Chapter 10 - The Cardiovascular System Flashcards
Coronary sinus
Large vein that drains blood from the walls of the heart and drains into the right atrium.
Tricuspid valve
Atrioventrical valve on the right side of the heart
Mitral valve
Also called the bicuspid valve. Atrioventrical valve on the left side of the heart
Pulmonary valve
Between the right ventricle and the pulmonary artery.
Aortic valve
Between the left ventricle and the aorta
Systole
Contraction of the heart
Diastole
Relaxing of pressure of the heart
Chordae tendinae
Tendons that connect the inlet valves to papillary muscles of the inferior wall of the ventricles. Also called heart strings
Pacemaker cells
Ability to generate an electrical impulse and pass it to other cells. Shortens the fibers in the heart when receiving the impulse
Sinoatrial node
Pacemaker node in the right atrium near the superior vena cava.
Atrioventrical node
Located lower in the septal wall of the right atrium. Slows impulses to allow the atria to fill with blood before contracting the ventricles.
Bundle of His
Heart muscles specialized for electrical conduction. After the AV node.
Purkinje fibers
End of the bundle branches. Lie across the surface of the ventricles and signal the myocardium to contract the ventricles
Coronary arteries
Two arteries that emerge from the aorta and split into left and right segments. Supply oxygen and nutrient rich blood to the myocardium
Left coronary artery
1 inch long and about the diameter of a soda straw. Splits into left anterior descending and left circumflex coronary arteries.
Left anterior descending artery
Embedded in the surface of the front side of the heart
Left circumflex coronary artery
Circles around the left side of the heart and is embedded in the surface of the back of the heart.
Right coronary artery
Travels along the atrioventrical groove between the right atrium and ventricle. Gives rise to the acute marginal branch as it wraps around the right side and branches into smaller branches that penetrate the heart muscle
Acute marginal branch
Split from the right coronary artery and covers the anterior portion of the right ventricle
Systemic circulation
Blood that circulates throughout the body
Pulmonary circulation
Blood travels from the heart to the lungs, and back to the heart
Coronary circulation
Blood that travels through the tissues of the heart
Aneurysm/o
Aneurysm
Angi/o, vas/o, vascul/o
Vessel
Aort/o
Aorta
Arter/o, arteri/o
Artery
Arteriol/o
Arteriole
Ather/o
Yellowish, fatty plaque
Atri/o
Atrium
Carcin/o
Cancer
Coron/o
Coronary
Endocardi/o
Endocardium
My/o
Muscle
Phleb/o, ven/o
Vein
Scler/o
Hard
Sept/o
Septum
Sin/o
Sinus
Steth/o, thorac/o
Chest
Venul/o
Venule
Valv/o, valvul/o
Valve
Brady-
Slow
Tachy-
Fast
-edema
Swelling, accumulation of fluid
-ium
Membrane, structure
-oma
Tumor
-sclerosis
Hardening
-stenosis
Narrowing, stricture, constriction
Acute rheumatic fever
Complication of strep throat with Group A streptococci that is left untreated. Rare but life threatening condition. Fever, muscle aches, and swollen and painful joints. Can lead to rheumatic heart disease
Rheumatic heart disease
Sequelae of rheumatic fever that leads to issues with heart valves and in rare circumstances heart failure
Hypertension
High blood pressure. Classified as primary or secondary.
Primary hypertension
High blood pressure for which no medical cause can be found. 90-95% of cases
Secondary hypertension
Caused by other conditions affecting the kidneys, arteries, heart, or endocrine system. 5-10% of cases
Hypertension with heart disease
Assumed causal relationship and are a combination code unless documentation is specific that they are unrelated. If heart failure code type of heart failure as well
Hypertension and chronic kidney disease
Assumed relationship. Use additional codes for heart failure and stage of chronic kidney disease
Hypertensive cerebrovascular disease
Code first the cerebrovascular condition then the hypertension code
Hypertensive retinopathy
Two codes necessary. Code from hypertensive retinopathy and a code to indicate type of hypertension
Secondary hypertension
Two codes. A code for the underlying condition and a code for hypertension. Sequences based on reason for the encounter
Myocardial infarction
Heart attack. Sudden decrease in coronary artery blood flow resulting in the death of the heart muscle. Provider often orders labs to determine levels of phosphokinase and troponin in the blood. Elevation in these levels can indicate damage to the heart muscle. 5 different classifications
Elevated phosphokinase and troponin labs coding
Code from the category Abnormal Findings
Type I myocardial infarction
Related to ischemia due to primary coronary event such as plaque erosion and/or rupture fissuring, or dissection. Prototypical heart attack. Can be STEMI or NSTEMI
STEMI
ST elevation myocardial infarction. Coronary artery is completely blocked and virtually all heart muscle supplied by the affected artery starts to die.
NSTEMI
Non-ST elevated myocardial infarction. Plaque or blockage only partially occluded the affected artery.
Type 2 Myocardial Infarction
Myocardial infarction secondary to ischemia due to either decreased supply or increased demand. Code for underlying cause if known
Type 3 Myocardial Infarction
Sudden, unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of ischemia, accompanied by presumably new ST elevation, new left bundle branch block, or fresh thrombus in a coronary artery. Death occurred before samples could be obtained.
Type 4a-4c myocardial infarction
Myocardial infarction associated with revascularization procedures
Type 5 Myocardial Infarction
Myocardial infarction associated with coronary artery bypass graft surgery
Ischemia
An inadequate blood supply to an organ or part of the body, especially the heart muscles.
Arteriosclerosis
Hardening of the arteries. Verify is it is a native artery, bypassed artery, or transplanted heart. Verify presence of angina pectoris.
Endocarditis
Inflammation of the endocardium.
Heart failure
Occurs when the heart cannot pump enough blood to supply the other organs. Shortness of breath, orthopnea, and edema of the lower legs and feet.
Pericarditis
Inflammation of the pericardium. Caused by infection. Chest pain on inspiration, and often worse when lying down.
Peripheral artery disease
Similar to coronary artery disease but affects arteries outside the heart and brain. Verify presence of diabetes and gangrene
Valve stenosis
Narrowing of a heart valve. Restricts the flow of blood in the heart. Verify if congenital or rheumatic, acute, or involves multiple valves.
Valve regurgitation
When the valve does not close properly and blood back flows into the heart chamber
Valve prolapse
Occurs when valves prolapse into the heart chamber.
Pericardiocentesis
Involves drawing off collected fluid, with a specialized needle, built up inside the double layered pericardial sac. If not resolved can lead to cardiac tamponade.
Cardiac tamponade
Cardiac tamponade puts pressure on the heart and keeps it from filling properly. The result is a dramatic drop in blood pressure that can be fatal.
Pericardiotomy
Incision into the pericardium for clot/foreign body removal. Verify method used to reach the pericardium (thorascopic? See code 32658)
Pericardiectomy
Removal of the pericardium surrounding the heart. Verify if cardiopulmonary bypass is used.
Transmyocardial laser revascularization
Surgical procedure to treat severe angina. Thoracotomy incision and laser is inserted. Laser is fired at a viable ischemic area. Increased blood flow to severely damaged muscle and stimulates the growth of new blood vessels within the myocardium
Pacemakers
Verify whether procedure is insertion, revision, or removal. Verify temporary or permanent. What components are being worked on (electrodes, pulse generator). How many leads and placement of the leads.
Cardiac Assist Devices
Pacemaker, and implantable defibrillators. Cardiac assist devices is where to find these codes in the index of the CPT book.
Subcutaneous cardiac rhythm monitor
Event recorder that is activated during irregular cardiac activity.
Wireless pressure sensor for hemodynamic monitoring.
Sensor placed in the pulmonary artery to monitor hemodynamics
Mitral regurgitation
Backwash of blood into the left atrium. Blood cannot move efficiently through the heart to the rest of the body leading to fatigue or shortness of breath
Aortic stenosis
Narrowing of the aortic valve due to disease or aging. Narrowing causes left ventricular hypertrophy because of the increased pressure necessary to blood through the stenotic valve
Aortic regurgitation
The aortic valve does not close properly and blood leaks back through the valve. Causes an overload of the left ventricle, resulting in an eventual decrease in muscular elasticity necessary for effective pumping.
