ICD10-CM , ICD10-PCS cardiovascular presentation

2,105 views

Published on

transition from ICD-9-CM to ICD-10-CM
anatomy and physiology
cardiovascular system

Published in: Education
0 Comments
6 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,105
On SlideShare
0
From Embeds
0
Number of Embeds
54
Actions
Shares
0
Downloads
49
Comments
0
Likes
6
Embeds 0
No embeds

No notes for slide
  • The circulatory system is responsible to deliver blood to the organs and all the other parts of the body including hands, legs, brain, etc.. it delivers Pure (Oxigenated blood) through out the body and receives Impure ( Deoxiginated blood ) from them and deliever them back to heart,
  • The septum: is the wall dividing the left and right ventricles. The papillary muscles and chordae tendineae (above right) function to open and close the atrioventricular valves.
  • Tunica media : endothelium secretes certain chemicals that regulate blood flow : such as NO…….endothelin ,, prostaglandins  VD,( thromboxanproducedc by pltelets to carry VC ) both work against each otherTunica media : The primary function of this layer is to regulate blood pressure and flow by contraction and dilationTunica externa : In the case of larger vessels, the tunica externa also contains very small vessels that supply blood to the vessel wall.
  • Arterioles :are increasingly smaller arteries that control blood flow to capillary networks. Changes at this level can impact blood pressure, with arteriole vasodilatation decreasing blood pressure and arteriole vasoconstriction increasing blood pressure.capillaries, which are the body's smallest blood vessels. They exchange substances in the blood and interstitial fluid of the body's cells. They are not present in cartilage or in the cornea or lens of the eye, but they are found in abundance in connection with tissues that have high metabolic requirements, such as the nervous system, liver, and muscles.c Capillaries function as part of a capillary bed, comprising 10 to 100 capillaries through which blood flows and capillary exchange takes place. Diffusion is the primary mechanism of this process, allowing oxygen, hormones, nutrients, and byproducts of metabolism to cross the capillary walls. Transcytosis may also take place, particularly with larger or lipid-insoluble materials, such as antibodies and proteins.
  • Ascending aorta: Arises from the left ventricle and is the site of the coronary arteries. Aortic arch: First arching to the left, the aorta descends through the diaphragm. This segment includes arteries that travel to the head, neck, and upper extremities. Thoracic aorta: Part of the aorta between the arch and the diaphragm that contains arterial branches that supply the bronchi, esophagus, pericardium, mediastinum, intercostal muscles, muscles of the chest, and a portion of the diaphragm. Abdominal aorta: Portion of the aorta between the diaphragm and the branches of the common iliac arteries that supplies part of the diaphragm, intestines, all of the visceral organs, lower limbs, reproductive organs, bladder, and buttock muscles
  • Ascending aorta: Arises from the left ventricle and is the site of the coronary arteries. Aortic arch: First arching to the left, the aorta descends through the diaphragm. This segment includes arteries that travel to the head, neck, and upper extremities. Thoracic aorta: Part of the aorta between the arch and the diaphragm that contains arterial branches that supply the bronchi, esophagus, pericardium, mediastinum, intercostal muscles, muscles of the chest, and a portion of the diaphragm. Abdominal aorta: Portion of the aorta between the diaphragm and the branches of the common iliac arteries that supplies part of the diaphragm, intestines, all of the visceral organs, lower limbs, reproductive organs, bladder, and buttock muscles
  • ICD10-CM , ICD10-PCS cardiovascular presentation

    1. 1.  At the end of this chapter you should be able to : 1-describe the function of cardiovascular system. 2-Identify types of tissues found in the cardiovascular system(cardiac muscles in the heart smooth muscles in the blood vessels. 3-Describe and identify the major heart structures including the pericardium , heart chambers and valves. 4- Map the direction of blood flow through the heart. 5- Identify the major blood vessels of the heart that transport blood from and to the heart. 6- Explain the basic physiology of the electrical conduction system of the heart. 7-Describes the structural and functional differences between arteries , veins and capillaries. 8- Identify the major subdivisions of systemic circulation 9-Describes common diseases affecting the cardiovascular system.
    2. 2. Valves Great vessels Chambers LA Septa RA LV LV Walls Tissues, and layers Coronary circulation and venous drainage RV Location and surface anatomy size
    3. 3. The heart Superior and inferior vena cava veins Aorta Main component s of the circulatory system Big arteries Small arteries Venules capillaries
    4. 4. Important tissues in the circulatory system Cardiac muscles smooth muscles Found in the heart Found in blood vessels Responsible for heart contraction (involuntary) Responsible for vasoconstriction and vasodilation in response to chemical mediators Non striated Striated Has tight junction and intercalated disk Act as one syncytium
    5. 5. The heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body. So that oxygen and and nutrients can reach all cells of the body and waste products are removed The heart, is a small organ, approximately the size of a fist. It is located in the mediastinum, with the heart tip pointing to the left of the body's midline.
    6. 6. The heart is enclosed in a protective, two-layer membrane is made up of dense connective tissue. , with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the heart's surface. Between these two layers, the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart.
    7. 7. Valves allow blood to flow in one direction only, preventing backflow . The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambers. This allows blood to flow from areas with higher pressure to those with lower pressure.
    8. 8. Difference Between Systole and Diastole Diastole: Systole: During diastole the ventricles relax , the A-V valves are opened , the semilunar valves are closed , the ventricles are filling During systole the ventricles contract , the A-V valves are closed , the semilunar valves are opened , the ventricles are ejecting blood into corresponding large arteries Exhibit 2
    9. 9. Atrioventricular valves Vs. semilunar valves (in systole and Diastole)
    10. 10. Coronary circulation Exhibit 3
    11. 11. ACUTE CORONARY SYNDROMES • These are number of conditions that results from Obstruction of a coronary artery • According to percentage and location of obstruction NSTEMI STEMI Sudden cardiac death Also referred to as a heart attack, may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques.
    12. 12. • Chest discomfort / pain with or without dyspnea. • Nausea. • Diaphoresis . • A diagnosis is made by a) ECG changes b) by the use of specific serologic markers.
    13. 13. • Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM. • New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction • Change in subsequent episode of care designation. Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation, observation, or treatment of an acute myocardial infarction treated on a previous admission. The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction • Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
    14. 14. ICD-9-CM ICD-10-CM 1. Acute myocardial infarction. Unspecified 1- Acute myocardial infarction. unspecified 2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial, but the site is provided, it is still coded as a subendocardial AMI. If NSTEMI evolves to STEMI, assign the STEMI code. If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI 2-AMI documented as nontransmural or subendocardial but site provided If only STEMI or transmural Ml without the site is If only STEMI or transmural Ml without the site documented, assign code I 21.3. is documented, query the provider as to the site, or assign a code from subcategory 410.9 If an AMI is documented as nontransmural or subendocardial, but the site is provided, it is still coded as a subendocardial AMI.
    15. 15. ICD-9-CM ICD-10-CM 3-Subsequent acute myocardial infarction A code from category I22, Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction, is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI. A code from category I22 must be used in conjunction with a code from category 121. The sequencing of the I22 and 121 codes depends on the circumstances of the encounter.
    16. 16. 1- Bypass: Bypass is defined as altering the route of passage of the contents of a tubular body part. Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part. Example of Bypass circulatory system procedures: coronary artery bypass graft (CABG) 2- Dilation: This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice. The orifice can be a natural orifice or an artificially created orifice. A device placed to maintain the new diameter is an integral part of the Dilation procedure, and is coded to the sixth-character device value in the procedure code. Examples: -Percutaneous transluminal coronary angioplasty (PTCA). -PTCA with insertion of either drug-eluting or non drug-eluting stent
    17. 17. • Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your heart's blood vessels using special X-rays called angiograms. Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter.
    18. 18. A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty. The stent stays in the artery permanently. The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina).
    19. 19. CORONARY ANGIOGRAM • • is a special X-ray test performed to find out if your coronary arteries are clogged, where and by how much. During an angiogram, your doctor inserts a thin tube (catheter) into an artery and up to the heart. Once in place, a dye that is visible by X-rays (contrast dye) is injected into the bloodstream. The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing. This procedure is done as part of the cardiac catheterization procedure.
