpose of an CS Item or service related, in whole or in part, to an electronic health record incentive payment illness, injury, or condition that was caused by or BA Item furnished in conjunction with parenteral exacerbated by the effects, direct or indirect, of the enteral nutrition (PEN) services 2010 oil spill in the Gulf of Mexico, including but BL Special acquisition of blood and blood products not limited to subsequent clean-up activities BO Orally administered nutrition, not by feeding tube CT Computed tomography services furnished using equipment that does not meet each of the BP The beneficiary has been informed of the purchase attributes of the National Electrical Manufacturers and rental options and has elected to purchase the Association (NEMA) XR-29-2013 standard item DA Oral health assessment by a licensed health BR The beneficiary has been informed of the purchase professional other than a dentist and rental options and has elected to rent the item E1 Upper left, eyelid BU The beneficiary has been informed of the purchase and rental options and after 30 days has not E2 Lower left, eyelid informed the supplier of his/her decision E3 Upper right, eyelid CA Procedure payable only in the inpatient setting E4 Lower right, eyelid when performed emergently on an outpatient who EA Erythropoietic stimulating agent (ESA) expires prior to admission administered to treat anemia due to anti-cancer CB Service ordered by a renal dialysis facility (RDF) chemotherapy physician as part of the ESRD beneficiary’s dialysis EB Erythropoietic stimulating agent (ESA) administered benefit, is not part of the composite rate, and is to treat anemia due to anti-cancer radiotherapy separately reimbursable EC Erythropoietic stimulating agent (ESA) CC Procedure code change (use ‘CC’ when the procedure

escriptors administered to treat anemia not due to anti-

D code submitted was changed either for administrative cancer radiotherapy or anti-cancer chemotherapy reasons or because an incorrect code was filed) ED Hematocrit level has exceeded 39% (or hemoglobin CD AMCC test has been ordered by an ESRD facility or level has exceeded 13.0 G/dl) for 3 or more MCP physician that is part of the composite rate consecutive billing cycles immediately prior to and and is not separately billable including the current cycle Modifier Modifier

Terminology E stlander operation — Algorithm

Terms Definition Abbe Estlander operation Transfer of a full thickness section of one lip to the other lip ensuring survival of the graft. Abdominal approach The provider makes an incision in the abdomen to perform various operations in the abdomen. Abdominal paracentesis Surgical puncture of the abdominal cavity for the removal of fluid for diagnosis or treatment. Abdominal wall Boundaries of the abdominal cavity. Abdominoperineal approach A surgical procedure that requires two approaches, one through the abdomen and a second through the perineum which requires excising the anal sphincter. Abdominoperineal pull A surgical procedure that involves two approaches, one through the abdomen and a second through through procedure the perineum. Ablation Removal of a body part or organ, or destruction of its function; in laser ablation a provider uses heat produced by adjustable focused light energy to destroy lesions or abnormal tissue, while in a radiofrequency ablation the provider uses heat produced by focused electromagnetic waves to destroy lesions or abnormal tissue. Abscess Sac or pocket formed due to the accumulation of purulent material, pus in the soft tissues. Absorption Taking in of substances by tissues. Acid Sour chemical substance that has can neutralize alkalis, dissolve certain metals and have a pH less than seven. Acid analysis, or gastric acid A laboratory test to determine the presence and amount of gastrin, a hormone that regulates acid secretion test production in the stomach, and the pH, the acidity or alkalinity, in stomach fluid; acidity is normal, but too much acidity causes ulcers. Acid-base balance The condition of the balance between the acid ions and the base or alkaline ions, a delicate mechanism, which controls the pH or acidity-alkalinity in the body. Acidosis Increased acidity in the blood due to increased hydrogen ions, causing a decrease in pH below 7.35; this affects all body functions especially metabolism and respiration. Acute A medical condition or injury of sudden onset, sometimes severe in nature, and typically lasts a short period of time; opposite of chronic. Acute necrotizing pancreatitis Life threatening and painful condition that is short term, rather than chronic, and often associated with severe inflammation and necrosis, or tissue death, of the pancreas. Acute pancreatitis Life threatening and painful condition that is short term, rather than chronic, and associated with severe inflammation of the pancreas. Addison’s disease A disease caused by insufficient production of cortisol or aldosterone by the adrenal glands. Adenoma Benign tumor of a glandular structure. Adhesiolysis Separation of adhesions. Adhesions Fibrous bands that form between tissues and organs, sometimes as a result of injury during surgery; they may be thought of as internal scar tissue. Adhesive material Cotton or a fabric coated with a covering that is used to cover minor skin injuries. Adjustable gastric restrictive A band placed around the stomach to restrict the size of the stomach; it encloses a balloon which can device be adjusted by adding or removing saline via a reservoir and port attached just below the skin of the abdomen, effectively reducing or enlarging the outlet to regulate the amount of food that can pass through. Advance directive A document which enables a person to make provision for his health care decisions in case if in the future, he becomes unable to make those decisions; include documents such as a living will and a medical power of attorney. Afferent loop culture A sample of secretions from the proximal loop of the duodenum and jejunum for bacterial analysis.