Annuloplasty
Repair of the ring (annulus) of a heart valve
Valvuloplasty
Repair of a valve with sutures, patches, or rings. Involves work on the whole valve including work on the leaflets and the annulus.
Valve replacement
Replacement with either a mechanical or biological prosthesis. Report procedures for each valve worked on. Verify if cardiopulmonary bypass is included in the procedure.
Transcatheter aortic valve replacement procedure
Replacement of the aortic valve with a prosthetic valve. Catheter is placed in an artery and threaded to the heart. Requires 2 surgeons and modifier 62. Verify if cardiopulmonary bypass is used.
Infundibulum
The outflow tract that extends to the pulmonary artery. If this tract is stenosed blood backs up into the right ventricle.
Transcatheter pulmonary valve implantation
Percutaneous implantation of a prosthetic valve. Lots of procedures include in this service.
Commissurotomy
Surgical opening or division of a fibrous ring. Used when a valve must be opened and the outflow tract augmented.
Ramus intermedius
5th coronary artery which is a variant coronary artery resulting from trifurcation of the left main coronary artery
Fistula
Abnormal opening from a hollow organ to the surface or from one organ to another.
Atreriovenous fistula
Communication between a vein and an artery allowing oxygenated and deoxygenated blood to mingle. Can develop into an AV aneurysm or bulging pouch. One of the of the fistula is closed by surgery
Takeuchi procedure
Holes are made in the aorta and pulmonary artery at the level of the anomalous artery and where the vessels touch each other. Holes are sewn together to form a direct aortopulmonary opening. Blood is then diverted from the aorta to the anomalous coronary artery
Coronary artery bypass grafts
Surgical procedure to bypass blockages of coronary arteries to improve blood flow to the heart. Verify # of grafts, how many were arteries or veins and what arteries and veins were used. A few vessels get add on codes. Endoscopic harvesting of vessels is an add on code as well.
Secundum
A hole between the right and left atria. Most common is a ostium secundum which is normal for a developing fetus but closes at birth
Tetralogy of Fallot
Congenital heart condition with four anomalies
- Stenosis of the infundibulum. (Outflow passage from the right ventricle to the pulmonary artery
- Ventricular septal defect
- Abnormally positioned aorta causing a mixture of arterial and venous blood
- Hypertrophy of the right ventricle
Subclavian to pulmonary shunt procedure
Also known as Blalock-Taussig procedure. Palliative procedure for children who do not get enough O2 in their blood. To little blood to the lungs. Used for complicated defects like tricuspid atresia.
Transposition of great vessels
Aorta and pulmonary are reversed. Must be shunted for the patient to survive.
Truncus Arteriosus
Common arterial trunk opening out of both ventricles in the heart while the fetus is in early stages of development in utero. Usually divides on its own, but if not surgery is needed. Common to have other abnormalities with this condition
Aneurysm
Local abnormal dilation of an artery due to congenital defect or weakness of the vessel wall. Can be caused by atherosclerosis, trauma, or infection. Can cause ruptured, emboli to the peripheral artery, pressure on surrounding tissue, or obstruction of blood flow.
Pseduoaneurysm
False aneurysm. Blood vessel wall is injured causing blood to be contained in surrounding tissue. Can occur due to injury or surgical complications.
Dissection
Tear in the innermost layer of the aorta. Rare to be isolated to the abdominal aorta.
Penetrating aortic ulcer
Plaque from atherosclerosis wears away the arterial wall lining causing a penetration of the vessel.
Traumatic disruption
Tear or rupture in the aorta. Causes severe hemorrhaging.
Endovascular repair of the abdominal aorta and/or iliac arteries
Open or percutaneous femoral or iliac artery exposure and access to place a device to treat the abdominal aortic defect. Coded based on vessels involved, type of endograft, and whether the vessel has ruptured.
