Cardiopulmonary Anatomy and Physiology : Review for ICD Coding

Deidra Woods, MD, FACP, CMD, FAAHPM

November 16, 2011GCHIMA

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