Otolaryngology Coding Alert

If your ENT ventures past the pharynx, youll want to review some basic anatomy.

Esophagus: Youre probably pretty familiar with the esophagus, which extends about 24 cm from the pharynx to the stomach. If the esophagus is narrowed (530.3, Stricture and stenosis of esophagus), your physician may have to dilate it to complete an EGD.

Gastroesophageal junction: You may have seen your ENTs op reports mention the GE junction,where the esophagus empties into the stomach. Signs of problems such as gastroesophageal reflux disease (530.81, Other specified disorders of esophagus; esophageal reflux) can appear here before they show up elsewhere in the esophagus.

Lower esophageal sphincter: Located at the GE junction, a healthy LES lets food in the stomach, and keeps it in. In a patient with achalasia (530.0, Achalasia and cardiospasm), the sphincter fails to properly relax, and the esophagus distends over time.

Stomach: The stomach is a sac that varies greatly in shape and size, depending on its own changes and changes in its surrounding structures. The pylorus is the valve that empties food from the stomach into the small intestine.

Small intestine: The small intestine is in three parts.

" The duodenum -- the D in EGD -- is the shortest and largest part of the small intestine, connecting to the stomach at the pylorus. Where it unites with the jejunum, it forms the duodenojejunal flexure. Of importance here is a short tube called the ampulla of Vater that releases digestive juices from the pancreatic and common bile ducts.

" The jejunum lies at the end of the duodenum,but there is no morphological line to distinguish the end of the jejunum and the beginning of the ileum.

" The ileum is narrower than the jejunum, and its lining is thinner and less vascular. It ends in the pelvic region where it connects to the colon. Its not necessary for a physician to explore this far in order to code an EGD procedure.