Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Objectives At the end of this chapter you should be able to
1-describe the function of cardiovascular system
2-Identify types of tissues found in the cardiovascular
system(cardiac muscles in the heart
smooth muscles in the blood vessels
3-Describe and identify the major heart structures
including the pericardium heart chambers and
valves
4- Map the direction of blood flow through the heart
5- Identify the major blood vessels of the heart that
transport blood from and to the heart
6- Explain the basic physiology of the electrical conduction
system of the heart
7-Describes the structural and functional differences between arteries veins and
capillaries
8- Identify the major subdivisions of systemic circulation
9-Describes common diseases affecting the cardiovascular system
Outlines Overview of the circulatory system (importance) Anatomy of the circulatory system
(cellstissueorgan)
- The heart
- Blood vessels (Arteries veins capillaries)
- Types and subdivisions of circulations physiology of the circulatory system - The heart amp blood vessels
1-Properties of cardiac muscle
2-ECG recording of electrical activity of the heart
3-The blood pressure
4- The Cardiac cycle Some pathophysiological aspects related to the circulatory system
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Outlines Overview of the circulatory system (importance) Anatomy of the circulatory system
(cellstissueorgan)
- The heart
- Blood vessels (Arteries veins capillaries)
- Types and subdivisions of circulations physiology of the circulatory system - The heart amp blood vessels
1-Properties of cardiac muscle
2-ECG recording of electrical activity of the heart
3-The blood pressure
4- The Cardiac cycle Some pathophysiological aspects related to the circulatory system
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Heart AnatomyChambers
Great vessels
Coronary circulation
and venous
drainage
sizeLocation and
surface anatomy
WallsTissues
and layers
Septa
Valves
RA
RV
LA
LVLV
Types of circulationsHepatic Portal
circulation
Braincirculation
The left ventricle
The Aorta
Big arteries
Arterioles
Capillaries venules
veins
Inferior vena cava
superior vena cava
Pulmonary artery
Circulatory system
The heart
Aorta
Big arteri
es
Small arteri
es
arterioles
capillaries
Venules
veins
Superior and
inferior vena cava
Main components of the circulatory system
Components of the Circulatory system
Important tissues in the circulatory system
Cardiac muscles
smooth muscles
Found in the heart Found in blood vessels
Responsible for heart contraction (involuntary)
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Types of circulationsHepatic Portal
circulation
Braincirculation
The left ventricle
The Aorta
Big arteries
Arterioles
Capillaries venules
veins
Inferior vena cava
superior vena cava
Pulmonary artery
Circulatory system
The heart
Aorta
Big arteri
es
Small arteri
es
arterioles
capillaries
Venules
veins
Superior and
inferior vena cava
Main components of the circulatory system
Components of the Circulatory system
Important tissues in the circulatory system
Cardiac muscles
smooth muscles
Found in the heart Found in blood vessels
Responsible for heart contraction (involuntary)
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The left ventricle
The Aorta
Big arteries
Arterioles
Capillaries venules
veins
Inferior vena cava
superior vena cava
Pulmonary artery
Circulatory system
The heart
Aorta
Big arteri
es
Small arteri
es
arterioles
capillaries
Venules
veins
Superior and
inferior vena cava
Main components of the circulatory system
Components of the Circulatory system
Important tissues in the circulatory system
Cardiac muscles
smooth muscles
Found in the heart Found in blood vessels
Responsible for heart contraction (involuntary)
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The heart
Aorta
Big arteri
es
Small arteri
es
arterioles
capillaries
Venules
veins
Superior and
inferior vena cava
Main components of the circulatory system
Components of the Circulatory system
Important tissues in the circulatory system
Cardiac muscles
smooth muscles
Found in the heart Found in blood vessels
Responsible for heart contraction (involuntary)
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Important tissues in the circulatory system
Cardiac muscles
smooth muscles
Found in the heart Found in blood vessels
Responsible for heart contraction (involuntary)
Responsible for vasoconstriction and vasodilation in response to chemical mediators
Striated Non striated
Has tight junction and intercalated diskAct as one syncytium
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The HeartThe heart is a hollow muscular organ designed to Provide the necessary force to circulate blood to all tissues and cells of the body So that oxygen and and nutrients can reach all cells of the body and waste products are removedSize and anatomic location of the heart The heart is a small organ approximately the size of a fist It is located in the mediastinum with the heart tip pointing to the left of the bodys midline
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Structure of the heartLayers of the heart
The pericardium
The myocardiumThe endocardium
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The heart is enclosed in a protective two-layer membranea) The outer layer (fibrous pericardium)
