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CHAPTER 21CHAPTER 21

ENDOCRINE AND ENDOCRINE AND NERVOUS SYSTEMSNERVOUS SYSTEMS

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Endocrine System SubsectionEndocrine System Subsection• 9 glands in Endocrine System; 9 glands in Endocrine System;

only 4 included in subsectiononly 4 included in subsection– ThyroidThyroid– ParathyroidParathyroid– Thymus Thymus – AdrenalAdrenal

• PituitaryPituitary and and pinealpineal: See : See Nervous SystemNervous System

• PancreasPancreas: Digestive System : Digestive System • OvariesOvaries and and testestestes: Respective: Respective

Genital systemGenital system

(Cont’d…)(Cont’d…)

Figure: 21.1Figure: 21.1

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Endocrine System (60000-60699)Endocrine System (60000-60699)

(…Cont’d)(…Cont’d)

• Divided into 2 subheadingsDivided into 2 subheadings

– Thyroid GlandThyroid Gland

– Parathyroid, Thymus, Adrenal Glands, Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body Pancreas, and Carotid Body

(Cont’d…)(Cont’d…)

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Endocrine System (60000-60699)Endocrine System (60000-60699)

(…Cont’d)(…Cont’d)

• Carotid bodyCarotid body refers to refers to area adjacent to area adjacent to carotid arterycarotid artery

– Can be site of tumorsCan be site of tumors

Figure: 21.2Figure: 21.2The baroreceptor The baroreceptor system for controlling system for controlling arterial pressure. arterial pressure. (Modified from Guyton (Modified from Guyton AC, Hall JE: AC, Hall JE: Textbook Textbook of Medical of Medical Physiology,Physiology, ed 11, ed 11, Philadelphia, 2006, Philadelphia, 2006, Saunders.)Saunders.)

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Thyroid Gland, Excision (60100-60281)Thyroid Gland, Excision (60100-60281)

• 2 lobes2 lobes

• Code descriptions often refer toCode descriptions often refer to

– Partial orPartial or subtotalsubtotal: Something less than total: Something less than total

– Removes problem side of the gland, isthmus, and Removes problem side of the gland, isthmus, and majority of opposite lobemajority of opposite lobe

– TotalTotal: All: All

– Lobectomy (Partial)Lobectomy (Partial)

– Total Thyroid Lobectomy (solitary nodules, follicular Total Thyroid Lobectomy (solitary nodules, follicular adenomas, nodules, goiters)adenomas, nodules, goiters)

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Nervous SystemNervous System

• Divided anatomicallyDivided anatomically

– Skull, Meninges, and BrainSkull, Meninges, and Brain

– Spine and Spinal CordSpine and Spinal Cord

– Extracranial Nerves, Peripheral Nerves, Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous Systemand Autonomic Nervous System

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Skull, Meninges, and Brain Skull, Meninges, and Brain (61000-62258)(61000-62258)• CategoriesCategories

– Injection, Drainage, Injection, Drainage, or Aspiration or Aspiration

– Twist Drills, Burr Twist Drills, Burr Hole(s), or TrephineHole(s), or Trephine

• Meninges—3 layers Meninges—3 layers of connective of connective tissue membranes tissue membranes that surround the that surround the brain and spinal brain and spinal cordcord

(Cont’d…)(Cont’d…)

Meninges of the central nervous system. (Modified from Meninges of the central nervous system. (Modified from Applegate E: Applegate E: The Anatomy and Physiology Learning The Anatomy and Physiology Learning System,System, ed 3, Philadelphia, 2006, Saunders.) ed 3, Philadelphia, 2006, Saunders.)

