Minimally Invasive Superficial Femoral Artery Endarterectomy: Early Experience with a Modified Technique
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Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple
Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple By Amy Crenshaw Pritchett February 19, 2014 1 Agenda In this webinar: Expand your understanding of ICD-10-PCS with can’t miss ICD-10-PCS coding conventions & guidelines. Understand the basic differences between ICD-9-CM Volume 3 and ICD-10-PCS. Learn code structure, organization, & characters: Step 1 to coding section “0” ICD-10-PCS? Pinpoint the body system. To build your ICD-10-PCS code, you must identify the root operation. Study 7 options when assigning your PCS code’s 5th character. Master how to determine the device value for your PCS code’s character. Raise your awareness of unique ICD-10-PCS challenges pertaining to documentation and specificity: Prepare physicians now for more detailed transfusion notes under ICD- 10-PCS. Discover why writing “Right Carotid Endarterectomy” won’t be enough. Know where to find ICD-10-PCS tools, techniques, and best practices. 2 Understanding ICD-10-PCS ICD-10-PCS is a major departure from ICD-9-CM procedure coding, requiring you to know which root word applies. Effective October 1, 2014, this procedure coding system will be used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the US. 3 Gear Up for ICD-10-PCS This procedure coding system is starkly different from ICD-9-CM procedure coding: Every ICD-10-PCS code has seven characters, each character defining one aspect of the procedure performed. For instance, not correctly identifying your physician’s approach – the fifth character – and not being able to distinguish between similar root operations can throw off your claims accuracy! 4 Converting to ICD-10-PCS Have your inpatient coders and clinical documentation specialists begun preparing for ICD-10-PCS yet? That’s why we’re here today … to ease your transition from ICD-9-CM procedure coding to ICD-10-PCS. -
Targeting Endothelial Kruppel-Like Factor 2 (KLF2) in Arteriovenous
Targeting Endothelial Krüppel-like Factor 2 (KLF2) in Arteriovenous Fistula Maturation Failure A dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY (Ph.D.) in the Biomedical Engineering Program Department of Biomedical Engineering College of Engineering and Applied Science 2018 by Keith Louis Saum B.S., Wright State University, 2012 Dissertation Committee: Albert Phillip Owens III, Ph.D. (Committee Chair) Begona Campos-Naciff, Ph.D Christy Holland, Ph.D. Daria Narmoneva, Ph.D. Prabir Roy-Chaudhury, M.D., Ph.D Charuhas Thakar, M.D. Abstract The arteriovenous fistula (AVF) is the preferred form of vascular access for hemodialysis. However, 25-60% of AVFs fail to mature to a state suitable for clinical use, resulting in significant morbidity, mortality, and cost for end-stage renal disease (ESRD) patients. AVF maturation failure is recognized to result from changes in local hemodynamics following fistula creation which lead to venous stenosis and thrombosis. In particular, abnormal wall shear stress (WSS) is thought to be a key stimulus which alters endothelial function and promotes AVF failure. In recent years, the transcription factor Krüppel-like factor-2 (KLF2) has emerged as a key regulator of endothelial function, and reduced KLF2 expression has been shown to correlate with disturbed WSS and AVF failure. Given KLF2’s importance in regulating endothelial function, the objective of this dissertation was to investigate how KLF2 expression is regulated by the hemodynamic and uremic stimuli within AVFs and determine if loss of endothelial KLF2 is responsible for impaired endothelial function. -
Transpulmonary Closure of Giant Persistent Ductus Arteriosus Under Cardiopulmonary Bypass and Normothermic Cardioplegia
Published online: 2019-11-25 THIEME 36 TranspulmonaryPoint of Technique Closure of Giant Persistent Ductus Arteriosus Chowdhury et al. Transpulmonary Closure of Giant Persistent Ductus Arteriosus under Cardiopulmonary Bypass and Normothermic Cardioplegia Ujjwal K. Chowdhury1 Sukhjeet Singh1 Niwin George1 Lakshmi Kumari Sankhyan1 Poonam Malhotra Kapoor2 1Department of Cardiothoracic and Vascular Surgery, All India Address for correspondence Ujjwal K. Chowdhury, MCh, Institute of Medical Sciences, New Delhi, India Department of Cardiothoracic and Vascular Surgery, All 2Department of Cardiac Anaesthesia, All India Institute of Medical India Institute of Medical Sciences, New Delhi 110029, India Sciences, New Delhi, India (e-mail: [email protected]). J