2/20/2019 BRAIN DISSECTION CODING AND DOCUMENTATION OBJECTIVES INTRODUCTION

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1 BRAIN DISSECTION CODING AND DOCUMENTATION Diana R. Phelps, CPC, CPC-I, CEMC OBJECTIVES Identify general structure of the human brain Describe how the different parts work Recognized the two hemispheres of the brain Identify the differences between the right and left hemispheres Describe functions of Broca s and Wernicke s areas INTRODUCTION Human brain is the most complex and highly organized structure of the body It allows us to think, move, feel, see, hear, taste and smell, etc. Controls our body to move, receive, analyze and store information Produces electrical signals which together with chemical reactions let the parts of the body communicate to nerves that sent these signals throughout the body Weighs approximately 3 lbs. (1.5 kg.) Makes up about one-fiftieth of the body s weight Uses up to one-fifth of the body s energy Made almost entirely of nerve cells Approximately 100 billion of them Communicates in trillions of connections called synapses 1

2 CRANIUM (SKULL) Upper part of your skull Made of curved bones fused together. Helps to protect from injuries Inside skull is 3 distinct areas Known as the brain box MENINGES Thin protective layers or membranes Consists of three layers Dura Matter White, thick outermost membrane Acts to support and protect the brain Arachnoid Matter Helps to circulate cerebral spinal fluid (CSF) through out the brain through sinuses and canals Pia Matter Covers and protects the central nervous system Encloses blood vessels and cerebrospinal fluid within the cortex LOBES OF THE BRAIN Frontal Lobe Located in the anterior (front/forehead) part of the cranial floor Functions: Judgement, planning, problem solving Personality, behavior, emotions Speech; speaking and writing (Broca s area - located on left frontal lobe) Body movement Intelligence, concentration, self-awareness Parietal Lobe Located behind the frontal lobe, forms top sides of the cranial cavity Functions Major role is sense of touch, pain, temperature (sensory strip) Interprets language, words Spatial and visual awareness and perception Interprets vison, hearing, sensory and memory 2

3 LOBES OF THE BRAIN, cont. Occipital Lobe Located in the posterior part of cranium Function Processing thoughts Interprets vision (color, light, movement) Temporal Lobe Located in lower sides of cranium; contains middle and inner ear structures Function Hearing Information/retrieval (memory) Sequencing and organization Language comprehensive (Wernicke s area located on the left temporal side) LOBES OF THE BRAIN, cont. Sphenoid Lobe Located in the central part of cranium (shaped like a wasp) Function Boundary between the intra and extracranial structures and conduit for several cranial nerves Protects the pituitary gland Ethmoid Lobe Located in the anterior part of cranium between the eyes Function Lubricates (mucus) the inner nose. Make one s voice more resonant CEREBRUM, CEREBELLUM & BRAIN STEM Cerebrum Largest part Divided into two hemispheres, Each hemisphere is divided into 4 lobes Function is interpreting touch, vision and hearing Cerebellum Back of the head under the cerebrum, and behind the brain stem Know as Little brain Function is to coordinate muscle movement, Maintain posture, and balance Takes over learned activities (like riding a bike) Brain Stem (Medulla) Between the spinal cord and brain Functions are breathing, heart rate, body temperature, wake and sleep cycles, digestion, etc. 3

4 HEMISPHERES Hemispheres are joined by a bundle of fibers (corpus callosum) Controls the opposite side of the body Left hemisphere Controls speech, comprehension, arithmetic, and writing Dominant in hand use and language in 92% of people Right hemisphere Controls creativity, imagination, artistic, and musical skills CORTEX Outer part of the brain Where information is usually stored Connections between different parts Consists of grooves and ridges Grooves are called sulci Ridges are called gyrus Not smooth on the surface so that it would be severely limited in its ability to grow It expands by stacking more layers together, forming sulci and gyri DEEP STRUCTURES Hypothalamus Pituitary Gland Pineal Gland Thalamus Basal Ganglia Limbic System 4

5 MEMORY Short-term Process in the prefrontal cortex Stores information for about a minute, and capacity is 7 items Long-term Process in the hippocampus of the temporal lobe Stores information longer, unlimited content and duration Skill memory Process in the cerebellum Procedural learned memories LANGUAGE Aphasia Broca s area Difficulty speaking and writing Can still read Understand spoken language Wernicke s area May speak in long sentences with no meaning Difficulty speaking Unaware of their mistakes CRANIAL NERVES Twelve cranial nerves No. Name Function I Olfactory Smell II Optic Sight III Oculomotor Moves eye, pupil IV Trochlear Moves eye V Trigeminal Face sensation VI Abducens Moves eye VII Facial Moves face, salivate VIII Vestibulocochlear Hearing and balance IX Glossopharyngeal Taste, swallow X Vagus Heart rate XI Accessory Moves head XII Hypoglossal Moves tongue 5

