Q: Atherosclerosis of the left internal mammary artery bypass graft? I see nothing specific on the mammary (artery, is what they they’re talking about). How would you code this?
A: I did some little bit extra research on this because I was a little confused when I went to go look at it as well, and then it dawned on me that I had to break it down and remind myself what all the parts were.
Atherosclerosis is just a disease of the artery, and it just means the plaque has built up on the inner wall of that artery. Then I found this fantastic little article and I’ll go through this really quickly, you can go back and read it more in-depth when you get your copy. It says: a blood vessel located in the inside chest cavity. This is the internal mammary artery (IMA); it’s actually a pretty major vessel. And because it is where it’s located by the sternum, it’s a very good artery to use as a bypass artery.
What they do when they bypass is they actually take that mammary artery and disconnect it and put it in other place to [feed] a location of the heart. I’ve got some pictures of that here, but they’re talking about how it’s such a good artery to use, so it’s most often used for a specific types of bypasses they’re needing to be done.
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Content
0.24 -> Q: Atherosclerosis of the left internal mammary
artery bypass graft?
5.91 -> I see nothing specific on the mammary (artery,
is what they they're talking about).
14.589 -> How would you code this?
16.8 -> A: I did some little bit extra research on
this because I was a little confused when
24.08 -> I went to go look at it as well, and then
it dawned on me that I had to break it down
30.64 -> and remind myself what all the parts were.
52.93 -> Atherosclerosis is just a disease of the artery,
and it just means the plaque has built up
59.45 -> on the inner wall of that artery.
61.34 -> Then I found this fantastic little article
and I'll go through this really quickly, you
66.71 -> can go back and read it more in-depth when
you get your copy.
71.88 -> It says: a blood vessel located in the inside
chest cavity.
76.27 -> This is the internal mammary artery (IMA);
it's actually a pretty major vessel.
83.939 -> And because it is where it's located by the
sternum, it's a very good artery to use as
94.189 -> a bypass artery.
98.1 -> What they do when they bypass is they actually
take that mammary artery and disconnect it
103.74 -> and put it in other place to [feed] a location
of the heart.
107.409 -> I've got some pictures of that here, but they're
talking about how it's such a good artery
112.46 -> to use, so it's most often used for a specific
types of bypasses they're needing to be done.
121.479 -> So, why is that important?
123.479 -> The IMA is also conveniently located near
the most important coronary branch, up at
130.96 -> the top, and the left anterior descending
(LAD).
135.97 -> The surgeon can transfer the lower end of
the IMA down to the heart surface to use as
145.01 -> a bypass.
146.01 -> It's a good artery that's big and it's just
in the right place.
151.37 -> And so, what they do is there's a picture
of it...
155.68 -> Oh, one more thing that they made a note of
because when you go back up and you look at
160.9 -> that, the problem that the person is having
is they're having a problem with the bypass
166.67 -> graft, there's stenosis.
170.04 -> So, this is a wonderful artery to work with.
173.76 -> However, it says: the mammary artery may also
be affected by functionally significant stenosis
182.17 -> (it gets hard).
183.41 -> Most stenoses of the mammary artery are secondary
to the surgical procedure (so once they do
188.81 -> this bypass, if it's going to have any problems,
I guess you could say gets stenotic or it
195.64 -> gets stiff and hard, but only usually after
this procedure) at the anastomosis site (where
204.89 -> they actually connect it back in).
206.72 -> This is that artery that they're talking about.
211.63 -> This is that vein that they want to lead it,
put it into, so here's where it goes normally.
216.71 -> See how it's so close and they're just going
to connect it to this artery.
219.72 -> Here's another view, so this is what they
do.
223.06 -> Now, they've turned this but see they took
that artery and they just tucked it into that
228.061 -> other - this vein right here and that oxygenates
the part of the heart that's in trouble.
233.12 -> The code for that in ICD-9 is 414.04 and it
states this in bold, and then underneath in
241.46 -> fine print it says internal mammary artery,
because it's the most often artery used for
248.02 -> that.
249.02 -> In ICD-10, I wrote that down for you, I25
Chronic ischemic heart disease.
255.45 -> And then right here it tells you.
257.329 -> Now, it goes in more depth and I didn't copy
all that for you because it says "with or
262.37 -> without" and this is chest pain, this angina
and stuff.
266.4 -> I think that's it, but I wanted you to see,
it's not that it has anything else to do with
272.49 -> something...this initials and stuff get very
confusing, it's just a very available and
284.199 -> most often used artery to go into this specific
vein and get that oxygenated.
291.289 -> So that's it!
293.11 -> Laureen: It looks like pot roast to me [laughs].
297.62 -> Alicia: There were some really graphic pictures
out there on Google.
303.499 -> And that vein is really big, you can really
see it when they crack the chest open but
307.34 -> I didn't put those on there.
308.49 -> Boyd: Thank you.
309.599 -> I appreciate that.
310.719 -> Alicia: [Laughs]
311.719 -> Laureen: Oh, you can handle it.
313.599 -> Boyd: No I couldn't, not what I was going
through ICD-10, what chapter was that, I had
318.469 -> to look away.
319.469 -> Laureen: I don't know but they were getting
pretty... yeah.
321.99 -> Alicia: I do like the graphic stuff, like,
"Oh, wow!
325.18 -> Look, they broke open this heart!"
326.87 -> Boyd: But you also have some weird things
where you get squeamish on things that shouldn't
330.749 -> upset you.
331.749 -> I forgot what that one was, but anyway --
