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Chapter 11: Circulatory System

International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach 2012 Edition. Chapter 11: Circulatory System. Body System Characters for the Circulatory System. 2 – Heart and Great Vessels 3 – Upper Arteries 4 – Lower Arteries

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Chapter 11: Circulatory System

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  1. International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach2012 Edition Chapter 11: Circulatory System

  2. Body System Characters for the Circulatory System • 2 – Heart and Great Vessels • 3 – Upper Arteries • 4 – Lower Arteries • 5 – Upper Veins • 6 – Lower Veins

  3. Function of the Circulatory System • Circulate blood to the lungs for oxygenation • Circulate blood throughout the body • Eliminates waste products

  4. Organization of the Circulatory System • Heart • Great Vessels • Arteries- carry blood away from the heart • Veins – return blood to the heart • Capillaries- connect arteries to veins

  5. Heart and Great Vessels • Heart – four chambers -2 upper atrium, 2 lower ventricles • Right atrium and ventricle -Receive deoxygenated blood from the superior and inferior vena cavae – to lungs through pulmonary arteries • Left atrium and ventricle-receive blood via pulmonary veins and throughout the body via aorta • See Figure 11.1

  6. Valves of the Heart • Atrioventricular -Tricuspid -bicuspid • Semilunar -Pulmonary -Aortic

  7. Great Vessels • Aorta- root, ascending, aortic and thoracic arch • Vena Cavae- superior and inferior • Pulmonary arteries- trunk, right and left • Pulmonary veins- right and left inferior and superior

  8. Coronary Arteries and Veins • Supply blood to the heart muscle -Right -Left main -Circumflex -Left anterior descending • Veins of the heart – great, middle and small veins • See Figure 11.2

  9. Other structures • Atrial septum • Chordae tendinea • Conduction mechanism • Papillary muscles • Pericardium • Ventricular septum

  10. Upper and Lower Arteries • Carry blood away from the heart • Branch into smaller arteries, arterioles, capillaries – exchange blood with the cells • Often named for the areas or organs they supply with blood -EG -internal mammary artery, temporal artery, thyroid artery • See Figure 11.3

  11. Upper and Lower Veins • Carry blood to the heart after collection from the capillaries in venules • Venules lead to bigger veins -Superior vena cava -Inferior vena cava • Valves that keep the blood flowing against gravity to the heart • See Figure 11.4

  12. Coronary Artery Bypass • Body part value represents the number or sites treated • Qualifier indicates the vessel bypassed from, or source of blood flow • See Figure 11.5

  13. Autologous Tissue Grafts • Separate procedure for harvesting the graft • See Coding Guideline B3.9 -If an autograft is obtained from a different body part in order to complete the objective of the procedure, a separate procedure is coded • E.g. – Coronary bypass with excision of saphenous vein graft, excision of saphenous vein is coded separately

  14. Percutaneous Transluminal Angioplasty • Dilation to mechanically widen the artery • Balloon catheter passed to the narrowed location and inflated • Balloon crushes the fatty deposits and withdrawn • If Device – reflected 6th character • PTCA • PTA

  15. Heart Catheterization • Percutaneous approach to the circulatory system • If PTCA = Dilation • If Imaging only = Image section • If pressure measurements and sampling – Measurement and Monitoring section

  16. Common Root Operations • See Table 11.1 for a comprehensive list • Extirpation – in declotting tubular body parts • Embolization -Completely closed – Occlusion -Narrow – Restriction -See Coding Guideline B3.12

  17. Common Root Operations (continued) • Supplement-valvular annuloplasty -ring added to heart valve • Map – Intraoperative cardiac mapping/heart catheterization • Drainage-Venipuncture to remove blood directly from an artery or vein -If blood is removed from an indwelling device= Collection in Section 8 Other Procedures

  18. Coronary Arteries Body Part Values • Coronary arteries- not individually identified with body part values • Assigned based on the number of sites treated • Separate body part values to specify the number of sites treated when the same procedure is performed on multiple sites in the coronary arteries -See Coding Guideline B4.4

  19. Body Part Values • Many body part values available for different arteries and veins • Generic body part value available • See Tables -11.2 Heart and Great Vessels -11.3 Upper and Lower Arteries -11.4 Upper and Lower Veins • If specific body part is not listed refer to the Index

  20. Approaches • 0 - Open • 3 – Percutaneous • 4 – Percutaneous Endoscopic • X – External -Fragmentation -Removal -Revision -Inspection

  21. Devices • Pressure sensor monitoring device • External heart assist system • Internal heart assist system • Drug-eluting intraluminal device • Bioactive intraluminal device • See Tables 11.6- 11.8

  22. Qualifiers • Bypass -Coronary – Qualifier is the origin of the Bypass -Non-Coronary – Qualifier is the body part bypassed to • Different Devices and/or Qualifiers -Separate codes for each • See Coding Guideline B3.6c -Left internal mammary artery • Not coded as a device as it is not a free graft • Represented in the 7th character Qualifier

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