1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THE COMPLETE DIAGNOSIS CODING SOLUTION THIRD EDITION Chapter 12 Coding Circulatory Conditions 12-1

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes 12.1 Name the components of the circulatory system. 12.2 Discern the included signs and symptoms of cardiovascular disease. 12.3 Interpret the difference between elevated blood pressure and hypertension. 12-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes (cont.) 12.4 Accurately code the known manifestations of hypertension. 12.5 Apply the guidelines correctly to code the sequelae of CVA. 12.6 Code the sequelae of cerebrovascular disease accurately. 12-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Angina pectoris Atherosclerosis Atrium Cerebral infarction Cerebrovascular accident (CVA) Edema 12-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Elevated blood pressure Embolus Gestational hypertension Hypertension Hypotension Infarction 12-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Myocardial infarction NSTEMI Secondary hypertension STEMI Thrombus Vascular Ventricle 12-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction The circulatory (cardiovascular) system includes the heart, arteries, and veins and has the job of circulating blood to carry oxygen to cells throughout the body and waste products away from those cells. 12-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Circulatory System Anatomy The center of your body is the heart. The heart is divided into four chambers: –Right atrium –Left atrium –Right ventricle –Left ventricle Learning Outcome: 12.1 12-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Circulatory System Anatomy (cont.) The heart is wrapped and protected by the pericardium, a fluid-filled sac, consisting of three layers: –Endocardium –Myocardium –Epicardium Learning Outcome: 12.1 12-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Dysfunction Circulatory conditions affect the flow of blood and, therefore, the delivery of oxygen. Older individuals are more susceptible to such conditions. Learning Outcome: 12.2 12-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Dysfunction (cont.) Long-term improper nutrition and lack of cardiovascular exercise contribute to the circulatory system’s inability to do its job. Learning Outcome: 12.2 12-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Signs and Symptoms of Cardiovascular Disease There are many disorders that affect the cardiovascular system. Frequently seen conditions: Angina (angina pectoris) Cardiac arrest Dyspnea Dysrhythmia or arrhythmia Edema Learning Outcome: 12.2 12-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hypotension and Hypertension Blood pressure is the force with which blood travels through the veins and arteries. Hypotension = low blood pressure –Can result in organs and tissue cells being unable to function –Lightheadedness and dizziness can occur Learning Outcome: 12.3 12-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hypotension and Hypertension (cont.) Hypertension = high blood pressure –Force of the pressure can actually damage organs and tissues as the blood rushes through Learning Outcome: 12.3 12-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hypotension and Hypertension (cont.) Systolic pressure (SP)—measure of the maximum push of blood being forced into an artery from the ventricle during a cardiac contraction. Top number of a reported blood pressure. Learning Outcome: 12.3 12-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hypotension and Hypertension (cont.) Diastolic pressure (DP)—measure of the pressure of blood left in the arteries in between ventricular contractions. Bottom number of a reported blood pressure. Learning Outcome: 12.3 12-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hypertension versus Elevated Blood Pressure The physician must specifically state the diagnosis of hypertension. The patient may simply have elevated blood pressure with no diagnosis of hypertension (code R03.0) rather than the actual chronic disorder of hypertension. Learning Outcome: 12.3 12-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Common Hypertensive Manifestations Hypertension with heart disease Hypertensive heart disease with heart failure Hypertensive chronic kidney disease Hypertensive heart and chronic kidney disease Learning Outcome: 12.4 12-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Common Hypertensive Manifestations (cont.) Secondary hypertension Hypertension and pregnancy Hypertensive retinopathy Hypertensive cerebrovascular disease Learning Outcome: 12.4 12-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. CVA and Cerebral Infarction Cerebrovascular accident (CVA)— rupture of a blood vessel causing hemorrhaging in the brain or an embolus in a blood vessel in the brain causing loss of blood flow; also known as stroke. Learning Outcome: 12.5 12-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. CVA and Cerebral Infarction (cont.) Cerebral Infarction—an area of dead tissue (necrosis) in the brain caused by a blocked or ruptured blood vessel. Infarction—tissue or muscle that has deteriorated or died (necrotic). Learning Outcome: 12.3 12-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Heart Failure There are several types of heart failure: Left heart failure (pulmonary edema) Right heart failure Systolic heart failure Diastolic heart failure Combined systolic and diastolic heart failure Learning Outcome: 12.3 12-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Myocardial Infarction Myocardial infarction (MI)—malfunction of the heart due to necrosis or deterioration of a portion of the heart muscle; also known as a heart attack. Learning Outcome: 12.3 12-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Myocardial Infarction (cont.) Myocardial infarction (MI) signs and symptoms can be confirmed by: –EKG (electrocardiogram) –Blood test –Echocardiogram Learning Outcome: 12.3 12-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Myocardial Infarction (cont.) ST elevation myocardial infarction (STEMI)—heart event during which the coronary artery is completely blocked by a thrombus or embolus. Nontransmural myocardial infarction (NSTEMI) indicates that only a portion of the artery is blocked. Learning Outcome: 12.3 12-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Deep Vein Thrombosis Deep vein thrombi can block blood flow. Reporting a diagnosis of deep vein thrombosis (DVT) will require you to know: –Is the condition identified as acute or chronic? –Where (the specific anatomical site) has the thrombus been located? Learning Outcome: 12.3 12-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Atherosclerotic Coronary Artery Disease (ACAD) Atherosclerosis, also known as arteriosclerosis, is a stricture or stenosis of an artery. Coronary artery disease (CAD) is the collection of plaque specifically within the coronary arteries; the heart becomes oxygen-deprived. Learning Outcome: 12.5 12-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Sequelae of Cerebrovascular Disease The sequelae of cerebrovascular disease are coded differently from other sequelae. ICD-10-CM provides a series of combination codes in category I69. Learning Outcome: 12.6 12-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Other Cardiovascular Conditions Hypercholesterolemia indicates accumulation of plaque in the arteries, causing them to narrow. Code E78.0, Pure hypercholesterolemia. Learning Outcome: 12.6 12-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Other Cardiovascular Conditions (cont.) Atrial fibrillation—a condition in which the atria, instead of contracting to push blood through to the ventricles, shudders or trembles. Results in incomplete emptying of the atria, leaving blood to collect and sometimes clot. Code I48.2, Chronic atrial fibrillation. Learning Outcome: 12.6 12-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Other Cardiovascular Conditions (cont.) Mitral valve prolapse prevents the mitral valve from closing properly. Code I34.1, Nonrheumatic mitral (valve) prolapse. Learning Outcome: 12.6 12-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary The manifestations of heart failure and heart disease can affect the patient anywhere in the body—from the brain to the feet. 12-32