Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 22 HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Hemic and Lymphatic Systems Subsection (Excision, repair, introduction) DivisionsDivisions –Spleen –General –Lymph Nodes and Lymphatic Channels (Figure 17–1 in text)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Spleen ( ) Spleen easily ruptured, causes massive hemorrhageSpleen easily ruptured, causes massive hemorrhage May require splenectomyMay require splenectomy Splenectomy: total or partialSplenectomy: total or partial (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Spleen ( ) (…Cont’d) Often done as part of more major procedureOften done as part of more major procedure Bundled into major procedureBundled into major procedure

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 General ( ) Codes divided based onCodes divided based on –Aspiration –Biopsy –Harvesting –Transplantation Stem cellsStem cells –Immature blood cells originating in bone marrow –Used in leukemia treatment (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 General ( ) (…Cont’d) Types of stem cells:Types of stem cells: –Allogenic : Close relative –Autologous : Patient’s own

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Lymph Nodes and Lymphatic Channels ( ) Two types of lymphadenectomies:Two types of lymphadenectomies: –Limited: Lymph nodes only –Radical: Lymph nodes, submandibular gland, and surrounding tissue Term “complete” same as radical neck dissectionTerm “complete” same as radical neck dissection

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 (…Cont’d) Submental and submandibular nodes, chin area and below mandibleSubmental and submandibular nodes, chin area and below mandible Upper jugular notes, at mandibular angle in front of sternocleidomastoid muscleUpper jugular notes, at mandibular angle in front of sternocleidomastoid muscle Middle jugular nodes, between hyoid bone and cricoid cartilageMiddle jugular nodes, between hyoid bone and cricoid cartilage Lower jugular nodes, between cricoid cartilage and clavicleLower jugular nodes, between cricoid cartilage and clavicle Posterior triangle nodes divided into groupsPosterior triangle nodes divided into groups Upper visceral nodes, by the hyoid boneUpper visceral nodes, by the hyoid bone Superior mediastinal nodes, between common carotid arteriesSuperior mediastinal nodes, between common carotid arteries 38700, 38720—are unilateral codes38700, 38720—are unilateral codes (Cont’d…) Lymph Nodes and Lymphatic Channels ( )

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 (…Cont’d) “Modified” radical neck: removal of all lymph nodes routinely removed by radical neck dissection, while preserving the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscles (38724)“Modified” radical neck: removal of all lymph nodes routinely removed by radical neck dissection, while preserving the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscles (38724) This is a unilateral procedureThis is a unilateral procedure Lymph Nodes and Lymphatic Channels ( )

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Lymphadenectomies Often bundled into more major procedure (e.g., prostatectomy)Often bundled into more major procedure (e.g., prostatectomy) –Do not unbundle and report lymphadenectomy separately

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Mediastinum Area between lungsArea between lungs Figure: 22.3

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Mediastinum ( ) Assigned by approachAssigned by approach Incision codes for foreign body removal or biopsyIncision codes for foreign body removal or biopsy Excision codes for removal of cyst or tumorExcision codes for removal of cyst or tumor EndoscopyEndoscopy RepairRepair

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Diaphragm ( ) Only category: RepairOnly category: Repair –Most codes for hernia or laceration repairs –Codes indexed in CPT manual under “Diaphragm”

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Conclusion CHAPTER 22 HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM