The physician completed all the necessary documentation required by the insurance company, including his opinion that the patient would be unable to work in the future, as his pulmonary function is markedly impaired, in spite of continual respiratory and pharmacologic therapy. Note that there are three history and examination codes; one is specifically for a newborn assessment and discharge from a hospital or birthing room on the same date (99463), one is for hospital or birthing room deliveries (99460), and one is for other than a hospital or birthing center (99461). If the physician provides a discharge service to a newborn discharged subsequent to the admission date, you would choose a code from the Hospital Inpatient Services subsection, Hospital Discharge Services subheading (99238, 99239). Delivery/Birthing Room Attendance (99464, 99465) codes report the attendance of a physician, at the request of the delivering physician, to provide the initial stabilization of a newborn or for the resuscitation/ventilation of the newborn. Inpatient neonatal intensive care and pediatric and neonatal critical care services (9946699486) Pediatric critical care patient transport. These codes (99466, 99467) report face-to-face services provided to a pediatric patient (24 months of age or younger). During the provision of these services, the patient is being transported from one facility to another. Codes 99485 and 99486 report supervision by a control physician with the first 30 minutes reported with 99485 and each additional 30 minutes reported with 99486. If the physician is in physical attendance for less than 30 minutes, the service is not reported with these transportation codes. Other services provided before transport and nonroutine services provided during transport may be reported separately. Codes 99468-99476 report initial and subsequent critical care services to neonatal and pediatric patients. The codes are based on the age of the patient: Neonate, 28 days or younger Pediatric, 29 days through 24 months of age or 2 years through 5 years the name of the intensive care unit does not matter in the assignment of these codes. The services can be provided in a pediatric intensive care unit, neonatal critical care unit, or any of the many other names that these types of intensive care units have. Bundled into the codes are many services you would anticipate would be used in the support of a critically ill neonate or pediatric patient (for example, arterial catheters, nasogastric tube placement, endotracheal intubation, and invasive electronic monitoring of vital signs). The notes preceding the codes list bundled services, descriptions, and codes for services (for example, blood transfusion, 36440). To ensure that you do not unbundle, you will need to refer back to these lists of bundled services. If the physician performed a service not listed in the bundle, you would report the service separately. For example, cardiac and/or respiratory support is bundled into some of the codes. When a neonate or infant is not considered critically ill but still needs intensive observation and other intensive care services, the Initial and Continuing Intensive Care Services codes (99477-99480) are reported. The codes from the subsection are reported only once in every 24-hour period (same day). The physician provided evaluation and management services including the admission and the discharge. At least 20 minutes of physician directed staff time is provided during the month. Complex chronic care management services (99487, 99489) Codes 99487 and 99489 report complex chronic care management services provided during a month. In addition to compliance with chronic care criteria, there is development of or substantial revision of a comprehensive care plan. The codes are time-based of at least 60 minutes per calendar month and each additional 30 minutes. Transitional care management services (99495-99496) Codes 99495 and 99496 are transitional care management codes that are based on the number of days after discharge from a medical facility and if the medical decision making complexity is moderate or high. The service involves the management of the various available care options for the patient. When reporting these codes, there is no active management of the problem(s) during the reported time. Services are reported based on the first 30 minutes and each additional 30-minute increment. Other evaluation and management services Other Evaluation and Management Services (99499) is the last subsection in the E/M section. Code 99499 is an unlisted code that is used to indicate that there is no other code that accurately represents the services provided to the patient. Can you imagine how well you would know your favorite novel if you read it several times a month
The most common histologies for brain and spinal cord tumors are given in Tables 56. Most retrospective outcome studies of brain tumor therapy show that the age of the patient at the time of diagnosis is one of the most powerful predictors of outcome. This fact holds true for the gliomas, which are the most common primary brain tumors, and for most other tumors that affect the adult population, including most metastatic tumors to the brain. There are, however, some childhood tumors that have a very poor prognosis, are inherently high grade, and rapidly progress to a fatal outcome. Some metastatic tumors, such as melanoma, occur in younger patients and also violate this general statement with regard to the specific effect of age on prognosis. Behavior is coded /0 for benign tumors, /3 for malignant tumors, and /1 for borderline or uncertain behavior. In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. For this relatively ill-defined group of patients, there were 17,200 new cases estimated for 2001. Excellent observational insight and patterns of care data for surgically treated malignant gliomas [glioblastomas and malignant (grade 3) gliomas] are available from the Glioma Outcome Project, which evaluated 788 patients accrued from 1997 to 2000. One of the most promising is the codeletion of 1p 19q in anaplastic oligodendroglioma and its prognostic value. It is hoped that ways will be found to apply these methods of scientific analysis of tumor growth potential to predict survival more effectively than is possible today. Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Gliomas Study. The Glioma Outcomes Project: a resource for measuring and improving glioma outcomes. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. Radiotherapy of intracranial astrocytomas: analysis of 417 cases treated from 1960 through 1969. Non-Hodgkin lymphomas occur in more than 63,000 new individuals each year and have been increasing in incidence over the past several decades. They include Hodgkin lymphoma (Hodgkin disease), non-Hodgkin lymphoma, multiple myeloma, and lymphoid leukemias. Thus, it is artificial to call them different diseases, when in fact they are just different presentations of the same disease. For this reason, we now refer to these diseases as lymphoid neoplasms rather than as lymphomas or leukemias, reserving the latter terms for the specific clinical presentation. In the current classification of lymphoid neoplasms, diseases that typically produce tumor masses are called lymphomas, those that typically have only circulating cells are called leukemias, and those that often have both solid and circulating phases are designated lymphoma/leukemia. Finally, plasma cell neoplasms, including multiple myeloma and plasmacytoma, have typically not been considered "lymphomas," but plasma cells are part of the B-cell lineage, and, thus, these tumors are B-cell neoplasms, which are now included in the classification of lymphoid neoplasms. Lymphoid Neoplasms 599 In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. Cases represent all lymphoma types and are not predictive of outcome for any particular lymphoma type. Lymphoid cells include lymphoblasts, lymphocytes, follicle center cells (centrocytes and centroblasts), immunoblasts, and plasma cells. Job Name: - /381449t numbers in almost every organ of the body, where they either wait to encounter antigens or carry out specific immune reactions. This scheme had the advantage of being simple, with only ten categories, and it did not require any special studies such as immunophenotyping or genetic studies. In addition, it provided simple clinical groupings for determining the approach to treatment (low, intermediate, and high clinical grades).
The Index to External Causes (E codes) is located separately in the Index to Diseases, after the Table of Drugs and Chemicals. Although many states require the reporting of E codes, provider office insurance claims do not. However, reporting E codes on claims can expedite payment by health insurance carriers when no third-party liability for an accident exists. In such cases, it is necessary to report two E codes in addition to the appropriate injury codes. The fractured pelvis is coded and sequenced first on the claim followed by two E codes, one for the external cause and another for the place of occurrence: 808. Injury: External Cause: Place of Occurrence: Fracture pelvis Fall (falling) from, off ladder Accident (to) occurring (at) (in) home (private) (residential) 808. At the end of the Index to External Causes is a section entitled: "Fourth-Digit Subdivisions for the External Cause (E) Codes. Preprinted diagnosis codes on encounter forms, routing slips, and coding lists should be reviewed to verify accuracy. Diagnosis codes should be reviewed for accuracy when updates are installed in office management software. A policy should be established to address assignment of codes when the office is awaiting the results of laboratory and pathology reports. Some computer programs automatically generate insurance claims for each encounter. Office staff should intercept these claims to verify the diagnosis code(s) assigned. Diagnosis codes should be proofread to ensure proper entry in the permanent record. The "x" placeholder: is applicable to selected codes (that would otherwise have just five digits) so that the code has the potential for expanded meaning while not altering the significance and placement of code extensions. Coding conventions assist in the accurate assignment of codes, and Coding conventions assist in the accurate assignment of codes Instructions. Conditions with new treatment protocols and/or that were recently discovered are classified in appropriate chapters. There are two types of excludes notes: Excludes1 indicates codes listed elsewhere are mutually exclusive, which means they are never reported together. Excludes2 indicates both codes may be reported together if the excluded condition is not classified by the code in question and if the patient is treated for both conditions. Early and late vomiting of pregnancy are assessed against the criteria of "before or after 20 weeks gestation" as time delineation. Seventh-character code extensions are assigned to most categories in the for Injuries, Poisoning and Certain Other Consequences of External Causes chapter. Third-party payers use medical necessity measurements to make a decision about whether to pay a claim. It also contains a hypertension table, neoplasm table, and table of drugs and chemicals. To properly code, refer first to the Index to Diseases (to locate main term and subterm entries) and then to the Tabular List of Diseases (to review notes and verify the code selected). Underline the main term in each item; then use Index to Diseases and Tabular List of Diseases coding rules and conventions to assign the code(s). Metastatic adenocarcinoma from breast to brain (right mastectomy performed 5 years ago) 19. Defibrination syndrome following termination of pregnancy procedure 2 weeks ago 92. Pyrexia of unknown origin during the puerperium (postpartum), delivery during previous admission 99. Open frontal fracture with subarachnoid hemorrhage with brief loss of consciousness 127. Supracondylar fracture of right humerus and fracture of olecranon process of the right ulna 128. Traumatic subdural hemorrhage with open intracranial wound; loss of consciousness, 30 minutes 137. Traumatic hemothorax with open wound into thorax and concussion with loss of consciousness 140. Visit to radiology department for barium swallow; abdominal pain; findings are negative; barium swallow performed and the findings are negative 169.
However, T1 tumor substratification has been adopted based on the impact of lymphovascular invasion and its associated increased risk of lymph node metastasis that should prompt more aggressive care. Patients with direct extension into the prostate from the penile shaft have extensive tumors involving an adjacent organ. Beyond management of the primary tumor clinicians must decide if the inguinal region is at risk for metastases from the primary tumor as the incidence and extent of metastases are the most important factors determining survival. There is general consensus that in patients with palpable adenopathy there is a higher likelihood of finding metastasis, a lower survival, and thus lymphadenectomy is justified. In contrast, those with extranodal extension of cancer and pelvic lymph node metastases are rarely cured with surgery alone. Patients with multiple unilateral or bilateral nodes that do not exhibit extranodal extension or pelvic disease form an intermediate prognosis group (N2). Thus, clinical and pathologic staging information not only determines prognosis but forms the basis of integrating systemic chemotherapy or radiation into the treatment regimen for select patients with more advanced disease. Lymphatic invasion and vascular embolism have been shown to be independent predictors of node involvement (Table 40. The multiple variables in addition to anatomic stage that have been proposed as prognostic in penile carcinoma have been recently evaluated using an outcomes prediction nomogram tool to define lymph node involvement by Ficarra et al. This tool may serve as a clinically useful adjunct to standard anatomic staging enabling physicians to counsel patients regarding the selection of therapeutic interventions based on risk of clinical recurrence. This model will need to be validated in larger groups of patients prior to widespread implementation. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Histologic confirmation provided by an adequate excisional-incisional biopsy to determine the extent of anatomic invasion, tumor grade, and the presence of lymphovascular invasion is required. Computed tomography is a useful adjunct to palpation in patients with palpable inguinal adenopathy or those in whom palpation is unreliable. Clinical examination along with cross-sectional imaging and chest radiography should be performed as appropriate. Lymphadenectomy is performed in those patients felt to be at significant risk for metastasis by virtue of palpable adenopathy or histopathologic features of the primary tumor. Pathologic confirmation can also be achieved via lymph node biopsy of clinically suspicious lymph nodes. The definitions of primary tumor (T) for Ta, T1, T2, T3, and T4 are illustrated in Figures 40. T1: Tumor invading subepithelial connective tissue; T1a: no vascular invasion and not poorly differentiated; and T1b: high grade and/or poorly differentiated. Penis 449 In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. Job Name: - /381449t *Note: Broad pushing penetration (invasion) is permitted; destructive invasion is against this diagnosis. Penile intraepithelial neoplasia: specific clinical features correlate with histologic and virologic findings. Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm. Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Penile Cancer Project members: nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. Prognostic factors of survival: analysis of tumors, nodes and metastasis classification system. Squamous cell carcinoma of the penis: accuracy of tumor, nodes and metastasis classification system, and role of lymphangiography, computerized tomography scan and fine needle aspiration cytology.