is made up of dense connective tissue b) The serous pericardium is double layered with the outermost parietal layer adherent to the fibrous pericardium and the inner visceral layer (epicardium) adherent to the hearts surface Between these two layers the pericardial cavity contains lubricating pericardial fluid that decreases friction caused by the beating of the heart
fibrous pericardium
serous pericardium
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
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>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Chambers of the heartThe right atrium It receives deoxygenated blood from the body through the superior and inferior venae cavaThe right ventricle
It pumps deoxygenated blood to the lung through the pulmonary arteryThe left atrium It receives oxygenated blood from the lungs through the four pulmonary veins
The left ventricle It pumps oxygenated blood to the body through the Aorta
The interventricular septum (function)
Papillary muscles and chordae tendineae
RA
RV
LV
LA
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Great vessels of the heart
The AortaThe left ventricle pumps oxygenated blood through the aortic opening
The pulmonary ArteryThe right ventricle pumps non oxygenated blood through the pulmonary artery opening
The venae cavaReceive non oxygenated blood from the body
Four Pulmonary veins Receive oxygenated blood from the lung
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Valves of the heartValves allow blood to flow in one direction only preventing backflow
The valves open and close in response to pressure differences caused by contraction and relaxation of the heart chambersThis allows blood to flow from areas with higher pressure to those with lower pressure
Exhibit 1
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Valves of the heart
The Tricuspid valve (Atrioventricular)Allows blood to pass from the right atrium to the right ventricle
The pulmonary valve Allows blood to flow from the right ventricle to the the lungs through the pulmonary artery
The Mitral valve (ATRIOVENTRICULAR)Allows blood to pass from the left atrium to the left ventricle
The Aortic ValveAllows blood to pass from the left ventricle to the whole body through the Aorta
SEMILUNAR VALVE
SEMILUNAR VALVES
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Difference Between Systole and DiastoleDiastole
During diastole the ventricles relax the A-V valves are opened the semilunar valves are closed the ventricles are filling
SystoleDuring systole the ventricles contract the A-V valves are closed the semilunar valves are opened the ventricles are ejecting blood into corresponding large arteries
Exhibit 2
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Atrioventricular valves Vs semilunar valves (in systole
and Diastole)
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Coronary circulationThe left main coronary artery
Circumflex artery
LAD
Right coronary artery
Exhibit 3
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ACUTE CORONARY SYNDROMES bull These are number of conditions that results from
Obstruction of a coronary artery
bull According to percentage and location of obstruction
Unstable angina NSTEMI STEMI Sudden cardiac death
Also referred to as a heart attack may be caused by several conditions but is most frequently attributed to narrowing of the coronary blood vessels due to atheromatous plaques
Myocardial infarction
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
SYMPTOMS FOR ANGINA AND MYOCARDIAL INFARCTIONS
bull Chest discomfort pain with or without dyspnea
bull Nausea
bull Diaphoresis
bull A diagnosis is made by a) ECG changes
b) by the use of specific serologic markers
TREATMENT OF ACUTE CORONARY SYNDROME
bull May include
bull A) Non surgical
-antiplatelet drug
-anticoagulants nitrates and beta-blockers
-For STEMI treatment may also include emergency reperfusion using fibrinolytic drugs
B) Surgical
-Percutaneous intervention
-Coronary artery bypass graft surgery
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Difference between ICD-9-CM and ICD10-CMin the approach to myocardial infarction
bull Healing time for an acute myocardial infarction has changed to four weeks (28 days) in ICD-10-CM from the 8-week time frame used in ICD-9-CM
bull New code category for a subsequent (new) acute myocardial infarction occurring within the 4-week time frame of healing from the initial acute myocardial infarction
bull Change in subsequent episode of care designation Subsequent episode of care in ICD-10-CM is no longer used for re-evaluation observation or treatment of an acute myocardial infarction treated on a previous admission The subsequent episode of care is limited to a subsequent (new) acute myocardial infarction during the 4-week healing period of the initial myocardial infarction
bull Old myocardial infarction is classified under chronic ischemic heart disease in ICD-10-CM
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM ICD-10-CM1 Acute myocardial infarction UnspecifiedIf only STEMI or transmural Ml without the site is documented query the provider as to the site or assign a code from subcategory 4109
1- Acute myocardial infarction unspecified If only STEMI or transmural Ml without the site is documented assign code I 213
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI If NSTEMI evolves to STEMI assign the STEMI code If STEMI converts to NSTEMI due to thrombolytic therapy it is still coded as STEMI
2-AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial but the site is provided it is still coded as a subendocardial AMI
