Download HS225 – Week 5

HS225 – Week 5
Hemic/Lymphatic System
Mediastinum/Diaphraghm
Digestive System
Urinary System
Maternity & Delivery Care
Robyn Korn, MBA, RHIA, CPHQ
Ch 9 – Hemic & Lymphatic Systems
The hemic and lymphatic systems often are viewed as subsystems of
the circulatory system.
• The repair of a ruptured spleen is also known as a splenorrhaphy.
• The spleen is located in the left upper quadrant of the abdomen,
behind the stomach and just below the diaphragm.
• The lymphatic channels, or vessels, transport fl uid away from the
tissues of the body and toward the thoracic cavity.
• Lymph nodes, also known as lymph glands, are located at various
areas along the lymphatic vessels.
• In an autologous bone marrow transplant, cells are cultivated from
the patient's own marrow.
• In an allogenic bone marrow transplant, cells are taken from a donor
and then transplanted.
• There are four major concentrations of lymph nodes: cervical lymph
nodes, submandibular lymph nodes, axillary lymph nodes, and
inguinal lymph nodes.
Ch 10 – Mediastinum & Diaphragm
The mediastinum is the space in the thoracic cavity behind the
sternum and in between the two pleural sacs that contains all the
viscera of the chest except the lungs and pleurae.
• The diaphragm is a dome-shaped muscle that separates the thoracic
cavity from the abdominal cavity.
• A mediastinotomy is a procedure in which an incision is made to
open the mediastinum.
• A cervical or anterior mediastinotomy is completed from the front
of the body.
• During a transthoracic mediastinotomy the incision is made in the
fourth intercostal space to enter the mediastinum.
• A mediastinoscope is a lighted instrument that is used to visually
examine the mediastinum.
• A transabdominal approach occurs when an incision is made across
the abdomen.
CH 11 – Digestive System
• The digestive system is sometimes referred to as the alimentary
canal.
• The procedure codes begin with procedures on the mouth and oral
cavity and move through the entire digestive system.
• The vestibule of the mouth is the mucosal tissue and submucosal
tissue of the lips and cheeks.
• Lingual refers to the tongue, and the sublingual area refers to the area
under the tongue.
• A tracheostomy is a surgical opening in the trachea through the
neck.
• An endoscopic procedure involves insertion of a flexible or rigid
instrument called an endoscope, which is used to view the internal
structures.
• Endoscopic and laparoscopic procedures are frequently completed
on the digestive system.
• Manipulation is a maneuver by hand to treat or perform therapy.
Chapter 11 – Digestive (cont)
• Dilation is performed when an expansion or stretching is necessary.
• Enterolysis is the freeing of intestinal adhesions.
• Duodenotomy is the process of making an incision into the
duodenum.
• A hemorrhoid is an enlarged varicose vein in or near the anus and
includes the following types:
internal, external, combined, and mixed.
• Meckel’s diverticulum is a form of diverticulum of the ileum.
• A proctosigmoidoscopy is the examination of the rectum with scope
advancement into the sigmoid colon.
• A sigmoidoscopy is a procedure in which the endoscope is moved all
the way through the rectum and sigmoid colon and may even
advance slightly into the descending colon.
• The examination in which the entire colon, from the rectum to the
cecum, is visualized is known as a colonoscopy.
Chapter 12 – Urinary System
The structures that are found in the urinary system include bilateral
kidneys, bilateral ureters, the urinary bladder, and the urethra.
• The external sphincter controls the release of the urine from the
bladder.
• The kidneys are located in the back of the abdominal region of the
body on either side of the vertebral column.
• The ureters are muscular tubes that lead urine from the kidneys to
the bladder.
• The urinary bladder is located in the pelvic cavity and serves as a
temporary reservoir for the urine.
• The urethra is a mucous membrane–lined tube that leads urine from
the bladder to be excreted from the body.
Chapter 12 – Urinary System (cont)
• A pyelotomy is an incision made into the renal pelvis.
• Endoscopy codes for ureteral procedures completed
through an established ureterostomy are reported
with codes 50951 to 50961.
• Code range 50970 to 50980 is used to report ureteral
endoscopy through a ureterotomy.
• An alternate method of catheterizing the bladder for
drainage is completed by performing a cystostomy.
• Code range 52400–52700 is used for male patients to
report procedures completed on the vesical neck and
prostate.
Case Study 1 Chapter 12
Pre- and Postoperative Diagnosis: Ureteral calculus
Anesthesia: General
Procedure: Ureteroscopy of left ureter for removal of calculus; stent
placement
The patient was taken from the presurgery area to the operating room and
prepped and draped in the usual fashion. General anesthesia was
administered. The endoscope was placed into the urethra that appeared to be
inflamed. The scope was then carefully passed through the bladder, which
appeared normal. The guidewire was introduced, and a balloon was used to
dilate the left ureter. The scope was advanced to view the ureter, where a
small stone was seen. A stent was placed. The area was checked for bleeding,
and the scope was then removed. The stent was attached to a string, which
was in the correct position. Blood loss was minimal, and the patient was sent
to the recovery room in good condition.
CPT code(s):____________________________________
Case 1 Answer Chapter 12
Case 1—52352-LT
 Rationale: Reference Removal as the
main term in the Index with the subterm
calculi. Ureter will offer a large code
range, which should be referenced to
locate the correct code.