Surgery involves exploration and management of injuries of the carotid sheath, esophagus, and laryngotracheal complex (Table 5. There is no role for probing or local exploration of the neck in the trauma bay or emergency room because this may dislodge a clot and initiate uncontrollable hemorrhage. Head and Neck 341 N Outcome and Follow-Up Standard postoperative management for neck surgery is followed. Selective management of penetrating neck trauma based on cervical level of injury. The differential diagnosis is broad, and both benign and malignant processes should be considered. A systematic approach is crucial to developing a rapid diagnosis and treatment plan. Each age group exhibits a certain relative frequency of disease occurrences, which can guide the diagnostician to further differential considerations. In older adults, a neck mass should be considered neoplastic until proven otherwise. The location of malignant neck masses particularly if metastatic may help identify the primary tumor. N Clinical Signs and Symptoms Depending on the cause, the neck mass may be painless (early neoplasm or congenital mass) or painful (infection or trauma). Depending on the etiology, associated symptoms may be those of an upper respiratory infection, toothache (infectious or inflammatory mass) or dysphagia, odynophagia, hoarseness, otalgia, hemoptysis, weight loss, night sweats, and fever (neoplasm). N Evaluation History A thorough review of the developmental time course of the mass, associated symptoms, personal habits prior to the trauma or infection, irradiation, or surgery is important. Ask about smoking, tobacco chewing, alcohol use, fever, pain, weight loss, night sweats, exposure to tuberculosis, animals, pets, and occupational/sexual history. Physical Exam All mucosal surfaces of the nasopharynx, oropharynx, larynx, and nasal cavity should be visualized by direct examination or by indirect mirror or fiberoptic visualization. Regarding the neck mass, emphasis on location, tenderness, mobility, and consistency of the neck mass can often place the mass within a general etiologic grouping. Criteria such as heterogeneity of the center of the mass, blurred borders, and a round shape are suggestive of malignancy. Contrast should be used except in the suspected thyroid lesion as it may interfere with radioactive-iodine imaging studies or therapy. Ultrasound is helpful in differentiating solid from cystic masses and congenital cysts from solid lymph nodes and glandular tumors. More specialized laboratory tests may become necessary as the investigation proceeds. Panendoscopy: If careful examination in the office does not identify the etiology of the neck mass and a tumor is suspected, the upper aerodigestive tract should be examined under anesthesia. G N Treatment Options Medical A tender, mobile mass or one highly suggestive of inflammatory or infectious etiology may warrant a short clinical trial of antibiotics and observation with close follow-up. Use steroids judiciously; steroids may shrink a neck mass caused by lymphoma lulling the physician and patient into a false sense that the condition is improving. Surgical G G G G Open excisional biopsies should be avoided in cases in which a nonlymphoma malignancy (epidermoid, melanoma) is suspected. The patient and surgeon should be prepared to proceed immediately with a complete neck dissection depending on the results of frozen sections. Inflamed congenital masses are typically treated with antibiotics and then surgically removed after inflammation has subsided. Surgery in the form of incision and drainage is used in cases that do not respond to appropriate medical therapy. Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site.
Tanaceti parthenii (Feverfew). Allopurinol.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96896
A defect analysis should be done systematically to avoid untoward long-term results. Flap design must consider vectors of tension, resultant scars, and areas from which to recruit. Cutaneous defects can arise from a host of different causes, but skin cancer remains the most common etiology in the Caucasian population. Local facial flaps are widely used for defects that are too large for primary closure or second intention healing. They remain the workhorse for facial reconstruction and should be within the comfort level of all otolaryngologists. Examples of this would be the hairline, vermillion border of the lip, and nasal alar rim. These critical structures must remain undisturbed by scars as well as by flap tension. Third, evaluate the preexisting lines of the face and how are they oriented around the defect. The face is separated into distinct aesthetic units such as the forehead, nose, and cheek. When possible, it is best to place incisions along the margins of the aesthetic units and use flaps that lie within the same aesthetic unit as the defect. For every flap design, one should be able to anticipate the exact orientation of the final scars and attempt to design the flap in a way that best conforms to the third step, having the scars lie within or parallel to the preexisting lines. Moreover, one must anticipate the vectors of tension for each flap with respect to the landmarks noted in the first step. N Flap Nomenclature the different systems for classification of local flaps include tissue content, proximity of the flap, blood supply, and method of tissue transfer, the last two of which are the principal methods of nomenclature. The blood supply within a flap can be random (based on the rich dermal plexus of the face), can have an axial pattern (supplied by numerous larger caliber vessels in the dermis and subcutaneous layer that are arranged in an axial pattern along the flap), or can be pedicled (maintained by larger, named vessels). They create no distortion to the adjacent tissues, although a standing cutaneous deformity will often arise. They are further subclassified based on their vascular pedicle, be it a unilateral pedicle, a bipedicle, or subcutaneous pedicle (island flap). The remaining method of tissue transfer is the pivotal flap, in which the tissue transposition has a rotational element as well. A true rotation flap moves tissue along the circumference of a circle, around a single, fixed pivot point, such as a scalp rotation flap. A transposition flap involves mobilizing tissue over an incomplete bridge of skin. Interposition flaps are similar to transposition flaps but include elevation of the incomplete skin bridge to the site of the donor defect, such as a Z-plasty. Finally, interpolated flaps move the skin paddle and pedicle over an intact skin bridge with its pedicle base removed from the defect. These interpolated flaps are two-staged flaps that require a secondary pedicle division, usually 3 weeks later. N Advancement Flaps the most simple advancement flap is the lateral undermining and mobilization along the margin of a defect with primary closure. When closing a defect primarily, the apices of the defect should be less than 30 degrees to avoid a standing cutaneous deformity. Traditional unipedicled (U-plasty) and bipedicled (H-plasty) advancement flaps without any rotational component have a narrow indication. These flaps are used when minimal tension is desired perpendicular to the direction of advancement to avoid distortion of adjacent anatomic landmarks such as the eyebrow. The V-Y island advancement flap is a unipedicled triangular flap based on a subcutaneous pedicle that is mobilized in a linear vector toward the defect. The V-Y flap creates minimal distortion around the primary defect, but its reach is limited by the subcutaneous pedicle. It is well suited for small defects of the upper lip and medial cheek that are in proximity to important anatomic landmarks. N Pivotal Flaps the rotation flap is a pivotal flap mobilized along a curvilinear incision around a fixed point used for tissue that is not extensible, such as the scalp.
Syndromes
N Evaluation When evaluating the aging face for volume deficiency, the strategic areas for correction with fat grafting (or alternative filler) include the temporal hollow, brow and upper eyelid deflation, inferior orbital rim, nasojugal groove, anterior and lateral cheeks, buccal region, precanine fossa, prejowl sulcus, anterior chin, and lateral mandible. Fat grafting is not particularly useful for lip enhancement or correction of facial lines, and injectable fillers are preferred. For this reason, injectable fillers are preferred in highly mobile facial regions. Surgical Fat grafting is the ideal method for volume correction of the aging face or to manage complex three-dimensional defects that may arise from cancer, trauma, or other pathology that may not be as precisely addressed with standard alloplasts. As mentioned, fat grafting does not provide tremendous benefit for lip enhancement or facial lines, which are better managed with office-based injectable fillers. For the aging face, fat grafting provides ideal improvement over alloplastic implants, as implants can actually worsen the hollowness that becomes more evident above (under the eyes) and below (submalar) the implant, whereas fat grafting can more effectively contour the extensive and subtle panfacial volume loss elaborated in the physical examination section of this chapter. N Complications Complications following alloplastic implant (malposition, infection, extrusion) usually must be managed with removal and subsequent reinsertion. Undercorrection or partial resorption can be easily managed with injection of additional fat. Not good for lips, nose contour correction, around the eyes/upper face, also not a great primary method for correction of facial lines if that is main concern of the patient. Vascular compromise, especially in the glabellar region, following use of injectable fillers is an emergency that can lead to tissue loss and skin necrosis and should be managed with hyaluronidase (for hyaluronic acid products), warm soaks, nitropaste application, and possible subcutaneous heparin until improvement and