    20. 20. ICD-10-PCS AND THE CIRCULATORY SYSTEM • ALL codes in ICD-10-PCS are seven characters in length
    21. 21. CHARACTER DEFINITION FOR CIRCULATORY SYSTEM • Character 1: • Medical and Surgical, 0 • Character 2: • 5 of 31 body systems pertain to the circulatory system 1. Heart and Great Vessels (character value 2) 2. Upper Arteries (character value 3) 3. Lower Arteries (character value 4) 4. Upper Veins (character value 5) 5. Lower Veins (character value 6)
    22. 22. CHARACTER 3: SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM Alteration Division Inspection Reposition Bypass Drainage Map Resection Change Excision Occlusion Restriction Control Extirpation Reattachment Revision Creation Extraction Release Supplement Destruction Fragmentation Removal Transfer Detachment Fusion Repair Transplantation Dilation Insertion Replacement
    23. 23. • Character 4: Body Part • body part or specific anatomical site where the procedure was performed. Examples: Character Value Heart and Great Vessels 0 Coronary Artery, One Site 1 Coronary Artery, Two Sites 2 Coronary Artery, Three Sites 3 Coronary Artery, Four or More Sites
    24. 24. Sample Grid for Combinations of characters 4 to 7 Percutaneous Transluminal Angioplasty with Stent of a single artery = 02705DZ
    25. 25. DEVELOPMENT OF ICD 10 PCS
    26. 26. The right atrium
    27. 27. the middle cardiac vein
    28. 28. Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN , the AVN ) conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively. Exhibit 4
    29. 29. Normal ECG …P wave…QRS complex……….ST segment……….T wave
    30. 30. In patients with acute coronary syndrome watch for the followings:
    31. 31. A cardiac cycle is the sequence of events that occur during each heart beat.
    32. 32. impulse from the SA node The four chambers of the heart then relax, and the cycle begins again. The increased ventricular pressure forces the SL valves open, ejecting blood from the heart.(ventricular ejection) Ejecting 70cc leaving 60cc (ESV) ventricles contract The atria relax Atrial systole ventricular diastole Atria contraction forces blood through the open A V valves to the ventricles. ventricle is able to fill with approximately 130 cc of blood, a volume referred to as the enddiastolic volume (EDV)
    33. 33. Blood vessels • Although there are variations in the function of each particular blood vessel, the walls of most have the following three layers: 1. 2. 3. Tunica interna: Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow. Tunica media: Thick middle layer of mostly smooth muscle cells and extensive elastic fibers. Tunica externa: Outermost layer of the vessel, its function is to attach the vessel to the surrounding tissue. It is made up of collagen, elastic fibers, and many nerves.
    34. 34. Blood vessels anatomy and sequence of flow Large Arteries transport blood away from heart to all organs and cells of the body. 1- Large arteries : are Elastic, conducting, arteries ,that receive blood from ventricles Which are high pressure chambers That’s why they should be thick walled , elastic include the aorta, pulmonary trunk, brachiocephalic, common carotid, common iliac, and subclavian arteries.
    35. 35. 2- Muscular (distributing) arteries : are mid-size arteries that are branches of the elastic large arteries. Varying in size from the pencil-sized axillary and femoral arteries to the small, string-size arteries that carry blood to organs, the thick walls of these arteries are able to regulate blood flow with vasoconstriction and vasodilatation. ie: the brachial and radial arteries of the arm • Those arteries are responsible for peripheral resistance ..and control blood pressure to certain extent
    36. 36. CO2 O2
    37. 37. Venules then begin to reunite and become successively larger veins, eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava.
    38. 38. Large veins carries blood to the the heart in reverse Direction : against gravity in the lower ½ of the body That’s why they are provided with valves
    39. 39. Blood pressure (BP), sometimes referred to as arterial blood pressure. is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs.
    40. 40. During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure. The blood pressure in the circulation is principally due to: a)the pumping action of the heart. b)peripheral resistance of arterioles
    41. 41. Old methods for classification of hypertension used in ICD-9-CM
    42. 42. Classification of Hypertension in ICD-10-CM • ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10–I15) Sub-categories: • I10, Essential (primary) hypertension • I11, Hypertensive heart disease • I12, Hypertensive chronic kidney disease • I13, Hypertensive heart and chronic kidney disease • I15, Secondary hypertension
    43. 43. Classification of Hypertension in ICD-10-CM • Hypertension is classified by type, primary or secondary, in ICD-10-CM. • The nature of hypertension (benign, malignant, unspecified) no longer exists for classifying hypertension in ICD-10-CM. • There is only one code, I10, for essential or primary hypertension. • Assign I10 if the physician documented any of the following: arterial hypertension, benign hypertension, essential hypertension, malignant hypertension, primary hypertension or systemic hypertension
    44. 44. Hypertensive Heart Disease • Hypertensive Heart Disease – Category I11 – I11 Hypertensive heart disease – I11.0 Hypertensive heart disease with heart failure – I11.9 Hypertensive heart disease without heart failure • Documentation must indicate a relationship between the heart disease and hypertension
    45. 45. Hypertension and Chronic Kidney Disease • Hypertensive Chronic Kidney Disease – Category I12 – ICD-10-CM presumes a cause-and-effect relationship between chronic kidney disease and hypertension. • Hypertensive Heart and Chronic Kidney Disease – Category I 13 – combination category for hypertensive heart disease (I11) and hypertensive chronic kidney disease (I12)
    46. 46. Heart Failure congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Common risk factors of heart failure in the united states • Ischemic heart disease 62% • Cigarette smoking 16% • Hypertension (high blood pressure) 10% • Obesity 8% • Diabetes 3% • Valvular heart disease 2% (much higher in older populations)
    47. 47. Systolic dysfunction Diastolic dysfunction 2 pathophysiological types failure of the ventricle to adequately It is of heart failure exist It is failure of the pump function of the heart. It is characterized by a decreased ejection fraction (less than 45%). -caused by dysfunction or destruction of cardiac myocytes or their molecular components. -The most common mechanism of damage is ischemia causing infarction and scar formation. -On echocardiogram, this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia), ventricular end-diastolic pressure and volumes increase. relax and typically denotes a stiffer ventricular wall. This causes inadequate filling of the ventricle, and therefore results in an inadequate stroke volume. The failure of ventricular relaxation also results in elevated end-diastolic pressures, and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure, peripheral edema in right heart failure.)
    48. 48. Systolic dysfunction Diastolic dysfunction This is transmitted to the atrium. On the left side of the heart, the increased pressure is transmitted to the pulmonary vasculature, and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma, causing pulmonary edema. On the right side of the heart, the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds, favoring extravasation of fluid into the tissues of target organs and extremities, resulting in dependent peripheral edema. Heart failure may be described as chronic when it is stable . Acute decompensated heart failure is worsening of symptoms, typically shortness of breath (dyspnea ) , edema and fatigue ,
    49. 49. a) Imaging Diagnosis Echocardiography used to determine : 1-stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat). 2-end-diastolic volume (EDV, the total amount of blood at the end of diastole), 3-ejection fraction (EF). the SV in proportion to the EDV, Normally, the EF should be between 50% and 70%; in systolic heart failure, it drops below 40%. 4-identify Valvular heart disease 5-Assess the state of the pericardium . 6-Echocardiography may also aid in deciding what treatments will help the patient, such as medication, insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy. b) Angiography Heart failure may be the result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle). As a result, coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery. c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
    50. 50. Management of heart failure • • Diet and lifestyle measures. Fluid restriction : consider an individualized fluid prescription, potentially based on patient body weight, sodium intake, and likelihood of adherence. Generally water intake should be limited to 1.5 L daily or less in patients with hypernatremia. • Pharmacological management Diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone antagonists (e.g. Spironolactone). Some drugs which increase heart function, such as the positive inotrope Milrinone, lead to increased mortality, and are contraindicated. ACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure, irrespective of symptomatic severity or blood pressure. ACE inhibitors improve symptoms, decrease mortality and reduce ventricular hypertrophy. • Devices. Patients with NYHA class III or IV, left ventricular ejection fraction (LVEF) of 35% or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT; pacing both the left and right ventricles), through implantation of a bi-ventricular pacemaker, or surgical remodeling of the heart. These treatment modalities may make the patient symptomatically better, improving quality of life and in some trials have been proven to reduce mortality. • Surgery The final option, if other measures have failed, is heart transplantation or (temporary or prolonged) implantation of an artificial heart. These remain the recommended surgical treatment options
    51. 51. Some Procedures done to heart failure patients • cardiac resynchronization therapy (CRT; pacing both the left and right ventricles), through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm. It does this with a small electric stimulation that helps your heart to beat regularly. It is puts the under the skin on your chest, just under your collarbone. It’s hooked up to your heart with tiny wires
    52. 52. A heart transplant, or a cardiac transplant is a surgical transplant procedure performed on patients with endstage heart failure or severe coronary artery disease. As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient. The patient's own heart is either removed (orthotopic procedure) or, less commonly, left in place to support the donor heart (heterotopic procedure); both were controversial solutions to an enduring human ailment. Post-operation survival periods averaged 15 years. Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients.