Card Crit Care TSS 2020;3:36–38 Abstract A 25-year-old female patient with a giant, short, calcified, hypertensive, window duc- tus arteriosus underwent successful closure via transpulmonary approach under nor- Keywords mothermic cardiopulmonary bypass without circulatory arrest using a Foley catheter ► giant ductus for temporary occlusion. arteriosus ► adult ductus ► cardiopulmonary bypass ► transpulmonary closure ► calcified ductus Introduction chylothorax, or recanalization. Postoperative computerized tomographic angiography revealed complete ductal inter‑ Despite 80 years of experience, correction of persistent duc‑ ruption with no residual shunt or ductal aneurysm (►Fig. 3). tus arteriosus remains a surgical challenge in the subset of 1. Primary median sternotomy is performed. patients -
Arteriography After Carotid Endarterectomy
325 Arteriography after Carotid Endarterectomy John Holder 1 Of 55 patients undergoing carotid endarterectomy, 16 had abnormal postoperative Eugene F. Binet2 angiograms by accepted literature criteria. Five of the 16 were symptomatic. The other Stevenson Flanigan3 11 were neurologically stable or improved from their preoperative condition. None of the 16 patients underwent reoperation. Of those 11 who had abnormal postoperative Ernest J. Ferris 1 angiograms but a good clinical result, four had a second postoperative angiogram some months later that demonstrated marked improvement in the appearance of the endarterectomy site. Patients undergoing carotid endarterectomy should not be sub jected to routine postoperative angiography without clinical indications nor should they undergo reoperation on the basis of angiographic findings alone without consideration of their clinical status. Cerebral angiography remains th e most precise method to evaluate the path ologic changes that occur in extracrani al cerebrovascular disease involving th e internal carotid artery in th e neck. Several authors have strongly endorsed its use in the immediate postoperative period to evalu ate the patency of th e end arterectomy site. In some institutions reoperation is performed if the angiographic findings appear unsatisfactory without consideration of the patient's neurologic status. This report will examine the preoperative and postoperative angiograms of patients who were not subjected to reoperation despite having abnormal appearing postoperative carotid angiograms. Materials and Methods Postoperative arteriography has been routinely perform ed on all pati ents subiected to carotid endarterectomy by the Neurosurgery Service at the Little Rock Veterans Adminis tration Medical Center. The angiographic studies of 55 such patients operated on during a Received August 28, 1980; accepted after re 6 year period were evaluated. -
Carotid Endarterectomy Compared with Angioplasty and Stenting: the Status of the Debate
Neurosurg Focus 5 (6):Article 2, 1998 Carotid endarterectomy compared with angioplasty and stenting: the status of the debate Felipe C. Albuquerque, M.D., George P. Teitelbaum, M.D., Donald W. Larsen, M.D., and Steven L. Giannotta, M.D. Department of Neurological Surgery, Los Angeles County and University of Southern California Medical Center, Los Angeles, California Endarterectomy is the treatment of choice for patients with symptomatic stenosis of the internal carotid artery. Recently, debate has arisen over the potential benefits of endovascular techniques. Although retrospective analyses of angioplasty and stenting procedures suggest comparable clinical efficacy to endarterectomy, prospective evaluation is pending. The authors review the status of the debate and discuss those issues on both sides that are particularly contentious and clinically relevant. Key Words * carotid endarterectomy * angioplasty * stenting Atherosclerotic disease of the common carotid artery bifurcation is associated with 20 to 30% of cerebrovascular accidents.[13,15,27] Stroke is the third leading cause of death in the United States and the most common and disabling neurological disorder among the elderly worldwide.[13,15,27] In light of these public health concerns, research in the last half of this century has been focused on the optimum treatment of carotid artery stenosis. Prospective analyses such as those performed by the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the Asymptomatic Carotid Atherosclerosis Study (ACAS), and the European Carotid Surgery Trial have demonstrated superior reduction in stroke incidence among symptomatic and a select group of asymptomatic patients who undergo carotid endarterectomy (CEA).[17,18,36] In fact, these studies have established CEA as the "gold standard" for the treatment of carotid artery atherosclerosis. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Carotid Endarterectomy— an Evidence-Based Review
