3 Series Class Notes Need To Take

3 Series Respiratory System
1. Which is carrying o2 blood from lungs to heart?

Answer: pulmonary vein
2. Which is carrying Do2 blood from heart to lungs?

Answer: pulmonary artery
3. Bicuspid valve situated in which location?

Answer: between LA to LV
4. Which chamber is having most muscular, largest, strongest chamber in heart?

Answer: left ventricle
{Because this chamber is pumping blood to all over the body that’s why it is situated like that?}
Upper respiratory parts?
URT composed of the nose, the pharynx, and the larynx the organs of the upper respiratory that
are located outside the chest cavity.
 Nasal cavity – inside the nose, the sticky mucous membrane ling the nasal cavity traps dust
particles, and tiny hairs called cilia help move them to the nose to be sneezed or blown out
 Sinuses - these air filled spaces alongside the nose help make the skull lighter
 Pharynx – both food and air pass through the pharynx before reaching their appropriate
destinations. The pharynx also plays a role in speech
 Larynx – the larynx is essential to human speech
Lower respiratory tract parts?

LRT composed of the trachea, the lungs and all segments of the bronchial tree (including alveoli)
the organs of the lower respiratory tract are located the chest cavity
 Trachea – located just below the larynx the trachea is the main airway to the lungs
 Lungs - together the lungs from one of the body’s largest organs they’ve responsible for
providing oxygen to capillaries and exhaling cabondioxide
 Bronchi – the bronchi from the trachea into each lungs and create the network of intricate
passages that supply the lungs with air
 Diaphragm – the diaphragm is the main respiratory muscle that contracts and relaxes to allow
air into the lungs
CABG: (Coronary Artery Bypass Grafting)
Coding points:
 Identify whether an artery, vein or both are being used as bypass graft
 How many grafts being done
Harvesting Guidelines:
 Harvesting of saphenous veins is included in veins procedure. Whereas some other vein should
be separately coded.
Some other vein
Any upper extremity vein open – 35500

Endoscopic – 33508
Femoral popliteal vein segment – 35572
Harvesting guidelines
Harvesting of all artery included in artery procedure except upper extremity artery (e.g.) (radial or ulna
artery)
Upper extremity artery code = 35600
1. MD performing CABG x 3 with saphenous vein
2. CABG x 3 with femora popliteal vein segment?
3. CABG x 3, Harvested from ulna artery?
Q4. CABG x 5, first 2 is harvested from radial artery, another 3 is harvested from endoscopic vein?
Q5. CABGx6 harvested from
 Upper extremity vein open

 Endoscopic vein
 Femora popliteal vein segment
 Radial artery
 LIMA
 Saphenous vein
CVIR (Cardio Vascular Interventional Radiology)
 Cardio vascular procedures performed with the help of radiological guidance

 Catheters inserted in arteries for treatment purpose
Non- selective catheterization
Catheter inserted into main stream of artery
Selective catheterization
Catheter inserted into branches of specific artery
CVIR = 362XX (category) for 4 & 5th digit we have some guidelines
4th digit BASED ON catheter entry site
If above abdomen 4th digit is 1
If below abdomen 4th digit is 4

5th digit is based on coder
1st order: 5
2nd order: 6
3rd or more order = 7
1. RT MIDDLE CEREBRAL ARTERY
2. COMMON HEPATIC ARTERY
CVAP (Central Venus Access Procedure)
 Catheter inserted into vein for treatment purpose
Central 36555 to 36566 Peripheral 36568-36573
Jugular Basilic
Subclavian Cephalic
Femoral vein
Inferior vena cava
1. First cheek the procedure is done centrally or peripherally

2. Cheek whether the procedure is performed with tunnel or without tunnel
{Tunnel – it is the soft tube before the procedure they will insert that tunnel and with that they
will insert catheter}
3. Check whether the procedure is performed with port pump or without port pump
4. Check the age of the patient
Example:
1. Patient is 4 year old patient came to ED for respiratory failure physician performed catheter into
femoral vein for treatment purpose?
Answer:
2. Catheter inserted into basilic vein with US guidance for 10 year old patient.
Pacemaker (Cardiovascular System)
Pacemaker & Defibrillator

A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart
rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are
used to treat arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat.
Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the
heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow
or too fast. Defibrillators can also restore the heart's beating if the heart suddenly stops
Pacemaker – SA node – natural pacemaker

