Chapter 26 - CPT Medical Coding

Central Nervous System CNS
brain and spinal cord
Peripheral Nervous System PNS
12 cranial, 31 spinal nerves, divided into somatic, autonomic, and enteric nervous system
Somatic nerve
sensory or motor nerve
Autonomic nervous system
divided into sympathetic (responds to stress) and parasympathetic (constricts pupils, slows heartbeat dilates blood vessels, stimulates digestion)
Enteric nervous system
manages digestion; not under conscious control
largest part of brain
Cerebral hemispheres
paired halves of the cerebrum, each hemisphere is divided into 4 major lobes, frontal, parietal, occipital, temporal
posterior part of the brain that coordinates the voluntary muscle movements and maintains balance
Cerebral cortex
outer region of the cerebrum (gray matter)
groove in the surface of the cerebral cortex
Medulla oblongata
part of the brain located just above the spinal cord that controls breathing, heartbeat and blood vessel size
reservoirs in the interior of the brain filled with cerebrospinal fluid
Spinal cord
column of nerve tissue extending from medulla oblongata to 2nd lumbar vertebra
cauda equina
located at end of spinal cord, (group of nerve fibers below 2nd lumbar vertebra) carries all the nerves that affect the lower part and limbs and serves as the pathway for impulses going to and from brain
consists of 3 layers of connective membranes that surround the brain and spinal cord
1st outermost- dura mater
2nd layer- arachnoid membrane
3rd layer- pia mater
Neurological diseases of meninges
congenital, degenerative (movement and seizure), infectious, neoplastic, traumatic, vascular
Ventrical puncture
puncture through the top portion of skull
Cisternal puncture
approach at the base of the skull
that part of the skeleton that encloses the brain
entire skeletal framework of the head
a method of identifying a specific area or point in the brain
surgical excision of the lamina
Sympathetic nerve
part of the peripheral nervous sytem that controls automatic body function; activate under stress
divert or make an artifical passage
Puncture, Twists, or Burr Holes
deal with conditions that may require holes or openings be made into the brain to relieve pressure, insertion of monitoring devices, placement of tubing, injection of contrast material, or to drain a hemorrhage
Craniectomy/ Craniotomy
procedures that deal with incision into the skull with possible removal of a portion of the skull to open the operative site to the surgeon. Based on site and condition, many procedures are bundled. Additional grafting is reported seperately
Skull Base
area at base of cranium where the lobes of the brain rest. Procedures are divided on approach, definitive and reconstruction/ repair procedure
Aneurysm, Arteriovenous Malformation, or Vascular Disease
arteriovenous malformation is a condition in which the arteries and veins are not in the correct anatomical position, usually congenital. codes are divided on the basis of approach and method
Cerebrospinal Fluid Shunts CSF
drainage device, category describes all the various types of shunting procedures including placement and subsequent repair, replacement, and removal.
Spine and Spinal Cord
includes codes for injections, laminectomies, excisions, repairs, and shunting, based on condition and approach
lumbar puncture
spinal tap obtains cerebrospinal fluid by insertion of a needle into the subarachnoid space in the lumbar region
neurolytic agent
chemical denervation (alcohol or glycerol injection) radiofrequency (passes a current through an electrode) cryogenic surgery (inserting a probe into tissue with fluoroscopy guidance and freezing a region of tissue)
Extracranial Nerves, Peripheral Nerves, and Autonomic Nerves
common procedure: injection, destruction, decompression, and suture/repair. code assigned according to type of nerve being injected for nerve block introduction/injection of anesthetic agent
Trigeminal nerve
5th cranial nerve, sensory nerve that supplies the face, teeth, mouth and nasal cavity, and motor nerve that supplies the muscles of mastication (chewing)
Facial nerve
7th cranial nerve, consists of large motor root (supplies muscles of facial expression) and smaller root (nervus intermendius) that contains the sensory and parasympathetic fibers of the facial nerve
Greater occipital nerve
spinal nerve orginating from the cervical spinal nerve C2, supplies stimuli to the scalp, over the ears, and the parotid gland
Vagus nerve
10th cranial nerve, supplies sensory fibers to the ear, tongue, pharynx, and larynx and motor fibers to the pharnx, larynx, and esophagus
Phrenic nerve
affects the pleura, pericardium, diaphragm, peritoneum, and sympathetic plexus
Cervical plexus
plexus in the posterior cervical region that is formed by the dorsal rami of the first three or four cervical spinal nerves
Axillary nerve
originates from the brachial plexus at th axilla (armpit) sensory information from the shoulder joint and the inferior region of the deltoid muscle
Suprascapular nerve
orgin in the brachial plexus at the C5-C6 level that descends through suprascapular and spineiglenoid notches and supplies acromioclavicular and shoulder joints and supraspinatus muscles
orginates in the sacral plexus at the S2-S4 and sometimes S5, divides into the perineal nerve and the dorsal nerve of the penis distributed to the muscles, skin, and erectile tissue of perineum
decompression (freeing) of intact nerves, most common procedure is carpal tunnel release (median nerve and the transverse carpal ligament of the wrist are surgically released
Thyroid Gland
Composed of a right and left lobe on either side of the trachea; secretes 80% T4 and 20% T3
Parathyroid Glands
Four small oval bodies located on the dorsal aspect of the thyroid gland
Adrenal Glands
Two small glands situated one on top of each kidney (suprarenal)
Thymus Gland
Located behind the breast bone, head of the organ is attached to the duodenum
Carotid Body
Tissue rich in capillaries that act as receptors located near the bifurcation of the carotid arteries
Ductless glands; secrete hormones directly into the bloodstream
Send their chemical substances into ducts and then out of the body; sweat, mammary, mucous, salivary and lacrimal