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM ICD-10-CM3-Subsequent acute myocardial infarction A code from category I22 Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI A code from category I22 must be used in conjunction with a code from category 121 The sequencing of the I22 and 121 codes depends on the circumstances of the encounter
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Some Procedures for acute coronary syndrome
1- Bypass Bypass is defined as altering the route of passage of the
contents of a tubular body part
Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part
Example of Bypass circulatory system procedures coronary artery bypass graft (CABG)
2- Dilation This root operation is coded when the objective of the procedure is to enlarge the diameter of a tubular body part or orifice The orifice can be a natural orifice or an artificially created orifice A device placed to maintain the new diameter is an integral part of the Dilation procedure and is coded to the sixth-character device value in the procedure code
-PTCA with insertion of either drug-eluting or non drug-eluting stent
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Cardiac Catheterization
bull Cardiac Catheterization (cardiac cath) is a procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
1 2 3
4 5 6
7 8 9
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
A Coronary Stent is a tiny wire mesh tube used to prop open an artery during angioplasty The stent stays in the artery permanently The stent will also improve blood flow to the heart muscle and will relieve chest pain (angina)
10 11
12 13
14
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CORONARY ANGIOGRAM
bull is a special X-ray test performed to find out if your coronary arteries are clogged where and by how much During an angiogram your doctor inserts a thin tube (catheter) into an artery and up to the heart Once in place a dye that is visible by X-rays (contrast dye) is injected into the bloodstream The X-ray machine takes a series of images (angiograms) which will show any areas of narrowing This procedure is done as part of the cardiac catheterization procedure
bull
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
How to code for Dilation coronary artery one percutaneous intraluminal with intraluminal
Device
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-10-PCS AND THE CIRCULATORY SYSTEM
bull ALL codes in ICD-10-PCS are seven characters in length
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
bull Character 1
bull Medical and Surgical 0
bull Character 2
bull 5 of 31 body systems pertain to the circulatory system
1 Heart and Great Vessels (character value 2)
2 Upper Arteries (character value 3)
3 Lower Arteries (character value 4)
4 Upper Veins (character value 5)
5 Lower Veins (character value 6)
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CHARACTER 3 SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
bull Character 4 Body Part
bull body part or specific anatomical site where the procedure was performed Examples
Character Value Heart and Great Vessels
0 Coronary Artery One Site
1 Coronary Artery Two Sites
2 Coronary Artery Three Sites
3 Coronary Artery Four or More Sites
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Sample Grid for Combinations of characters 4 to 7Percutaneous Transluminal Angioplasty with Stent of a single artery
= 02705DZ
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
DEVELOPMENT OF ICD 10 PCS
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Empty deoxygenated blood into
the coronary sinusit is the main vein of the coronary circulation
lies in the posterior coronary sulcus and drains in an opening in the right atrium
Venous drainage of the heart
Anterior cardiac veins Drain the right
ventricle
bull Great cardiac vein
Drains the left atrium and both ventricles (main tributary of coronary sinus)lies in the anterior interventsulcus
The right atrium
Middle cardiac vein
Drains both ventricles lies in the posterior
intervent sulcus
bull Small cardiac vein (venae cordis minimae or thebassian veins ) Drains the right atrium and ventricle
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
THE CORONARY SINUS
the great cardiac vein
the middle cardiac vein
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The followings are physiological properties
that are Inherent in the hearts muscle
tissuebull Automaticity ability of a cardiac cells to generate an impulse on its own without stimulation from another source
bull Conductivity Ability to transfer an impulse from cell to cell
bullExcitability Capacity of a cell to respond to a stimulus
bull Contractility Property that allows shortening of the muscle when stimulated
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Conduction System of the Heart
Before conduction of action potential specialized autorhythmic cells in the cardiac muscle generate electric impulses that initiate the heart beat ( example the SAN the AVN )
conduction system conducts action potential to all muscle cells to stimulates the contraction of the heart to make it pump effectively
Exhibit 4
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Conduction System of the Heart
SAN
AVN
Bundle of Hiss
Right Bundle branch
Left Bundle branch
Purkinje Fibers
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
SAN and AVN are under control of the autonomic nervous system
Sympathetic nervous system (accelerator)
++
+
Parasympathetic nervous system Vagus (decelerator)
--
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
