1. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 22 HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM

2. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Hemic and Lymphatic Systems Subsection (Excision, Repair, Introduction) Divisions –Spleen –General –Lymph Nodes and Lymphatic Channels (Figure 22–1 in text)

3. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Spleen (38100-38200) Spleen easily ruptured, causes massive hemorrhage May require splenectomy Splenectomy: total or partial (Cont’d…)

4. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Spleen (38100-38200) (…Cont’d) Often done as part of more major procedure Bundled into major procedure

5. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 General (38204-38242) Codes divided based on –Aspiration –Biopsy –Harvesting –Transplantation Stem cells –Immature blood cells originating in bone marrow –Used in leukemia treatment (Cont’d…)

6. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 General (38204-38242) (…Cont’d) Types of stem cells: –Allogenic: Close relative –Autologous: Patient’s own

7. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Lymph Nodes and Lymphatic Channels (38300-38999) Two types of lymphadenectomies: –Limited: Lymph nodes only –Radical: Lymph nodes, submandibular gland, and surrounding tissue Term “complete” same as radical neck dissection

8. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 (…Cont’d) Submental and submandibular nodes, chin area and below mandible Upper jugular nodes, at mandibular angle in front of sternocleidomastoid muscle Middle jugular nodes, between hyoid bone and cricoid cartilage Lower jugular nodes, between cricoid cartilage and clavicle Posterior triangle nodes divided into groups Upper visceral nodes, by the hyoid bone Superior mediastinal nodes, between common carotid arteries 38700, 38720—are unilateral codes Lymph Nodes and Lymphatic Channels (38300-38999) (Cont’d…)

9. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 (…Cont’d) “Modified” radical neck: removal of all lymph nodes routinely removed by radical neck dissection, while preserving the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscles (38724) This is a unilateral procedure Lymph Nodes and Lymphatic Channels (38300-38999)

10. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Lymphadenectomies Often bundled into more major procedure (e.g., prostatectomy) –Do not unbundle and report lymphadenectomy separately

11. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Mediastinum Area between lungs Figure: 22.3

12. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Mediastinum (39000-39499) Assigned by approach Incision codes for foreign body removal or biopsy Excision codes for removal of cyst or tumor Endoscopy Repair

13. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Diaphragm (39501-39561) Only category: Repair –Most codes for hernia or laceration repairs –Codes indexed in CPT manual under “Diaphragm”

14. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Conclusion CHAPTER 22 HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM