1. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 26 ENDOCRINE AND NERVOUS SYSTEMS

2. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Endocrine System Subsection 9 glands in Endocrine System; only 4 included in subsection –Thyroid –Parathyroid –Thymus –Adrenal Pituitary and pineal: See Nervous System Pancreas: Digestive System Ovaries and testes: Respective Genital system (Cont’d…) Figure: 26.1

3. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Endocrine System (60000-60699) (…Cont’d) Divided into 2 subheadings –Thyroid Gland –Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body (Cont’d…)

4. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Endocrine System (60000-60699) (…Cont’d) Carotid body refers to area adjacent to carotid artery –Can be site of tumors Figure: 26.2 The baroreceptor system for controlling arterial pressure. (Modified from Guyton AC, Hall JE: Textbook of Medical Physiology, ed 11, Philadelphia, 2006, Saunders.)

5. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Thyroid Gland, Excision (60100-60281) 2 lobes Code descriptions often refer to –Partial or subtotal: 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)

6. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Nervous System Divided anatomically –Skull, Meninges, and Brain –Spine and Spinal Cord –Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System

7. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 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 3, Philadelphia, 2006, Saunders.)

8. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Skull, Meninges, and Brain (61000-62258) (…Cont’d) Conditions that require openings into brain to: –Relieve pressure –Insert monitoring devices –Place tubing –Inject contrast material

9. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Skull, Meninges, and Brain (61000-62258) (…Cont’d) Craniectomy or Craniotomy category (61304-61576) –Removal of portion of skull, usually as operative site –Codes divided by site and condition

10. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Surgery of Skull Base Category Skull base: Area at base of cranium –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

11. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Surgery of Skull Base Terminology Approach procedure: Used to gain exposure of lesion Definitive procedure: What is done to lesion Repair/reconstruction procedure: Reported separately only if extensive repair

12. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Surgery of Skull Base (61580-61619) Approach procedure and definitive procedure coded separatel y (Cont’d…)

13. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Surgery of Skull Base (61580-61619) (…Cont’d) Example: –Removal of an intradural lesion using middle cranial fossa approach –61590 Infratemporal pre-auricular approach procedure, middle cranial fossa and –61608 Definitive procedure of intradural resection of lesion

14. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Cerebrospinal Fluid (CSF) Shunt (62180-62258) Used to drain fluid Codes describe placement of –Devices –Repair –Replacement –Removal of shunting devices

15. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Spine and Spinal Cord (62263-63746) Codes divided on condition and approach Other important coding considerations –Unilateral or bilateral procedures (-50) –Multiple procedures (-51) –Radiologic supervision and fluoro guidance reported separately (Cont’d…)

16. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 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. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Introduction/Injection of Anesthetic Agent, Diagnostic or Therapeutic (64400-64530) Includes codes for: –Nerve blocks 64400-64530 –Facet joint injections 64490-64495 –Epidural injections 64479-64484 Used to provide pain relief

18. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Conclusion CHAPTER 26 ENDOCRINE AND NERVOUS SYSTEMS