Case Study 2 Chapter 12
Pre- and Postoperative Diagnosis: Urethral stricture
Procedure: Dilation of urethra, first attempt
This 45-year-old male patient was brought to the operating
room and prepped and draped in the usual fashion. After the
patient was anesthetized, a urethral dilator was inserted into
the urethra. The urethra was then dilated to normal range. The
dilator was removed, and no bleeding was noted. The patient
tolerated the procedure well and was taken to the recovery
room.
CPT code(s):
Case 2 Answer Chapter 12
Case 2—53600
 Rationale: Reference the main term
Urethra in the Index. The subterm dilation
directs the coder to a range of codes that
should be referenced for proper code
assignment.

Case Study 3 Chapter 12
The patient is a 70-year-old female with a history of bladder cancer. She
presents today for a cystoscopy, biopsy, and fulguration of an erythematous
area that appeared suspicious in previous testing. The area is the right trigone.
The patient was placed in the supine position, where spinal anesthesia was
administered. She was then turned to the dorsal lithotomy position, where
she was prepped and draped in the usual sterile manner. A #22 French
cystoscopy sheath was passed in atraumatic fashion per the urethra. The
bladder was resected with the 70 degree lens where the right trigone area
was found slightly erythematous and hypervascular. No tumors were found,
and no mucosal abnormalities were noted. A biopsy of the area was taken and
sent for pathology.
Pathology findings: Chronic cystitis with squamous cell metaplasia
CPT code(s): ____________________________________
Case 3 Answer Chapter 12
Case 3—52224
 Rationale: Referencing the Index under
the main term Biopsy then the subterm
bladder, the coder will need to determine
which of the codes given will best
represent the procedure performed. Keep
in mind that the area biopsied was
actually the trigone and no other
procedure was performed.

Case Study 4 Chapter 12
The 68-year-old male who presents today for laser coagulation of the
prostate due to urinary retention with urgency and difficulty
urinating.
Procedure: The patient was placed on the operating table in the
lithotomy position. Spinal anesthesia was administered, and external
genitalia was prepped and draped. A 21-French cystoscope was
introduced into the bladder. Upon inspection, there was no evidence
of a tumor. Mild trabeculations were observed on both ureteral
orifices. The retroscope was introduced with a resection of the lateral
lobes of the prostate being done; complete opening of the prostatic
urethra was allowed. The bladder was examined, and all prostatic
chips were removed. The bladder was coagulated and smoothed out
with the VaporTrode. An indwelling Foley catheter was
inserted into the bladder.
CPT code(s):___________________________
Case 4 Answer Chapter 12
Case 4—52647
 Rationale: Reference the main term
Laser in the Index. The subterm prostate
will offer a range of codes that the coder
would reference to find the correct code
assignment.