6 VENTRICLES AND CEREBROSPINAL FLUID Ventricles Hollow fluid-filled cavities Ribbon-like structure called the choroid plexus that makes CSF Lateral ventricles (2) Third ventricle Fourth ventricle Blockage or disruption BLOOD SUPPLY Carotid arteries Internal carotid supply most of the cerebrum Vertebral arteries Supply the cerebellum, brainstem, and the underside of the cerebrum Right and left join together to form the basilar artery Taking out the brain 6

7 Fresh brain INSTRUMENTS THAT CAN BE USED BURR HOLES FOR A HEMATOMA Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural (For bilateral procedure, report with modifier 50) ICD-10-CM CODES G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure I62.- Nontraumatic --- hemorrhage S06.4- Epidural hemorrhage S06.5- Traumatic subdural hemorrhage--- S06.6- Traumatic subarachnoid hemorrhage- 7

8 CRANIECTOMY OR CRANIOTOMY FOR HEMATOMA Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural intracerebral ICD-10-CM CODES I61.0-I62.9 Nontraumatic.. Hemorrhage categories Q28.2 Arteriovenous malformation of cerebral vessels S06.-- Traumatic or epidural hemorrhages categories CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy with lobectomy ICD-10-CM CODES There are a lot of codes from neoplasm, nontraumatic, traumatic, contusion, hemorrhages, etc. CRANIOTOMY FOR TUMOR Supratentorial is above the tentorium; includes frontal, parietal, temporal, occipital lobes Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma for excision of meningioma, supratentorial for excision of fenestration of cyst, supratentorial Implantation of brain intracavitary chemotherapy agent (List separately in addition to code for primary procedure) (Use only in conjunction with or 61518) (Do not report for brachytherapy insertion, for intracavitary insertion of radioelement sources or ribbons, see 77770, 77771, 77772) 8

9 CRANIOTOMY FOR TUMOR, cont. Infratentorial is below the tentorium; includes posterior fossa, brain stem, cerebellum Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull meningioma cerebellopontine angle tumor midline tumor at base of skull DIAGNOSTIC CODES FOR BRAIN TUMORS C70.0 Malignant neoplasm of cerebral meninges C70.9 Malignant neoplasm of meninges, unspecified C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles C71.1 Malignant neoplasm of frontal lobe C71.2 Malignant neoplasm of temporal lobe C71.3 Malignant neoplasm of parietal lobe C71.4 Malignant neoplasm of occipital lobe C71.5 Malignant neoplasm of cerebral ventricle C71.8 Malignant neoplasm of overlapping sites of brain C79.31-C79-49 Secondary malignant neoplasm of ---- brain D18.02 Hemangioma of intracranial structures D D33.3 Benign neoplasm of ---- D D48.2 Neoplasm of uncertain behavior of Several more are listed STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computed tomography and/or magnetic resonance guidance ICD-10-CM B69.0 Cysticercosis of central nervous system C71.- Malignant neoplasm of ---- C79.- Secondary neoplasm of D33.- Benign neoplasm of D43.- Neoplasm of uncertain behavior of brain E75.23 Krabbe disease G06.0 Intracranial abscess and granuloma G35 Multiple sclerosis G93.89 Other specified disorder of brain I61.- Nontraumatic intracerebral hemorrhage -- 9

10 VENTRICULOPERITONEAL (VP) SHUNT CODES Creation of shunt; ventriculo-peritoneal Replacement or irrigation, ventricular catheter Replacement or revision CSF shunt, obstructed valve or distal catheter Removal of complete CSF system; without replacement with replacement by similar or other shunt at same operation DIAGNOSTIC CODES FOR SHUNTS G91.- G93.0 G93.2 P10.2 P52.- Q03.0 Q03.8 Q05.- Q07.02 Q07.03 T85.- Z45.41 Hydrocephalus category Cerebral cysts Benign intracranial hypertension Intraventricular hemorrhage due to birth injury Intraventricular (nontraumatic) hemorrhage.. Newborn category Malformations of aqueduct of Sylvius Other congenital hydrocephalus.. Spinal bifida with hydrocephalus category Arnold-Chiari syndrome with hydrocephalus Arnold-Chiari syndrome with spina bifida and hydrocephalus Breakdown, leakage, displacement, etc. category Encounter for adjustment and management of cerebrospinal fluid drainage device Summary It is amazing what it does Eight lobes Frontal, Parietal, Occipital, Temporal, Sphenoid, Ethmoid Three main parts-cerebrum, cerebellum, and the brainstem Twelve cranial nerves and the functions Common surgical procedures and diagnoses It makes us who we are!! 10