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SESI 13
DISEASES OF CARDIOVADCULAR
(PENYAKIT JANTUNG-PEMBULUH)
(BAB IX)
Disusun oleh
dr Mayang Anggraini Naga
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DESKRIPSI
Pembahasan meliput tentang gangguan pada jantung,
sistem kardiovaskuler, struktur dan kekhususan Bab IX
“Diseases of the Cardiovascular System” disertai
pelatihan cara menentukan dan memilih kode diagnoses
gangguan sistem kardiovaskuler, cara pendokumetasian
kode klasiifkasi ganda, tambahan dan suplementer
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TUJUAN INSTRUKSIONAL UMUM
Mampu memahami definisi istilah gangguan
kardiovaskuler dan dampak penting dokumentasi
pernyataan waktu timbulnya serangan gangguan
jantung dan cara menentukan kode dan
pendokumentasian dengan benar.
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TUJUAN INSTRUKSIONAL KHUSUS
Menjelaskan:
definisi istilah-istilah gangguan sistem
kardiovaskuler
struktur dan kekhususan serta peraturan yang
berlaku bagi pemilihan nomor kode gangguan
sistem kardiovasluler
Cara memilih nomor kode diagnosis gangguan
sistem kardiovaskuker dengan akurat
Menyelesaikan nomor kode diagnoses dalam contoh
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POKOK & SUBPOKOK BAHASAN
-
Reading: “Disorders of The Heart”
Struktur dan kekhususan Bab IX
Peraturan-peraturan yang menyertai berbagai
nomor kode diagnoses.
Pelatihan pencarian kode melalui ICD-10 volume III
dan pengontrolan melalui daftar tabulasi volume I
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READING 4: DISORDERS OF THE HEART
Heart disorder are by far the most common cause of
death in developed countries . They also impair the
quality of life of millions of people, restricting activity by
causing pain, breathlessness, fatigue, fainting spells,
and anxiety. A wide range of conditions can affect the
heart by ultimately interfering with the pumping action of
the heart.
Genetic disorder
In general, inherited or genetic factors do not play a
large part in the causation of heart disorders. However,
they do contribute to the hyperlipidemias that
predispose a person to atherosclerosis and coronary
heart disease.
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READING-4 (Cont.-1)
• Congenital defects
Structural abnormalities in the heart are among the
most common birth defects, but are usually treatable.
They result from errors of development in the fetus and
include such conditions as septal (“holes in the heart”)
defects and some types of abnormal heart valves
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READING-4 (Cont.-2)
• Infection
Endocarditis is an infection of the heart valves, usually
occurring in people whose hearts have already been
damaged by rheumatic fever or are abnormal because
of some congenital or degenerative disorder. It may also
affect drug addicts who inject themselves intravenously
with nonsterile needles. The infection may cause
deformity and malfunctioning of any of the heart valves,
leading to, for example mitral insufficiency or aortic
insufficiency. Some types of cardiomyopathy are
triggered by viral infection.
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READING-4 (Cont.-3)
• Tumors
Tumors arising from the heart tissues are rare, the most
common being the benign myxoma (that grows inside
one of the heart’s chamber. Occasionally a malignant
sarcoma develops. Secondary tumors, spreading from
cancer elsewhere in the body are several times more
common than primary tumors. These metastases usually
grow within the heart muscle or the pericardium, but
seldom affect the valves. The tumor may produce
electrocardiographic abnormality and if extensive
result in congestive heart failure.
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READING-4 (Cont.-4)
• Muscle disorders
Cardiomyopathy is a general term for disease of the
heart muscle itself.
One type of cardiomyopathy is inherited, other may be
caused by vitamin deficiency or alcoholic poisoning,
or may be triggered by a viral infection.
Myocarditis is inflammation of the heart muscle.
It may be caused by a viral infection or by toxins
released during a bacterial infection.
Rarely, it results from drugs or radiation therapy.
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READING-4 (Cont.-5)
• Injury
Birth injury to the heart usually occur in car accidents
through impact with the steering wheel. .The heart is
compressed between the sternum and the spine and the
may suffer injury ranging from mild bruising to complete
rupture. In immediately fatal car accidents, up to two
thirds of the victims have suffered rupture of the heart
chamber. Seat belt use could probably prevent some of
these deaths.
Stab wounds to the heart are often fatal within minutes,
but, of patients who reach the hospital the great majority
survive. Bullet wounds are more serious, about 10% of
people shot in the heart reach the hospital alive.
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•
Nutritional disorders
The heart mucle is a sensitive to severe nutritional
deficiency and may become thin and flabby from simple
lack of protein and calories. Thiamine (Vit. B1) deficiency
which is common in chronic alcoholics, causes beriberi
with congestive heart failure. Obesity is another
important factor in causing heart disease, probably
through its effect on other risk factors such as
hypertension, diabetes, and cholesterol.
