ICD-9-CM Procedure Version 23
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Coding for Angioplasty & Stent Procedures
Coding for Angioplasty & Stent Procedures July 2020 Jennifer Bash, RHIA, CIRCC, RCCIR, CPC, RCC Director of Coding Education Agenda • Introduction • Definitions • General Coding Guidelines • Presenting Problems/Medical Necessity for Angioplasty & Stent • General Angioplasty & Stent Procedures • Cervicocerebral Procedures • Lower Extremity Procedures Disclaimer The information presented is based on the experience and interpretation of the presenters. Though all of the information has been carefully researched and checked for accuracy and completeness, ADVOCATE does not accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation. CPT codes are trademark and copyright of the American Medical Association. Resources •AMA •CMS • ACR/SIR • ZHealth Publishing Angioplasty & Stent Procedures Angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. Vascular Stent A stent is a tiny tube placed into the artery or vein used to treat vessel narrowing or blockage. Most stents are made of a metal or plastic mesh-like material. General Angioplasty & Stent Coding Guidelines • Angioplasty is not separately billable when done with a stent • Pre-Dilatation • PTA converted to Stent • Prophylaxis • EXCEPTION-Complication extending to a different vessel • Coded per vessel • Codes include RS&I • Territories • Hierarchy General Angioplasty -
Small Bowel Obstruction After Laparoscopic Roux-En-Y Gastric Bypass Presenting As Acute Pancreatitis: a Case Report
Netherlands Journal of Critical Care Submitted January 2018; Accepted April 2018 CASE REPORT Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass presenting as acute pancreatitis: a case report N. Henning1, R.K. Linskens2, E.E.M. Schepers-van der Sterren3, B. Speelberg1 Department of 1Intensive Care, 2Gastroenterology and Hepatology, and 3Surgery, Sint Anna Hospital, Geldrop, the Netherlands. Correspondence N. Henning - [email protected] Keywords - Roux-en-Y, gastric bypass, pancreatitis, pancreatic enzymes, small bowel obstruction, biliopancreatic limb obstruction. Abstract Small bowel obstruction is a common and potentially life-threatening bowel obstruction within this complication after laparoscopic Roux-en-Y gastric bypass surgery. population, because misdiagnosis We describe a 30-year-old woman who previously underwent can have disastrous outcomes.[1,3-5,7] gastric bypass surgery. She was admitted to the emergency In this report we describe the department with epigastric pain and elevated serum lipase levels. difficulty of diagnosing small Conservative treatment was started for acute pancreatitis, but she bowel obstruction in post- showed rapid clinical deterioration due to uncontrollable pain and LRYGB patients and why frequent excessive vomiting. An abdominal computed tomography elevated pancreatic enzymes scan revealed small bowel obstruction and surgeons performed can indicate an obstruction in an exploratory laparotomy with adhesiolysis. Our patient quickly these patients. The purpose of improved after surgery and could be discharged home. This case this manuscript is to emphasise report emphasises that in post-bypass patients with elevated Figure 1. Roux-en-Y gastric bypass that in post-bypass patients with pancreatic enzymes, small bowel obstruction should be considered ©Ethicon, Inc. -
Coronary Angiogram, Angioplasty and Stent Placement
Page 1 of 6 Coronary Angiogram, Angioplasty and Stent Placement A Patient’s Guide Page 2 of 6 What is coronary artery disease? What is angioplasty and a stent? Coronary artery disease means that you have a If your doctor finds a blocked artery during your narrowed or blocked artery. It is caused by the angiogram, you may need an angioplasty (AN-jee- buildup of plaque (fatty material) inside the artery o-plas-tee). This is a procedure that uses a small over many years. This buildup can stop blood from inflated balloon to open a blocked artery. It can be getting to the heart, causing a heart attack (the death done during your angiogram test. of heart muscle cells). The heart can then lose some of its ability to pump blood through the body. Your doctor may also place a stent at this time. A stent is a small mesh tube that is placed into an Coronary artery disease is the most common type of artery to help keep it open. Some stents are coated heart disease. It is also the leading cause of death for with medicine, some are not. Your doctor will both men and women in the United States. For this choose the stent that is right for you. reason, it is important to treat a blocked artery. Angioplasty and stent Anatomy of the Heart 1. Stent with 2. Balloon inflated 3. Balloon balloon inserted to expand stent. removed from into narrowed or expanded stent. What is a coronary angiogram? blocked artery. A coronary angiogram (AN-jee-o-gram) is a test that uses contrast dye and X-rays to look at the blood vessels of the heart. -