Pacemaker consist 2 components
Pulse generator (batteries)
Electrodes / leads / wires
Pulse generator are placed in a “subcutaneous pocket” created in either a subclavicular site or
underneath abdominal muscles joints below the ribcage.
Electrodes may be inserted through a vein – Trans venous or they may be placed on the surface of the
heart – epicardial. The epicardial location of the electrodes requires a thoracotomy for electrode
insertion.
Wire specifically y inserted into the vein of the heart.
Types of pacemaker:
1. Single chamber pacemaker: includes a pulse generator and one electrode inserted in either the
atrium or ventricle
2. Dual chamber pacemaker: pulse generator + one electrode inserted in the right atrium and one
electrode inserted in the right ventricle.
3. Bi ventricular pacemaker: pulse generator + electrode inserted into right & left ventricle.
4. Multiple chamber pacemaker: pulse generator + electrodes inserted into right & left atrium and
right or left ventricle
Coding points:
1. Types of pacemaker
2. Electrodes insertion method
a. Epicardial method
b. Trans-venous/Intravenous
3. Pacemaker is permanent or temporary
Default: PERMANENT
4. Methods:
Placement
Removal
Replacement
Example:
1. Removal and replacement of dual chamber pacemaker via transvenous
2. Removal of battery from pacemaker
3. Removal of single wire from single chamber pacemaker by transvenous
4. Pulse generator placed into exiting multiple leads cardiac defibrillator
5. Removal and replacement of dual chamber cardiac defibrillator via transvenous
Epistaxis (nose bleeding)
Anterior Posterior
Simple -> 30901 Initial -> 30905
Complex -> 30903 Subsequent -> 30906

Coding points:
First we have to check anterior or posterior
Anterior
When blood flows out from the front of the nose with the patient in sitting position
Posterior
Bleed from the nose lacrimal duct mainly blood flows back into throat
Simple – Silver nitrate applying, afrin spray
Complex – Packing with nasal balloon, rhino rocket, Vaseline gauze, wick placement
Common questions:
1. Nasal endoscopy surgical with repair of CSF leakage in ethmoid region?

2. Nasal endoscopy surgical with repair of CSF leakage in sphenoid region?
3. Mediastinoscopy with lymph node biopsy?
4. Mediastinoscopy with lymphoma node biopsy?
5. ECMO insertion four years old through percutaneous?
6. Bronchoscopy Trans bronchial lung biopsies (3biopsy)
7. VATS single lobectomy right upper lobe?
8. VATS bilobectomy right lung?
9. VATS bilobectomy left lung?
10. Laryngoscopy with excision of tumor & stripping of vocal card?

3 Series Class Notes Need To Take

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3 Series Class Notes Need To Take

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3 Series Respiratory System

1. Which is carrying o2 blood from lungs to heart?

2. Which is carrying Do2 blood from heart to lungs?

3. Bicuspid valve situated in which location?

4. Which chamber is having most muscular, largest, strongest chamber in heart?

Upper respiratory parts?

Lower respiratory tract parts?

CABG: (Coronary Artery Bypass Grafting)

Any upper extremity vein open – 35500

Upper extremity artery code = 35600

1. MD performing CABG x 3 with saphenous vein

2. CABG x 3 with femora popliteal vein segment?

3. CABG x 3, Harvested from ulna artery?

Q5. CABGx6 harvested from

 Upper extremity vein open

CVIR (Cardio Vascular Interventional Radiology)

 Cardio vascular procedures performed with the help of radiological guidance

Non- selective catheterization

Catheter inserted into main stream of artery

Catheter inserted into branches of specific artery

4th digit BASED ON catheter entry site

If above abdomen 4th digit is 1

If below abdomen 4th digit is 4

3rd or more order = 7

1. RT MIDDLE CEREBRAL ARTERY

2. COMMON HEPATIC ARTERY

CVAP (Central Venus Access Procedure)

 Catheter inserted into vein for treatment purpose

Central 36555 to 36566 Peripheral 36568-36573

1. First cheek the procedure is done centrally or peripherally

4. Check the age of the patient

Pacemaker & Defibrillator

Pacemaker – SA node – natural pacemaker

2. Removal of battery from pacemaker

3. Removal of single wire from single chamber pacemaker by transvenous

4. Pulse generator placed into exiting multiple leads cardiac defibrillator

5. Removal and replacement of dual chamber cardiac defibrillator via transvenous

Epistaxis (nose bleeding)

Simple -> 30901 Initial -> 30905

Complex -> 30903 Subsequent -> 30906

First we have to check anterior or posterior

Simple – Silver nitrate applying, afrin spray

1. Nasal endoscopy surgical with repair of CSF leakage in ethmoid region?

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