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CHAPTER 18

HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM

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Hemic and Lymphatic Systems Subsection (Excision, Repair, Introduction)

Divisions

Spleen

General

Lymph Nodes and Lymphatic Channels (Figure 18.1 in text)

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This subsection is divided into subheadings of Spleen, General, and Lymph Nodes/Lymphatic Channels.

Further division is based on type of procedure, such as excision, incision, or repair.

Where are the codes for spleen and lymph nodes located in the CPT manual Index? (Under main terms, spleen, lymph nodes, and bone marrow)

Spleen (38100-38200) (1 of 2)

Spleen easily ruptured, causes massive hemorrhage

May require splenectomy

Splenectomy: total or partial

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Codes for spleen are further divided into excision, repair, laparoscopy, and introduction.

Why can a person live without a spleen? (The bone marrow, liver, and lymph nodes take over the work of the spleen.)

Spleen (38100-38200) (2 of 2)

Often done as part of more major procedure

Bundled into major procedure

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Splenectomy carries the designation “(separate procedure)”; if the splenectomy is an integral part of another procedure, it is bundled into the main procedure code and is not reported separately.

General (38204-38243) (1 of 2)

Codes divided based on

Aspiration

Biopsy

Harvesting

Transplantation/Infusion

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What is a bone marrow needle aspiration? What is its code? (When a sample of bone marrow is withdrawn by a needle from the marrow cavity, 38220)

What is involved in a bone marrow biopsy? What is the code for this procedure? (Small pieces of marrow are withdrawn and the lab dissolves these in a solution. Then the substance is analyzed, 38221.)

What is bone marrow harvesting? What is the code for this procedure? (A larger amount of marrow is aspirated from a donor, 38230)

How is bone marrow transplanted? What is the code for this procedure? (Taken from donor and injected into the recipient, 38240-38243)

General (38204-38243) (2 of 2)

Types of cells:

Allogenic: Close relative

Autologous: Patient’s own

Hematopoietic progenitor cells (HPC)

Bone marrow

Peripheral blood apheresis

Umbilical cord blood

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Autologous cells are collected from the patient and reinfused later into the same patient.

Why would it be advantageous to collect stem cells from a close relative? (Because there is genetic similarity)

What are the codes for the harvesting and return of blood to the donor? (38205-38206)

Lymph Nodes and Lymphatic Channels (38300-38999) (1 of 3)

Two types of lymphadenectomies:

Limited: Lymph nodes only

Radical: Lymph nodes, submandibular gland, and surrounding tissue

Term “complete” same as radical neck dissection

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What is the purpose of the lymphatic system? (To transport fluids, proteins, and fats through the lymphatic channels back to the blood stream)

A limited lymphadenectomy, reported with codes 38562-38564, consists of removal of only the lymph nodes.

A radical lymphadenectomy, reported with codes 38700-38780, involves removal of the lymph nodes, glands, and surrounding tissue.

Submental and submandibular nodes, chin area and below mandible

Upper jugular nodes, at mandibular angle in front of sternocleidomastoid muscle

Middle jugular nodes, between hyoid bone and cricoid cartilage

Lower jugular nodes, between cricoid cartilage and clavicle

Posterior triangle nodes divided into groups

Upper visceral nodes, by the hyoid bone

Superior mediastinal nodes, between common carotid arteries

38700, 38720—are unilateral codes

Lymph Nodes and Lymphatic Channels (38300-38999) (2 of 3)

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“Modified” radical neck: removal of all lymph nodes routinely removed by radical neck dissection, while preserving the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscles (38724)

This is a unilateral procedure

Lymph Nodes and Lymphatic Channels (38300-38999) (3 of 3)

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Lymphadenectomies

Often bundled into more major procedure (e.g., prostatectomy)

Do not unbundle and report lymphadenectomy separately

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A limited lymphadenectomy may be bundled into a more major procedure; when this occurs, only the major procedure is reported.

What codes reflect whether the procedure was superficial or deep? (Superficial code is 38500 and deep codes are 38510-38525, and internal mammary code is 38530.)

Mediastinum (39000-39499) (1 of 2)

Area between lungs

Figure 18.3

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What is the mediastinum? (The area between the lungs)

Where does the Mediastinum and Diaphragm subsection fall in the CPT book? (Directly after the cardiology subsection)

Mediastinum (39000-39499) (2 of 2)

Assigned by approach

Incision codes for foreign body removal or biopsy

Excision codes for removal of cyst or tumor

Endoscopy

Repair

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The Mediastinum subheading is divided by procedures and includes incision, excision, and endoscopy categories.

Procedures are reported with use of the codes 39000-39499.

Codes are based on the surgical approach taken to perform the mediastinotomy—either cervical (neck area) or across the thoracic area or sternum.

What primary distinction is made in the excision codes that are listed under the Mediastinum subheading? (The excision codes vary according to whether a tumor or a cyst was excised.)

Diaphragm (39501-39561)

Only category: Repair

Most codes for hernia or laceration repairs

Codes indexed in CPT manual under “Diaphragm”

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Where is the diaphragm located? (The diaphragm is the wall of muscle that separates the thoracic and abdominal cavities.)

Only 1 category under Diaphragm subheading, Repair.

Repairs consist of lacerations and hernias.

How are the hernias of the diaphragm divided out? (Type of hernia, age of patient [neonate or other than neonate], and approach [transthoracic or combined thoracoabdominal])

ConclusionCHAPTER 18

HEMIC, LYMPHATIC, MEDIASTINUM, AND DIAPHRAGM

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