Applied Sciences

CHAPrER 21 r Cardiovascular System

Using the CPT and ICD-10-CM/ICD-9-CM manuals, code the fallowing:

41. Valvuloplasty of the aortic valve using transventdcular dilation with cardiopulmonary bypass.

CPT Code:

,/ i+

y’+2. Xeptacement aortic valve, with cardiopulmonary bypass, with prosthetic valve.

CPT Code:

43. Valvuloplasty, tricuspid valve, with ring insertion.

CPT Code:

d p”puirof a coronary arteriovenous fistula, without cardiopulmonary bypass.

CPT Code:

d *r”rnal electrical cardioversion.

CPT Code:

47. Percutaneous balloon angioplasty; one coronary vessel.

CPT Code:

t*{. Cpp.(Cardiopulmonary resuscitatio4).

CPT Code:

49. Electrocardiogram with interpretation and report only.

CPT C6de:

C rrrurs graft of the common carotid-ipsilateral iriternal carotid artery using synthetic vein.

CPT Code:

5L. Ligation of temporal artery.

CPT Code:

Odd-numbered answers are located in Appendtx B, while the full arrrwer key ts only avallable tn the TEACE Instructor Resources on Evolve.

Copyrlght @ 2015 by Saunde$, an imprint of Elsevier Irrc. All rights reseryed.

45. Routine ECG with components.

CPT Code:

L2leads with both the professional and technical

CHAPTER 21

a

I Cardiovascular System

,/ v52. Ligation of a common iliac vein.

CPT Code:

53. Open ftansluminal balloon angioplasty aorta.

CPT Code:

,An. Coronary artery bypass, single artery, for coronary atherosclerosis of native coronary artery in a transplanted heart.

CPT Code:

ICD-10-CM Code:

(ICD-9-CM Code:

four veins, no arteries. Diagnosis of acute55. Coronary artery bypass, coronary insufficiency.

& cpr code(s):

& tco-ro-cM code(s):

(& ICD-q-cM Code(s):

teriovenous fistula of a’Iower extremity.

CPT Code(s):

ICD-10-CM Code(s):

ICD-9-CM Code(s):

& Ur”. to declde number of codes necessary to conectly answer the question. Odd-numbered ansyyers are located in Appendix B, while the full anxwer key is only avallable in the TEACH Instructof Resources on Evolve,

&

&

@

/ g/SO. nepair of injury to intra-abdominal blood vessel, inferior vena cava,

hepatic vein, with a vein graft.

& cpr code(s):

& tco-ro-cM Code(s):

(& ICD-o-cM code(s):

57. Percutaneous insertion of an intra-aortic balloon assist device due to initial episode of acute myocardial infarction apd cardiogenic shock.

& cpr code(s):

& tco-ro-cM code(s):

/ (& ICD-o-cM code(s): I

VSa. nepair of a traumatic ar

Copy,right @ 2015 by Saunders, an impdnt of Elsevier Inc. Al1 rights teserved.

59. Repair congenital

CHAITTER 21 r

atrial septal defect, secundum, with

Cardiovasculat System

bypass and patch.

& cpr code(s):

& Ico-to-cM code(s):

.1& lco-o-cM code(s): ) ffiO. Repair of a patent ductus arteriosus by division on a 16-year-old patient.

& cpr code(s):

& Ico-ro-cM code(s):

1& Ico-e-cM code(s):

61. Reoperation of one arterial coronary bypass graft and one vein bypass graft for arteriosclerosis of native arteries, 3 months following the initial procedure.

& cpr Code(s):

& tco-ro-cM code(s):

1& rco-l-cM code(s):

B U””* to decide number of codes necessary to conectly answer the qucstloL odd-numbered answerc are located ln Appendix B, whlle the full answer key is only avallable ln the TEACE Instructor Resources on Evolve.

Copyright O 2015 by Saunders, an impdnt of Elsevier Inc. All rights reserved.

CHAI/IER 2t t Cardiovascular System

REPORTS

In Appenitix A of this workbook you will find a section titled Reports, which con{iins original reports. Read the reports indicated below and supply the appropriate cPT and ICD-10-CM/ICD-9-CM codes on the following lines:

tz. x”portzs & cpr code(s):

& tco-ro-cM code(s):

1& tco-l-cM code(s): -.-) 63. Report 26

& cpr code(s):

& Ico-ro-cM code(s):

, (& ICD-q-cM Code(s): /

J o+. Report 27

CPT Code(s):

ICD-1O-CM Code(s):

ICD-9-CM Code(s):

& Ur”r to decide number of codes necessary to correctly anslver the questlon. Odd-numbered answers are located in Appendix B, while the full answer key is only avallable in the TEACH InstrEctor Resources on Evolve.

&

&

(&

Cop)dght @ 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.

APPENDIX A T RepoItS

PROCEDURE PERFORMED: Fiberoptic bronchoscopy, bronchial biopsy, bronchial washings, bronchial brushings.

PREPROCEDURE DIAGNOSIS: Abnormal chest x-ray.

POSTPROCEDURE DIAGNOSIS: Inflammation in all lobes, pneumonia. With pleural plaquing consistent with possible candidiasis.