resolution of the condition. N Outcome and Follow-Up There is really no significant postoperative care that is needed for injectable fillers, fat grafting, or alloplastic implant placement. Unlike traditional otolaryngologic procedures, the endpoint is simply aesthetic improvement that meets the rigorous standards of the surgeon and patient alike. Follow-up is tailored to surgeon preference and patient desire for visitation and further intervention. Comprehensive Facial Rejuvenation: A Practical and Systematic Guide to Surgical Management of the Aging Face. Although many techniques have been described to lift sagging facial tissues, some are more effective and long-lasting than others. Recommendations should be modified to address the problems specific to each patient. Postoperative results of a rhytidectomy (aka rhytidoplasty or facelift procedure) should be designed to produce a "natural" and "unoperated" appearance. The skull gets smaller and fat is redistributed from the cheeks into the jawline and neck. As facial skin loses its elasticity, it responds to the downward forces of gravity. Prolonged stress, sun exposure, and illness seem to speed up the aging process, making the person appear older than he or she actually is. N Clinical Signs and Symptoms Patients in their late forties may present with early sagging of the cheeks and deepening of the melolabial creases. With each decade, the conditions worsen, resulting in drooping of the forehead, lateral brows, cheeks, and neck. Facial rhytides become more pronounced with each passing year, especially in the areas of facial animation. In some patients, the platysmal muscles in the midline of the neck become separated and migrate laterally, producing vertical banding from the clavicle to the submental region. Sagging and bulging tissues of the upper and lower lids are generally seen as well. Differential Diagnosis It is important to remember that surgery can reposition drooping tissues and remove loose skin; for facial rhytides, however, a resurfacing procedure is generally required. Dermabrasion, chemical peeling, or laser resurfacing can provide more permanent results in wrinkled skin. In general, unless it takes 2 weeks for a resurfaced area to heal, minimal long-term improvement is expected. Botox and injectable fillers provide only temporary improvement and need to be repeated several times each year. Fat or fascial grafting may provide more permanent improvement in deep folds and creases.
Codes for the external ear include biopsy by location of external ear (69100) or external auditory canal (69105), excision of the external ear, either partially or complete (69110, 69120). If the external ear was reconstructed after the excision, report the repair with split thickness autograft codes (15120, 15121) from the Integumentary System based on the square centimeters used in the repair. An incision is made behind the ear to gain access to the canal, and the bony growth is excised (69140). With the shape of the ear, it is easy to see how foreign bodies and cerumen (earwax) can become lodged in the external ear. When a foreign body is removed from the ear, the code reported is based on whether general anesthesia was or was not used (69200, 69205). Ear lavage (69209) is the unilateral removal of impacted cerumen (ear wax) using irrigation/lavage. Removal of the cerumen with instrumentation is reported with 69210 (if bilateral then append with modifier -50). An otoplasty is a procedure performed for a protruding ear that may or may not include a decrease in the size of the ear. This procedure is usually performed with the use of conscious sedation, which is included in 69300. Reconstruction of the external auditory canal (canalplasty/canaloplasty) may be performed for conditions such as stenosis due to injury or infection (69310) or for a congenital defect (69320). Canaloplasty is bundled into some middle ear repair codes, such as 69631-69646 and not reported separately. The eustachian tube connects the middle ear to the back of the throat and allows for drainage of fluid. Eustachian tube dysfunction is a fairly common condition in children, because the tube does not always mature to the level of normal function and therefore does not function properly. The fluid or inflammation prevents air from entering the middle ear, resulting in a pressure increase in the middle ear. Surgical intervention is an inflation of the eustachian tube with access through the nose (transnasal). Myringotomy is the incision into the tympanic membrane (69420, 69421) and reinflation of the eustachian tube. The tubes may later be removed, fall out naturally, or sometimes be left in place. Surgical removal of a ventilation tube is reported with 69424, which is a procedure that requires general anesthesia. Ventilation tube removal is bundled into many major procedures, in which case the removal is not reported separately. If an ear tube was not inserted, the incision into the tympanic membrane would do what in just a few days Middle ear excision procedures include antrotomy (simple mastoidectomy, 69501), mastoidectomy (complete, modified radical, or radical, 69502-69511), polyp removal (69540), and tumor removal (69550-69554). Sometimes, to remove the infected bone, a mastoidectomy is performed and is included in the petrous apicectomy code 69530. Middle ear repair procedures include revision mastoidectomies based on the extent of the procedure. For example, a simple mastoidectomy is performed on a patient with cholesteatoma of the middle ear. A cholesteatoma is a benign growth of skin in an abnormal location, in this case in the middle ear. The growth may reoccur and the surgeon may perform a complete mastoidectomy (69601). If the disease has progressed to the point where the tympanic membrane is damaged and requires repair, the procedure is reported with 69604. The two major divisions in the tympanoplasty codes are with or without removal of the mastoid bone (mastoidectomy). When no mastoidectomy is performed, choose the code from the 69631-69633 range, based on the extent of the procedure. When a mastoidectomy is performed, report the service with codes from the 69641-69646 range, based on the extent of the procedure. The ossicular chain is the bones of the ear that include the malleus (hammer), incus (anvil), and stapes (stirrup).
