Presenter: Cynthia Stewart, CPC, CPMA, CPC-H, CPC-I - AAPC
Presenter: Cynthia Stewart,CPC, CPMA, CPC-H, CPC-IThe information in this presentation was currentat the time the presentation was complied anddoes not include specific payer policies orcontract language. Always consult CPT , CMS,and your payers for specific guidance inreporting services. The views expressed in thispresentation are simply my interpretations ofinformation I have read, compiled and studied.Much of the information is directly from the AMA,AAPC, CMS literature, specialty societies andother reputable sources.1
Review the Anatomy of the Brain andppg structuressupportingUnderstand the various methods of approachand the tools used to get thereInterpret specific procedures and the CPT codes which represent themDiscuss diagnoses as each relates to theinterventional or therapeutic treatmentdescribed by assorted CPT codes2
8 Skull bones Support Enclose Protect Attachment points 1414 Facial Bones Framework Support Anterior base of craniumCentral bodySella turcica2 Pair wings3
Forms a portion of the anterior cranialfloorfl Crista Galli Cribriformplatep4
Reasoning MotorSkillsMSkill Motor cortex Higher level cognition Expressive languageDamage may lead to changes in: Socialization Attention Sexual habits Increased risk-taking5
Processing tactiley informationsensory Pressure Touch Pain Somatosensory cortex Processes body’ssensesDamage to this lobe may Verbal memory issues Impair control of eye gaze Problems with language Primary auditory cortexInterpret sound Interpret Interpret language Hippocampus Formation ofmemoriesDamage may leadl d to problemsblwith:h Memory Speech perception Language skills6
Interpreting visual stimuliand information Primary Visual Cortex Secondary Visual Cortex Tertiary Visual CortexDamage may lead to: Recognizing objects Indentifying colors Recognizing wordsBrainstem – Nerve pathways Medulla Oblongata Cardiac Respiratory Vasomotor Midbrain Auditory reflex centers Visual reflex centers Pons Respiratory centerCerebellum Fine movement coordination Balance and Equilibrium Muscle Tone7
SupratentorialCorpuscallosumRightOccipital lobeLeft OccipitallobeTentoriumPonsMedullaOblongatagBrain StemCerebellum hasbeen removedInfratentorial4 VentriclesAqueductoff SylviusdlCerebral AqueductCentral CanalProtects the BrainTransports CerebrospinalFluid8
Twist Drills Burr Hole(s) Punctures Injections Aspirations Drainage Biopsies Implantations/Insertions Exploration Trephine Biopsies Exploration9
Craniectomy – bone flapremoved w/o return tooriginal site Craniotomy – bone flap isremoved with return tooriginal site Immediate DelayedDelayed Decompression Excision Insertions Resections Repairs Implantations10
TransnasalTranscranialApproach is dependant upon site of lesion andcritical structures Skull arTranscondylarTranspetrosalSkull base Anterior FossaCentral FossaPosterior FossaOrbitocranial zygomaticCraniofacialInfratemporal Site lTransnasalIntracranialExtracranial11
12
Twist Drill61108 for evacuation and/or drainage ofsubdural hematomaBurr Hole61154 evacuationevacuation and/or drainage ofhematoma, extradural or subdural61156 with aspiration of hematoma or cyst,intracerebralCraniectomy /Craniotomy61312 for evacuation of hematoma,supratentorial: extradural or subdurali tb l61313intracerebral61314 for evacuation of hematoma,infratentorial; extradural or subdural61315intracerebralICD-9-CMExtradural432.0 hemorrhage432.1 Subduralhemorrhage432.9 UnspecifiedintracranialhemorrhageICD-10-CMg , unspecifiedpI62.00 Nontraumatic subdural hemorrhage,I62.01Nontraumatic acute subdural hemorrhageI62.02Nontraumatic subacute subdural hemorrhageI62.03Nontraumatic chronic subdural hemorrhageI62.1Nontraumatic extradural hemorrhageI62 9I62.9hemorrhageNontraumatic intracranial hemorrhage,unspecified13
I61.0I61.1I61.2431 .8I61.9Nontraumatic Intracerebral hemorrhage inhemisphere, subcorticalNontraumatic Intracerebral hemorrhage inhemisphere, corticalNontraumatic Intracerebral hemorrhage inhemisphere, unspecifiedNontraumatic Intracerebral hemorrhage inbrainstemNontraumatic Intracerebral hemorrhage incerebellumNontraumatic Intracerebral hemorrhage,intraventricularNontraumatic Intracerebral hemorrhage , multiplelocalizedOther nontraumatic Intracerebral hemorrhageNontraumatic Intracerebral hemorrhage,unspecifiedI60.0I60.00 – I60.02I60.1I60.10 – I60.12I60.2I60.20 – I60.22430SubarachnoidhemorrhageI60.3I60.30 – I60.32I60.4I60.5I605I60.50 – I60.52I60.6I60.7I60.8I60.9Nontraumatic subarachnoid hemorrhage from carotidsiphon and bifurcation (5th character identifieslaterality)Nontraumatic subarachnoid hemorrhage from middlecerebral artery (5th character identifies laterality)Nontraumatic subarachnoid hemorrhage fromanterior communicating artery (5th characteridentifies laterality)Nontraumatic subarachnoid hemorrhage fromposterior communicating artery (5th characteridentifies laterality)Nontraumatic subarachnoid hemorrhage frombasiliar arteryNontraumatic subarachnoid hemorrhage fromvertebral artery (5th character identifies laterality)Nontraumatic subarachnoid hemorrhage from otherintracranial arteryNontraumatic subarachnoid hemorrhage fromunspecified intracranial arteryOther nontraumatic subarachnoidNontraumatic subarachnoid hemorrhage, unspecified14
Temporary placementBurr Hole61020 Ventricular puncture through previous burr hole,fontanelle, suture, or implanted ventricular catheter/reservoir;without injection61026 with injection of medication or other substance fordiagnosis or treatment61120 Burr hole for ventricular puncture (including inj. of gas,contrast media, dye or radioactive material)61210 for implanting ventricular catheter, reservoir, EEGelectrode(s), pressure recording device, or other cerebralmonitoring device (separate procedure)Twist Drill61105 for subdural or ventricular puncture61107 for subdural, intracerebral, or ventricular puncture; forimplanting ventricular catheter, pressure recording device, orother intracerebral monitoring devicePlacement62220 Creation of shunt; ventriculo-atrial, -jugular, -auricular62223ventriculo-peritoneal, -pleural, other terminusReplacement62225 Replacement or irrigation, ventricular catheter62230 Replacement or revision of cerebrospinalfluid shunt, obstructed valve, or distalcatheter in shunt systemRemoval62256 RemovalRl off completel t cerebrospinalbi l flfluididshunt system; without replacement62258with replacement by similar or other shuntat same operation15
Other Shunt Related Services 62160 Neuroendoscopy, intracraninal, for placement ofintricular catheter and attachment to shunt systemor externall ddrainagei62252 Reprogramming of programmable cerebrospinalshunt61070 Puncture of shunt tubing or reservoir for aspirationor injection procedure75809 Shuntogram for investigation of previously placedindwelling nonvascular shunt (eg, LeVeen shunt,ventriculoperitoneal shunt, indwelling infusionpump), radiological supervision and interpretationICD-9-CMICD-10-CM331.3 Communicating hydrocephalusG91.0 Communicating hydrocephalus331.4 Obstructive hydrocephalusG91.1 Obstructive hydrocephalus331.5Idiopathic331 5 Idithi normall pressurehydrocephalusG91.2hydrocephalusG91 2 IdiopathicIdithi normall pressure hdh lG91.3 Post‐traumatic hydrocephalusG91.4 Hydrocephalus in diseases classifiedelsewhereG91.8 Other hydrocephalusG91.9 Hydocephalus, unspecifiedQ03 0 Malformations of aqueduct of SylviusQ03.0742.3 Congenital hydrocephalusQ03.1 Atresia of foramina of Magendie and LuschkaQ03.8 Other congenital hydrocephalusQ03.9 Congenital hydrocephalus, unspecified16
61531- Subdural implantation of strip electrodesthrough 1 or more burr hole(s) for long-term seizuremonitoring61533 - Craniotomy with elevation of bone flapflap, forsubdural implantation of an electrode array; forlong-term seizure monitoring61534 - ; For excision of epileptogenic focuswithout electrocorticography during surgery61535 - ; for removal of epidural or subduralelectrode array, without excision of cerebral tissue(separate procedure)61536 - ; for excision of cerebral epileptogenicfocus, with electrocorticography during surgery(includes removal of array)61538- Craniotomy with elevation of bone flap; forlobectomy, temporal lobe, with electrocorticographyduring surgery61539 - ; for lobectomy, other than temporal lobe,partial or total, with electrocorticograghy duringsurgery61567 - ; for multiple subpial transections, withelectrocorticography during surgery17
10-CMGeneralized nonconvulsive epilepsy,without mention of intractableepilepsyGeneralized nonconvulsive epilepsy,with intractable epilepsyN/AN/AGeneralized convulsive epilepsy,without mention of intractableepilepsyGeneralized convulsive epilepsy, withintractable epilepsyPetit mal statusG40 301G40.301Grand mal statusG40.311ICD-9-CM345.40 Localization‐relatedepilepsy and epilepticsyndromes with complexpartial seizures, womention of intractableepilepsy345.41 Localization‐relatedepilepsy and epilepticsyndromes with complexpartial seizures, withintractable epilepsyN/AN/AGeneralized idiopathic epilepsy andepileptic syndromes, not intractable,with status epilepticusGeneralized idiopathic epilepsy andepileptic syndromes, intractable,with status epilepticusICD-10-CMG40.201 Localization‐related (focal) (partial) symptomaticepilepsy and epileptic syndromes with complexpartial seizures, not intractable, with statusepilepticusG40.209 Localization‐related (focal) (partial) symptomaticepilepsy and epileptic syndromes with complexpartial seizures, not intractable, without statusepilepticusG40.211 Localization‐related (focal) (partial) symptomaticepilepsy and epileptic syndromes with complexpartial seizures, intractable, with statusepilepticusG40.219 Localization‐related (focal) (partial) symptomaticepilepsy and epileptic syndromes with complexpartial seizures, intractable, without statusepilepticus18
345.50 Localization‐related epilepsy andepileptic syndromes with simplepartial seizures, wo mention ofintractable epilepsyG40.101G40.109345.51 Localization‐related (focal)(partial) epilepsy and epilepticwith simplepartialsyndromesyp pseizures, with intractableepilepsy345.60Infantile spasms, withoutmention of .61Infantile spasms, withintractable epilepsyG40.411G40.419345.70Epilepsia partialisG40.501continua, without mentionof intractable epilepsyG40.509345.71Epilepsia partialiscontinua, with lated symptomatic epilepsyand epileptic syndromes with simplepartial seizures, not intractable, withstatus epilepticusLocalization‐related symptomatic epilepsyand epileptic syndromes with simplepartial seizures, not intractable, withoutstatus epilepticusLocalization‐related symptomatic epilepsyand epileptic syndromes with simplepartial seizures,, intractable,, with statuspepilepticusLocalization‐related symptomatic epilepsyand epileptic syndromes with simplepartial seizures, intractable, without statusepilepticusOther generalized epilepsy and epilepticsyndromes, not intractable, with statusepilepticusp p y and epilepticp pOther ggeneralized epilepsysyndromes, not intractable, without statusepilepticusOther generalized epilepsy and epilepticsyndromes, intractable, with status epilepticusOther generalized epilepsy and epilepticsyndromes, intractable, without statusepilepticusSpecial epileptic syndromes, not intractable,with status epilepticusSpecial epileptic syndromes, not intractable,without status epilepticusSpecial epileptic syndromes, intractable, withstatus epilepticusSpecial epileptic syndromes, intractable,without status epilepticus19
ICD-9-CMICD-10-CM345.80 Other forms of epilepsy andrecurrent seizures, withoutmention of intractable epilepsyG40.801G40.809G40.89345.81 Other forms of epilepsy andG40.811recurrent seizures, with intractableepilepsyG40.819345.90 Epilepsy, unspecified, withoutmention of intractable epilepsyG40.901G40.909345.91 Epilepsy, unspecified, withintractable epilepsyG40.911G40.919ICD-9-CMN/AOther epilepsy, not intractable, withoutstatus epilepticusOther epilepsy, not intractable, withoutstatus epilepticusOther seizuresOther epilepsy, intractable, with statusepilepticusOther epilepsy, intractable, withoutstatus epileticusEpilepsy, unspecified, not intractable,with status epilepticusEpilepsy, unspecified, not intractable,without status epilepticusEpilepsy, unspecified, intractable, withstatus epilepticusEpilepsy, unspecified, intractable,without status epilepticusICD-10-CMG40.309G40.319G40 319N/AG40.001N/AG40.009N/AG40 011G40.011N/AG40.019Generalized idiopathic epilepsy and epilepticsyndromes, not intractable, without status epilepticusGeneralizedidiopathicandGli d idithi epilepsyild epilepticil tisyndromes, intractable, without status epilepticusLocalization‐related idiopathic epilepsy and epilepticsyndromes with seizures of localized onset, notintractable, with status epilepticusLocalization‐related idiopathic epilepsy and epilepticsyndromes with seizures of localized onset, notintractable, without status epilepticusLocalization‐related idiopathic epilepsy and epilepticsyndromes with seizures of localized onset,intractable, with status epilepticusLocalization‐related idiopathic epilepsy and epilepticsyndromes with seizures of localized onset,intractable, without status epilepticus20
Less invasive Removal of tumors of Anterior skull base Anterior Brainstem Few codes described as transnasal61548 Hypophysectomy or excisionof pituitary tumor, transnasal ortransseptal approach, nonstereotactic62165 Neuroendoscopy, intracranial;with excision of pituitary tumor,transnasal or transphenoidalapproach62161 Neuroendoscopy, intracranial; with dissection ofadhesions, fenestration of septumpellucidum or intraventricular cysts(including placementplacement, replacementreplacement, orremoval of ventricular catheter)62162with fenestration or excision of colloid cyst,including placement or external ventricularcatheter for drainage62163with retrieval of foreign body62164with excision of brain tumor, includingplacement of external ventricular catheter fordrainage21
2 or 3 codes Approach Definitive Repair reconstruction ConditionsCraniofacial approach to anterior cranial fossa;61580 extradural, including lateral rhinotomy,ethmnoidectomy, sphenoidectomy, withoutmaxillectomy or orbital exenteration61581 extradural, including lateral rhinotomy, orbitalexenteration,, erthmoidectomy,y,sphenoidectomy and/or maxillectomy22
Craniofacial approach to anterior cranial fossa;61582 extradural, including unilateral or bifrontalcraniotomy, elevation of frontal lobe(s),osteotomy of base of anterior cranial fossa61584 intradural, including unilateral orbifrontal craniotomyy, elevation or resectionof frontal lobe, osteotomy of base ofanterior cranial fossa61584 Orbitocranial approach to anterior cranialfossa, extradural, including supraorbitalridge osteotomy and elevation of frontaland/or temporal lobe(s); without orbitalexenteration61585with orbital exenteration61585 BicoronalBicoronal, transzygomatic and/or LeFort Iosteotomy approach to anterior cranialfossa with or without internal fixation,without bone graft23
61590 Infratemporal pre-auricular approach to middlecranial fossa (parapharyngeal space, infratemporaland midline skull basebase, nasopharynx),) with orwithout disarticulation of the mandible, includingparotidectomy, craniotomy, decompression and/ormobilization of the facial nerve and/or petrouscarotid artery61591 Infratemporal post-auricular approach to middlecranial fossa (internal audiotory meatus, petrousiill area,apex, tentorium,cavernous sinus,parasellarinfratemporal fossa) including mastoidectomy,resection of sigmoid sinus, with or withoutdecompression and/or mobilization of contents ofauditory canal or petrous carotid artery61592 Orbitocranial zygomatic approach to middlecranial fossa (cavernous sinus and carotidartery, clivus, bassilar artery or petrous apex)including osteotomy of zygoma, craniotomy,extra- or intradural elevation of temporallobe24
61595 Transtemporal approach to posterior cranialfossa,base,fossa jugular foramen or midline skull baseincluding mastoidectomy, decompression ofsigmoid sinus and/or facial nerve, with orwithout mobilization61596 Transcochlear approach to posterior cranialforamen or midline skull base,fossa, jjugulargincluding labyrinthectomy, decompression,with or without mobilization of facial nerveand/or petrous carotid artery61597 Transcondylar (far lateral) approach toposterior craniall fossa,jugularfl fforamen ormidline skull base, including occipitalcondylectomy, mastoidectomy, resection ofC1-C3 vertebral body(s), decompression ofvertebral artery, with or without mobilization61598 Transpetrosal approach to posterior cranialfossa, clivus or foramen magnum, includingligation of superior petrosal sinus and/orsigmoind sinus25
61600 Resection or excision of neoplastic, vascularor infectious lesion of base of anteriorcranial fossa; extradural61601intradural, including dural repair, with orwithout graft61605 Resection or excision of neoplastic, vascularor infectious lesion of infratemporal fossa,parapharyngeal space, petrous apex;extradural61606intradural, including dural repair, with orwithout graft26
61607 Resection or excision of neoplastic, vascularor infectious lesion of parasellar area,cavernous sinus, clivus or midline skull base;extradural61608intradural, including dural repair, with orwithout graftAdd-on procedures: 61609 Transection or ligationligation, carotid artery incavernous sinus; without repair 61610with repair by anastomosis or graft 61611 Transection or ligation, carotid artery inpetrous canal; without repair 61612with repair by anastomosis or graft27
61613 Obliteration of carotid aneurysm,arteriovenous malformation, or carotidcavernous fistula by dissection withincavernous sinus61615 Resection or excision of neoplastic, vascularor infectious lesion of base of posteriorcranial fossa, jugular foramen, foramenmagnum, or C1-C3 vertebral bodies;extradural61616intradural, including dural repair, with orwithout graft28
y repairpp61618 Secondaryof dura for cerebrospinalfluid leak, anterior, middle or posteriorcranial fossa following surgery of the skullbase; by free tissue graft (eg. Pericranium,fascia, tensor fascia lata, adipose tissue,homologous or synthetic grafts)61619by local or regionalized vascularizedpedicle flap or myocutaneous flap(including galea, temporalis, frontalis oroccipitalis muscle)?29
2012 CPT ProfessionalEdition2012 ICD-9-CM2012 ICD-10-CM2012 Coders DeskReference for Procedures2011 Coders DeskReference for DiagnosisImagesTorricellaPeligna.comTallahassee CommunityCollegeAnatowiki.wetpaint.comMayfield ClinicJohn Hopkins NeurosurgeryAntranik.orgScience omEcc-book.com30
ICD-9-CM ICD-10-CM 345.40 Localization‐related epilepsy and epileptic syndromes with complex G40.201 Localization‐related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable,with status partial seizures
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ICD-10 will Change Everything Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, COBGC, CEMC, CDERC, CCS-P President & CEO AAPC Author of many AMA publications including: ICD-10 Implementation Guide, Make the Transition Manageable,‖ AMA Press 2 Overview of ICD-10
ICD-10 Will Change Everything Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, CPMA, COBGC, CPCD, CCS-P President & CEO AAPC Author of “ICD-10 Impp,lementation Guide, Make the Transition Manageable,” AMA Press, 2009 ICD-10 Final Rule CMS-0013-F Published January 16, 2009 October 1, 2013 – Compliance date for implementation of ICD-10 .
ICD-10 will Change Everything Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, COBGC, CEMC, CDERC, CCS-P President & CEO. AAPC. Author of many AMA publications including: ICD-10 Implementation Guide, Make the Transition Manageable,” AMA Press
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Candidates who wish to gain a CPC can either study in their own time or attend a training course at a CPC training centre. OCR does not endorse CPC training centres for the delivery of CPC training programmes although OCR approves centres to offer and invigilate the examination sessions. CPC
ARCHAEOLOGICAL ILLUSTRATION 13 HOME PAGE WHY DRAW? EQUIPMENT START HERE: TECHNIQUES HOW TO DRAW MORE ACTIVITIES LINKS Drawing pottery The general aim when drawing pottery is not only to produce an accurate, measured drawing but also to show the type of pot. Sh ape (or form) and decoration are therefore important. Many illustrators now include extra information to show how a pot was .