Ch 15 – Maternity Care & Delivery
An understanding of the global package for obstetric care is necessary
to select the proper codes for services rendered.
• An understanding of terminology is important to proper code
assignment.
• Complications that typically would not be part of the regular
maternity care should be coded separately using Evaluation and
Management codes.
• Cesarean section deliveries can be either planned or emergency.
• VBAC deliveries are those in which a vaginal birth is successfully
performed following a cesarean section during a prior pregnancy.
• Abortion treatment can be elective or necessary.
• An understanding of the different types of abortion is essential for
proper code assignment.
Case Study 1 Chapter 15
Woman presents in active labor and is admitted for
delivery at 41 weeks gestation. Dr. Martin is the cover
OB and has never seen the patient until today. Upon
check of the cervix, dilation is at 10, and baby is ready
to deliver. No type of anesthesia has been given. The
fetal monitor is showing a strong, viable fetus. After
several pushes, the head appears, and the baby is
suctioned immediately. A healthy male child is delivered
at 10:08 p.m. Apgar score is 8. Placenta is delivered, no
forceps, no episiotomy. Mother and child are doing well.
Dr. Martin will not be completing the postpartum care.
CPT Code(s):__________________________
Case 1 Answer – Chapter 15
Case 1—59409
 Rationale: Dr. Martin is reporting only
the delivery. He would not be reporting
the global service that includes
antepartum, delivery, and postpartum
care. The coder would reference Vaginal
Delivery as the main term in the Index.

Case Study 2 Chapter 15
A 28-year-old female presents to the emergency room
with severe abdominal pain. Upon examination, it is
determined that the patient is pregnant, but it is an
ectopic pregnancy. The tube is unruptured at this time,
so decision is made to do a laparoscopic resection of
the ectopic pregnancy. Laparoscopic technique is used
to get to the site. When the area is found, an incision is
made in the tube using electrosurgical technique. Using
forceps, the trophoblastic tissue is removed, bleeding is
controlled, and the procedure is finished in the usual
manner.
CPT code(s): ______________________
Case 2 Answer – Chapter 15
Case 2—59150
 Rationale: The ectopic pregnancy was
resolved with a laparoscopic technique
that did not require a salpingectomy or an
oophorectomy. The coder would
reference the main term Ectopic Pregnancy
in the Index. The subterm laparoscopy is
then referenced.

Case Study 3 Chapter 15
OFFICE NOTE
Diagnosis: Pregnancy at 30 weeks
This 29-year-old patient is 30 weeks pregnant and has
been seen by me since she was 8 weeks pregnant. She
is moving out of town and is going to be seen by Dr.
Nicon in Atlanta, Georgia. Her prenatal records will be
sent. At this time her pregnancy is normal with no
complications. She has been seen seven times by me.
Note to billing staff: Please bill patient’s insurance at this time.
CPT code(s):________________________
Case 3 Answer – Chapter 15
Case 3—59426
 Rationale: The coder would reference
Pregnancy or Antepartum Care and the
subterm vaginal delivery to find the
correct code to report.

Case Study 4 Chapter 15
Office Note
Diagnosis: Normal pregnancy and vaginal
delivery Mrs. Smith delivered a 6 pound 10
ounce baby girl on 1/10/XX at 1:23 a.m.
This is her final postpartum visit. See OB
flow sheet for physical findings.
Note to billing staff: Please bill patient’s insurance at this time.
CPT code(s): _______________
Case 4 Answer – Chapter 15
Case 4—59400
 Rationale: This code is used to report a
normal vaginal delivery, even if an
episiotomy or forceps use is necessary.
Reference the main term Vaginal Delivery
to locate this code.

Case Study 5 Chapter 15
Office Note
Diagnosis: Normal pregnancy followed by
attempted vaginal delivery after previous Csection delivery Mrs. Williams delivered an 8
pound 12 ounce baby boy on 4/15/XX at
11:11 a.m. via C-section after attempting to
vaginally deliver the child. This is her final
postpartum visit. See OB flow sheet for
physical findings.
Note to billing staff: Please bill patient’s insurance at this time.
CPT code(s): ___________________
Case 5 Answer – Chapter 15
Case 5—59618
 Rationale: Reference the main term
Vaginal Delivery to locate this code. The
coder will note that the subterm
attempted is found under after Previous
Cesarean Delivery.

Procedural Coding Exam
55 questions – 170 points
 4 hours
 10 true/false
 45 coding
 Covers Units 1-6
 In order to complete the exam, be
prepared to use the AHIMA Virtual Lab or
the CPT Coding Manual.

Coding Focus
Lab
 Radiology
 Evaluation and Management
 Medicine
 OB
 Cardiovascular System
 Endocrine System
 Nervous System
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Reminders
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