In patients with acute coronary syndrome watch for the followings
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Cardiac Cycle
A cardiac cycle is
the sequence of
events that occur
during each heart
beat
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
impulse from the SA node
Atrial systoleventricular diastole
Atria contraction forces
blood through the open A V
valves to the ventricles
ventricle is able to fill with approximately 130 cc of blood a volume referred to as the end-
diastolic volume (EDV)
ventricles contractThe atria relax
The increased ventricular pressure forces the SL
valves open ejecting blood from the heart(ventricular
ejection)
Ejecting 70cc leaving 60cc (ESV)
The four chambers of the heart then relax and the cycle begins
again
CARDIAC CYCLE
>
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
2 - Anatomy of blood vessels and different types of circulation
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Blood vesselsbull Although there are variations in the function of each particular blood vessel
the walls of most have the following three layers
1 Tunica interna Innermost layer of the vessel that contains a single layer of endothelium on the inner surface that helps influence blood flow
2 Tunica media Thick middle layer of mostly smooth muscle cells and extensive elastic fibers
3 Tunica externa Outermost layer of the vessel its function is to attach the vessel to the surrounding tissue It is made up of collagen elastic fibers and many nerves
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Blood vessels anatomyand sequence of flow
Large Arteries transport blood away from heart to all organs and cells of the body 1- Large arteries are Elastic conducting arteries that receive blood from ventricles Which are high pressure chambers Thatrsquos why they should be thick walled elasticinclude the aorta pulmonary trunk brachiocephalic common carotid common iliac and subclavian arteries
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
2- Muscular (distributing) arteries are mid-size arteries that are
branches of the elastic large arteries
Varying in size from the pencil-sized axillary and femoral arteries to
the small string-size arteries that carry blood to organs the thick
walls of these arteries are able to regulate blood flow with
vasoconstriction and vasodilatation
ie the brachial and radial arteries of the arm
bull Those arteries are responsible for peripheral resistance and control blood pressure to certain extent
>
>
>
>
>
>
>
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CO2O2
Arterioles
CapillariesVenules
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Venules then begin to reunite and become successively
larger veins eventually returning the blood full of wastes poor in oxygen to the right atrium via the inferior and superior vena cava
>
>
>
>
>
>
>
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Large veins carries blood to the the heart in reverse Direction against gravity in the lower frac12 of the bodyThatrsquos why they are provided with valves
>
>
>
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Differential pressure in various blood vessels
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Blood pressureBlood pressure (BP) sometimes referred to as arterial blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
During each heartbeat blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure
The blood pressure in the circulation is principally due to a)the pumping action of the heartb)peripheral resistance of arterioles
>
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Systolic Blood Pressure
Diastolic Blood Pressure
Old methods for classification of hypertension used in ICD-9-CM
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Classification of Hypertension in ICD-10-CM
bull ICD-10-CM classifies hypertension and hypertensive diseases to the Hypertensive diseases section (I10ndashI15)
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Classification of Hypertension in ICD-10-CM
bull Hypertension is classified by type primary or secondary in ICD-10-CM
bull The nature of hypertension (benign malignant unspecified) no longer exists for classifying hypertension in ICD-10-CM
bull There is only one code I10 for essential or primary hypertension
bull Assign I10 if the physician documented any of the following arterial hypertension benign hypertension essential hypertension malignant hypertension primary hypertension or systemic hypertension
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
failurebull Documentation must indicate a relationship
between the heart disease and hypertension
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Hypertension and Chronic Kidney Disease
bull Hypertensive Chronic Kidney Disease ndash Category I12ndash ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension
bull Hypertensive Heart and Chronic Kidney Disease ndash Category I 13ndash combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney disease (I12)
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Heart Failurecongestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the Heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body
Common risk factors of heart failure in the united states
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
2 pathophysiological types of heart failure existSystolic dysfunction Diastolic dysfunction
It is failure of the pump function of the heart It is characterized by a decreased ejection fraction (less than 45)-caused by dysfunction or destruction of cardiac myocytes or their molecular components-The most common mechanism of damage is ischemia causing infarction and scar formation-On echocardiogram this is manifest by abnormal wall motion (hypokinesia) or absent wall motion (akinesia) ventricular end-diastolic pressure and volumes increase
It is failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall This causes inadequate filling of the ventricle and therefore results in an inadequate stroke volume The failure of ventricular relaxation also results in elevated end-diastolic pressures and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure peripheral edema in right heart failure)
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Systolic dysfunction Diastolic dysfunctionThis is transmitted to the atrium On the left side of the heart the increased pressure is transmitted to the pulmonary vasculature and the resultant hydrostatic pressure favors extravasation of fluid into the lung parenchyma causing pulmonary edema On the right side of the heart the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds favoring extravasation of fluid into the tissues of target organs and extremities resulting in dependent peripheral edema
Heart failure may be described as chronic when it is stable Acute decompensated heart failure is worsening of symptoms typically shortness of breath (dyspnea ) edema and fatigue
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Diagnosis a) Imaging
Echocardiography used to determine 1-stroke volume (SV the amount of blood in the heart that exits the ventricles with each beat)2-end-diastolic volume (EDV the total amount of blood at the end of diastole) 3-ejection fraction (EF) the SV in proportion to the EDV Normally the EF should be between 50 and 70 in systolic heart failure it drops below 40 4-identify Valvular heart disease 5-Assess the state of the pericardium 6-Echocardiography may also aid in deciding what treatments will help the patient such as medication insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy
b) Angiography Heart failure may be the result of coronary artery disease and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle) As a result coronary catheterization may be used to identify possibilities for revascularization through percutaneous coronary intervention or bypass surgery
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Management of heart failurebull Diet and lifestyle measuresbull Fluid restriction consider an individualized fluid prescription potentially based on patient body
weight sodium intake and likelihood of adherence Generally water intake should be limited to 15 L daily or less in patients with hypernatremiabull Pharmacological management
Diuretic agents vasodilator agents positive inotropes ACE inhibitors beta blockers and aldosterone antagonists (eg Spironolactone) Some drugs which increase heart function such as the positive inotrope Milrinone lead to increased mortality and are contraindicatedACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure irrespective of symptomatic severity or blood pressure ACE inhibitors improve symptoms decrease mortality and reduce ventricular hypertrophy
bull DevicesPatients with NYHA class III or IV left ventricular ejection fraction (LVEF) of 35 or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker or surgical remodeling of the heart These treatment modalities may make the patient symptomatically better improving quality of life and in some trials have been proven to reduce mortality
bull Surgery The final option if other measures have failed is heart transplantation or (temporary or prolonged) implantation of an artificial heart These remain the recommended surgical treatment options
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Some Procedures done to heart failure patients
bull cardiac resynchronization therapy (CRT pacing both the left and right ventricles) through implantation of a bi-ventricular pacemaker which is is a small battery-operated device that helps your heart beat in a regular rhythm It does this with a small electric stimulation that helps your heart to beat regularly It is puts the under the skin on your chest just under your collarbone Itrsquos hooked up to your heart with tiny wires
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
A heart transplant or a cardiac transplant
is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient The patients own heart is either removed (orthotopic procedure) or less commonly left in place to support the donor heart (heterotopic procedure) both were controversial solutions to an enduring human ailment Post-operation survival periods averaged 15 years Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients
Exhibit 5
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM ICD-10-CM 428 heart failure I 50 heart failure
4280 congestive heart failure unspecified 4281 left heart failure I501 left ventricular failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM ICD-10-CM4284 combined Systolic and Diastolic heart failure
I504 combined Systolic (congestive) and Diastolic (congestive) heart failure
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
Biventricular (heart) failure NOSCardiac heart or myocardial failure NOSCongestive heart diseaseCongestive heart failure NOSRight ventricular failure (secondary to heart failure)
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
