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Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm.

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Presentation on theme: "Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm."— Presentation transcript:

1 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm

2 CPT copyright 2013 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. CPT ® Disclaimer 2

3 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Understand basic anatomy and functions of the respiratory system, the hemic and lymphatic systems, and the mediastinum and diaphragm Define key terms Discuss common CPT® codes and modifiers Review diagnoses common to the respiratory system, the hemic and lymphatic systems, and the mediastinum and diaphragm Introduce HCPCS Level II codes and coding guidelines as they apply to these systems. Objectives 3

4 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Nose Larynx Pharynx Trachea Bronchi Bronchioles Lungs Respiratory System 4

5 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Alveoli –Located at the ends of the bronchioles –Function is gas exchange (CO 2 and O 2 ) Pleura Respiratory System 5

6 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Respiratory System Acute Respiratory Infections ( ) Other Disease of the Upper Respiratory System ( ) Pneumonia and Influenza ( ) COPD and Allied Conditions ( ) ICD-9-CM 6

7 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Laryngitis Croup Respiratory Syncytial Virus (RSV) Pneumonia Influenza COPD ICD-9-CM 7

8 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Asthma Bronchitis Pneumoconiosis Empyema Pneumothorax Interstitial Lung Disease ICD-9-CM 8

9 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Pulmonary Edema V codes –Personal history –Family history –Screenings ICD-9-CM 9

10 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Respiratory procedures –Progress downward from the head to the thorax Parenthetical statements –Directions on how to use specific codes –Apply to codes above parenthetical note; not below Most codes are unilateral Use modifier 50 if bilateral procedure performed –Unless code descriptor states bilateral CPT® Rules/Guidelines 10

11 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision Drainage –Abscess or hematoma The Nose 11

12 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision Biopsy code Nasal polyps –Polyp is a growth protruding from a mucous membrane in a body cavity –Simple or extensive –Use modifier 50 to bill bilateral –One or multiple polyps removed, report code one time The Nose 12

13 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision Lesion destruction –Approach used –Lasers –Cryotherapy –Electrocautery Cyst removals Turbinates/procedures –Soft, small bones in nose –Can inhibit proper breathing when enlarged/diseased –Billed per turbinate Code up to six turbinate removals The Nose 13

14 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Rhinectomy Total rhinectomy –Remove entire nose Deep cancer of skin Bad case of frost bite The Nose 14

15 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Introduction –Therapeutic turbinate injection –Prosthesis for deviated nasal septum Plug placed by physician Removal of foreign body –Office setting –Facility setting General anesthesia The Nose 15

16 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Repair Rhinoplasty –Cleft palate/lip repair –Parenthetical statement Reconstruction, grafts Septoplasty Choanal atresia Fistula (promaxillary) The Nose 16

17 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Destruction –Turbinate mucosa Do not use modifier 50 Other procedures –Control of epistaxis (nose bleed) Approach Simple or complex Use modifier 50 for bilateral on anterior approach –Fracturing of turbinates The Nose 17

18 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision Open vs. closed (or endoscopic) –Cutting into the body area Sinus lavage Sinusotomies –Drainage –Polyp removal –Biopsy Accessory Sinuses 18

19 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy All surgical endoscopies always include a diagnostic endoscopy Diagnostic evaluation –Includes inspection of nasal cavity, meatus, spheno- ethmoid recess and turbinates Accessory Sinuses 19

20 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy –Biopsies –Maxillary, ethmoidectomy, sphenoidotomy –Repair of CSF leak (ethmoid region) – With optic nerve decompression –Many parenthetical statements in CPT® for accessory sinus endoscopies Other procedures –Unlisted procedure codes always end in “99” Accessory Sinuses 20

21 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision Removal of part of larynx, pharynx, surrounding tissue –Due to tumor of benign or malignant nature Approaches –laterovertical –anterovertical –anter-latero-vertical The Larynx 21

22 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision Always includes tracheostomy –Not coded separately Neck dissections –Radical-Remove sternocleidomastoid muscle. submandibular salivary gland, internal jugular vein, lymph nodes of lateral neck, chin and mandible and also supraclavicular nodes The Larynx 22

23 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision Emergency endotracheal intubation Change of tracheotomy tube The Larynx 23

24 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy Use of operating microscope or telescope –Parenthetical statement instructs not to code the operating microscope Direct visualization –View anatomical structures via bronchoscope inserted into laryngoscope Indirect visualization –Structures viewed in a laryngoscopic mirrored reflection The Larynx 24

25 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy Tumor excision Vocal cord injection or stripping Biopsies Flexible fiberoptic and ridged scopes are used and have different codes The Larynx 25

26 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Repair –Stenosis –Scarring Result of burn –Laryngeal web Web of tissue between vocal folds Destruction –Laryngeal nerve – unilateral and therapeutic The Larynx 26

27 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision Tracheotomy, tracheal punctures, tracheostoma revision Tracheobronchoscopy through established tracheostomy EBUS Trachea and Bronchi 27

28 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy Many bronchoscopy codes –Use common portion of main or parent code (up to the semicolon) as the first part of each indented code descriptor under the parent code –Watch for bull’s eye - includes moderate sedation Bronchoscopy codes –Bronchial lung biopsies –Foreign body removals –Stent or catheter placements –Flexible or rigid scopes –Many parenthetical statements Trachea and Bronchi 28

