Alright, Peripheral Vascular Disease.
Alicia.
Alicia: Ooh, another exciting one.
I just did have another webinar class on PVDs so I learned quite a bit.
It was very interesting.
PVD and PAD kind of the same thing.
When a person has a diagnosis, this means that thereís something going on with the
large arteries or the peripheral vascular system.
And mind you, this is a very broad system.
Alicia: Okay, 1) Thereís 3 things you can have going on.
You can have an obstruction, stenosis or narrowing.
So obstruction, of course, means thereís something in there clogging up the process.
Stenosis is more or less a hardening and a narrowing is just like it sounds, itís narrowing
the veins or the arteries.
PVD is not resolved with angioplasty or any other test.
Youíll often see that a person went in for an angioplasty.
But letís seeÖ once the person has PVD, thatís it.
Youíve got it.
Itís chronic.
Itís not going away.
So what they do is they treat the side effects and thatís what angioplasty does.
Common medications that youíre going to see when a person has PVD is like Zocar and Plavix.
Youíll see that quite a bit.
These are heads up that the person has PVD.
Signs and symptoms of PVD: you need to know these because especially when youíre doing
outpatient coding, you want toÖ you donít do signs and symptoms.
So your personís going to have pain in the calf.
Theyíre going to have weakness in their extremities.
Theyíll complain of numbness.
Theyíll have cramping in their extremities or they complain that their feet and their
hands are always cold.
Claudication, I canít tell you how many charts doing this Medicare Advantage coding that
the patient has claudication or itíll state patient does not complain of claudication.
And after a few of those, I had to go look it up to make sure I understood what it was
because it didn't always seem to fit.
But I had always thought of claudication as more or less limping.
This is the way I had learned it.
But it also just having pain, tired or weak feeling that occurs in your legs, usually
doing an activity such as walking.
So you know, you heard people say, ìOh, they went weak in the kneesî or ìThey were walking
but their legs are just so week all of a sudden.í And thatís claudication.
And then also, the limp, a lot of times, with claudication and thatís a sign that the person
has PVD.
And you will see that in the charts.
Okay, thereís different diagnostic tests that they do for PVD.
Theyíll do the ankle brachial pressure.
So youíll see, theyíll go down and checkÖ theyíre checking the pulses is what theyíre
doing.
Doppler studies are done to make sure thereís good blood flow.
Ultrasounds are done to see if they can see the vessels and if theyíre working properly.
These people are going to get routine labs and theyíre going to see them getting lipid
panels.
Theyíre checking their cholesterol and triglycerides when they have PVD.
Theyíre going to be doing this on a routine basis.
They got to keep that blood thin and not clogged up to make sure they donít have any suffering
anymore.
And I think the nextÖ when you scroll down, itís going to show up some medication or
treatments.
Okay, one other thing that makes PVD even worse is if youíre smoking because everybody
knows that smoking is like a vasoconstrictor.
And so if youíve already got PVD and then youíre smoking, youíre shrinking those vessels
even more.
So what the first thing they need to do is stop smoking and youíll see a lot of counseling
to stop smoking on the charts and stuff.
Managing the underlying condition ñ if a person has diabetes or hypertension or hyperlipidemia
then they develop the PVD.
Well, they probably got it because of these other diagnoses.
So you canít cure PVD but you can treat the diabetes and you can make sure their blood
pressure stays low.
And then you can give them medications that are going to keep their cholesterol at a manageable
level because of the hyperlipidemia, meaning they just have too much fat in their blood
and itís clogging up their arteries.
The angioplasty, this treatment, theyíll do an artherectomy.
Theyíll do a stenting to keep those vessels open and sometimes, theyíll do bypass grafts
if theyíre still clogged up.
But remember, PVD is peripheral vascular so thatís all those extremities.
You know, you can do bypass grafts of the heart and angioplasties and stuff.
But you really canít do much for those extremities because the vessels are just too small.
So again, once you have PVD, thatís it.
Youíve got it and itís not a curable condition.
So keep that in mind when youíre doing your charts that if a person has PVD, down the
road, theyíre probably going to get that diagnosis again and again and again.
Youíll be able to code it because it does not go away like diabetes doesnít go away.
Laureen: Thank you.
We had a quick question in the chat I thought you could answer.
I think you had mentioned in your previous blip about advanced coding.
They want to know what you meant by advanced coding.
Alicia: Oh well, at the college, what they did was they had students that were in different
medical fields.
And so they took a basic coding ICD9 and CPT and did a little bit in HCPCS.
But if they were going to coding as a specialty, they took advanced coding.
And then that actually was not just diagnosis coding you know, where they gave you statements
where you looked at a chart and said, ìOh, I need a code for hypertension.î You know,
if you were working in the medical field and someone said, ìI needed a code for hypertensionî
then they could look it up and say 401.9.
But if youíre in advanced coding then youíre actually coding charts and op reports and
you really get into the guidelines, things like what goes with Peripheral Vascular DiseaseÖ
you know, what conditions, how do you code first, like the questions that we just did
with cancer coding ad things.
You really know the guidelines and youíre usually going to sit for the CPC exam.
Basic coders donít usually get a certification, an advanced certification like a CPC exam
or CCS.
So itís more detailed, kind of likeÖ it would be like what we do at CCO.
That course is an advanced coding course because itís instructing you on how to pass the exam
and code in the real world.
Laureen: Thank you, maíam.
And Anna says, ìAlicia, I love your enthusiasm.î
Alicia: Iím always enthusiastic when it comes to coding.