Albumin A liver protein that tells a provider about a patient’s liver function and nutritional status by measuring Terminology the level of the protein in the blood. Albumin dialysis A process to remove albumin-bound toxins (waste products harmful to the body) from patients in liver failure or impending liver failure; albumin is the most abundant protein in blood plasma and helps maintain the water concentration of blood. Algorithm A specific set of step-by-step calculations using defined inputs at each step to produce a useful output.

1045 Coders’ Specialty Guide 2021: Gastroenterology Terminology Alkali — Antibiotic solution

Terms Definition Alkali Chemical substance that neutralizes with acid, serves weak bases and has a pH more than seven. Alkalosis Decreased acidity in the blood due to decrease in hydrogen ions, causing an alkaline state of a pH greater than 7.45; this affects all body functions especially metabolism and respiration. Alligator forceps Strong toothed pincers or tongs used for grasping. Allograft A tissue graft harvested from one person for another; donors include cadavers and living individuals related or unrelated to the recipient; also called allogeneic graft and homograft. Allotransplantation An organ or tissue transfer between genetically different individuals of the same species. Alveolar bone A thick bone that makes up the bony process of the upper jaw, called the maxilla, and the lower jaw, called the mandible; includes sockets for the teeth; the bone has small blood vessels and a nerve supply, and it provides support to the teeth. Alveolar process A bony ridge that forms the borders of the upper and lower jaw and contains the sockets for the teeth. Alveolar ridge A ridge like border on the upper and lower jaw containing tooth sockets. Alkali — Antibiotic solution — Antibiotic Alkali Alveolectomy Surgical procedure in which the provider excises the alveolar process along with reshaping the surface. Alveolus Also known as the alveolar process, dental alveolus, or alveolar bone, this is the bony ridge with tooth sockets in both the jaws. Amenable Manageable or responsive to treatment. Amoeba A tiny single cell organism which lives in fresh water. Amplification Making more copies of a desired gene for study by processes such as polymerase chain reaction, called PCR, or transcription of DNA to RNA and reverse transcription from RNA to make an additional copy of the DNA. Ampulla of Vater Also known as the hepatopancreatic ampulla, formed by the union of the pancreatic duct and the common bile duct. Anal canal The terminal portion of the digestive tube from the rectum to the anus. Anal fissure A break or tear in the skin of the anal canal. Anal fistula An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and usually the perianal skin. Anal incontinence Lack of control over the muscles involved in defecation, leading to involuntary loss of bowel contents; also known as fecal or rectal incontinence. Anal papilla Well defined projections of epithelium at the junction of skin and mucous of anus. Anal sphincter The anal sphincter consists of the internal anal sphincter and the external anal sphincter; the internal anal sphincter is formed from smooth muscle of the anal canal; the external anal sphincter, which is larger and of importance in fecal continence, is made up of striated muscle. Anal tag Lump or shapeless protrusions of skin, near the anal opening. Anastomosis Surgical connection between two, usually tubular, structures or the rejoining of a tubular structure, such as a vessel or the intestines, after removal of a diseased portion. Aneurysm Weakness in the wall of a blood vessel or wall of a ventricle of the heart, typically the left ventricle, causing the wall to balloon out; sometimes requiring surgical excision or repair to prevent rupture. Aneurysm needle A needle with a handle, which the provider commonly uses to tie blood vessels. Ankyloglossia Also called tongue tie, is a minor defect present from birth in which the frenum is too short and it limits the movement of the tongue. Anomaly Not normal structurally or functionally, out of place; typically describes a congenital deformity, one present at birth. Anoperineal fistula A fistula relating to the anus and surrounding perineum. Anoplasty Surgical procedure to reconstruct the anus. Anorectal Pertaining to the anus, or the distal opening of the intestine, and the rectum. Anorectal manometry Use of a pressure recording device to measure the contraction strength of the anus and rectum. Anorectal myomectomy The removal of a myoma, or tumor of the muscle, from the anal or rectal region. Anorectal ring A muscular structure between the anus and the rectum. Anorectovaginoplasty A surgical technique to repair female anorectal and a vaginal defect or malformation. Anoscope A medical instrument which the provider passes through the anal cavity for examination purposes. Anoscopy A procedure in which the provider passes a medical instrument called an anoscope through the anal cavity to examine the inner wall of the anus and the rectum. Anterior Closer to the front part of the body. Antibiotic Substance that inhibits infection. Antibiotic solution A solution of water or saline that contains an antibiotic, a substance that inhibits infection. Terminology