29 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Bronchial Thermoplasty –Treats severe asthma Introduction –Catheterization with bronchial brush biopsy –Aspiration (catheter) –Indwelling tube/stent placement for oxygen therapy Trachea and Bronchi 29

30 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision and Repair Carinal reconstruction –Needed after removal of cancer at this site Tracheal tumor excision –Thoracic and intrathoracic Stenosis and anastomosis excision Injury suturing Tracheostomy scar revision Trachea and Bronchi 30

31 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision codes Thoracostomy –Drainage –Rib resection Thoracotomy –Exploration –Biopsy –Hemorrhage control –Cardiac massage Lungs and Pleura 31

32 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Incision Pneumonostomy Pleural scarification –Treatment for repeat pneumothorax Decortication –Removal of a constricting layer of tissue from surface of lung(s) –Allow for full lung expansion Lungs and Pleura 32

33 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Excision Biopsies –Percutaneous needle –Open –Parenthetical statement directions Additional codes for imaging guidance Fine needle aspiration Pathology evaluation of biopsies Lungs and Pleura 33

34 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Removal Total pneumonectomy –Removal of entire lung Lobectomy –Removal of a lobe or lobes of a lung Resections Lungs and Pleura 34

35 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Introduction and Removal Thoracostomy (chest tube) – Treatment for pneumothorax and persistent pleural effusion –Left in patient for several days Stitched to skin –Use larger tube than used in thoracentesis Lungs and Pleura 35

36 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Introduction and Removal Thoracentesis –Review picture in CPT codebook –Used to remove fluid or air from the pleural space –With or without image guidance Pleural Drainage –With or without image guidance Lungs and Pleura 36

37 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Thoracoscopy (Video-assisted thoracic surgery [VATS]) Diagnostic –Anatomic location (lungs, pericardial sac, mediastinal or pleural space) –With or without biopsy –Infiltrate or masses Surgical –Procedure performed Lungs and Pleura 37

38 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lung Transplantation Three steps –Harvesting –Backbench work –Insertion Live donors –Rare –Only one lobe donated Cadaver donors –Most commonly used Lungs and Pleura 38

39 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Surgical collapse therapy/thoracoplasty –Resection –Thoracoplasty Other procedures –Lung lavage –Tumor ablation –Unlisted Lungs and Pleura 39

40 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Ventilator Management Other Procedures –Spirometry –Pulmonary capacity studies –Respiratory flow studies –Pulmonary stress testing –Inhalation treatment –Oxygen uptake –Pulse oximetry Pulmonary ( ) 40

41 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Mediastinum-thoracic cavity between the lungs that contains the heart, aorta, esophagus, trachea, thymus gland Diaphragm-muscle that divides the thoracic cavity from the abdominal cavity Mediastinum and Diaphragm 41

42 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Mediastinum and Diaphragm Diaphragm Herniation Diaphragmatic Paralysis Thymic hyperplasia ICD-9-CM 42

43 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Mediastinotomy –Cervical approach –Thoracic approach Excision –Cyst –Tumor Mediastinum 43

44 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Endoscopy - mediastinoscopy Used for lung cancer staging Mediastinum 44

45 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lymphatic System Network of channels –Carries clear fluid –Includes lymphoid tissue Structures dedicated to circulation and production of lymphocytes –Spleen –Thymus –Bone marrow Hemic and Lymphatic Systems 45

46 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lymphatic System (continued) Three interrelated functions –Removal of interstitial fluid from tissues –Absorbs and transports fatty acids to circulatory system –Transport antigen presenting cells to lymph nodes Hemic and Lymphatic Systems 46

47 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Spleen Located left side of stomach Reservoir for blood cells Produces lymphocytes involved in fighting infection Hemic and Lymphatic Systems 47

48 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Hemic and Lymphatic Systems Lymphoma Lymphadenitis Hypersplenism Splenic Rupture Leukemia ICD-9-CM 48

49 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Splenectomy Code selection based on type –Total –Partial –Total with extensive disease Hemic and Lymphatic Systems 49

50 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Repair Splenorrhaphy –Repair of Spleen –Reported when a ruptured spleen is repaired With or without partial splenectomy Hemic and Lymphatic Systems 50

51 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Bone Marrow or Stem Cell Services Bone marrow or blood cell transplant –Treatment for patients with blood diseases Obtained by –Aspiration –Bone marrow biopsy –Bone marrow harvesting –Allogenic bone marrow From close relative –Autologous From the patient Hemic and Lymphatic Systems 51

52 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lymph Nodes & Lymphatic Channels Network of nodes that carry lymph throughout the body Clear fluid containing infection fighting WBCs Drainage of lymph node abscess –Simple –Extensive Hemic and Lymphatic Systems 52

53 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lymph Nodes & Lymphatic Channels (cont) Biopsy or Excision –Code selection based on method and location Open or needle Cervical, inguinal, axillary Superficial or deep Lymphadenectomy –Limited – removes only lymph nodes –Radical – removal of lymph nodes, glands and surrounding tissue Hemic and Lymphatic Systems 53

54 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Lymph Nodes & Lymphatic Channels (cont) Injection Procedures Lymphangiography –To view lymphatic circulation Use modifier 50 for bilateral procedure –Identify sentinel node Hemic and Lymphatic Systems 54

55 Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm The End


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