Direct repair or aneurysm or excision and graft for aneurysm, pseudo aneurysm, ruptured aneurysm, and associated occlusive disease
Codes 35001-35152 include artery preparation and endarterectomy. Codes 35201-35286 are for excision and replacement with a graft.
Deep vein thrombosis
Can be temporary or permanent. Causes distal vessels damage due to pressure, hypoxemia, stretch, and malnutrition. Edema can result. Can also cause clots in response to inflammation and trauma.
Thrombus
Blood clot. Can break loose and become an embolism. Most often lodge in pulmonary capillaries.
Thrombophlebitis
Inflammation of a vein, usually in the leg due to presence of a thrombus. Causes calf pain and tenderness.
Thromboendartectomies
Used when calcified plaque or clot formations do not respond to angioplasty procedures. Thrombus is removed along with inner lining of the artery. Codes based on site needing surgery
Angioplasty
Opens narrow or blocked vessels. Verify if used on coronary arteries. Those are coded in a different section of the CPT book.
Codes chosen by vessel. Lower extremity percutaneous transluminal angioplasty is coded from Endovascular Revascularization
Bypass Grafts
3 types. Vein, In-situ vein, and other than vein. Must know anastomosis sites (where the vein is connected) and what type of graft (can be a combination of autologous and synthetic)
Arterial transposition
Moving of an artery to another blood supply or anastomosis of a diseased artery to a healthy artery. Add on codes for reimplantation of a visceral artery to a infrarenal aortic graft
Central venous access devices
Catheters placed in large veins for patients who require frequent access to the bloodstream. Catheter must terminate in the subclavian, braciocephalic, or iliac vein, the inferior or superior vena cava, or the right atrium.
Central venous access procedure types
Insertion, repair, partial replacement, complete replacement, and removal.
Central insertion sites
Jugular, subclavian, or femoral veins, or the inferior vena cava.
Peripheral insertion sites
Basilic, cephalic, or other peripheral veins.
Tunneled catheter
Tunnel made under the skin and the catheter is secured for long term access
Intraosseous infusion
Insertion of a special needle through the skin, muscle tissue, and into the bone marrow cavity of the tibia or fibula. Used in infants who have inaccessible vessels and needs fluids to be infused into the bone marrow
Dialysis circuit
Divided into two parts. Central and peripheral. Coding for this section is based on hierarchy with each more intensive service includes the services lower in the hierarchy
Portal decompression procedures
Patients that develop portal hypertension due to occlusion of the portal vein. Decompressed by making anastomoses between portal vein and the listed combinations.
Transvenous intrahepatic portosystemic shunt
Procedure used to reduce portal pressure. Catheter is threaded into the portal vein and a self expanding stent to bridge the portal and hepatic veins is placed to divert blood to the hepatic vein. Performed when pressure in the portal vein is so great it causes bleeding from vessels in the esophagus
Transcatheter procedures
Subsection of vascular codes describes procedures to resolve a vascular condition cross the vessel. Vessel is accessed and a drug infusion, biopsy, or removal of a foreign body is performed inside the vessel.
Ligation
the surgical procedure of closing off a blood vessel or other duct or tube in the body by means of a ligature or clip.
Angiography
Radiographic visualization of blood vessels following the introduction of contrast material
Antegrade
Moving or extending anteriorly,
Moving with the flow
Contralateral
Situated on, pertaining to, or affecting the opposite side
Digital subtraction angiography
Arteriography using electronics to remove the background of bone and soft tissues to show useful arteries only
First order vessel
Primary branch of the main trunk of a vascular system
Ipsilateral
Situated on, pertaining to, or affecting the same side
Arterial main trunk
Aorta
Venous main trunk
Vena cava
Non-selective catheterization
Catheter placed in main trunk, contrast may be injected, images may be taken, but the catheter is not moved into any branches
Retrograde
Moving backwards or against the usual flow
Roadmapping
Overlaying of two images
Second order vessel
Secondary branch that comes off a first order vessel
Selective catheterization
Catheter is placed in the branches further off the main trunk
Third order and higher vessels
Tertiary and higher vessels. Come off second order vessels
Vascular family
Network of vessels arising from the aorta’s main branch or network of vessels arising from one primary branch off the access site
Sclerotherapy
Obliterating veins through a reaction caused by chemical solution injected directly into the veins. Can be used after surgical removal of large veins to obliterate small residual spider veins
Endovascular revascularization
Lower extremity services for occlusive disease only. Includes transluminal angioplasty, placement of stent, atherectomy, and placement of stent with atherectomy in the arterial areas: iliac, femoral/popliteal, and tibial/peroneal.