1046 0184T — 43020 Code Index

Codes Page No. Codes Page No. Codes Page No. Codes Page No. Codes Page No. 0184T 894 40804 26 41130 57 42180 85 42660 114 0312T 894 40805 27 41135 57 42182 86 42665 115 0313T 895 40806 28 41140 58 42200 86 42699 115 0314T 895 40808 29 41145 59 42205 87 42700 116 0315T 896 40810 30 41150 60 42210 88 42720 117 0316T 896 40812 31 41153 61 42215 89 42725 117 0317T 897 40814 32 41155 62 42220 90 42800 118 0355T 897 40816 33 41250 62 42225 90 42804 119 +0397T 898 40818 33 41251 63 42226 91 42806 119 0405T 899 40819 34 41252 64 42227 92 42808 120 +10004 5 40820 34 41510 64 42235 92 42809 121 10005 5 40830 35 41512 65 42260 93 42810 121 +10006 6 40831 36 41520 66 42280 94 42815 122 10007 6 40840 37 41530 67 42281 94 42820 123 +10008 7 40842 37 41599 67 42299 95 42821 124 10009 7 40843 38 41800 68 42300 96 42825 126 +10010 8 40844 39 41805 69 42305 96 42826 127 10011 8 40845 40 41806 69 42310 97 42830 128 +10012 9 40899 40 41820 70 42320 97 42831 129 10021 10 41000 41 41821 71 42330 98 42835 130 31525 11 41005 41 41822 72 42335 99 42836 131 31575 12 41006 42 41823 72 42340 100 42842 132 38573 13 41007 43 41825 73 42400 101 42844 133 40490 14 41008 44 41826 73 42405 101 42845 133 40500 14 41009 45 41827 74 42408 102 42860 134 40510 15 41010 45 41828 75 42409 103 42870 134 40520 16 41015 46 41830 75 42410 103 42890 135 40525 16 41016 47 41850 76 42415 104 42892 136 40527 17 41017 48 41870 77 42420 105 42894 137 40530 18 41018 49 41872 77 42425 106 42900 137 40650 18 41019 49 41874 78 42426 107 42950 138 40652 19 41100 50 41899 78 42440 107 42953 138 40654 20 41105 51 42000 79 42450 108 42955 139 40700 20 41108 51 42100 79 42500 108 42960 139 40701 21 41110 52 42104 80 42505 109 42961 141 40702 22 41112 53 42106 81 42507 110 42962 142 40720 22 41113 53 42107 81 42509 111 42970 143

40761 23 41114 54 42120 82 42510 112 42971 144 Code Index 40799 24 41115 55 42140 82 42550 113 42972 145 40800 24 41116 55 42145 83 42600 113 42999 145 40801 25 41120 56 42160 84 42650 114 43020 146

1079 CSG: Gastroenterology 2021

2233 South Presidents Dr., Suites F–C Salt Lake City, Utah 84120. Fax 801-236-2258 9 781635 277678 www.aapc.com | 800-626-2633 ISBN: 978-1-635277-678 eBook ISBN: 978-1-635277-890