bull As the coder can observe the close similarity in classification and coding of heart failure in both ICD -9-Cm and ICD -10-CM by first classifying heart failure into systolic and diastolic as well as combined and each class is further subdivided into acute chronic and acute on chronic with the only difference ion the code range values in both systems (numeric in ICD-9-CM belonging to category 428-- and alphanumeric in ICD-10-CM belonging to category I50 )
bull Also both require that the coder code first due to hypertension
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM versus ICD-10-PCS and heart failure procedures
bull Coding for transvenous ventricular pacing for heart failure
ICD-9-CM ICD-10-PCS
3771 initial insertion of transvenous lead [electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into right ventricle percutaneous approach
02HL3JZ Insertion of pacemaker lead into left ventricle percutaneous approach
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-10-PCS and the Circulatory Systembull ALL codes in ICD-10-PCS are seven characters in length
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Character Definition for Circulatory System
bull Character 1 ndash Medical and Surgical 0
bull Character 2 ndash 5 of 31 body systems pertain to the circulatory
system1 Heart and Great Vessels (character value 2)2 Upper Arteries (character value 3)3 Lower Arteries (character value 4)4 Upper Veins (character value 5)5 Lower Veins (character value 6)
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CHARACTER 3 Some Root Operations related to circulatory system
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion H Replacement
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
bull Character 4 Body Partndash body part or specific anatomical site where the
procedure was performed ExamplesCharacter Value Heart and Great Vessels
4 Coronary vein
6 Atrium right
7 Atrium left
k Ventricle right
L Ventricle left
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Sample Grid for Combinations of characters 4 to 7Insertion of pacemaker lead into right ventricle percutaneous approach
= 02HK3JZ
0 monitoring Device pressure sensor 2 monitoring device3 Infusion device D Intraluminal deviceJ Cardiac lead pacemakerK Cardiac lead defibrillatorM Cardiac lead
4 Coronary vein6 Atrium right7 Atrium leftK Ventricle right L Ventricle left
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Medical and Surgical 2 Heart and great vesselsH Insertion putting in a non biological appliance that monitors assists performs or prevents a physiological function but does not physically take the place of a body part
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
ICD-9-CM versus ICD-10-PCS and Coding for cardiac transplantation
ICD-9-CM ICD-10-PCS
3751 Heart transplantation0093 transplant from cadaver
02YA0Z0 Transplantation of heart Allogeneic open approach
02YA0Z1 Transplantation of heart Syngeneic open approach02YA0Z0 Transplantation of heart Zooplastic open approach
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
No deviceA Heart 0 Open
0 Medical and Surgical 2 Heart and great vesselsY Transplantation Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and or function of all or a portion of a similar body part
0 Allogeneic1 Syngeneic2 Zooplastic
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Types of circulations
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
SYSTEMIC CIRCULATIONThe aorta which is approximately one inch in diameter is the largest artery in the body From every part of the aorta other arteries branch off into a network of successively smaller arteries until they eventually divide into arterioles and finally capillaries where the exchange of oxygen nutrients and waste products takes place within the individual organs
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
The aorta is divided into four segments
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Ascending Aorta
Aortic Arch
Descending Aorta
Thoracic Aorta
Abdominal Aorta
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Aortic Divisions First Order Branches Second Order Branches
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
AortaVEINS TO
VENAE CAVA
>
>
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Some special circulations
Brain circulation
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
>
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
cerebral aneurysms are
inclined to develop at
the arterial junctions
4
2020
4040
3434
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
the carotid and vertebral arteries supply oxygenated blood to the brain
bull The carotid arteries are easily palpated under the jaw
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Venous circulationbull Deoxygenated blood is removed from the brain via the jugular vein
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Portal CirculationWhat is meant by portal circulation
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through one
capillary bed to
another network of
capillaries prior to
being returned to
systemic circulation
CO2 O2
O2CO2
Pulmonary circulation
Systemic circulation
PULMONARY ARTERY
Pulmonary veins
Aorta
VEINS TO
VENAE CAVA
>
>
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
bull The portal venous system channels blood from parts of the digestive tract spleen and pancreas to the liver for processing prior to returning to the heart
Blood flow to the liver differs
from that in the general
