cerebrovascular disease - ministry of public health ix i60-i69 cerebrovascular diseases...

Chapter IX I60-I69 Cerebrovascular Diseases

นพ.บก เจญล

กมงานลยกรรม รพ.สวรรประชาก นครสวรร

1

Cerebrovascular Accident / Stroke

Cerebral Infarction

Intracerebral Hemorrhage

Subarachnoid Hemorrhage

Old of Cerebrovasvular Disease

Cerebrovascular Disease

2


3

Cerebrovascular Accident / StrokeClinical classification

Transient Ischemic Attack (TIA)

acute focal neurological deficit resulting from CVD with resolution

of signs and symptoms within 24 hours

Reversible Ischemic Neurological Deficit (RIND)

attack lasting longer than 24 hours but with complete clearance of signs

and symptoms within 7 days

Completed Stroke

neurological deficit lasts longer than 7 days

Ischemic Stroke ~84% of CVA

4


Summary Diagnosis ICD-10

No Imaging

Stroke

Cerebrovascular accident / CVA

!

I64

I64

Clinical Diagnosis

TIA

RIND

!

G45.9

I63.9

5


Thrombotic stroke หลอดเอดสมองบ

Embolic stroke หลอดเอดสมองดน

Hemorrhagic stroke หลอดเอดสมองแตก

Pathological classification

6

Ischemic StrokeObstruction of an artery leading to or in the brain

Thrombotic stroke (50%)

blood clot within blood vessel of

the brain and neck

: Large vessel thrombosis 30%

: Small vessel disease 20%

(Lacunar infarction)

: Hypercoagulable disorders

Embolic stroke (30%)

blood clot or other material carried to

the brain from another part of the body

: Atrial fibrillation (cardiac emboli)

: Myocardial infarction

: Bacterial endocarditis

7

Cerebral Infarction

I63 Cerebral infarction Includes: occlusion and stenosis of cerebral and precerebral

arteries, resulting in cerebral infarction

Excludes: sequelae of cerebral infarction ( I69.3 )

I63.0 Cerebral infarction due to thrombosis of precerebral arteries

I63.1 Cerebral infarction due to embolism of precerebral arteries

I63.2 Cerebral infarction due to unspecified occlusion or stenosis

of precerebral arteries

I63.3 Cerebral infarction due to thrombosis of cerebral arteries

I63.4 Cerebral infarction due to embolism of cerebral arteries

I63.5 Cerebral infarction due to unspecified occlusion or stenosis

of cerebral arteries

I63.6 Cerebral infarction due to cerebral venous thrombosis,

nonpyogenic

I63.8 Other cerebral infarction

I63.9 Cerebral infarction, unspecified

I64 Stroke, not specified as haemorrha e or infarction

Cerebral thrombosis vs. Cerebral embolism

8

Cerebral Artery

ACA MCA PCA

9

Cerebral Infarction

10

Cerebral Artery Stroke SyndromeInternal Carotid Artery Symptoms

Anterior Cerebral Artery • Loss of discriminatory sensation and weakness or

paralysis of the contralateral foot and leg, perhaps with

some deficits in the contralateral shoulder and arm

• Occasionally, deviation of the head and eyes toward the

side of the affected cerebral artery

• Occasionally, central motor problems, ranging from

expressive aphasia to dyskinesia

Middle Cerebral Artery • Full sensory loss and weakness or paralysis of the face,

arm, and leg on there opposite side to the body

• Blindness in the opposite visual field

• Deviation of the head and eyes toward the side of the side

of the affected MCA

• If the dominant MCA had been occluded, global aphasia

• If the nondominat MCA had been occluded, contralateral

neglect or anosognosia

11

Cerebral Artery Stroke SyndromeInternal Carotid Artery Symptoms

Posterior Cerebral Artery • Sensory loss on the entire contralateral body; here, when

sensation gradually returns, it is frequently accompanied

by pain

• CN VII palsy, which may also be associated with

hemiparesis, hemiplegia, ataxia, or decreased levels of

consciousness

• Movement disorders on one side of the body, such as

hemiballismus, hemichoreathetosis, or hemiataxia

• Visual loss, specially, homonymous hemianopia

• Dyslexia

12

Precerebral Artery

Basilar artery

Carotid artery

Vertebral artery

13

Precerebral Artery Stroke Syndrome

Internal Carotid Artery Symptoms

Vertebral Artery • Vertigo, nystagmus, vomiting, ipsilateral atzxia, and

hypoglossal nerve dysfunction

Basilar Artery • Bilateral neurological problems, such as bilateral sensory

and motor deficits

• Combined cerebellar and cranial nerve problems

• When the stroke affects the medulla, stupor, coma, or a

quadriplegic, mute, but conscious condition

• Hemiparesis with contralateral cranial nerve dysfunction

or with ipsilateral ataxia

Internal Carotid Artery • Amaurosis fugux

• Watershed infarctions

• MCA?ACA - either alone or in combinations

14

Vertebral Artery Stroke SyndromeInternal Carotid Artery Symptoms

Wallenberg’s syndrome

[Lateral Medullary]

• Ipsilateral ataxia, Horner’s syndrome, reduce corneal

reflex, nystagmus, hypacusis, dysarthria, dysphagia,

paralysis of palate-pharynx-vocal cord, loss of taste in

posterior 1/3

• Contralateral loss of pain and temperaturesesation in

there trunk and limb, tachycardia, dyspnea, palatal

myoclonus

Dejerine’s syndrome

[Medial Medullary]

• Ipsilateral tongue paresis with deviation to the side of the

lesion

• Contralateral hemiplegia with facial sparing

• Ipsilateral loss of vibration and proprioception

Foville’s syndrome • Ipsilateral paresis of the whole face

• Loss of ipsilateral horizontal gaze

• Contralateral hemiplegia with facial sparing

Millard-Gubler

syndrome

• Diplopia with facial paresis

• Contralateral hemiparesis

15

Vertebral Artery Stroke SyndromeInternal Carotid Artery Symptoms

Weber’s syndrome • Ipsilateral mydriasis, CN III palsy and ptosis

• Contralateral hemiplegia

Benedikt’s syndrome • Ipsilateral oculomotor effect as inWeber’s syndrome

• Contralateral tremor, ataxia or chorea

Reymond-Cestan

syndrome

• Ipsilateral ataxia and tremor

• Weakness of mastication

• Contralateral loss of sensory modalities

• May involve facial weakness and hemiparesis

Locked-in syndrome • Quadriplegia with preserved consciousness

One-and-a-half

syndrome

• Ipsilateral conjugate gaze palsy and internuclear

ophthalmoplegia

• Inability to move the ipsilateral eye and only abduct the

contralateral eye with nystagmus

16

Cerebral Vein Thrombosis

17

Cerebral Infarction


Cerebral infarction due to precerebral artery

Vertebral artery, Basilar artery, Carotid artery

Thrombosis of precerebral artery

Embolism of precerebral artery

Unspecified stenosis of precerebral artery

!

!

I63.0

I63.1

I63.2

Cerebral infarction due to cerebral artery

Anterior/Middle/Posterior Cerebral artery, Cerebellar artery

Thrombosis of cerebral artery

Embolism of cerebral artery

Unspecified

!

!

I63.3

I63.4

I63.5

Cerebral infarction due to venous thrombosis I63.6

18

All of these are I63.9 in ICD-10-CM

๏ Acute ischemic stroke ๏ Acute thrombotic stroke ๏ Basal ganglion infarction ๏ Brain stem infarction ๏ Cerebellar infarction ๏ Cerebellar stroke syndrome ๏ Cerebrovascular accident ๏ Ischemic stroke ๏ Lacunar infarction ๏ Reversible ischemic neurologic deficit (RIND) ๏ Thalamic infarction ๏ Thrombotic stroke

