1. Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 26 ENDOCRINE AND NERVOUS SYSTEMS

2. Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endocrine System Subsection 9 glands in Endocrine System; only 4 included in subsection –Thyroid –Parathyroid –Thymus –Adrenal Pituitary and pineal: See _______ System Pancreas: _______ System Ovaries and testes: Respective ______ system (Cont’d…) Nervous Digestive Genital Figure: 26.1

3. Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endocrine System (60000-60699) (…Cont’d) Divided into 2 subheadings –Thyroid Gland –Parathyroid, Thymus, ______ Glands, Pancreas, and Carotid Body Adrenal (Cont’d…)

4. Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Endocrine System (60000-60699) (…Cont’d) Carotid body refers to area adjacent to carotid _____ –Can be site of tumors artery Figure: 26.2 The baroreceptor system for controlling arterial pressure. (Modified from Hall JE: Guyton and Hall Textbook of Medical Physiology, ed 12, Philadelphia, 2011, Saunders.)

5. Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Thyroid Gland, Excision (60100-60281) 2 lobes Code descriptions often refer to –Partial or _______ : Something less than total –Removes problem side of the gland, isthmus, and majority of opposite lobe –Total: All –Lobectomy (Partial) –Total Thyroid Lobectomy (solitary nodules, follicular adenomas, nodules, goiters) subtotal

6. Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Nervous System Divided anatomically –Skull, Meninges, and Brain –Spine and Spinal Cord –Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System

7. Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain (61000-62258) Categories –Injection, Drainage, or Aspiration –Twist Drills, Burr Hole(s), or Trephine Meninges—3 layers of connective tissue membranes that surround the brain and spinal cord (Cont’d…) Meninges of the central nervous system. (Modified from Applegate E: The Anatomy and Physiology Learning System, ed 4, St. Louis, 2011, Saunders.)

8. Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain (61000-62258) (…Cont’d) Conditions that require openings into brain to: –Relieve ________ –Insert monitoring _______ –Place tubing –Inject _______ material (Cont’ d…) pressure devices contrast

9. Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain (61000-62258) (…Cont’d) Craniectomy or Craniotomy category (61304-_____) –Removal of portion of skull, usually as operative site –Codes divided by ___ and condition 61576 site

10. Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base Category Skull base: Area at base of _______ –Lesion removal from this area very complex Extensive category notes Surgical management of lesions in skull base Often involve surgeons from different specialties working during same operative session cranium

11. Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base Terminology ________ procedure: Used to gain exposure of lesion _______ procedure: What is done to lesion Repair/ ____________ procedure: Reported separately only if extensive repair Approach Definitive reconstruction

12. Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base (61580-61619) Approach procedure and definitive procedure coded ________ separately (Cont’d…)

13. Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base (61580-61619) (…Cont’d) Example: –Removal of an intradural lesion using middle cranial fossa approach –61590 Infratemporal pre-auricular ________ procedure, middle cranial fossa and –61608 ________ procedure of intradural resection of lesion approach Definitive

14. Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Cerebrospinal Fluid (CSF) Shunt (62180-62258) Used to drain ___ Codes describe placement of –Devices –Repair –Replacement –Removal of _______ devices fluid shunting

15. Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Spine and Spinal Cord (62263-63746) Codes divided on _______ and approach Other important coding considerations –Unilateral or bilateral procedures (___) –Multiple procedures (___) –Radiologic supervision and _____________ reported separately condition -50 -51 fluoro guidance (Cont’d…)

16. Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Many codes in the Nervous System involve conditions responsible for the procedure –Example: abscess, cyst, hematoma, foreign body, tumor, etc., as well as the technique used for the operation Review CCI edits Spine and Spinal Cord (62263-63746) (…Cont’d)

17. Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Introduction/Injection of Anesthetic Agent, Diagnostic or Therapeutic (64400-64530) Includes codes for: –_____ blocks 64400-64530 –Facet ____ injections 64490-64495 –_______ injections 64479-64484 Used to provide pain relief Nerve joint Epidural

18. Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 26 ENDOCRINE AND NERVOUS SYSTEMS