today we're going to talk about chapter
four the nervous system I found this
simple diagram in google images that
shows you the different levels of a
spinal column cervical thoracic lumbar
and sacral and the very tip of at the
end is coccygeal the two procedures that
are talked about in the book or the
lemon notta me and the lemon neck to me
so here I have two definitions that
explain what those two surgeries are for
and we're just going to jump into the
exercises as you've probably noticed
from looking at the cpt codes the nerves
section nervous system section is pretty
complex so they the best thing we can do
in this course is to just make you aware
of the different subsections within the
nervous system the different kinds of
repair procedures that are done on parts
of the nervous system and we will look
at some terms as we go through these
questions the first one is using an
operating microscope the physician
performs a neuro plasti of a left ring
finger so what should come to your mind
operating microscope it has its own
entry in the index and your plasti is
the procedure and when you're looking at
the digits the fingers remember that
there are modifiers on the inside the
front cover to identify individual
fingers let's think about this operating
microscope for a moment if you review
the use of the operating microscope
guidelines it tells us we will use this
code when surgical services are
performed using microsurgery techniques
the code is reported in addition to the
primary procedure performed not report
it when the use of the operating
microscope is an inclusive component in
other words is in the code description
here's a screenshot from the cpt code
book with the guidelines and the
description of the operating microscope
you see the little plus sign to the left
of the code that tells us an add-on code
and reminds us that this will be
reported in addition to the primary
procedure that we are coding another
little thing about these procedures
neuroplastic and you're a plastic vs new
rafi the neuro plastic surgery that
repairs a nerve and your aura fee is the
joining together usually by suture of
two parts of a divided nerve I think
it's interesting when you look at the
subsections under the nervous system
instead of having repair as we've had in
previous body systems this one is called
urography they take away that repair
word and just use the word specific to
repair the nerves and here's that
problem we looked at a few slides ago
using the operating microscope the
physician performs a neuro plasticity at
the left ring finger here's our codes
our modifier f3 identifying the left
hand fourth digit and the operating
microscope is included with these two
codes and here is an exercise that has
to do with the new rafi of the digital
nerves right thumb ring finger so we
know we're going to have modifiers and
there are the modifiers identifying the
right hand thumb in the right hand
fourth digit and i have a youtube link
here to the pronunciation of narara fee
if you forget how to say that there's
this YouTube account is Emma says Emma
like my granddaughter Emma says calm and
she pronounces these words so it's very
interesting and I use it quite a bit to
know how to say medical words the next
one has to do with the repair of the
five centimeter Milo meningocele
have some information here under our
facts to remember that describes to us
what it is exactly it is a very serious
form of spina bifida the images that are
on google images were just heartbreaking
so I didn't want to add those but
there's quite a bit of information you
can read about this on the Seattle
Children's Hospital website and here is
the code as well as the index pathway
this exercise has to do with a and FS
trills and epidural steroid injection in
the l5 s1 interspace so I found this
clay model it looks like showing you
where the needle is going in to the
space there and here is the code and the
index pathway the next exercise is a
craniotomy for evacuation of a
supratentorial subdural hematoma so i
have several explanatory slides here the
first is a craniotomy versus a
craniectomy the difference between these
two procedures primarily the craniotomy
the bone is replaced the craniectomy it
is not replaced immediately it was going
to be left open for whatever reason I
believe sometimes they do that for the
swelling to go down before they replace
that bone and obviously there are
specialized tools that are used to
remove that section of the skull this is
a nice diagram of a subdural hematoma
that shows you how it is just under the
dura and pressing against the side of
the head and this particular diagram
also shows you the midbrain the
tentorium the pons of the medulla and
here I have some information about the
supra tutorial versus the infra tint
Oreo region of the brain and you can see
here the divide the division in this
child's brain it shows in the diagram
the cerebrum is part of the supra
tutorial and the cerebellum is part of
the infra to
real back to some medical terminology
reminders supra usually means above and
infra below and back to our question and
there's the code and you notice there's
two pathways one is just for the
craniotomy and the second one is the
hematoma using the evacuation via a
create craniotomy the next one is this
suture repair of the posterior tibial
nerve and I did find a diagram of the
posterior tibial nerve in the back you
see of the lower leg just above the
ankle and that would typically probably
repayment probably necessary because for
some reason that's been injured in an
accident or something you have any
questions about coding procedures in the
nervous system please post them in the
discussion board along with the path you
have used from the index to try and find
your code and I will attempt to help you
thanks so much and have a good day
you