    53. 53. ICD-9-CM vs. ICD-10-CM and coding for heart failure ICD-9-CM 428 heart failure ICD-10-CM I 50 heart failure 428.0 congestive heart failure , unspecified 428.1 left heart failure . I50.1 left ventricular failure 428.2 Systolic heart failure . I50.2 Systolic (congestive) heart failure 428.20 unspecified I50.20 unspecified systolic (congestive) heart failure 428.21 acute I50.21 Acute systolic (congestive) heart failure 428.22 chronic I50 .22 Chronic systolic (congestive) heart failure 428.23 Acute on chronic I50 .23 Acute on chronic systolic (congestive) heart failure
    54. 54. ICD-9-CM vs. ICD-10-CM and coding for heart failure (cont.) ICD-9-CM ICD-10-CM 428.3 Diastolic heart failure . I50.3 Diastolic (congestive) heart failure 428.30 unspecified I50.30 unspecified diastolic (congestive) heart failure 428.31 acute I50.31 Acute diastolic (congestive) heart failure 428.32 chronic I50 .32 Chronic diastolic (congestive) heart failure 428.33 Acute on chronic I50 .33 Acute on chronic diastolic (congestive) heart failure
    55. 55. ICD-9-CM vs. ICD-10-CM and coding for heart failure (cont.) ICD-9-CM 428.4 combined Systolic and Diastolic heart failure. ICD-10-CM I50.4 combined Systolic (congestive) and Diastolic (congestive) heart failure 428.40 unspecified I50.40 unspecified combined Systolic (congestive) and Diastolic (congestive) heart failure 428.41 acute I50.41 Acute combined Systolic (congestive) and Diastolic (congestive) heart failure. 428.42 chronic I50 .42 Chronic combined Systolic (congestive) and Diastolic (congestive) heart failure 428.43 Acute on chronic I50 .43 Acute on chronic combined Systolic (congestive) and Diastolic (congestive) heart failure
    56. 56. ICD-9-CM vs. ICD-10-CM and coding for heart failure (cont.) ICD-9-CM 428.9 heart failure unspecified Cardiac failure NOS heart failure NOS myocardial failure NOS Weak heart ICD-10-CM I50.9 heart failure unspecified Biventricular (heart) failure NOS Cardiac , heart or myocardial failure NOS Congestive heart disease Congestive heart failure NOS Right ventricular failure (secondary to heart failure)
    57. 57. • As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM, by first classifying heart failure into systolic and diastolic , as well as combined and each class is further subdivided into acute , chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 ). • Also both require that the coder code first due to hypertension.
    58. 58. ICD-9-CM versus ICD-10-PCS and heart failure procedures • Coding for transvenous ventricular pacing for heart failure. ICD-9-CM ICD-10-PCS 37.71 initial insertion of transvenous lead [electrode] into ventricle 02HK3JZ Insertion of pacemaker lead into right ventricle , percutaneous approach. 02HL3JZ Insertion of pacemaker lead into left ventricle , percutaneous approach.
