Hepatobiliary & Pancreatic

Question 1

Overview

Question 2

Most Conditions found in following chapters:

• Chapter 11 (diseases of Digestive system) K00-K97
• Chapter 2 - Neoplasm of gallbladder, liver, pacreas (C00-D48)
• Chapter 1 - Certain infectious and parasitic diseases - (A00-B99)

Watch Terminology
- Chol/e = bile, gall?
- - confirm if gall is accurate

-cyst/o = bladder, sac

-Doch/o = duct

• Angi/o = vessel

Lith/o = Stone

Question 3

Biliary Disorders

Question 4

Formation of gallstones leading to inflammation and/or obstruction of bile ducts

Answer 4

K80.0^ ~ Cholelithiasis
- includes acute cholecystitis with calculi

K81.0 ~ Acute Cholecystitis

Question 5

Chronic Cholecystitis

Answer 5

Chronic cholecystutus with calculi
K80.1^ ~ calculus of gallbladder with other cholecystitis

Chronic cholecystitis without calculi:
K81.1 ~ Chronic Cholecystitis

Question 6

Cholecystolithiasis/
Cholelithiasis
(gallbladder/cystic duct)

Answer 6

K80.0^ to K80.2^ ~ calculus of gallbladder

Question 7

Choledocholithiasis
(common or hepatic duct)

Answer 7

K80.3^ to K80.5^ ~ calculus of bile duct

Question 8

Diagnostic Imaging Interventions

Question 9

Gallbladder alone

Answer 9

3.OD.^^

Question 10

Biliary ducts with or without gallbladder

Answer 10

3.OE.^^

Question 11

Biliary ducts with pancreas

Answer 11

3.OG.^^

Question 12

Pancreas alone

Answer 12

3.OJ.^^

Question 13

Abdominal cavity

Answer 13

3.OT.^^

Question 14

Transabdominal ultrasound

Answer 14

3.OT.30.^^

Question 15

Endoscopic Ultrasonography (EUS)

Answer 15

3.OT.30.HA ~ultrasound abdominal cavity , endoscopic [EUS]

Question 16

Cholangiography

Answer 16

Percutaneous transhepatic cholangiography (PTC or PTHC) – 3.OE.10.XA

T-tube cholangiogram - 3.OE.10.WX

Question 17

ERC/ ERCP – endoscopic retrograde cholangiogram/cholangiopancreatography

Answer 17

ERC = 3.OE.10.WZ ~ xray, bile ducts following endoscopic (retrograde) injection contrast
ERCP = 3.OG.10.WZ ~ xray, biliary ducts with pancreas ….

Question 18

Related interventions

Question 19

Cholecystectomy without Bile Duct Intervention

Answer 19

1.OD.89^^ ~ excision total gallbladder
DA – laparoscopic (*standard of care)
LA – open

Conversion from laparoscopic to open – assign status attribute “C”

Question 20

Cholecystectomy with T-Tube drainage

Answer 20

Use additional code - 1.OE.52.^^ ~ drainage bile ducts

Question 21

Cholecystectomy with Exploration Common Bile Duct (ECBD)

Answer 21

Classify to 1.OD.89.EC or 1.OD.89.TP depending on surgical approach

Question 22

Cholecystectomy with Extraction of Common Bile Duct Stones

Answer 22

When stones extracted during cholecystectomy, the intervention is classified to a combination code

1.OD.89.^^ indicating cholecystectomy and extraction qualifiers

Extraction qualifiers indicate device used to perform extraction

Question 23

Cholecystostomy

Answer 23

1.OD.52.HA-TS ~ drainage gallbladder using percutaneous needle approach, drainage tube in situ

Question 24

Cholecystoenterostomy/Cholecystojejunostomy

Answer 24

EUS-guided transmural gallbladder drainage (EUS-GBD)

Classified to 1.OD.76.DA ~ Bypass, gallbladder using endoscopic [laparoscopic] approach

Question 25

Extraction Bile Duct Stones (without cholecystectomy)

Answer 25

1.OE.57.^^ ~ extraction, bile duct

Question 26

Destruction of bile duct stones Dissolution Therapy Lithotripsy

Answer 26

Shock wave lithotripsy – ESWL (extracorporeal shock wave lithotripsy) - 1.OE.59.KQ-AS ~ destruction, bile duct, using extracorporeal shock wave lithotripsy - ‘Code also’ - any concomitant extraction of calculi to 1.OE.57

Question 27

Dilation and Drainage of Bile Ducts

Answer 27

Placement of a stent in area of obstruction to keep duct open for drainage 1.OE.50.^^ ~ dilation bile duct Placement of a catheter for external drainage brought out through skin 1.OE.52 ~ drainage bile duct

Question 28

Viral Hepatitis

Question 29

Infectious disorder of liver caused by viruses A, B, C, D, and E All may cause acute hepatitis Only B, C, D develop into chronic

Question 30

HAV Hepatitis A

Answer 30

B15.^ ~ acute hepatitis

Question 31

HBV Hepatitis B

Answer 31

Acute Hepatitis B - ~ B16.^ Chronic Hepatitis B ~ B18.^ Carrier ~ classified to Chronic viral Hepatitis B

Question 32

HDV Hepatitis D

Answer 32

When occurs as a super-infection classify to: B17.0 ~ acute delta-(super) infection of hepatitis B carrier

Question 33

HCV Hepatitis C

Question 34

HEV Hepatitis E

Answer 34

B17.2

Question 35

Alcoholic Cirrhosis of Liver and Hepatitis

Question 36

If applicable code additional code for

Answer 36

alcohol dependence (F10.2) or alcohol abuse (F10.1) Portal Hypertension (K76.6) Ascites (R18) esophageal varices? ? confirm Obstructive Jaundice (K83.1)

Question 37

Interventions

Question 38

Abdominal Paracentesis

Answer 38

1.OT.52.^^-drainage abdominal cavity

Question 39

Portacaval Shunt

Answer 39

1.KQ.76.^^ - Bypass, abdominal veins NEC

Question 40

Hemorrhage control

Answer 40

1.NA.13.^^ - Control of bleeding, esophagus

Question 41

Neoplasia of Liver

Answer 41

When morphology not stated or behavior indicated as primary/secondary classify to: C22.9 ~ malignant neoplasm of liver unspecified

Question 42

Diagnosing liver disease

Answer 42

2.OA.71.HA ~ biopsy liver, using percutaneous (needle approach)

Question 43

Pancreatitis

Question 44

Look for underlying cause: Alcoholism – most common cause of chronic pancreatitis Gallstone obstruction common cause of acute pancreatitis. Read and interpret the documentation regarding making the connection