Special Article Carotid endarterectomy— CME An evidence-based review Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology S. Chaturvedi, MD; A. Bruno, MD; T. Feasby, MD; R. Holloway, MD, MPH; O. Benavente, MD; S.N. Cohen, MD; R. Cote, MD; D. Hess, MD; J. Saver, MD; J.D. Spence, MD; B. Stern, MD; and J. Wilterdink, MD Abstract—Objective: To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symp- tomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. Methods: The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. Results: For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy. -
V5 Data Dictionary Supplement with Pending Data Element Updates
V5 Data Dictionary Supplement with Pending Data Element Updates The mission of the NCDR® is to improve the quality of cardiovascular patient CathPCI by providing information, knowledge and tools; implementing quality initiatives; and supporting research that improves patient CathPCI and outcomes. The NCDR® is an initiative of the American College of Cardiology Foundation, with partnering support from the Society for Cardiovascular Angiography and Interventions for the CathPCI Registry. CONFIDENTIALITY NOTICE This document contains information confidential and proprietary to the American College of Cardiology Foundation. This document is intended to be a confidential communication between ACCF and participants of the CathPCI Registry and may involve information or material that may not be used, disclosed or reproduced without the written authorization of the ACCF. Those so authorized may only use this information for a purpose consistent with the authorization. Reproduction of any section of this document with permission must include this notice. Table of Contents Section G. Cath Lab Visit Seq#7400 Indications for Cath Lab Visit....................................................................................Page 3 Seq#7405 Chest Pain Symptom Assessment…………………………………….…………………………………..Page 5 Section I. PCI Procedure Seq#7825 Percutaneous Coronary Intervention Indication......................................................Page 6 Review of Cath Lab Indications & PCI Indications…………………………………………….….….……….…. Page 8 Section K. Intra and Post-Procedure -
NCDR® Cathpci Registry® V4.4 Coder's Data Dictionary
NCDR® CathPCI Registry® v4.4 Coder's Data Dictionary A. Demographics Seq. #: 2000 Name: Last Name Coding Instructions: Indicate the patient's last name. Hyphenated names should be recorded with a hyphen. Target Value: The value on arrival at this facility Selections: (none) Supporting Definitions: (none) Seq. #: 2010 Name: First Name Coding Instructions: Indicate the patient's first name. Target Value: The value on arrival at this facility Selections: (none) Supporting Definitions: (none) Seq. #: 2020 Name: Middle Name Coding Instructions: Indicate the patient's middle name. Note(s): It is acceptable to specify the patient's middle initial. If the patient does not have a middle name, leave field blank. If the patient has multiple middle names, enter all of the middle names sequentially. Target Value: The value on arrival at this facility Selections: (none) Supporting Definitions: (none) Seq. #: 2030 Name: SSN Coding Instructions: Indicate the patient's United States Social Security Number (SSN). Note(s): If the patient does not have a US Social Security Number (SSN), leave blank and check 'SSN NA'. Target Value: The value on arrival at this facility Selections: (none) Supporting Definitions: (none) Seq. #: 2031 Name: SSN N/A Coding Instructions: Indicate if the patient does not have a United States Social Security Number(SSN). Target Value: The value on arrival at this facility Selections: Selection Text Definition No Yes Supporting Definitions: (none) Effective for Patient Discharges April 1, 2011 © 2008, American College of Cardiology Foundation 1/5/2011 3:12:46 PM Page 1 of 82 NCDR® CathPCI Registry® v4.4 Coder's Data Dictionary A. -
Importance of Computed Tomography in Defining Segmental Disease in Chronic Thromboembolic Pulmonary Hypertension