19

Cerebral Infarction

อาการและอาการแสดงเาไบโรคหลอดเอดสมองบ/ดน

การตรวจสมองเอกซเรคอมวเตอ หอคนสนามแเหก

ผลตรวจอาจปกไ

Focal necrosis due to complete and prolonged ischemia of brain

WARNING ๏ Acute ischemic stroke

๏ Ischemic stroke

๏ Lacunar infarction

๏ MCA infarction

MEANING …….. I64 Stroke

…….. I64 Stroke

…….. I63.9 Cerebral infarction

…….. no code

20

Intracranial Hemorrhage

A-deep cerebral, B-basal ganglia, C-thalamus, D-pons, E-cerebellum

21

Intracranial HemorrhageHemorrhagic stroke

Intraparenchymal hemorrhage

: Intracerebral hemorrhage

: Basal ganglion hemorrhage

: Lobar hemorrhage

: Pontine hemorrhage

: Cerebellar hemorrhage

Intraventricular hemorrhage

Extra-axial hemorrhage

: Epidural hemorrhage

: Subdural hemorrhage

: Subarachnoid hemorrhage

22

Intracerebral Hemorrhage

I61 Intracerebral haemorrhage Excludes: sequelae of intracerebral haemorrhage ( I69.1 )

I61.0 Intracerebral haemorrhage in hemisphere, subcortical

Deep intracerebral haemorrhage

I61.1 Intracerebral haemorrhage in hemisphere, cortical

Cerebral lobe haemorrhage

Superficial intracerebral haemorrhage

I61.2 Intracerebral haemorrhage in hemisphere, unspecified

I61.3 Intracerebral haemorrhage in brain stem

I61.4 Intracerebral haemorrhage in cerebellum

I61.5 Intracerebral haemorrhage, intraventricular

I61.6 Intracerebral haemorrhage, multiple localized

I61.8 Other intracerebral haemorrhage

I61.9 Intracerebral haemorrhage, unspecified

I62 Other nontraumatic intracranial haemorrhage

23

Intracranial Hemorrhage


Intracerebral hemorrhage

Basal ganglion hemorrhage

Internal capsule hemorrhage

Brain stem hemorrhage

Cerebral lobar hemorrhage

Cerebellar hemorrhage

Posterior fossa hemorrhage

Multiple intracerebral hemorrhage

I61.2

I61.0

I61.0

I61.3

I61.1

I61.4

I61.8

I61.6

Deep intracerebral hemorrhage [subcortical]

Superficial intracerebral hemorrhage [cortical]

I61.0

I61.1

24

Comorbidity of StrokeComplication of intracranial haemorrhage

Brain herniation

Brain edema

Hydrocephalus

Acute respiratory failure

25

Stroke


Intraventricular hemorrhage

Brain herniation

Brain edema

Hydrocephalus

I61.5

G93.5

G93.6

G91.-

Complication of intracranial haemorrhage

26

Hemorrhagic TransformationHemorrhagic transformation of cerebral infarct

15–20% of MCA occlusions

: Petechial hemorrhage

: Secondary hematoma

Reperfusion of infarcted tissues which have weakened tissue

After stroke onset by 48–72 hours

Common location

: Basal ganglia

: Cortex

27

Old Cerebrovascular Accident

วยประโรคหลอดเอดสมอง (CVA) — Old CVA

กรตรวจางกายพบความดปกทางระบบประสาทหลงเหออ

เดนอางอย 1 หอนบอาการและญหานเยวองบ

โรคเมหลงเหออ

ในกา Sequelae of …………

กรไความดปกทางระบบประสาทหลงเหอ (ปกกอาง)

ในกา Personal history of ………… [แอยากบอกคนน]

Sequelae vs. Personal history

28

Sequelae of Stroke

I69 Sequelae of cerebrovascular disease Note: Category I69 is to be used to indicate previous episodes

of conditions in I60-I67.1 and I67.4-I67.9 as the cause of

sequelae, themselves classified elsewhere.

The "sequelae" include conditions specified as such or as

late effects, or those present one year or more after onset

of the causal condition.

Not to be used for chronic cerebrovascular disease. Code

these to I60-I67.

I69.0 Sequelae of subarachnoid haemorrhage

I69.1 Sequelae of intracerebral haemorrhage

I69.2 Sequelae of other nontraumatic intracranial haemorrhage

I69.3 Sequelae of cerebral infarction

I69.4 Sequelae of stroke, not specified as haemorrhage or infarction

I69.8 Sequelae of other and unspecified cerebrovascular diseases

Diseases of arteries, arterioles and capillaries

--

Late effects, Present one year or more after onset

29

“มหมอนนอนเอ”

“Confined to bed because of illness, especially for a long period”

ขภาพเอมโทรมองนอนอในเยงตลอดเวลา อาจขบว

ไเกอย วยเหอตนเองอางนๆ ไไ โดยงการกวปก

หอไกวไ

เดจากโรค จากเห จากการาดให จากย

ICD-10 แงเน 2 ปแบบ

: อาน (Bedridden status)

: ใการพยาบาลในสถานพยาบาล (Care for bedridden status)

Bedridden

30

Bedridden

“Confined to bed because of illness, especially for a long period”

“มหมอนนอนเอ”

31

Bedridden

R26.3 Immobility-

Bedfast

Chairfast

R26.8 Other and unspecified

(Z99.-)

Z74.0 Need for assistance due to reduced mobility

Z74.1 Need for assistance with personal care


Bedridden status

Care for bedridden status

R26.3

Z74.0

32

Stroke


Flaccid hemiplegia / Flaccid hemiparesis

Hemiplegia / Hemiparesis

Flaccid paraplegia / Flaccid paraparesis

Paraplegia / Paraparesis

Flaccid quadriplegia / Flaccid quadriparesis

Quadriplegia / Quadriparesis

Flaccid monoplegia / Flaccid monoparesis

G81.0

G81.9

G82.0

G82.2

G82.3

G82.5

G83.-

Dysarthria

Dysphagia

R47.0

R13

Complication of intracranial haemorrhage

33


34


400 WHO’s ICD-10

I60 Subarachnoid haemorrhage Includes: ruptured cerebral aneurysm

Excludes: sequelae of subarachnoid haemorrhage ( I69.0 )

I60.0 Subarachnoid haemorrhage from carotid siphon and

bifurcation

I60.1 Subarachnoid haemorrhage from middle cerebral artery

I60.2 Subarachnoid haemorrhage from anterior communicating

artery

I60.3 Subarachnoid haemorrhage from posterior communicating

artery I60.4 Subarachnoid haemorrhage from basilar artery

I60.5 Subarachnoid haemorrhage from vertebral artery

I60.6 Subarachnoid haemorrhage from other intracranial arteries

Multiple involvement of intracranial arteries

I60.7 Subarachnoid haemorrhage from intracranial artery,

unspecified

35


I60 Subarachnoid haemorrhage Includes: ruptured cerebral aneurysm

Excludes: sequelae of subarachnoid haemorrhage ( I69.0 )

I60.0 Subarachnoid haemorrhage from carotid siphon and

bifurcation

Multiple involvement of intracranial arteries

I60.7 Subarachnoid haemorrhage from intracranial artery,

unspecified

Ruptured (congenital) berry aneurysm NOS

Subarachnoid haemorrhage from:

· cerebral

· communicating } artery NOS

I60.8 Other subarachnoid haemorrhage

Meningeal haemorrhage

Rupture of cerebral arteriovenous malformation

I60.9 Subarachnoid haemorrhage, unspecified

Ruptured (congenital) cerebral aneurysm NOS

I61 Intracerebral haemorrhage

36

Chapter IX I70-I89 Diseases of Artery, Vein, Lymphatic

นพ.บก เจญล

กมงานลยกรรม รพ.สวรรประชาก นครสวรร

37

Disease of Arteries

Peripheral Vascular Disease

Critical Limb Ischemia

Acute Vascular Occlusion

Buerger’s Disease

Raynaud’s Phenomenon

!

38


Peripheral vascular disease / PVD

Peripheral arterial disease / PAD

Peripheral arterial occlusive disease / PAOD

โรคหลอดเอดแดงเยงขาดน

: Atherosclerotic vascular disease

: Thromboembolism

: Arteritis [Buerger’s disease]

: Non-atherosclerotic vascular disease [Raynaud’s phenomenon]

39

Atherosclerosis

โรคหลอดเอดแดงแง เนโรคเองเดจากผงหลอดเอด

หนาวนจากไขนสะสมผงหลอดเอด (atherosclerotic plaque)

เอหลอดเอดบลงำใเอดไหลเยนไไพอ เนผลำใ

เดอาการของการขาดเอดเอง (chronic limb ischemia)

เอเอดไหลานบแคบลงเนเหเอดไหลเยนวนรวดเว

ไปกระแทกำใผงหลอดเอดและแนนนแตกออกเดเน

อนมเอด (thromboembolism) หดไปดหลอดเอดเนผลใ

เดการขาดเอดเยบพนของแขนขาน (acute limb ischemia)

40

Atherosclerosis

โรคหลอดเอดแดงแงเนสาเหหกของการดนหลอดเอด

ของขาในวยอามากกา 40

อาการของการขาดเอดเอง (Chronic limb ischemia)

: Intermittent claudication อาการเอออกแรง จะนเอไก

: Rest pain อาการแในขณะก

: Tissue loss แผลไหายหอเอตาย

“Chronic arterial occlusion”

อาการของการขาดเอดเยบพน (Acute limb ischemia)

: 5P’s [Pain, Pallor, Pulseless, Paralysis, Paresthesia]

“Acute arterial occlusion”

41

Atherosclerosis

(I70-I79)

I70 Atherosclerosis Includes: arteriolosclerosis

arteriosclerosis

arteriosclerotic vascular disease

atheroma

degeneration:

· arterial

· arteriovascular

· vascular

endarteritis deformans or obliterans

senile:

· arteritis

· endarteritis

The following supplementary classification to indicate the

presence or absence of gangrene is provided for optional use.

0 without gangrene-

1 with gangrene-

Excludes: cerebral ( I67.2 )

coronary ( I25.1 )

mesenteric ( K55.1 )

pulmonary ( I27.0 )

I70.0 Atherosclerosis of aorta

42

Atherosclerosis

I70.20 I70.20 I70.20 I70.21

43

Buerger’s Disease

Thromboangiitis obliterans (TAO): Leo Buerger (1879)

เนการกเสบของผงหลอดเอดแดงขนาดเกและขนาดกลาง

หลอดเอดำและเนประสาทของแขนขา

กพบในชายอาอยกา 45–50 ประบหด [จน

พบในเพศหงอยน]

เมวยอเาอาการเนและปวด ตามวยปวดแสบปวดอน

ปลายอปลายเา แผลวอวเาและกลายเนำ

Buerger’s disease

ในป¡ ค.ศ. ได›อธบายรายละเอยดทางพยาธสภาพของโรคหรอ Buerger’s disease นว‹าเป‰นการอกเสบของหลอดเลอดซงเกดขนกบหลอดเลอดแดงขนาดเลกและขนาด

กลาง หลอดเลอดดาและเส›นประสาทบรเวณแขนและขาตามมาด›วยการตบแคบ มลกษณะแบบ “presenile ” จะมลกษณะเฉพาะสาคญทแตกต‹างจาก อน

ประวตความเป‰นมา

สาเหตทแท›จรงของโรค Buerger’s disease หรอ ยงไม‹ทราบแน‹นอนแต‹สนนษฐานว‹าเกยวข›องกบการสบบหรเช‹นเดยวกนกบโรคหลอดเลอดแดงส‹วนปลายทวไป การสบบหรทาให›อาการของโรคเป‰นมากขนและมโอกาสเกดเป‰นซาได›อกหลงจากหายแล›ว

สาเหตและพยาธกาเนด

Leo Buerger

Buerger’s disease






http://medicina.ufm.edu/index.php/Enfermedad_de_Buerger

Buerger’s disease






http://medicina.ufm.edu/index.php/Enfermedad_de_Buerger

http://www.panafrican-med-journal.com/images-

medicine/ViewImage.php?ImageId=979

44


Maurice Raynaud (1862)

เนการหดวของหลอดเอดแดงเมมากนจากการมสอากาศ

หนาวเน

วอวเาจะเปยนเนขาวด จากนจะ

อยๆ เนเนวง หงจากมสอากาศน

นจะเปยนเนแดง ในรายเนนานๆ และ

นแรงจะเดเนแผลจากการขาดเอดปลาย

วอวเา !

