Top Banner
Cardiothoracic Surgery John F. Seccombe, MD AAPC 20 th National Conference All rights reserved
146

AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Jun 24, 2020

Download

Documents

dariahiddleston
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Cardiothoracic Surgery

John F. Seccombe, MD

AAPC 20th National Conference

All rights reserved

Page 2: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #1

Accept that

– anatomy is the FOUNDATION of medical

understanding

Objectives

2

Page 3: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #2

Understand How Things Work

– Physiology

Objectives

3

Page 4: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #3

Know What is Broken

– Pathology

Objectives

4

Page 5: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #4

Understand the Goal of the Surgeon

– Surgical Procedures

Objectives

5

Page 6: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #5

Learn to Decipher the Surgeon’s Intent

– Diagnosis vs. Treatment

Objectives

6

Page 7: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

7

Page 8: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

8

Page 9: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

9

Page 10: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Complex CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

10

Page 11: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

11

Page 12: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

12

Page 13: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest Wall Musculature

Regional Differences in Anatomy

Page 14: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest Wall Musculature

Regional Differences in Anatomy

Wisconsin

Page 15: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest Wall Musculature

Regional Differences in Anatomy

Page 16: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest Wall Musculature

Regional Differences in Anatomy

Las Vegas

Page 17: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest Wall Musculature

17

Page 18: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Chest - Skeleton

Page 19: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Lungs

Page 20: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Lobes

Right Upper Lobe

Right Lower Lobe

Right Middle Lobe

Page 21: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Lobes

Right Lung

Page 22: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Lobes

Left Upper Lobe

Left Lower Lobe

Right Lung Left Lung

Page 23: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Lung Segments

Apical

Segment

Anterior

Segment

Posterior

Segment

Right Upper Lobe

Page 24: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Thymus

Page 25: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Great Veins

Page 26: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Anatomy – Pericardial Sac

Page 27: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

The Pericardial Sac

27

Page 28: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

The Heart

28

Page 29: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

The Coronary Arteries

29

Page 30: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

The Aorta

Ascending Aorta

Aortic Root

Aortic Arch

Descending Aorta

Abdominal Aorta

Page 31: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Esophagus

Page 32: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

32

Page 33: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

The Heart in Action

Page 34: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Inside the Heart

34

Page 35: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Inside the Heart

35

Page 36: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Inside the Working Heart

Page 37: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Normal Valve Function

Page 38: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Normal Heart Valves

Page 39: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Normal Valve Function

Page 40: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Confusing CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

40

Page 41: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Disease

41

Page 42: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Atherosclerosis

Page 43: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Stenting

43

Page 44: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Stenting

44

Heart Surgery History

Page 45: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

History of Heart Surgery

"Any surgeon who would attempt an

operation of the heart should lose the

respect of his colleagues."

Theodor Billroth

Page 46: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Theodore Billroth

Page 47: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Dr. Daniel Hale Williams

47

Page 48: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

July 9, 1883

48

William Cornish

Page 49: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Dr. Daniel Hale Williams

49

Page 50: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Dr. Charles Mayo

50

Page 51: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

51

Page 52: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Bypass Grafting

Page 53: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Greater Saphenous Vein

53

Page 54: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Endoscopic Vein Harvest

54

Page 55: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Coronary Artery Bypass Grafting

Proximal Anastomosis

Distal Anastomosis

Page 56: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: End to Side Anastomosis

Page 57: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Sequential Vein Graft

57

Page 58: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Side to Side Anastomosis

58

Page 59: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: End to Side Anastomosis

Page 60: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Sequential Graft

60

Page 61: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG Options

• On Pump – Motionless Heart

• Off Pump – Beating Heart

• On Pump – Beating Heart

Page 62: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: On Pump

Page 63: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: Off Pump

Page 64: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: Off Pump

Page 65: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

CABG: On Pump – Beating Heart Options

Page 66: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Endarterectomy

66

http://www.youtube.com/watch?v=M0kW-

VcNAsU

Page 67: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Heart Valves

67

Page 68: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Normal Valve Function

Page 69: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Valve Stenosis

Page 70: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Leaky Heart Valves

Page 71: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Leaky Heart Valves

Page 72: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Heart Valve Surgery

72

• Replacement

• Repair

• Valvuloplasty

• Artificial chordae

• Annuloplasty

• Trans-Catheter Techniques

Page 73: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Median Sternotomy

73

Page 74: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Connecting to the Heart Lung Machine

74

Page 75: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Removing the Old Valve