• Impaired blood supply
The major cause of heart disease in developed countries
is impaired blood supply. The coronary arteries become
narrowed due to atherosclerosis and parts of the heart
muscle are deprived of oxygen. The result of coronary
heart disease may be angina pectoris or eventually, a
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myocardial infarction.
READING -4 (Contl-6)
• Poisoning
The most common toxic substance affecting the heart is
alcohol. A large intake for many years may cause a type
of cardiomyopathy in which the heart becomes enlarged
and heart failure develops. If alcohol intake is stopped,
recovery is possible.
• Drugs
Certain drugs may disturb the heart beat, or even
cause permanent damage to the heart muscle. These
drugs includes the anticancer drug doxorubicin, the
tricyclic antidepressants, and even many drugs used to
treat heart diseases.
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READING -4 (Contl-7)
• Other disorders
Many common and important heart disorders may result
from some other underlying condition, such as coronary
heart disease, cardiomyopathy, or a congenital defect.
Such disorders include:
cardiac arrhythmia,
some cases of heart block and heart failure.
Cor pulmonale is a failure of the right side of the heart,
it is a consequence of lung diseases (emphysema),
which increase resistance in blood flow.
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READING -4 (Cont.-8)
• Investigation
Heart disease and disorders are investigated by such
technigues as:
auscultation,
ECG,
heart imaging techniques (x-ray,
echocardiography,
coronary angiography,
CT-scanning,
MRI,
cardiac catherization,
blood tests, and
in rare cases by a biopsy of the heart muscle.
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SRUKTUR & KEKHUSUSAN BAB IX\
DISEASES OF CARDI0OVASCULAR SYSTEM
(i00-I99) [Hal. 471-514]
Excludes:
certain condition originating in the perinatal period
(P00-P96) (kondisi tertentu yang timbul pada period
perinatal)
certain infectious and parasitic diseases (A00-B99)
(penyakit infeksi dan parasitic tertentu)
complications in pregnancy, childbirth & the
puerperium (O00-O99) (komplikasi dari kehamilan,
persalinan dan nifas)
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Exckudes (Lanjutan-1)
congenital malformations, deformations &
chromosomal abnormalities (Q00-Q99) (malformasi,
deformasi dan abnormalitas kromosom yang
kongenital)
endocrine, nutritional and metabolic diseases (E00E99) (penyakit endokrin, nutrisi dan metabolik)
injury, poisoning and certain other consequences
of external causes (S00-T98) (cedera, keracunan
dan konskeuensi sebab luar lain-lain)
neoplasms (C00-D48) (neoplasma)
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Exckudes (Lanjutan-2)
symptoms, signs and abnormal clinical and
laboratory findings NEC (R00-R99) (gejala,
tanda dan temuan klinik, dan laboratoris yang
abnormal)
systemic connective tissue disorders (M30-M36)
(Gangguan sistemik jaringan ikat)
transient cerebral ischaemic attacks and related
syndromes (serangan iskaemi (G45.-) serebri
yang sementara dan kumpulan gejala yang tertkait)
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Bab IX terbagi dalam blok-blok:
•
•
•
•
•
I00-I02
I05-I09
I10-I15
I20-I25
I26-I28
•
•
•
•
•
I30-I52
I60-I69
I70-I79
I80-I89
I95-I99
Demam reumatik akut
Penyakit-2 jantung reumatik menahun (kronis)
Penyakit-2 hipertensi
Penyakit-2 jantung iskemik
Penyakit jantung paru dan penyakit-2 sirkulasi
paru
Bentuk-2 penyakit jantung lain
Penyakit-2 serebrovaskuler
Penyakit-2 arteria, arterioles dan kapiler darah
Penyakit-2 vena, saluran dan nodi limfatik NEC
Gangguan-2 tak dirinci dan lain-2 sistem
sirkulasi.
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Ada 8 kode ber (*): [471]
I32* Pericarditis pd penyakit terklasifikasi di bagian lain
I39* Endocarditis dan gangguan katub pada penyakit
terklasifikasi di bagian lain.
I41* Myocarditis pd penyakit terklasifikasi di bagian lain
I43* Cardiomyopathy pd peny. terklasifikasi di bg lain
I52* Gangguan-2 lain jantung pada penyakit terklasifikasi di bagian lain
I68* Cerebrovascular disorders pd peny. terklasifikasi ..
I79* Penyakit arteria, arteriole dan kapiler pd peny. …
I98* Gangguan-gangguan lain sistem kardiovascular…
• (Bila code ber-* ini digunakan maka pasangannya harus
diberi/ber-! dagger )
• Jantung Reumatik, Hipertensi, Angina Pectoris
dan Infark Miokardium
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Perhatian perlu diberikan pada proses pengkodean bagi
diagnosis:
Demam reumatik yang dikelompokan di bawah
Penyakit Sistem Sirkulasi.
Kode-2 disediakan untuk: yang disertai dan tidak disertai
keterlibatan jantung  I00 dan I01
Baca excludes: …di bawah I01
Kode hypertension dibedakan untuk yang esensial,
ginjal dan jantung dan yang sekunder
Kode angina pectoris membedakan yang stable dan
yang unstable.
Kode infark miokard dibedakan sesuai waktu timbulnya
akut atau kronik serta letak infark di otot
jantungnya.Kronik iskemik jantung
mempunyai nomor code tersendiri.
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Perhatian perlu diberikan pada proses pengkodean (lanjutan-1)
Emboli Paru, Perikarditis, Gangguan Mitral, Miokarditis,
Kardiomiopati dan Gagal Jantung
Kode emboli paru membedakan apakah disertai
gangguan jantung atau tidak.
Kode pericarditis membedakan akut atau kronik.
Kode I32* untuk pericarditis pada penyakit yang
terklasifikasi di Bab lain
Gangguan katub mitral membedakan apakah rematik
atau nonrematik
Kode I41* Myocarditis perlu dilengkapi dengan nomor
berdagger untuk menjelaskan penyebabnya
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Perhatian perlu diberikan pada proses pengkodean (lanjutan-2)
Cardiomyopathy dikelompokan ke dalam 2 code untuk
membedakan penyakit penyebab.
Tachycardia dan gangguan irama jantung harus
dibedakan dengan kode terkait di bab R.
Gagal jantung, perhatikan nomor kode gagal jantung
bila akan digunakan untuk “Cause of death” (ICDVolume 2)
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CVD – CVA, Stroke dan Gangguan Sirkulasi Limfe
Baca aturan pemanfaatan nomor-2 code untuk CVDCVA & stroke
Stroke harus dibedakan apakah emboli, thrombosis,
perdarahan atau spasm pembuluh darah cranial.
Baca aturan di bawah I69 (Sequelae of CVD)
Kode artherosclerosis, aneurysma dibedakan sesuai
site lokasi gangguannya.
Perhatikan nomor kode untuk phlebitis, thromosis vena,
varices.
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CVD-CVA …… Gangguan Sirkulasi Limfe (Lanjutan)
Kode haemorrhoid dirinci pada digit ke-4 untuk
menjelaskan site pembuluh haemorrhoid.
Esophageal varices dilengkapi rincian ada perdarahan
atau tidak.
Lymphadenitis dibedakan yang spesifik dan nonspecific.
Hipotensi dirinci apakah akibat luar obat atau tidak.
Gangguan sistem sirkulasi postprosedural menduduki
nomor kode tersendiri
Disediakan kode I98.0* yang harus dilengkapi dengan
causanya.
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SOAL-SOAL LATIHAN
Cari nomor kode pada istilah yang dicetak tebal dan diberi
garis bawah pada materi Reading 4
Istilah
No. ICD-10
pain, breathlessness, fatigue, fainting spells,
anxiety.
hyperlipidemias
atherosclerosis
coronary heart disease.
endocarditis
rheumatic fever
mitral insufficiency
aortic insufficiency
cardiomyopathy
No:
No:
No:
No:
No:
No:
No:
No:
No:
No:
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SOAL-SOAL LATIHAN (Lanjutan-1)
Istilah
No. ICD-10
benign myxoma
malignant sarcoma
electrocardiographic
cardiomyopathy
vitamin deficiency or alcoholic poisoning,
myocarditis
Injury
Birth injury to the heart
mild bruising.
stab wounds to the heart
No:
No:
No:
No:
No:
No:
No:
No:
No:
No:
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SOAL-SOAL LATIHAN (Lanjutan-2)
Istilah
No. ICD-10
bubllet wounds
thiamine (Vit. B1) deficiency beriberi
congestive heart failure.
obesity
hypertension,
diabetes
cholesterol.
coronary heart disease
angina pectoris
myocardial infarction.
No:
No:
No:
No:
No:
No:
No:
No:
No:
No:
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SOAL-SOAL LATIHAN (Lanjutan-3)
Istilah
No. ICD-10
anticancer drug doxorubicin,
tricyclic antidepressants
heart failure
cardiac arrhythmia,
heart block
cor pulmonale
emphysema
No:
No:
No:
No:
No:
No:
No:
• Apakah semua istilah di atas bisa ditemukan nomor
kodenya di ICD-10?
• Bila ada yang tidak dapat ditemukan, jelaskan mengapa.
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