Cardiovascular CPT Coding: Long Case & Scenario Review | AMCI Medical Coding Instruction Part II

[Music]

foreign

in this presentation we will discuss

steps to solving a medical coding exam

case study but first I want to introduce

you to the team first up Mr Sandeep

Mr Sandeep coming to you live from Abu

Dhabi he is an AMCI co-lead instructor

next up Miss Eva

coming to you live from the state of

Florida she's also a co-lead instructor

and the intern coordinator and finally

myself Mrs J I'm the curriculum director

at AMCI

now

let's meet the AMCI interns we have Miss

anubama

followed by

Miss Carla

Miss Courtney

Miss Dolly Miss Vivian and Miss Melissa

goals of the presentation we only have

one

cardios vascular system scenarios

now let's talk about how to solve a

multiple choice case study scenario the

AMCI way for the board exam this is how

we do it we teach you to highlight your

key terms and this key on the right

tells you the colors that you should use

and for what a yellow highlighter should

be used for diagnoses all diagnoses

signs and symptoms

the green will be for procedures so if

you have a green highlighter the green

will be used to highlight only

procedures and pink these are inclusive

or bundled items all right

once you've done your highlighting

you're going to have to document your

inventory that's your procedures

diagnoses and select a primary code

which diagnosis is primary which

procedure is primary then you're going

to review all pertinent guidelines

and finally the code that best matches

your inventory list is often the correct

code or a code that is pertinent to a

guideline that will be your best code

all right so here are some do Nots when

you're highlighting you can kind of get

discombobulated so we've compiled some

things that you don't even have to

highlight

number one don't highlight things

observed by The Physician because you

cannot code for them

number two

don't highlight closures if a provider

or surgeon is closing up a surgical site

there's no need to highlight it however

if it involves a skin procedure or skin

defect closure you may definitely have

to code that so if it's closing a

surgical site other than skin defects or

wounds or lesions

you do not code it or highlight it also

you don't highlight bleed control

hemostasis because that's pretty

customary and it's bundled into the

procedure code you don't highlight

drains irrigation of the surgical site

nope and you don't highlight

installation and removal of clamps and

trocars because that these are used to

open up or maintain the surgical or

operative site so the physician can view

what they're doing particularly if it's

an open procedure also you don't

highlight dressings and finally you do

not highlight surgical wrists now that

we've gotten that out of the way I think

you're ready to get started and I'm

going to hand it over to Mr Sandeep all

right Mr Sandeep take it away

I'm sure this is all your favorite

chapter

and to read out the first scenario I

would invite

Miss Jolly to come up this is Dolly

the stage is all yours

thank you Mr Sandeep and hi coders all

right so I will start off with the

question what CBT and icd-10-cm codes

are reported

a33465-33530-ta 2.6 xxa

i07.9 answer B 0 0 5 4 5 t t 82.6 x6a

i07.9 c

33460-33465-ta 2.6 xxa

i07.9 answer D

33465

t82.6 xxa is zero seven point nine

pre-operative diagnosis prosthetic valve

endocarditis post-operative diagnosis

same

operation re-replacement of a 10 year

old tricuspid valve using a 31

millimeter Carpentier Edwards

pericardial bioprosthesis

procedure

the patient was brought to the operating

room excuse me the patient was brought

to the operating room and having the

appropriate monitoring devices placed he

was intubated and general endotracheal

anesthesia was achieved the patient was

repaired and draped in the usual sterile

fashion the chest was entered via a

median sternotomy incision simultaneous

to this the right common femoral vein

was dissected the pericardium was opened

the patient was given systemic Heparin

and the ascending aorta and superior

vena cava were cannulated

similarly the right common femoral vein

was cannulated the patient was started

on bypass caval snares were replaced and

the right atrium was opened an

intraatrial thrombus excised and

cultured the prosthetic valve was

excised the annulus was debrided and

irrigated the valve was sized and a 31

millimeter valve was selected

budgeted 2-0 ethyl Bond sutures were

passed circumferentially around the

annulus in a ventricular atrial fashion

these Citrus were tied and the valve was

inspected the valve was found to be well

seated and the atrium was closed with

running for zero Proline sutures the

patient was rewarmed de-aired and then

weaned from bypass with low-dose

inotropic support

temporary drains were placed and the

mediastinum was policed for hemostasis

and the sternum reapproximated with

stainless steel wire

the thermal vein and groin wounds were

closed with layered vehicle Citrus the

patient was taken back to the cardiac

surgical unit in stable condition after

tolerating the procedure well

our coders you have two and a half

minutes and your time starts now

okay code is that was two minutes and 45

seconds I know this is a little bit big

scenarios

uh so you can keep working on this and

put your answers keep putting your

answers in the chat and I also want to

okay uh and I also want to uh tell you

that you can take a screenshot of these

scenarios because these uh sessions will

be only live sessions uh and uh no

recorded version will be available so uh

going ahead you can also solve them and

work on them uh later after the class so

please do take a screenshot if you need

to take

okay

yes now I will move on and solve the

case for you the pre-operative diagnosis

and the post-operated diagnosis for this

case is the same and it is going to be

prosthetic wealth endocarditis

operation performance replacement of a

10 year old

tricuspid valve

or the patient was intubated and

intratrical anesthesia was given and

incision was made in astronotomy

uh the right common femoral uh win was

dissected

the pericardium was opened ascending

Iota and superior vena cava were

calculated the right common femoral

brain was calculated and patient was

started on a bypass

the prosthetic wall was excised and the

valve sized and a 31 mm valve was

selected

and passed circumferentially around the

annulus so the correct answer to this

scenario is going to be option a

let me see how many of you have got okay

I think this is a great scenario to kick

start

the study session

and let's go and solve this one together

these are your inventories the procedure