HS225

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HS225 Week 5Hemic/Lymphatic SystemMediastinum/
DiaphraghmDigestive SystemUrinary
SystemMaternity Delivery Care

• Robyn Korn, MBA, RHIA, CPHQ

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Ch 9 Hemic Lymphatic Systems

• The hemic and lymphatic systems often are viewed
  as subsystems of the circulatory system.
• The repair of a ruptured spleen is also known
  as a splenorrhaphy.
• The spleen is located in the left upper
  quadrant of the abdomen, behind the stomach and
  just below the diaphragm.
• The lymphatic channels, or vessels, transport
  fl uid away from the tissues of the body and
  toward the thoracic cavity.
• Lymph nodes, also known as lymph glands, are
  located at various areas along the lymphatic
  vessels.
• In an autologous bone marrow transplant, cells
  are cultivated from the patient's own marrow.
• In an allogenic bone marrow transplant, cells
  are taken from a donor and then transplanted.
• There are four major concentrations of lymph
  nodes cervical lymph nodes, submandibular lymph
  nodes, axillary lymph nodes, and inguinal lymph
  nodes.

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Ch 10 Mediastinum Diaphragm

• The mediastinum is the space in the thoracic
  cavity behind the sternum and in between the two
  pleural sacs that contains all the viscera of the
  chest except the lungs and pleurae.
• The diaphragm is a dome-shaped muscle that
  separates the thoracic cavity from the abdominal
  cavity.
• A mediastinotomy is a procedure in which an
  incision is made to open the mediastinum.
• A cervical or anterior mediastinotomy is
  completed from the front of the body.
• During a transthoracic mediastinotomy the
  incision is made in the fourth intercostal space
  to enter the mediastinum.
• A mediastinoscope is a lighted instrument that
  is used to visually examine the mediastinum.
• A transabdominal approach occurs when an
  incision is made across the abdomen.

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CH 11 Digestive System

• The digestive system is sometimes referred to
  as the alimentary canal.
• The procedure codes begin with procedures on
  the mouth and oral cavity and move through the
  entire digestive system.
• The vestibule of the mouth is the mucosal
  tissue and submucosal tissue of the lips and
  cheeks.
• Lingual refers to the tongue, and the
  sublingual area refers to the area under the
  tongue.
• A tracheostomy is a surgical opening in the
  trachea through the neck.
• An endoscopic procedure involves insertion of a
  flexible or rigid instrument called an endoscope,
  which is used to view the internal structures.
• Endoscopic and laparoscopic procedures are
  frequently completed on the digestive system.
• Manipulation is a maneuver by hand to treat or
  perform therapy.

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Chapter 11 Digestive (cont)

• Dilation is performed when an expansion or
  stretching is necessary.
• Enterolysis is the freeing of intestinal
  adhesions.
• Duodenotomy is the process of making an
  incision into the duodenum.
• A hemorrhoid is an enlarged varicose vein in or
  near the anus and includes the following types
• internal, external, combined, and mixed.
• Meckels diverticulum is a form of diverticulum
  of the ileum.
• A proctosigmoidoscopy is the examination of the
  rectum with scope advancement into the sigmoid
  colon.
• A sigmoidoscopy is a procedure in which the
  endoscope is moved all the way through the rectum
  and sigmoid colon and may even advance slightly
  into the descending colon.
• The examination in which the entire colon, from
  the rectum to the cecum, is visualized is known
  as a colonoscopy.

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Chapter 12 Urinary System

• The structures that are found in the urinary
  system include bilateral kidneys, bilateral
  ureters, the urinary bladder, and the urethra.
• The external sphincter controls the release of
  the urine from the bladder.
• The kidneys are located in the back of the
  abdominal region of the body on either side of
  the vertebral column.
• The ureters are muscular tubes that lead urine
  from the kidneys to the bladder.
• The urinary bladder is located in the pelvic
  cavity and serves as a temporary reservoir for
  the urine.
• The urethra is a mucous membranelined tube
  that leads urine from the bladder to be excreted
  from the body.

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Chapter 12 Urinary System (cont)

• A pyelotomy is an incision made into the renal
  pelvis.
• Endoscopy codes for ureteral procedures
  completed through an established ureterostomy are
  reported with codes 50951 to 50961.
• Code range 50970 to 50980 is used to report
  ureteral endoscopy through a ureterotomy.
• An alternate method of catheterizing the
  bladder for drainage is completed by performing a
  cystostomy.
• Code range 5240052700 is used for male
  patients to report procedures completed on the
  vesical neck and prostate.

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Case Study 1 Chapter 12

• Pre- and Postoperative Diagnosis Ureteral
  calculus
• Anesthesia General
• Procedure Ureteroscopy of left ureter for
  removal of calculus stent placement
• The patient was taken from the presurgery area to
  the operating room and prepped and draped in the
  usual fashion. General anesthesia was
  administered. The endoscope was placed into the
  urethra that appeared to be inflamed. The scope
  was then carefully passed through the bladder,
  which appeared normal. The guidewire was
  introduced, and a balloon was used to dilate the
  left ureter. The scope was advanced to view the
  ureter, where a small stone was seen. A stent was
  placed. The area was checked for bleeding, and
  the scope was then removed. The stent was
  attached to a string, which was in the correct
  position. Blood loss was minimal, and the patient
  was sent to the recovery room in good condition.
• CPT code(s)____________________________________

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Case 1 Answer Chapter 12

• Case 152352-LT
• Rationale Reference Removal as the main term in
  the Index with the subterm calculi. Ureter will
  offer a large code range, which should be
  referenced to locate the correct code.

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Case Study 2 Chapter 12

• Pre- and Postoperative Diagnosis Urethral
  stricture
• Procedure Dilation of urethra, first attempt
• This 45-year-old male patient was brought to the
  operating room and prepped and draped in the
  usual fashion. After the patient was
  anesthetized, a urethral dilator was inserted
  into the urethra. The urethra was then dilated
  to normal range. The dilator was removed, and no
  bleeding was noted. The patient tolerated the
  procedure well and was taken to the recovery
  room.
• CPT code(s)

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Case 2 Answer Chapter 12

• Case 253600
• Rationale Reference the main term Urethra in the
  Index. The subterm dilation directs the coder to
  a range of codes that should be referenced for
  proper code assignment.

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Case Study 3 Chapter 12

• The patient is a 70-year-old female with a
  history of bladder cancer. She presents today for
  a cystoscopy, biopsy, and fulguration of an
  erythematous area that appeared suspicious in
  previous testing. The area is the right trigone.
  
• The patient was placed in the supine position,
  where spinal anesthesia was administered. She was
  then turned to the dorsal lithotomy position,
  where she was prepped and draped in the usual
  sterile manner. A 22 French cystoscopy sheath
  was passed in atraumatic fashion per the urethra.
  The bladder was resected with the 70 degree lens
  where the right trigone area was found slightly
  erythematous and hypervascular. No tumors were
  found, and no mucosal abnormalities were noted. A
  biopsy of the area was taken and sent for
  pathology.
• Pathology findings Chronic cystitis with
  squamous cell metaplasia
• CPT code(s) ____________________________________

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Case 3 Answer Chapter 12

• Case 352224
• Rationale Referencing the Index under the main
  term Biopsy then the subterm bladder, the coder
  will need to determine which of the codes given
  will best represent the procedure performed. Keep
  in mind that the area biopsied was actually the
  trigone and no other procedure was performed.

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Case Study 4 Chapter 12

• The 68-year-old male who presents today for laser
  coagulation of the prostate due to urinary
  retention with urgency and difficulty urinating.
• Procedure The patient was placed on the
  operating table in the lithotomy position. Spinal
  anesthesia was administered, and external
  genitalia was prepped and draped. A 21-French
  cystoscope was introduced into the bladder. Upon
  inspection, there was no evidence of a tumor.
  Mild trabeculations were observed on both
  ureteral orifices. The retroscope was introduced
  with a resection of the lateral lobes of the
  prostate being done complete opening of the
  prostatic urethra was allowed. The bladder was
  examined, and all prostatic chips were removed.
  The bladder was coagulated and smoothed out with
  the VaporTrode. An indwelling Foley catheter was
• inserted into the bladder.
• CPT code(s)___________________________

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Case 4 Answer Chapter 12

• Case 452647
• Rationale Reference the main term Laser in the
  Index. The subterm prostate will offer a range of
  codes that the coder would reference to find the
  correct code assignment.

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Ch 15 Maternity Care Delivery

• An understanding of the global package for
  obstetric care is necessary to select the proper
  codes for services rendered.
• An understanding of terminology is important to
  proper code assignment.
• Complications that typically would not be part
  of the regular maternity care should be coded
  separately using Evaluation and Management codes.
• Cesarean section deliveries can be either
  planned or emergency.
• VBAC deliveries are those in which a vaginal
  birth is successfully performed following a
  cesarean section during a prior pregnancy.
• Abortion treatment can be elective or
  necessary.
• An understanding of the different types of
  abortion is essential for proper code assignment.

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Case Study 1 Chapter 15

• Woman presents in active labor and is admitted
  for delivery at 41 weeks gestation. Dr. Martin is
  the cover OB and has never seen the patient until
  today. Upon check of the cervix, dilation is at
  10, and baby is ready to deliver. No type of
  anesthesia has been given. The fetal monitor is
  showing a strong, viable fetus. After several
  pushes, the head appears, and the baby is
  suctioned immediately. A healthy male child is
  delivered at 1008 p.m. Apgar score is 8.
  Placenta is delivered, no forceps, no episiotomy.
  Mother and child are doing well. Dr. Martin will
  not be completing the postpartum care.
• CPT Code(s)__________________________

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Case 1 Answer Chapter 15

• Case 159409
• Rationale Dr. Martin is reporting only the
  delivery. He would not be reporting the global
  service that includes antepartum, delivery, and
  postpartum care. The coder would reference
  Vaginal Delivery as the main term in the Index.

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Case Study 2 Chapter 15

• A 28-year-old female presents to the emergency
  room with severe abdominal pain. Upon
  examination, it is determined that the patient is
  pregnant, but it is an ectopic pregnancy. The
  tube is unruptured at this time, so decision is
  made to do a laparoscopic resection of the
  ectopic pregnancy. Laparoscopic technique is used
  to get to the site. When the area is found, an
  incision is made in the tube using
  electrosurgical technique. Using forceps, the
  trophoblastic tissue is removed, bleeding is
  controlled, and the procedure is finished in the
  usual manner.
• CPT code(s) ______________________

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Case 2 Answer Chapter 15

• Case 259150
• Rationale The ectopic pregnancy was resolved
  with a laparoscopic technique that did not
  require a salpingectomy or an oophorectomy. The
  coder would reference the main term Ectopic
  Pregnancy in the Index. The subterm laparoscopy
  is then referenced.

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Case Study 3 Chapter 15

• OFFICE NOTE
• Diagnosis Pregnancy at 30 weeks
• This 29-year-old patient is 30 weeks pregnant and
  has been seen by me since she was 8 weeks
  pregnant. She is moving out of town and is going
  to be seen by Dr. Nicon in Atlanta, Georgia. Her
  prenatal records will be sent. At this time her
  pregnancy is normal with no complications. She
  has been seen seven times by me.
• Note to billing staff Please bill patients
  insurance at this time.
• CPT code(s)________________________

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Case 3 Answer Chapter 15

• Case 359426
• Rationale The coder would reference Pregnancy or
  Antepartum Care and the subterm vaginal delivery
  to find the correct code to report.

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Case Study 4 Chapter 15

• Office Note
• Diagnosis Normal pregnancy and vaginal delivery
  Mrs. Smith delivered a 6 pound 10 ounce baby girl
  on 1/10/XX at 123 a.m. This is her final
  postpartum visit. See OB flow sheet for physical
  findings.
• Note to billing staff Please bill patients
  insurance at this time.
• CPT code(s) _______________

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Case 4 Answer Chapter 15

• Case 459400
• Rationale This code is used to report a normal
  vaginal delivery, even if an episiotomy or
  forceps use is necessary. Reference the main term
  Vaginal Delivery to locate this code.

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Case Study 5 Chapter 15

• Office Note
• Diagnosis Normal pregnancy followed by attempted
  vaginal delivery after previous C-section
  delivery Mrs. Williams delivered an 8 pound 12
  ounce baby boy on 4/15/XX at 1111 a.m. via
  C-section after attempting to vaginally deliver
  the child. This is her final postpartum visit.
  See OB flow sheet for physical findings.
• Note to billing staff Please bill patients
  insurance at this time.
• CPT code(s) ___________________

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Case 5 Answer Chapter 15

• Case 559618
• Rationale Reference the main term Vaginal
  Delivery to locate this code. The coder will note
  that the subterm attempted is found under after
  Previous Cesarean Delivery.

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Procedural Coding Exam

• 55 questions 170 points
• 4 hours
• 10 true/false
• 45 coding
• Covers Units 1-6
• In order to complete the exam, be prepared to use
  the AHIMA Virtual Lab or the CPT Coding Manual.

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Coding Focus

• Lab
• Radiology
• Evaluation and Management
• Medicine
• OB
• Cardiovascular System
• Endocrine System
• Nervous System

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Reminders

• You will only be able to enter your online exam
  one time
• Click the "Save Answers" button often
• If you lose your internet connection during your
  exam, logon again and try to access your exam. If
  you are unable to enter the exam, contact your
  instructor.
• You will always be able to see the time remaining
  in the exam at the top right of the page

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