The patient was already on a ventilator, so the bronchoscope tube was introduced through the endotracheal tube. We saw 2.5 cm above the carina of the trachea, which was red and swollen, as was the carina. The right lung-all entrances were patent, but they were all swollen and red, with increased secretions. The left lung was even more involved, with more swelling and more edema and had bloody secretions, especially at the left base. This area from the carina all the way down to the smaller airways on the left side had shown white plaquing consistent with possibie candidiasis. These areas were brushed, washed, biopsied. A biopsy specimen was also sent for tissue culture, as well as two biopsy specimens sent for pathology. Sheath brushings were also performed. The patient tolerated the procedure well, was still in the ICU, monitored throughout the procedure’

PROCEDURES PERFORMED: Left-sided heart catheterization, selective coronary angiography, and left ventricuiography.

INDICATION: Chest pain and abnormal Cardiolite stress test.

COMPLICATIONS: None.

RESULTS:

I. HEMODYNAMICS: The left ventricular pressure before the Lv-gram was 11,7lL with an LVEDP of 4. After the LV-gram, it was 11114 with an LVEDP of 10. The aortic pressure on pullback was 111177.

II. LEFT VENTRICULOGRAPHY The left ventriculography showed that the left ventricle was of normal size. There wele no significant segmental wall motion abnormalities. The overall left ventricular systolic function was normal with an ejection fraction of better tll,an 600/o.

III. SELECTIVE CORONARY ANGIOGRAPHY: A. RIGHT CORONARY ARTERY: The right coronary artery is a medium to large size dominant artery that has about 8Oo/o to 9Oo/o proximal/mid eccentric stenosis. The rest of the artery has only mild surface irregularities. The PDA and the posterolateral branches are small in size and have only mild surface irregularities.

B. LEFT MAIN CORONARY ARTERY: The left main has mild distal narrowing.

C. LEFT CIRCITMFLEX ARTERY: The left circumflex artery was a medium size, nondominant artery. It gave rise to a very high first obtuse marginal/intermedius, which was a bifurcating medium size artery that has only mild surface irregularities. The second obtuse marginal was also a medium size artery that has about 2oo/o to 25o/o proximal narrowing. After that second obtuse marginal, the circumflex artery was a small size artery that has about 2Oo/o to 30olo narrowing, a small aneurysmal segment. After

Copyright @ 2015 by Saunders, an imprint of Elsevier Inc. Al1 rights reserved

I i

APPENDIX A r Reports

that, it continued as a small third obtuse marginal that has mild atherosclerotic disease.

D. LEFI ANTERIOR DESCENDING CORONARY ARTERY: The left anterior descending artery was a medium size artery that is mildly calcified. It gave rise to a very tiny flrst diagonal that has mild diffuse atherosclerotic disease. Right at the origin of the second diagonal, the LAD has about 30olo narrowing. The rest of the artery was free of significant obstructive disease. The second diagonal was also a small caliber artery that has no significant obstructive disease.

CONCLUSION:

1. Normal overall left ventricular systolic function 2. Severe single vessel atherosclerotic heart disease

RECOMMENDATIONS: Angioplasty stent of the right coronary artery.

PREOPERATM DIAGNOSIS: Atherosclerotic heart disease, coronary artery disease with depressed LV function.

POSTOPERATM DIAGNOSIS: Same.

PROCEDURE PERFORMED: Single vessel coronary artery bypass grafting, LIMA to LAD, off-pump.

ANESTHESIA: General endotracheal.

SPONGE COUNT, NEEDLE COUNT, INSTRUMENT COLINT: Correct.

ESTIMATED BLOOD LOSS: Approximately 666 cc and CellSaver given back is approximately 287 cc.

DRAINS: Four 19-French round Blake drains, one in the left chest, one in the right chest, one over the heart, and one over the pericardial wall, placed to Pleur-evac suction.

INDICATIONS: The patient is a 62-year-old man who has undergone approximately 72 heart catheterizations in the last several years. He has had recurrent in-stent stenosis of the proximal LAD lesion and also a branch of an OM with disease proximally. The patient is taken to the operating room because of recurrent angina, Class IIi anginal symptoms.

PROCEDURE: After informed consent was obtained, the patient was taken to the operating room. The patient was properly identifled. A Swan-Ganz catheter was placed and a right arterial line was placed. A Foley catheter was inserted. The patient was prepped from his chin to both feet bilaterally. A midline sternotomy was performed. The sternum was divided with the sternal saw and the left internal mammary was harvested in a standard fashion.

Simultaneously, the right greater saphenous vein was harvested beginning in the thigh and extending down to the level of the knee. The vein was adequate for bypass grafting. It was excised. The wound was then closed in layers.

Once the LIMA was nearly completely dissected free, the patient was heparinized. The LIMA was divided distally and noted to have excellent flow. It was tied distally. LIMA bed was examined for bleeding. There appeared to be no bleeding present from the LIMA bed. Attention was then turned to the pericardium. The pericardium was opened. Pericardial stay

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APPENDIX A T RepOTtS

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