circulation since the liver
receives oxygenated blood as
well as partially deoxygenated
blood Oxygenated blood from
the hepatic artery mixes with
the nutrient rich blood from the
portal vein in the liver sinusoids
Superior mesentericvein
inferior mesentericvein
splenicvein
Hepatic portal vein
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection such as streptococcal pharyngitis Believed to be caused by antibody cross-reactivity that can involve the heart joints skin and brain[1] the illness typically develops two to three weeks after a streptococcal infectionDepending on the extent of heart inflammation involved patients with the acute form of the disease may develop1- heart failure2-pericarditis3-myocarditis4-endocarditis which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and aortic valves (25 percent of cases)
Rheumatic fever
commonly appears in children between the ages of 6 and 15 with only 20 of first-time attacks occurring in adults[1] The illness is so named because of its similarity in presentation to rheumatism
Acute rheumatic fever ( I 00 ndash I 02)
Chronic rheumatic fever ( I 05- I 09) Usually manifested in the form of valvular lesions such as Mitral stenosis Mitral incompetence and aortic valve diseases
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Some important medical terms
InsufficiencyWhen using the term with regard to valve function it typically means
the valve isnt functioning as well as it should be allowing blood to
flow back into the chamber inappropriately
ProlapseProlapse specifically mitral valve prolapse occurs when the cusps of the mitral valve protrude into the left atrium during ventricular systole It is sometimes referred to as mitral valve prolapse syndrome
Stenosis
Stenosis means narrowing or constriction of a path Regarding the valves it is caused by a multitude of factors such as calcification rheumatic degeneration or congenital malformation
Exhibit 6
Exhibit 7
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Mitral stenosis is a problem when the valve is supposed to be opened
mid diastolic rumbling murmur
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
For acute rheumatic heart conditions there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code
For instance ICD-9-CM code 3910 for acute rheumatic pericarditis
directly correlates to code I 011 in ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM does classify some conditions as rheumatic in nature
ICD-10-CM has distinguished in large part specific valvular diseases caused by rheumatic fever versus those not related to the disease as well as the specific valve
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Comparison between ICD-9-CM and ICD-10-CM as regard valvular heart diseases
Rheumatic
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
Thank you
Thank you
Slide 1
Objectives
Outlines
Slide 4
Types of circulations
Slide 6
Slide 7
Important tissues in the circulatory system
Size and anatomic location of the heart
Structure of the heart
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Difference Between Systole and Diastole
Atrioventricular valves Vs semilunar valves (in systole and Di
Slide 18
Acute Coronary Syndromes
Symptoms for angina and myocardial infarctions
Difference between ICD-9-CM and ICD10-CM in the approach to myo
Slide 22
Slide 23
Some Procedures for acute coronary syndrome
Cardiac Catheterization
Slide 26
Slide 27
Coronary Angiogram
How to code for Dilation coronary artery one percutaneous
ICD-10-PCS and the Circulatory System
Character Definition for Circulatory System
CHARACTER 3 Some Root Operations related to circulatory syste
Slide 33
Sample Grid for Combinations of characters 4 to 7
Development of ICD 10 PCS
Venous drainage of the heart
Slide 37
Slide 38
Slide 39
Slide 40
Slide 41
Slide 42
Normal ECG hellipP wavehellipQRS complexhelliphelliphellipST segmenthelliphelliphellipT wave
In patients with acute coronary syndrome watch for the followi
Cardiac Cycle
Cardiac Cycle (2)
Slide 47
Blood vessels
Blood vessels anatomy and sequence of flow
Slide 50
Slide 51
Slide 52
Slide 53
Differential pressure in various blood vessels
Blood pressure
Slide 56
Slide 57
Classification of Hypertension in ICD-10-CM
Classification of Hypertension in ICD-10-CM
Hypertensive Heart Disease
Hypertension and Chronic Kidney Disease
Heart Failure
2 pathophysiological types of heart failure exist
Slide 64
Diagnosis
Management of heart failure
Some Procedures done to heart failure patients
A heart transplant or a cardiac transplant
ICD-9-CM vs ICD-10-CM and coding for heart failure
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (2)
ICD-9-CM vs ICD-10-CM and coding for heart failure (cont) (3)
Slide 73
ICD-9-CM versus ICD-10-PCS and heart failure procedures
ICD-10-PCS and the Circulatory System (2)
Character Definition for Circulatory System (2)
CHARACTER 3 Some Root Operations related to circulatory syste (2)
Slide 78
Sample Grid for Combinations of characters 4 to 7 (2)
Slide 80
Slide 81
Types of circulations (2)
Systemic Circulation
The aorta is divided into four segments
Slide 85
Slide 86
Slide 87
Some special circulations
Slide 89
Slide 90
Slide 91
Slide 92
Slide 93
the carotid and vertebral arteries supply oxygenated blood to t
Venous circulation
Portal Circulation
Slide 97
Rheumatic heart diseases and valvular problems
Some important medical terms
Mitral stenosis is a problem when the valve is supposed to be
Slide 101
Comparison between ICD-9-CM and ICD-10-CM as regard valvular he
