UMA STUDY GUIDE BC3020 Week 5 Please review the following topics in preparation for your week 5 coursework. MAKE SURE YOU COMPLETE THE ICD-10 MODULE FOR THIS WEEKS TEST! Objectives for \"Next Step\" Chapter 6 (used in conjunction with the ICD-10-CM and CPT-4 code books) Objective 1 o Remember to use the main term in the index of the ICD-9-CM and the appropriate sub-terms for the best code options. Read the guidelines for specific information regarding additional coding and code sequencing. o There may be multiple diagnoses for each patient. Objective 2 o Read and be familiar with the guidelines found within the cardiovascular subsection as in the CPT-4 code book. o Use the main term in the index of the CPT-4 code book and the appropriate subterm for specific code range. Objective 3 o Cardiovascular sub-section divided by coronary and non-coronary vessels o o o o o o o Be familiar with the approach involved with pacemaker placement: Epicardial Transvenous Know the difference between pacemaker and cadioverter-defibrillator. Single -one chamber Dual -two chambers Multiple-more than two chamber Lead=electrode Battery=pulse generator PTCA is Percutaneous Transluminal Coronary Angioplasty Holter monitor are used for ambulatory ECG's Cardiovascular codes are located in Surgery, Medicine and Radiology Stationary blood clot is thrombus; moving blood clot is embolus Ultrasound of blood vessels is a vascular study (Duplex scan)(Doppler) Echocardiology Echocardiology is ultrasound Transthoracic Echocardiography TEE Transesophageal Echocardiography Doppler and Color-flow Doppler Echocardiography o Review abbreviations throughout the chapter LAD - left anterior descending RCA- right coronary artery SVT- supraventricular tachycardia Other topics to study o Use your Language of Medicine text book for additional resource with vocabulary and anatomy found in the medical record o Read the entire chapter and do the practice exercises o Attend live learning labs with Academic Coaches to improve your coding skills (found in the Student Took Kit on the MyUMA page in Blackboard) o Attend any of the instructor labs for extra coding tips and help o MAKE SURE YOU COMPLETE THE ICD-10 MODULE FOR THIS WEEKS TEST! Complete the following scenarios to prepare for your Coding Experience. Steps for correct CPT coding 1. 2. 3. 4. 5. 6. 7. 8. 9. Determine the procedure, test, or service to be coded Identify all terms Locate each main term in the Alphabetic Index Review and select the subterms indented below the main term Note the code number(s) found opposite the selected main term or subterm Verify the code in the Tabular List Review coding notes and coding conventions Determine modifiers when applicable Repeat steps for additional code(s) Steps for correct ICD coding 1. 2. 3. 4. Identify all terms in the diagnosis Locate each main term in the Alphabetic Index. Refer to any subterms indented under the main term. Follow cross-reference instructions if the needed code is not located under the first main entry consulted. 5. Verify the code in the Tabular List. 6. Read and be guided by any instructional terms in the Tabular List. 7. Assign codes to the highest level of specificity. 8. Code the diagnosis until all elements are completely identified. Cardiovascular System- Case 1 LOCATION: Outpatient, Hospital PATIENT: Bernie Lieberwitz SURGEON: David Barton, MD PROCEDURES PERFORMED: Left heart catheterization, selective coronary angiography and left ventriculography INDICATION: Chest pain and abnormal Cardiolite stress test COMPLICATIONS: None RESULTS: 1. HEMODYNAMICS: The left ventricular pressure before the LV (left ventricle)-gram was 117/1 with an LVEDP of 4. After the LV-gram, it was 111/4 with an LVEDP of 10. The aortic pressure on pullback was 111/17. 2. LEFT VENTRICULOGRAPHY: The left ventriculography showed that the left ventricle was normal in size. There were no significant segmental wall motion abnormalities. The overall left ventricular systolic function was normal, at better than 60%. 3. SELECTIVE CORONARY ANGIOGRAPHY: A. RIGHT CORONARY ARTERY: The right coronary artery is a medium-to large-size dominant artery that has about 80% to 90% proximal/mid eccentric stenosis. The rest of the artery has only mild surface irregularities. The PDA (posterior descending artery) 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 CIRCUMFLEX 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 at about 20% to 30% proximal narrowing. After that second obtuse marginal, the circumflex artery was a small-size artery that has about 20% to 30% narrowing, a small aneurysmal segment. After that, it continued as a small third obtuse marginal that has mild atherosclerotic disease. D. LEFT 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 first diagonal that has mild diffuse atherosclerotic disease. Right at the origin of the second diagonal, the LAD (left anterior descending coronary artery) has about 30% 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. RECOMMENDATION: Angioplasty stent of the right coronary artery What is the name of physician you are coding for in Case-1? What is the documented reason for the procedure in Case-1? What is the main term referenced for the procedure in Case-1? Assign the CPT code for Case-1: _________ Assign the Modifier for Case-1: _____ What does the use of this modifier explain about Case-1? What is the main term referenced for the diagnosis in Case-1? Assign the ICD-10-CM code for