75

Page 76: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Prosthetic Aortic Valve

76

Page 77: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Prosthetic Aortic Valve

77

Page 78: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Implanting the New Valve

78

Page 79: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Valve Repair

79

Page 80: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve - Normal

80

Page 81: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve - Leaflet Segment Prolapse

81

Page 82: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve Repair – Leaflet Segment Prolapse

82

Page 83: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve Repair– Resection of Leaflet Segment

83

Page 84: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve Repair – Resection of Leaflet Segment

84

Page 85: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve Repair - Valvuloplasty

85

Page 86: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Mitral Valve Repair - Annuloplasty

86

Page 87: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Artificial Chordae

87

Page 88: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Artificial Chordae

88

Page 89: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Artificial Chordae

89

Page 90: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

TAVR

90

Page 91: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Trans – Apical AVR

91

Page 92: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Trans – Catheter Repair for Mitral Regurgitation

92

Page 93: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Complex CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

93

Page 94: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

94

Page 95: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Importance of Beer in the History of Heart Surgery

95

Page 96: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

C. Walton Lillehei

96

Page 97: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

97

Child

Parent

Page 98: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Lyman and Gregory Glidden

98

Page 99: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

99

Page 100: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Importance of Beer in the History of Heart Surgery

100

Page 101: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

101

Page 102: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

102

Page 103: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Complex CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

103

Page 104: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

104

Page 105: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Aneurysm

105

Page 106: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Thoracic Aortic Aneurysms

106

Page 107: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Root Aneurysms

107

Page 108: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Removing the Old Valve

108

Page 109: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Composite Graft – Valved Conduit

109

Page 110: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Modified Bentall Procedure

110

ç

Page 111: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Modified Bentall Procedure

111

Page 112: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Replacement of Aortic Valve, Aortic Root and Ascending Aorta

112

Page 113: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Replacement of Ascending Aorta

113

Page 114: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Valve Sparing Replacement of Aortic Root Replacement

114

Page 115: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Valve Sparing Replacement of Aortic Root Replacement

115

Page 116: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Valve Sparing Replacement of Aortic Root Replacement

116

Page 117: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Valve Sparing Replacement of Aortic Root Replacement

117

Page 118: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Ascending Aortic Aneurysms

118

Page 119: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Replacement of Aortic Root and Ascending Aorta

119

Page 120: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Interposition Graft

120

Page 121: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Arch Aneurysm

121

Page 122: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Replacement of Aortic Arch

122

Page 123: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Ascending, + Arch + Descending Aortic Aneurysms

123

Page 124: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Elephant Trunk

124

Page 125: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Descending Thoracic Aortic Aneurysm

125

Page 126: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Descending Thoracic Aortic Aneurysm

126

Page 127: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

TEVAR

127

Page 128: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Dissection

128

Page 129: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Dissection

129

Page 130: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Case Scenario

130

Page 131: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Interposition Graft

131

Page 132: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Replacement of Aortic Root and Ascending Aorta

132

Page 133: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

133

Page 134: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Transection

134

Page 135: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Transection

135

Page 136: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Aortic Transection

136

Page 137: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Anatomy of the Chest

• Normal Heart Function

• Common Problems and Procedures

• Complex CT Surgical Procedures

• CT Surgery Coding – The Importance of Intent

Outline

137

Page 138: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Objective #5

Learn to Decipher the Surgeon’s Intent

– Surgical Procedures

Objectives

138

Page 139: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Deciphering the Surgeon’s Intent

139

► However, a diagnostic biopsy of a lung nodule using a wedge

technique requires only that a tissue sample be obtained without

particular attention to resections margins. A therapeutic wedge

resection requires attention to margins and complete resection

even when the wedge resection is ultimately followed by a more

extensive resection. In the case of a wedge resection where

intraoperative pathology consultation determines that a more

extensive resection is required in the same anatomic location, it

becomes classified as a diagnostic wedge resection (32507,

32668). When no more extensive resection is required, the same

procedure is a therapeutic wedge resection (32505, 32666).◄

Page 140: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

• Is the Intent of the Surgeon to Diagnose or to Treat?

– Case Scenarios

32507 and 32668 OR 32505 and 32666

140

Page 141: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

Questions

141

Page 142: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

142

Page 143: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

143

Page 144: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

144

Page 145: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

145

Page 146: AAPC 20th National Conferencestatic.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0... · 2013-03-20 · Aortic Dissection 128 . Aortic Dissection 129 . Case Scenario 130 . Interposition

146