    59. 59. ICD-10-PCS and the Circulatory System • ALL codes in ICD-10-PCS are seven characters in length
    60. 60. Character Definition for Circulatory System • Character 1: – Medical and Surgical, 0 • Character 2: – 5 of 31 body systems pertain to the circulatory system 1. 2. 3. 4. 5. Heart and Great Vessels (character value 2) Upper Arteries (character value 3) Lower Arteries (character value 4) Upper Veins (character value 5) Lower Veins (character value 6)
    61. 61. CHARACTER 3: Some Root Operations related to circulatory system Alteration Division Inspection Reposition Bypass Drainage Map Resection Change Excision Occlusion Restriction Control Extirpation Reattachment Revision Creation Extraction Release Supplement Destruction Fragmentation Removal Transfer Detachment Fusion Repair Transplantation Dilation Insertion H Replacement
    62. 62. • Character 4: Body Part – body part or specific anatomical site where the procedure was performed. Examples: Character Value Heart and Great Vessels 4 Coronary vein 6 Atrium right 7 Atrium left k Ventricle right L Ventricle left
    63. 63. 0 Medical and Surgical 2 Heart and great vessels H Insertion putting in a non biological appliance that monitors , assists , performs , or prevents a physiological function but does not physically take the place of a body part 4 Coronary vein 6 Atrium right 7 Atrium left K Ventricle right L Ventricle left 0 Open 3 Percutaneous 4 Percutaneous Endoscopic 0 monitoring Device, pressure sensor 2 monitoring device 3 Infusion device D Intraluminal device J Cardiac lead , pacemaker K Cardiac lead , defibrillator M Cardiac lead Sample Grid for Combinations of characters 4 to 7 Insertion of pacemaker lead into right ventricle , percutaneous approach. = 02HK3JZ
    64. 64. ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation ICD-9-CM 37.51 Heart transplantation. 00.93 transplant from cadaver. ICD-10-PCS 02YA0Z0 Transplantation of heart , Allogeneic ,open approach 02YA0Z1 Transplantation of heart , Syngeneic ,open approach. 02YA0Z0 Transplantation of heart , Zooplastic ,open approach
    65. 65. 0 Medical and Surgical 2 Heart and great vessels Y Transplantation : Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and /or function of all or a portion of a similar body part A Heart 0 Open No device 0 Allogeneic 1 Syngeneic 2 Zooplastic
    66. 66. Types of circulations
    67. 67. The aorta, which is approximately one inch in diameter, is the largest artery in the body. From every part of the aorta, other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries, where the exchange of oxygen, nutrients, and waste products takes place within the individual organs.
    68. 68. Aortic Divisions First Order Branches Second Order Branches
    69. 69. CO2 O2 CO2 O2
    70. 70. 40 % 40 % 34 % 34 % 20 % 20 % 4% cerebral aneurysms are inclined to develop at the arterial junctions
    71. 71. the carotid and vertebral arteries supply oxygenated blood to the brain. • The carotid arteries are easily palpated under the jaw:
    72. 72. • Deoxygenated blood is removed from the brain via the jugular vein
    73. 73. Portal Circulation What is meant by portal circulation? CO2 O2 a portal system consists of a network of blood vessels through which blood is transported after passing through one capillary bed to another network of capillaries prior to being returned to systemic circulation. CO2 O2
    74. 74. • The portal venous system channels blood from parts of the digestive tract, spleen, and pancreas to the liver for processing prior to returning to the heart. Blood flow to the liver differs from that in the general circulation since the liver receives oxygenated blood, as well as partially deoxygenated blood. Oxygenated blood from the hepatic artery mixes with the nutrient rich blood from the portal vein in the liver sinusoids.
    75. 75. Rheumatic heart diseases and valvular problems Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain,[1] the illness typically develops two to three weeks after a streptococcal infection. Depending on the extent of heart inflammation involved, patients with the acute form of the disease may develop: 1- heart failure. 2-pericarditis 3-myocarditis. 4-endocarditis, which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases). commonly appears in children between the ages of 6 and 15, with only 20% of first-time attacks occurring in adults.[1] The illness is so named because of its similarity in presentation to rheumatism Usually manifested in the form of valvular lesions such as Mitral stenosis , Mitral incompetence, and aortic valve diseases.
    76. 76. Exhibit 6 Exhibit 7 Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors, such as calcification , rheumatic degeneration or congenital malformation.
    77. 77. Mitral stenosis is a problem when the valve is supposed to be opened mid diastolic rumbling murmur
    78. 78. For acute rheumatic heart conditions, there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code. For instance, ICD-9-CM code 391.0 for acute rheumatic pericarditis directly correlates to code I 01.1 in ICD-10-CM. ICD-9-CM ICD-9-CM does classify some conditions as rheumatic in nature ICD-10-CM ICD-10-CM has distinguished, in large part, specific valvular diseases caused by rheumatic fever versus those not related to the disease, as well as the specific valve

    ×