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Cardiopulmonary Anatomy and
 Physiology : Review for ICD
           Coding
   Deidra Woods, MD, FACP, CMD,
             FAAHPM
         November 16, 2011
             GCHIMA
Cardiac and Pulmonary Function

• Pulmonary Function
  – Oxygenate the blood
• Cardiac Function—act as a pump to
  – Deliver unoxygenated blood to the lungs
  – Return oxygenated blood from the lungs and
  – Then deliver it to the rest of the body
Cardiac Structures
Cardiac Structures

•   Atrium—right and left
•   Ventricles—right and left
•   Vena cava
•   Aorta
•   Valves
    – Mitral
    – Aortic
    – Pulmonic
Cardiac Circulation
Cardiac Electrical or Conduction
            System
Cardiac Impulse
         Conduction/Disturbance
• Sinoatrial node (SA node)
   – Bradycardia
   – Sinus tachyardia
   – Sick sinus syndrome (SSS)
• Atrioventricular node (AV node)
   – Varying ―degrees‖ of AV block
      • First degree
      • Second degree
      • Third degree or complete
   – Junctional rhythms
• Right and Left ventricular bundles
   – RBBB, LBBB
• Purkinje fibers
Cardiac Structures ICD 10 I
• Valves
   – Insufficiency or regurgitation
       • Leaky or floppy—let blood flow the wrong way
   – Stenosis
       • Tight—restrict blood flow, cause the muscle to work too hard to get
         blood out of the heart chamber
       • Rheumatic aortic stenosis I06.0
       • Non-rheumatic aortic stenosis I35.0
• Muscle itself
   – Hypertrophy
       • large, overdeveloped, due to hypertension, accumulation of iron,
         amyloid
   – Dilated
       • Thin, floppy, ineffective contractions due to damage from MI {I25.5
         ischemic cardiomyopathy}, muscular dystrophy, viral infection, unknown
         cause
Cardiac Function

– { I50 } Heart failure indicates that the pump
  function of the heart is not adequate
– Symptoms vary depending on the cause
   • Right sided or diastolic heart failure {I50.32}
      –   Swelling (edema) in legs
      –   Enlarged liver (hepatomegaly)
      –   Loss of appetite (anorexia)
      –   Fatigue
      –   Dyspnea
      –   Increased neck vein distention (JVD—jugular vein
          distention)
Cardiac Function Diseases ICD 10
               I 50
   • Left sided heart failure
      –   Dyspnea R06.00
      –   Edema
      –   Can’t lie flat without dyspnea (orthopnea)
      –   Wakens with acute dyspnea (paroxysmal nocturnal
          dyspnea or PND)
      –   Palpitations (sensation of heart beating irregularly or
          quickly)
      –   Irregular heart beat
      –   Rapid weight gain or weight loss
      –   Anorexia R63.0
Pulmonary Function

• Purpose of the lungs is to oxygenate blood
  and remove carbon dioxide from the body
• Heart delivers blood from the right
  ventricle via pulmonary artery to the lungs
  and returned to the heart (the left atrium)
  via the pulmonary veins
Lung Structure
Pulmonary Diseases ICD 10 J

• Airway
  – Bronchial tree
  – Alveoli
• Parenchyma
• Circulation: these are coded in circulation
  – Primary
     • Pulmonary hypertension I27.0
  – Secondary
     • Pulmonary embolus –I26.0
Pulmonary Diseases ICD 10 J

• Bronchial tree
  – Asthma
  – Bronchitis
  – Emphysema
  – Pneumoconioses
  – Hypersensitivity pneumonitis
Pulmonary Diseases

• Interstitial pulmonary diseases
  – Pulmonary edema
  – Idiopathic pulmonary fibrosis
  – Usual interstitial pneumonia
  – Alveolar proteinosis
  – Pulmonary eosinophilia
Hospice Patients

– End stage of any illness
– Poor functional status
– Need assist with activities of daily living
– House bound
– Palliative Performance Scale 40% or less
– Frequent hospitalizations or emergency room
  visits for symptom management
Palliative Performance Scale

– Scale rated 0% (dead) to 100% (normal)
– Assesses
  •   Ambulation
  •   Activity and evidence of disease progression
  •   Self care
  •   Intake
  •   Consciousness
– Most hospice patients rated at 40% or lower

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Cardiopulmonary Disease by Deirdre Woods, MD

  • 1. Cardiopulmonary Anatomy and Physiology : Review for ICD Coding Deidra Woods, MD, FACP, CMD, FAAHPM November 16, 2011 GCHIMA
  • 2. Cardiac and Pulmonary Function • Pulmonary Function – Oxygenate the blood • Cardiac Function—act as a pump to – Deliver unoxygenated blood to the lungs – Return oxygenated blood from the lungs and – Then deliver it to the rest of the body
  • 4. Cardiac Structures • Atrium—right and left • Ventricles—right and left • Vena cava • Aorta • Valves – Mitral – Aortic – Pulmonic
  • 6. Cardiac Electrical or Conduction System
  • 7. Cardiac Impulse Conduction/Disturbance • Sinoatrial node (SA node) – Bradycardia – Sinus tachyardia – Sick sinus syndrome (SSS) • Atrioventricular node (AV node) – Varying ―degrees‖ of AV block • First degree • Second degree • Third degree or complete – Junctional rhythms • Right and Left ventricular bundles – RBBB, LBBB • Purkinje fibers
  • 8. Cardiac Structures ICD 10 I • Valves – Insufficiency or regurgitation • Leaky or floppy—let blood flow the wrong way – Stenosis • Tight—restrict blood flow, cause the muscle to work too hard to get blood out of the heart chamber • Rheumatic aortic stenosis I06.0 • Non-rheumatic aortic stenosis I35.0 • Muscle itself – Hypertrophy • large, overdeveloped, due to hypertension, accumulation of iron, amyloid – Dilated • Thin, floppy, ineffective contractions due to damage from MI {I25.5 ischemic cardiomyopathy}, muscular dystrophy, viral infection, unknown cause
  • 9. Cardiac Function – { I50 } Heart failure indicates that the pump function of the heart is not adequate – Symptoms vary depending on the cause • Right sided or diastolic heart failure {I50.32} – Swelling (edema) in legs – Enlarged liver (hepatomegaly) – Loss of appetite (anorexia) – Fatigue – Dyspnea – Increased neck vein distention (JVD—jugular vein distention)
  • 10. Cardiac Function Diseases ICD 10 I 50 • Left sided heart failure – Dyspnea R06.00 – Edema – Can’t lie flat without dyspnea (orthopnea) – Wakens with acute dyspnea (paroxysmal nocturnal dyspnea or PND) – Palpitations (sensation of heart beating irregularly or quickly) – Irregular heart beat – Rapid weight gain or weight loss – Anorexia R63.0
  • 11. Pulmonary Function • Purpose of the lungs is to oxygenate blood and remove carbon dioxide from the body • Heart delivers blood from the right ventricle via pulmonary artery to the lungs and returned to the heart (the left atrium) via the pulmonary veins
  • 13. Pulmonary Diseases ICD 10 J • Airway – Bronchial tree – Alveoli • Parenchyma • Circulation: these are coded in circulation – Primary • Pulmonary hypertension I27.0 – Secondary • Pulmonary embolus –I26.0
  • 14. Pulmonary Diseases ICD 10 J • Bronchial tree – Asthma – Bronchitis – Emphysema – Pneumoconioses – Hypersensitivity pneumonitis
  • 15. Pulmonary Diseases • Interstitial pulmonary diseases – Pulmonary edema – Idiopathic pulmonary fibrosis – Usual interstitial pneumonia – Alveolar proteinosis – Pulmonary eosinophilia
  • 16. Hospice Patients – End stage of any illness – Poor functional status – Need assist with activities of daily living – House bound – Palliative Performance Scale 40% or less – Frequent hospitalizations or emergency room visits for symptom management
  • 17. Palliative Performance Scale – Scale rated 0% (dead) to 100% (normal) – Assesses • Ambulation • Activity and evidence of disease progression • Self care • Intake • Consciousness – Most hospice patients rated at 40% or lower