Case-1: _____________ Cardiovascular System-Case 2 LOCATION: Inpatient, Hospital PATIENT: A. G. Vanyo ATTENDING/ADMIT PHYSICIAN: Frank Gaul, MD SURGEON: James Noonar, MD PREOPERATIVE DIAGNOSIS: Atherosclerotic heart disease. POSTOPERATIVE DIAGNOSIS: Atherosclerotic heart disease. PROCEDURE: Coronary artery bypass graft times two of the left internal mammary artery to the left anterior descending bypass and a single saphenous vein bypass from the aorta to the obtuse marginal branch of the left circumflex. ANESTHESIA: General. INDICATION: This 76-year-old male patient with accelerating angina was noted on cardiac catheterization to have high-grade ostial left main coronary disease. He also had a 70% obtuse marginal branch lesion. The left ventricular function was normal. FINDINGS AT SURGERY: The left anterior descending artery was diffusely diseased throughout and measured 1.5 mm in diameter where it was grafted and was of poor quality. The internal mammary artery was a 2-mm vessel of good quality with excellent flow. The vein was a 6-mm diameter vessel of poor quality, somewhat varicosed, and was used in a reversed fashion. It was not harvested with the endoscopic technique because of the patient's unstable presentation. The obtuse marginal branch was a 2-mm diameter vessel and was of good quality. PROCEDURE: On May 8 of this year the patient was brought to the operating room and placed in the supine position, and under general intubation anesthesia, the anterior chest, abdomen, and legs were prepped and draped in the usual manner. A segment of greater saphenous vein was harvested from the left thigh and prepared for grafting. The sternum was opened in the usual fashion, and the left internal mammary artery taken down and prepared for grafting. The pericardium was incised sharply and pericardial well created. The patient was systemically heparinized and placed on single right atrial to aortic cardiopulmonary bypass with a sump in the main pulmonary artery for cardiac decompression. The patient was cooled to 26C, and on fibrillation, the aortic cross clamp was applied to potassium-rich cold crystalline cardioplegic solution administered through the aortic root with satisfactory cardiac arrest. Subsequent doses were given via the coronary sinus in retrograde fashion and down the vein graft as the anastomosis was completed. The end of the greater saphenous vein was then anastomosed to the proximal portion of the obtuse marginal branch with 7-0 Prolene. The left internal mammary artery was then brought down to the junction of the middle and distal one third of the left anterior descending and anastomosed thereto with 8-0 continuous Prolene. Please note that all grafts were pro patent prior to closure. The aortic cross clamp was removed after 47.6 minutes with spontaneous cardioversion to a normal sinus rhythm. The patient was then warmed to 37C esophageal temperature and weaned from cardiopulmonary bypass without difficulty after 72 minutes. No inotropes were used. The patient was decannulated, protamine given, and hemostasis achieved. Temporary pacer wires were placed in the right atrium and right ventricle. The chest was drained with two chest tubes and closed in layers in the usual fashion. The leg was closed similarly. Sterile compression dressings were applied, and the patient returned to surgical intensive care unit in satisfactory condition. Sponge count and needle count correct times two. Assign the CPT code for Case-2: ______________ Assign the additional CPT code for Case-2: ________ Assign the ICD-10-CM code for Case-2: ___________ Abstracting Questions: 1. Was the grafting in Case-2 done with arterial grafts, venous grafts, or both? 2. What code range in Case-2 is referenced for assignment of the venous grafting code? 3. Was the arterial grafting a single graft or multiple grafts in Case2? 4. Is the harvesting of the vein graft reported separately for Case-2? 5. Is the cardiopulmonary bypass and cooling reported by the cardiologist for Case-2? Cardiovascular System-Case 3 LOCATION: Inpatient, Hospital PATIENT: Matthew Logan ATTENDING PHYSICIAN: Leslie Alanda, MD SURGEON: James Noonar, MD INDICATION: ASHD PROCEDURES PERFORMED: Stenting of the LAD and angioplasty of the second marginal ANGIOPLASTY AND STENT OF THE LEFT ANTERIOR DESCENDING ARTERY: Mach 2.5 guide was used. The patient received intravenous heparin. He was preloaded with Plavix. A BMW was advanced to the LAD. Thereafter, a 3.0 X 15 balloon was dilated into the LAD. Thereafter, a 3.0 X 24 Taxus stent was deployed at 15 atmospheres with good angiographic result and no residual stenosis. ANGIOPLASTY OF IN-STENT RESTENOSIS OF THE SECOND MARGINAL OF THE LEFT CORONARY ARTERY: The BMW wire was advanced to the circumflex, and the stent was dilated with 2.5 X 20 a Quantum Maverick balloon with good angiographic result and no residual stenosis. Distal to the stent, there was a lesion that has a remainder of 20% to 30%, and I was not willing to stent the small vessel that is going to be prone to re-stenosis like it had done previously. Review the medical documentation from Case-3 to answer the following questions. Are the service code(s), modifier(s) and ICD-10-CM code(s) listed below correct for Case-3? Briefly explain why the code(s) or modifier(s) are correct or incorrect. What steps did you take to confirm the best code(s) and modifier(s) for Case-3? SERVICE CODE/MODIFIER: 92928-LD, 92920 ICD-10-CM DX CODE(S): I25.10