ORIGINAL ARTICLE PULMONARY VASCULAR DISEASE Importance of computed tomography in defining segmental disease in chronic thromboembolic pulmonary hypertension Micheal C. McInnis 1, David Wang1, Laura Donahoe2, John Granton3, John Thenganatt3, Kongteng Tan1, John Kavanagh1 and Marc de Perrot2 Affiliations: 1Dept of Medical Imaging, University of Toronto, Toronto, ON, Canada. 2Division of Thoracic Surgery, Dept of Surgery, University of Toronto, Toronto, ON, Canada. 3Division of Respirology, Dept of Medicine, University of Toronto, Toronto, ON, Canada. Correspondence: Micheal C. McInnis, Dept of Medical Imaging, Toronto General Hospital, 1 PMB-273, 585 University Avenue, Toronto, ON M5G 2N2, Canada. E-mail: [email protected] ABSTRACT Background: Radiological assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is critical to decide whether patients should be treated with pulmonary endarterectomy (PEA). Although computed tomography pulmonary angiography (CTPA) is increasingly used for decision making in CTEPH, the value of CTPA to predict surgical findings and outcome has never been explored. Methods: We retrospectively reviewed 100 consecutive patients with high-quality CTPA undergoing PEA for CTEPH between May 2015 and December 2017. The most proximal level of disease in the pulmonary artery on CTPA was classified by two blinded radiologists as level 1 (main pulmonary artery), 2a (lobar pulmonary artery), 2b (origin of basal segmental pulmonary artery), 3 (segmental pulmonary artery) or 4 (predominantly subsegmental pulmonary artery). Results: CTPA demonstrated level 1 in 20%, level 2a in 43%, level 2b in 11%, level 3 in 23% and level 4 in 3%. A majority of males presented with level 1 (55%) and level 2 (57%), and a majority of females (83%) with level 3 (p=0.01). -
Carotid Endarterectomy
Carotid Endarterectomy Mark Shikhman, MD, Ph.D., CSA Andrea Scott, CST This lecture presents one of the most often vascular surgical procedures – carotid endarterectomy. This type of surgery is performed to prevent stroke caused by atherosclerotic plaque at the common carotid artery bifurcation and, most important, internal carotid artery. Before we will discuss the anatomy of this region, it is necessary to mention that typical symptoms that lead to the diagnosis of carotid artery‘s partial or total occlusion include: Episodes of dizziness Loss of function in the hand or leg opposite the side of the lesion Episodic loss of vision in one eye Transient aphasia (see explanation of this condition below) Confusion with temporary loss of consciousness From all symptoms that were mentioned above I will spend a little bit more time to explain transient aphasia because the meanings of others are obvious. 25 percent of stroke victims suffer from a serious loss of speech and language comprehension. The affliction is commonly known as aphasia, and it is frustrating for patients and caregivers alike. It is estimated that more than 1 million Americans suffer from some form of aphasia, which can result from a stroke, brain tumor, seizure, Alzheimer‘s disease or head trauma. ―Aphasia is a very specific condition that deals with disorder of language,‖ said Michael Frankel, associate professor of neurology at the School of Medicine and chief of neurology at Grady Hospital. ―The easiest way to explain it is that a person can‘t express what he wants to say or cannot find the right words, or that someone else finds it difficult to understand what the person is saying. -
Development of the ICD-10 Procedure Coding System (ICD-10-PCS)
Development of the ICD-10 Procedure Coding System (ICD-10-PCS) Richard F. Averill, M.S., Robert L. Mullin, M.D., Barbara A. Steinbeck, RHIT, Norbert I. Goldfield, M.D, Thelma M. Grant, RHIA, Rhonda R. Butler, CCS, CCS-P The International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision (ICD-9-CM). The development of ICD-10-PCS was funded by the U.S. Centers for Medicare and Medicaid Services (CMS).1 ICD-10- PCS has a multiaxial seven character alphanumeric code structure that provides a unique code for all substantially different procedures, and allows new procedures to be easily incorporated as new codes. ICD10-PCS was under development for over five years. The initial draft was formally tested and evaluated by an independent contractor; the final version was released in the Spring of 1998, with annual updates since the final release. The design, development and testing of ICD-10-PCS are discussed. Introduction Volume 3 of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) has been used in the U.S. for the reporting of inpatient pro- cedures since 1979. The structure of Volume 3 of ICD-9-CM has not allowed new procedures associated with rapidly changing technology to be effectively incorporated as new codes. As a result, in 1992 the U.S. Centers for Medicare and Medicaid Services (CMS) funded a project to design a replacement for Volume 3 of ICD-9-CM.