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45


Primary Raynaud’s phenomenon หอ Raynaud’s disease

กพบในหงอาอย ไทราบสาเห

Secondary Raynaud’s phenomenon

พบไงสองเพศและอามากกากมแรก สาเหพบอยไแ

: Connective tissue disease – Polymyositis, Rheumatoid arthritis, SLE,

Scleroderma, Sjogren’s syndrome

: Endocrine disorder – Hypothyroidism

: Blood disorder – Polycythemia vera

: Neoplastic disorder – Carcinoid syndrome, Paraneoplastic syndrome

: Artery disease – Atherosclerosis, Buerger’s disease

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46



Intermittent claudication I73.9

Peripheral vascular disease

Peripheral arterial disease

Peripheral arterial occlusive disease

I73.9

I73.9

I73.9

Atherosclerosis of lower extremity

Buerger’s disease

Thromboangiitis obliterans

Raynuad’s phenomenon

DM type 2 with peripheral arterial disease

I70.2-

I73.1

I73.1

I73.0

E11.5 + I79.2

Additional Code to identify severity of Ulcer = L97

47

Vascular Gangrene


Gangrene

Atherosclerotic gangrene

Diabetic gangrene

R02

I70.21

E11.5

Buerger’s disease



I73.1

I73.1

I73.0

Vascular Gangrene…Not…Acute Limb Ischemia

48

Arterial thrombosis

: Atherosclerosis

: Aneurysm

: Bypass graft

: Trauma

Arterial embolism

: Cardiac embolism

: Atherosclerosis

: Aneurysm

: Idiopathic

Acute Limb Ischemia

49

Acute Limb Ischemia

aorta

I74.2 Embolism and thrombosis of arteries of upper extremities

I74.3 Embolism and thrombosis of arteries of lower extremities

I74.4 Embolism and thrombosis of arteries of extremities,

unspecified

Peripheral arterial embolism

I74.5 Embolism and thrombosis of iliac artery

I74.8 Embolism and thrombosis of other arteries

I74.9 Embolism and thrombosis of unspecified artery

I77 Other disorders of arteries and arterioles

50

Acute Arterial Occlusion


Gangrene

Atherosclerotic gangrene

R02

I70.21

Peripheral vascular disease

Peripheral arterial disease

Peripheral arterial occlusive disease

I73.9

I73.9

I73.9

Atherosclerosis of lower extremity I70.2-



I73.1

I73.0

51

Peripheral Vascular Procedures

Open procedure Endovascular procedure

Surgical thrombectomy

Surgical embolectomy

Catheter-directed thrombolysis

Percutaneous aspiration thrombectomy

Percutaneous mechanical thrombectomy

Rheolytic thrombectomy

Endarterectomy

Arterial bypass Endovascular stent

52

Endarterectomy

Addition Code

: number of vessels

: on bifurcation

Arterial bypass

: Aortofemoral bypass

: Femoropopliteal bypass

: Femorotibial bypass

: Femorofemoral bypass

: Axillofemoral bypassEndarterectomy Arterial bypass


53


Summary Procedure ICD-9-CM

Endarterectomy 38.1x

Arterial bypass

Aortoiliac bypass

Aortofemoral bypass

Iliofemoral bypass

Femorofemoral bypass

Femoropopliteal bypass

Femorotibial bypass

Femoroperineal bypass

Axillofemoral bypass

39.2x

39.25

39.25

39.25

39.29

39.29

39.29

39.29

39.29

#include: Patch graft, Thrombectomy, Temporary shunt

54

Surgical thrombectomy