If the patient had antepartum complications, but that complication is not present at delivery, you can still report a normal delivery with O80. According to the Guidelines, the only birth outcome code that can be reported with O80 is. Additional codes from other chapters may be used with code O80 if they are not related to or are in any way the pregnancy. Ectopic pregnancy includes ruptured ectopic pregnancies and is reported with a code from category O00 based on the location of the pregnancy (abdominal, tubal, ovarian, other, unspecified) and with or without intrauterine pregnancy. If there are any complications with the ectopic pregnancy, report those associated complications with a code from category O08, Complications following ectopic and molar pregnancy. If there is a complication with the hydatidiform mole, report a code from category O08, Complications following ectopic and molar pregnancy. Pre-existing hypertension in pregnancy Category O10, Pre-existing hypertension complicating pregnancy, childbirth and the puerperium, includes codes for hypertensive heart and hypertensive chronic kidney disease. When assigning one of the O10 codes that includes hypertensive heart disease or hypertensive chronic kidney disease, it is necessary to add a secondary code from the appropriate hypertension category to specify the type of heart failure or chronic kidney disease. When hypertension is a pre-existing condition that complicates pregnancy, delivery, or the five-month period after delivery, report the condition with a category O10 code, Pre-existing hypertension complicating pregnancy, childbirth, and the puerperium. The category O10 code is the first-listed diagnosis, and a secondary code is assigned to report any hypertensive heart disease or hypertensive chronic kidney disease. Pre-Existing Hypertension Example A pregnant patient is seen by her obstetrician in her first trimester for a routine prenatal check. The patient has pre-existing stage I hypertensive chronic kidney disease that is complicating her pregnancy. Fetal Conditions Affecting the Management of the Mother 1) Codes from categories O35 and O36 Codes from categories O35, Maternal care for known or suspected fetal abnormality and damage, and O36, Maternal care for other fetal problems, are assigned only when the fetal condition is actually responsible for modifying the management of the mother, i. Surgery performed in utero on a fetus is still to be coded as an obstetric encounter. Categories O35 and O36 report fetal abnormalities or other fetal problems when these abnormalities or problems affect the care of the mother. When you reference "Pregnancy, complicated by, fetal, damage from, maternal, alcohol addiction," what code are you directed to locate in the Tabular Within the Tabular, the code you reference only has 4 characters, but there are 7th characters to assign to the code. Diabetes mellitus in pregnancy Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should be assigned a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4. If the patient is treated with both oral medications and insulin, only the code for insulin-controlled should be assigned. Gestational (pregnancy induced) diabetes Gestational (pregnancy induced) diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus. It also puts the woman at greater risk of developing diabetes after the pregnancy. No other code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, should be used with a code from O24. If a patient with gestational diabetes is treated with both diet and insulin, only the code for insulin-controlled is required. If a patient with gestational diabetes is treated with both diet and oral hypoglycemic medications, only the code for "controlled by oral hypoglycemic drugs" is required. An abnormal glucose tolerance in pregnancy is assigned a code from subcategory O99. Poorly controlled diabetes mellitus during pregnancy can lead to serious complications for both the mother and the fetus and may result in miscarriage or stillbirth. Type 1 diabetes is a condition in which little or no insulin is produced by the body and is controlled with administration of insulin. Type 2 diabetes is a condition in which too little insulin is produced or the body cannot use the insulin that is produced and is controlled with dietary restrictions and medications and/or insulin. If the pregnant female has type 2 diabetes mellitus that is well controlled with the use of insulin or oral medication, you would report a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, as the first-listed diagnosis followed by a code to report the type of diabetes, E11.
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