Acr–Nasci–Sir–Spr Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (Cta)
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 47)* ACR–NASCI–SIR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF BODY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1. -
Middle Nasal Valve Collapse: a Way to Resolve
Journal of Otolaryngology-ENT Research Case Report Open Access Middle nasal valve collapse: a way to resolve Abstract Volume 10 Issue 3 - 2018 Middle nasal valve collapse is a partial or complete collapsing of soft structures of Dunja Milicic,1 Carolina Serodio2 nasal pyramid, due to negative intranasal pressures resulting in complete anterior nasal 1 obstruction of air-flow. Even though is relatively common, it is often misdiagnosed or Hospital da Luz Arrabida, Department of Otorhinolaryngology, Portugal neglected in diagnosis. There are too many suggestions of surgical resolution of the 2Hospital da Luz Póvoa de Varzim, Department of problem, giving an idea that all of them are actually only partially or insufficiently Otorhinolaryngology, Portugal resolving the problem. In this paper a possible solution of middle nasal vault collapse was presented. A Correspondence: Dunja Milicic, Hospital da Luz Arrábida, triangle cartilage grafting with respecting of anatomical and functional principles was Praceta de Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal, Tel +351-22 377-6800, suggested. An open rhinoplasty approach by its large exposure was, in our hands, the Email [email protected] election method for resolving the problem. Received: February 01, 2018 | Published: May 21, 2018 Keywords: nasal valve collapse, triangular cartilage, graft, open rhinoplasty Introduction the nostril (lateral alar crura) is usually annoying the patients, by its hardness and cosmetic deformity, even though some authors minimize Collapse -
Breast Cancer Screening HEDIS Tip Sheet
HEDIS® Tip Sheet Effectiveness of Care Measure Breast Cancer Screening Breast cancer is the most common type of cancer, and the second leading cause of cancer-related deaths among women in the United States. Approximately 237,000 cases of breast cancer are diagnosed in women, and about 41,000 women die each year of breast cancer.1 Mammography is an effective screening tool for early detection of breast cancer and reduction of breast cancer mortality. California Health & Wellness want to help your practice increase Healthcare Effectiveness Data and Information Set (HEDIS®) rates. This tip sheet outlines key details of the Breast Cancer Screening (BCS) measure, its codes and guidance for documentation. Measure Women ages 50–74 who had a mammogram to screen for breast cancer in the past two years.2 Exclusions: • Patients who meet the following – A unilateral mastectomy criteria anytime during the without a modifier and measurement year: a left mastectomy with – Medicare patients ages 66 and service dates 14 days or older enrolled in an institutional more apart. special needs plans (I-SNP) or – A unilateral mastectomy living long-term in an institution. without a modifier and a – Patients ages 66 and older with right mastectomy with service frailty and advanced illness. dates 14 days or more apart. – Patients in hospice. – Absence of the left breast and absence of the right breast on the • Patients with bilateral mastectomy. same or different dates of service. Any of the following meet the criteria – Both of the following (on the same for bilateral mastectomy: or different dates of service): – Bilateral mastectomy or history. -
Dorsal Approach Rhinoplasty Dorsal Approach Rhinoplasty
AIJOC 10.5005/jp-journals-10003-1105 ORIGINAL ARTICLE Dorsal Approach Rhinoplasty Dorsal Approach Rhinoplasty Kenneth R Dubeta Part I: Historical Milestones in Rhinoplasty ABSTRACT Direct dorsal excision of skin and subcutaneous tissue is employed in rhinoplasty cases characterized by thick rigid skin to achieve satisfactory esthetic results, in which attempted repair by more conventional means would most likely frustrate both surgeon and patient. This historical review reminds us of the lesson: ‘History repeats itself.’ Built on a foundation of reconstructive rhinoplasty, modern cosmetic and corrective rhinoplasty have seen the parallel development of both open and closed techniques as ‘new’ methods are introduced and reintroduced again. It is from the perspective of constant evolution in the art of rhinoplasty surgery that the author presents, in Part II, his unique ‘eagle wing’ chevron incision technique of dorsal approach rhinoplasty, to overcome the problems posed by the rigid skin nose. Keywords: Dorsal approach rhinoplasty, Eagle wing incision, Fig. 1: Ancient Greek ‘perikephalea’ to support the Rigid skin nose, External approach rhinoplasty, Historical straightened nose1 milestones. How to cite this article: Dubeta KR. Dorsal Approach and functions of the nose. Refinement of these techniques Rhinoplasty. Int J Otorhinolaryngol Clin 2013;5(1):1-23. seemingly had to await three antecedent developments; Source of support: Nil topical vasoconstriction; topical, systemic and local Conflict of interest: None declared anesthesia; and safe, reliable sources of illumination. The last half of the 20th century has seen the dissemination of INTRODUCTION two of the most important developments in the history of Throughout the ages, numerous techniques of altering, nasal surgery: correcting and more recently, improving the appearance and 1. -
Malignant Pleural Mesothelioma
CLINICAL PRACTICE GUIDELINE LU-009 Version 2 MALIGNANT PLEURAL MESOTHELIOMA Effective Date: December, 2012 The recommendations contained in this guideline are a consensus of the Alberta Provincial Thoracic Malignancies Tumour Team synthesis of currently accepted approaches to management, derived from a review of relevant scientific literature. Clinicians applying these guidelines should, in consultation with the patient, use independent medical judgment in the context of individual clinical circumstances to direct care. CLINICAL PRACTICE GUIDELINE LU-009 Version 2 BACKGROUND Mesothelioma is a rare asbestos-related tumour that arises from mesenchymal cells that are found in the lining of the pleural cavity (Malignant Pleural Mesothelioma; MPM) in 70 to 90 percent of cases, and the peritoneal cavity in 10 to 30 percent of cases.1, 2 Due to the long latency period between exposure and disease, which has been reported to be between 30 and 50 years, most cases of mesothelioma being diagnosed today are the result of asbestos exposure in the 1960s and 1970s.3 Although safety measures for the use of asbestos were adopted in most countries several decades ago, the incidence rates, which are highly age-specific, are still rising, and are expected to peak over the next two decades.4-6 In Canada, the number of men diagnosed with mesothelioma has been steadily increasing over the past 20 years: there were 153 cases reported in 1984 versus 344 cases reported in 2003.3 Mesothelioma is less common in women: there were 78 Canadian women diagnosed with mesothelioma in 2003.3 In the United States, the peak mesothelioma incidence occurred in the early to mid-1990s and has possibly started to decline since then. -
Breast Reconstruction with Expanders and Implants
Evidence-Based Clinical Practice Guideline: Breast Reconstruction with Expanders and Implants INTRODUCTION Disclaimer Evidence-based guidelines are strategies for patient management, The American Cancer Society estimates that nearly 230,000 American developed to assist physicians in clinical decision making. This women were diagnosed with invasive breast cancer in 2011.1 Many of guideline was developed through a comprehensive review of the these individuals will require mastectomy and total reconstruction of scientific literature and consideration of relevant clinical experience, the breast. The diagnosis and subsequent process can create signifi- and describes a range of generally acceptable approaches to diagnosis, cant confusion and distress for the affected persons and their families management, or prevention of specific diseases or conditions. This and, consequently, surgical treatment and reconstructive procedures guideline attempts to define principles of practice that should are of utmost importance in the breast cancer care continuum. In generally meet the needs of most patients in most circumstances. 2011, the American Society of Plastic Surgeons® (ASPS) reported an increase in the rate of breast reconstructions, citing nearly 100,000 However, this guideline should not be construed as a rule, nor procedures, of which the majority employed expanders/implants.2 should it be deemed inclusive of all proper methods of care The 3% increase in reconstructions over the course of just one year or exclusive of other methods of care reasonably directed at highlights the significance of maintaining patient safety and obtaining the appropriate results. It is anticipated that it will be optimizing surgical outcomes. necessary to approach some patients’ needs in different ways. -
Evidence Vs Experience in the Surgical Management of Necrotizing Enterocolitis and Focal Intestinal Perforation
Journal of Perinatology (2008) 28, S14–S17 r 2008 Nature Publishing Group All rights reserved. 0743-8346/08 $30 www.nature.com/jp ORIGINAL ARTICLE Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation CJ Hunter1,2, N Chokshi1,2 and HR Ford1,2 1Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA and 2Department of Surgery, Childrens Hospital Los Angeles, Los Angeles, CA, USA bacterial colonization and prematurity.4 There is a subset of low Introduction: Necrotizing enterocolitis (NEC) and focal intestinal birth weight infants, however, that sustain focal intestinal perforation (FIP) are neonatal intestinal emergencies that affect premature perforation (FIP) without classic clinical, radiographic, or infants. Although most cases of early NEC can be successfully managed with histological evidence of NEC.5 FIP appears to be a distinct clinical medical therapy, prompt surgical intervention is often required for advanced entity that occurs in 3% of very low birth weight (VLBW) infants or perforated NEC and FIP. and accounts for 44% of gastrointestinal perforations in this 6 Method: The surgical management and treatment of FIP and NEC are population. Optimal surgical management of severe NEC and discussed on the basis of literature review and our personal experience. FIP has been the subject of ongoing controversy for many years. Result: Surgical options are diverse, and include peritoneal drainage, laparotomy with diverting ostomy alone, laparotomy with intestinal Presentation of NEC and FIP resection and primary anastomosis or stoma creation, with or without Infants with NEC typically present with feeding intolerance and second-look procedures. -
Equilibrium Radionuclide Angiography/ Multigated Acquisition
EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION Equilibrium Radionuclide Angiography/ Multigated Acquisition S van Eeckhoudt, Bravis ziekenhuis, Roosendaal VJR Schelfhout, Rijnstate, Arnhem 1. Introduction Equilibrium radionuclide angiography (ERNA), also known as radionuclide ventriculography (ERNV), gated synchronized angiography (GSA), blood pool scintigraphy or multi gated acquisition (MUGA), is a well-validated technique to accurately determine cardiac function. In oncology its high reproducibility and low inter observer variability allow for surveillance of cardiac function in patients receiving potentially cardiotoxic anti-cancer treatment. In cardiology it is mostly used for diagnosis and prognosis of patients with heart failure and other heart diseases. 2. Methodology This guideline is based on available scientifi c literature on the subject, the previous guideline (Aanbevelingen Nucleaire Geneeskunde 2007), international guidelines from EANM and/or SNMMI if available and applicable to the Dutch situation. 3. Indications Several Class I (conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective) indications exist: • Evaluation of left ventricular function in cardiac disease: - Coronary artery disease - Valvular heart disease - Congenital heart disease - Congestive heart failure • Evaluation of left ventricular function in non-cardiac disease: - Monitoring potential cardiotoxic side effects of (chemo)therapy - Pre-operative risk stratifi cation in high risk surgery • Evaluation of right ventricular function: - Congenital heart disease - Mitral valve insuffi ciency - Heart-lung transplantation 4. Contraindications None 5. Medical information necessary for planning • Clear description of the indication (left and/or right ventricle) • Previous history of cardiac disease • Previous or current use of cardiotoxic medication PART I - 211 Deel I_C.indd 211 27-12-16 14:15 EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION 6. -
Comparison of Echocardiography and Angiography in Determining the Cause of Severe Aortic Regurgitation
Br Heart J: first published as 10.1136/hrt.51.1.36 on 1 January 1984. Downloaded from Br Heart J 1984; 51: 36-45 Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation NICHOLAS L DEPACE, PASQUALE F NESTICO, MORRIS N KOTLER, GARY S MINTZ, DEMETRIOS KIMBIRIS, INDER P GOEL, E ELAINE GLAZIER-LASKEY, JOHN ROSS From the LikoffCardiovascular Institute, Hahnemann University, Philadelphia, Pennsylvania, USA SUMMARY To assess the accuracy of echocardiography in determining the cause of aortic regurgita- tion M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a biscuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgi- tation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Aortic regurgitation may be caused by valvular dis- ment for predominant aortic regurgitation were http://heart.bmj.com/ ease, aortic root disease, or a combination of both. reviewed.