Aspiration thrombectomy

Mechanical thrombectomy


Surgical embolectomy

55


Endovascular stent

56


Summary Procedure ICD-9-CM

Thrombectomy

Embolectomy

38.0x

38.0x

Catheter-directed thrombolysis 39.50+99.10

Percutaneous transluminal angioplasty

Catheter thrombectomy

Aspiration thrombectomy


Endovascular non-drug-eluting stents

Endovascular drug-eluting stents

Injection of thrombolytic agent

Endovascular procedure

39.79

39.50

39.50

39.50

39.90

00.55

99.10

39.50

57

Adjunct Vascular Procedures

KEF/;/EO"VCDWNCT"NKUV"QH"RTQEGFWTGU"*H[32+"

Gzenwfgu<"vjcv"hqt"eqpvtqn"qh"jgoqttjcig""*rquv"qrgtcvkxg+<"cpwu"*6;0;7+"dncffgt"*790;5+"pqug"*43022/4302;+"rtquvcvg"*820;6+"vqpukn"*4:09+"

Gzenwfgu<"tgrncegogpv"qh"xguugn/vq/xguugn"ecppwnc *5;0;6+

Gzenwfgu<"vjcv"ykvj"tgrncegogpv"]tgxkukqp_"qh"ujwpv *5;064+

3 9 .5 0 A n g i o p l as t y o r a t h e r ec to m y o f o t h e r n o n - c o r o n a r y v es s e l(s) ® Percutaneous transluminal angioplasty (PTA) of non- coronary vessels:

Lower extremity vessels Mesenteric artery Renal artery Upper extremity vessels

Code also any: injection or infusion of thrombolytic agent (99.10) Insertion of non- drug- eluting peripheral vessel stent(s) or stent

grafts(s) (39.90) percutaneous insertion of carotid artery stent(s) (00.63) number of vascular stents inserted (00.45- 00.48) number of vessels treated (00.40- 00.43) procedure on vessel bifurcation (00.44) insertion of drug- eluting peripheral vessel stent (00.55)

Gzenwfgu<"rgtewvcpgqwu"cpikqrncuv{"qt"cvjgtgevqo{"qh"rtgegtgdtcn"qt"egtgdtcn"xguugn*u+ *22083"/22084+

Gzenwfgu<"enkrrkpi"qh"ctvgtkqxgpqwu"hkuvwnc"*5;075+

58



other removal of coronary artery obstruction (36.09)

0 0 .4 0 Pr oc e d u r e o n s i n g l e v es s e l

Number of vessels, unspecified

Gzenwfgu<"""*cqtvq+"eqtqpct{"d{rcuu"*58032" "5803;+"kpvtcxcuewnct"kocikpi"qh"dnqqf"xguugnu"*22043/2204;+"

0 0 .4 1 Pr oc e d u r e o n t w o v es s e l s

Gzenwfgu<""*cqtvq+"eqtqpct{"d{rcuu"*58032" "5803;+"kpvtcxcuewnct"kocikpi"qh"dnqqf"xguugnu"*22043/2204;+"

0 0 .4 2 Pr oc e d u r e o n t h r e e v es s e l s


0 0 .4 3 Pr oc e d u r e o n f o u r o r m o r e v es s e l s


0 0 .4 4 Pr oc e d u r e o n v es s e l b i f u rc a t i o n

Note: This code is to be used to identify the presence of a vessel bifurcation; it does not describe a specific bifurcation stent. Use this code only once per operative episode, irrespective of the number of bifurcations in vessels.

-

59



-

3 9 .7 9 O t h e r e n d o v asc u l a r p r oc e d u r es o n o t h e r v es s e l s ® Other coil embolization or occlusion Endograft(s) Endovascular graft(s) Liquid tissue adhesive (glue) embolization or occlusion Other implant or substance for repair, embolization or occlusion Repair of aneurysm

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60

cerebrovascular disease - ministry of public health ix i60-i69 cerebrovascular diseases...

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