Atherectomy in the iliac area
Reported with CPT category III codes. Do not include accessing or selectively cathing the vessel, or closing the ateriotomy.
S&I codes
Radiologic supervision and interpretation.
Heart MRI and CT procedures
Different from regular MRI because it provides physiologic evaluation of the cardiac function. Only one procedure and one add on for flow velocity can be reported per session. Stress tests can be reported as well if appropriate
Cardiac SPECT scans
Single photon emission computed tomography. Used to measure blood flow through the heart and detects areas of abnormal muscle.
Cardiac blood pool imaging
Radioactive solution is introduced into the blood stream and is monitored as it travels through the heart. Can be performed at rest or stress tested (report if appropriate)
Positron emission tomography
Nuclear imaging to evaluate heart function after administration of a natural biochemical substance. Can be used to look for coronary artery disease by examining blood flow through the heart or tissue after a heart attack.
CPR
Code 92950. No time frame and not bundled into critical care services
Cardioversion
Placement of defibrillator paddles. Can be internal and external. Review codes not be used with this code
Thrombolysis of a coronary artery
Coded by method of administration. Can be intracoronary infusion or IV infusion
Intravascular ultrasound or optical coherence tomography
Add on codes when performed during a diagnostic or therapeutic intervention. Ultrasound or light is used to examine coronary arteries and bypass grafts. Coded per vessel.
Percutaneous coronary intervention
Percutaneous revascularization for occlusive disease of the coronary arteries, branches, and bypass grafts. One procedure reported then add on codes
Percutaneous transluminal coronary angioplasty
Nonsurgical procedure to relieve narrowing and obstruction of coronary arteries. Ballon catheter inserted in groin or arm and advanced to the narrowing to flatten the accumulation of plaque. Add on code for additional branches.
Percutaneous transluminal coronary atherectomy
Cutting devices is used to remove plaque build up from artery walls. Includes angioplasty when performed.
Percutaneous intracoronary stent placement
Tube is placed on ballon catheter and once in place balloon is inflated and stent expands and is placed to keep artery open. Includes angioplasty when performed.
PCI code hierarchy
Acute MI Chronic/total occlusion Atherectomy and stent Atherectomy Stent Angioplasty
Modifier LC
Left circumflex coronary artery
Modifier LD
Left anterior descending coronary artery
Modifier LM
Left main coronary artery
Modifier RC
Right coronary artery
Modifier RI
Ramus intermedius coronary artery
Cardiac resynchronization therapy
Used to treat delays in contraction between right and left ventricles. Electrode is placed through a cardiac vein into the left ventricle. Electrical impulse caused the ventricle to contact improving output
Elective replacement interval
Battery levels getting low and will need replacement in a cardiac assist device
Replacement of pacemaker due to battery life ICD code
Search for Admission (for) adjustment/device then type of device
Atrial fibrillation
AV node is bombarded with electrical impulses from the atria which causes the ventricles to beat rapidly and irregularly
Maze procedure
Surgical treatment for atrial fibrillation. Also know as surgical ablation. Various practices to create scar tissue to stop conduction pathways for atrial fibrillation. Excision or isolation of the left atrial appendage is considered part of the procedure
Paroxysmal supraventricular tachycardia
Very fast heart rate that begins and ends abruptly. Occurs due to problems with the electrical connection between the atria and ventricles. Signals that begin in the atria and move to the ventricles can re-enter the atria resulting in extra heartbeats