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Skull, Meninges, and Brain Skull, Meninges, and Brain (61000-62258)(61000-62258)(…Cont’d)(…Cont’d)

• Conditions that require openings into Conditions that require openings into brain to:brain to:– Relieve pressureRelieve pressure

– Insert monitoring devicesInsert monitoring devices

– Place tubingPlace tubing

– Inject contrastInject contrast materialmaterial

(Cont’d…)(Cont’d…)

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Skull, Meninges, and Brain Skull, Meninges, and Brain (61000-62258)(61000-62258)

(…Cont’d)(…Cont’d)

• Craniectomy or Craniotomy category Craniectomy or Craniotomy category (61304-61576)(61304-61576)

– Removal of portion of skull, usually as Removal of portion of skull, usually as operative siteoperative site

– Codes divided by site and conditionCodes divided by site and condition

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Surgery of Skull Base CategorySurgery of Skull Base Category

• Skull base: Area at base of craniumSkull base: Area at base of cranium– Lesion removal from this area very Lesion removal from this area very

complexcomplex

• Extensive category notesExtensive category notes

• Surgical management of lesions in Surgical management of lesions in skull baseskull base

• Often involve surgeons from different Often involve surgeons from different specialties working during same specialties working during same operative sessionoperative session

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Surgery of Skull Base TerminologySurgery of Skull Base Terminology

• Approach procedureApproach procedure: Used to gain : Used to gain exposure of lesionexposure of lesion

• Definitive procedureDefinitive procedure: What is done : What is done to lesionto lesion

• Repair/reconstruction procedureRepair/reconstruction procedure: : Reported separately only if extensive Reported separately only if extensive repairrepair

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Surgery of Skull Base (61580-61619)Surgery of Skull Base (61580-61619)

• Approach procedure and definitive Approach procedure and definitive procedure coded separatelyprocedure coded separately

(Cont’d…)(Cont’d…)

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Surgery of Skull Base (61580-61619)Surgery of Skull Base (61580-61619)

(…Cont’d)(…Cont’d)

• Example:Example:

– Removal of an intradural lesion using Removal of an intradural lesion using middle cranial fossa approachmiddle cranial fossa approach

– 61590 Pre-auricular 61590 Pre-auricular approachapproach procedureprocedure, , middle cranial fossa andmiddle cranial fossa and

– 61608 61608 DefinitiveDefinitive procedureprocedure of intradural of intradural resection of lesionresection of lesion

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Cerebrospinal Fluid (CSF) Cerebrospinal Fluid (CSF) Shunt (62180-62258)Shunt (62180-62258)

• Used to drain fluidUsed to drain fluid

• Codes describe placement of Codes describe placement of

– DevicesDevices

– Repair Repair

– Replacement Replacement

– Removal of shunting devicesRemoval of shunting devices

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Spine and Spinal Cord Spine and Spinal Cord (62263-63746)(62263-63746)

• Codes divided on condition and Codes divided on condition and approachapproach

• Other important coding considerationsOther important coding considerations

– Unilateral or bilateral procedures (-50)Unilateral or bilateral procedures (-50)

– Multiple procedures (-51)Multiple procedures (-51)

– Radiologic supervision and fluoroguidance Radiologic supervision and fluoroguidance reported separatelyreported separately

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• Many codes in the Nervous System Many codes in the Nervous System involve conditions responsible for the involve conditions responsible for the procedureprocedure

– Example: abscess, cyst, hematoma, Example: abscess, cyst, hematoma, foreign body, tumor, etc., as well as the foreign body, tumor, etc., as well as the technique used for the operationtechnique used for the operation

• Review CCI editsReview CCI edits

Spine and Spinal Cord Spine and Spinal Cord (62263-63746)(62263-63746)

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Introduction/Injection of Anesthetic Agent, Introduction/Injection of Anesthetic Agent, Diagnostic or Therapeutic (64400-64530)Diagnostic or Therapeutic (64400-64530)

• Includes codes for:Includes codes for:

– Nerve blocks 64400-64530Nerve blocks 64400-64530

– Facet joint injections 64490-64495Facet joint injections 64490-64495

– Epidural injections 64479-64484Epidural injections 64479-64484

• Used to provide pain reliefUsed to provide pain relief

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ConclusionConclusionCHAPTER 21CHAPTER 21

ENDOCRINE AND ENDOCRINE AND NERVOUS SYSTEMSNERVOUS SYSTEMS