Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CHAPTER 21 ENDOCRINE AND NERVOUS SYSTEMS

2 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Endocrine System Subsection 9 glands in Endocrine System; only 4 included in subsection9 glands in Endocrine System; only 4 included in subsection –Thyroid –Parathyroid –Thymus –Adrenal Pituitary and pineal: See Nervous SystemPituitary and pineal: See Nervous System Pancreas: Digestive SystemPancreas: Digestive System Ovaries and testes: Respective Genital systemOvaries and testes: Respective Genital system(Cont’d…) Figure: 21.1

3 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Endocrine System ( ) (…Cont’d) Divided into 2 subheadingsDivided into 2 subheadings –Thyroid Gland –Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body (Cont’d…)

4 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Endocrine System ( ) (…Cont’d) Carotid body refers to area adjacent to carotid arteryCarotid body refers to area adjacent to carotid artery –Can be site of tumors Figure: 21.2 The baroreceptor system for controlling arterial pressure. (Modified from Guyton AC, Hall JE: Textbook of Medical Physiology, ed 11, Philadelphia, 2006, Saunders.)

5 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Thyroid Gland, Excision ( ) 2 lobes2 lobes Code descriptions often refer toCode descriptions often refer to –Partial or subtotal: Something less than total –Removes problem side of the gland, isthmus, and majority of opposite lobe –Total: All –Lobectomy (Partial) –Total Thyroid Lobectomy (solitary nodules, follicular adenomas, nodules, goiters)

6 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Nervous System Divided anatomicallyDivided anatomically –Skull, Meninges, and Brain –Spine and Spinal Cord –Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System

7 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain ( ) CategoriesCategories –Injection, Drainage, or Aspiration –Twist Drills, Burr Hole(s), or Trephine Meninges—3 layers of connective tissue membranes that surround the brain and spinal cordMeninges—3 layers of connective tissue membranes that surround the brain and spinal cord(Cont’d…) Meninges of the central nervous system. (Modified from Applegate E: The Anatomy and Physiology Learning System, ed 3, Philadelphia, 2006, Saunders.)

8 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain ( ) (…Cont’d) Conditions that require openings into brain to:Conditions that require openings into brain to: –Relieve pressure –Insert monitoring devices –Place tubing –Inject contrast material –Inject contrast material (Cont’d…)

9 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Skull, Meninges, and Brain ( ) (…Cont’d) Craniectomy or Craniotomy category ( )Craniectomy or Craniotomy category ( ) –Removal of portion of skull, usually as operative site –Codes divided by site and condition

10 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base Category Skull base: Area at base of craniumSkull base: Area at base of cranium –Lesion removal from this area very complex Extensive category notesExtensive category notes Surgical management of lesions in skull baseSurgical management of lesions in skull base Often involve surgeons from different specialties working during same operative sessionOften involve surgeons from different specialties working during same operative session

11 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base Terminology Approach procedure: Used to gain exposure of lesionApproach procedure: Used to gain exposure of lesion Definitive procedure: What is done to lesionDefinitive procedure: What is done to lesion Repair/reconstruction procedure: Reported separately only if extensive repairRepair/reconstruction procedure: Reported separately only if extensive repair

12 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base ( ) Approach procedure and definitive procedure coded separatelyApproach procedure and definitive procedure coded separately (Cont’d…)

13 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgery of Skull Base ( ) (…Cont’d) Example:Example: –Removal of an intradural lesion using middle cranial fossa approach –61590 Pre-auricular approach procedure, middle cranial fossa and –61608 Definitive procedure of intradural resection of lesion

14 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cerebrospinal Fluid (CSF) Shunt ( ) Used to drain fluidUsed to drain fluid Codes describe placement ofCodes describe placement of –Devices –Repair –Replacement –Removal of shunting devices

15 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Spine and Spinal Cord ( ) Codes divided on condition and approachCodes divided on condition and approach Other important coding considerationsOther important coding considerations –Unilateral or bilateral procedures (-50) –Multiple procedures (-51) –Radiologic supervision and fluoroguidance reported separately

16 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Many codes in the Nervous System involve conditions responsible for the procedureMany codes in the Nervous System involve conditions responsible for the procedure –Example: abscess, cyst, hematoma, foreign body, tumor, etc., as well as the technique used for the operation Review CCI editsReview CCI edits Spine and Spinal Cord ( )

17 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Introduction/Injection of Anesthetic Agent, Diagnostic or Therapeutic ( ) Includes codes for:Includes codes for: –Nerve blocks –Facet joint injections –Epidural injections Used to provide pain reliefUsed to provide pain relief

Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 21 ENDOCRINE AND NERVOUS SYSTEMS