Diagnostic coding of neurocognitive disorders: A roadmap to ICD-10-CM.

: Diagnosis coding is a core clinical competency. A basic understanding of the structure of the (ICD-10-CM), the conventions and rules for diagnosis coding, and what constitutes accurate coding, is fundamental to the clinician's knowledge base. This commentary seeks to provide a practical framework for clinicians to perform accurate diagnosis coding of neurocognitive disorders.

Optimizing cerebral oxygenation in cardiac surgery: A randomized controlled trial examining neurocognitive and perioperative outcomes.

Objective: The study objective was to determine whether targeted therapy to optimize cerebral oxygenation is associated with improved neurocognitive and perioperative outcomes.

Methods: In a prospective trial, intraoperative cerebral oximetry monitoring using bilateral forehead probes was performed in cardiac surgical patients who were randomly assigned to an intervention group in which episodes of cerebral oxygen desaturation (<60% for >60 consecutive seconds at either probe) triggered an intervention protocol or a control group in which the cerebral oximetry data were hidden from the clinical team, and no intervention protocol was applied. Cognitive testing was performed preoperatively and at postoperative months 3 and 6; domains studied were response speed, processing speed, attention, and memory.

ICD-10-CM Diagnosis Coding for Neuropsychological Assessment.

Objective: This paper summarizes the basic principles of diagnosis coding for neuropsychological evaluation of patients with known or suspected brain injury or disease.

Method: The resources forming the basis of this article are the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and the ICD-10-CM Official Guidelines for Coding and Reporting.

Conclusion: Diagnosis codes are used to communicate the specific reason for health care encounters and the conditions treated.

Selective cerebral perfusion for thoracic aortic surgery: association with neurocognitive outcome.

Objectives: Optimal brain protection for aortic arch surgery remains unclear. This prospective study examined neurocognitive outcomes in cardiac and thoracic aortic surgical patients, including a small cohort who underwent selective cerebral perfusion.

Methods: Fifty-seven adult cardiac and thoracic aortic surgical patients underwent preoperative and postoperative neurocognitive testing.

Internet-based assessment of postoperative neurocognitive function in cardiac and thoracic aortic surgery patients.

Objective: The primary purpose of this study was to determine the practicality of long-term, postoperative neurocognitive assessment via remote Internet-based testing in a cohort of patients who had undergone cardiac or thoracic aortic surgery within the previous 6 years. The secondary aim of this study was to examine the relationships among hypothermic circulatory arrest time, cardiopulmonary bypass time, and selective cerebral perfusion time with long-term postoperative neurocognitive function, as assessed by this novel testing method.

Methods: Three hundred patients who had undergone cardiac and/or proximal aortic surgery with cardiopulmonary bypass (n = 207), thoracic aortic surgery with hypothermic circulatory arrest (n = 67), or thoracic aortic surgery with hypothermic circulatory arrest and selective cerebral perfusion (n = 26) within the previous 6 years underwent Internet-based neurocognitive assessment.

Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function.

Objectives: Deep hypothermic circulatory arrest (DHCA) is commonly used during thoracic aortic surgery, and is initiated only after a sufficient degree of cerebral hypothermia is induced. The criteria for initiating DHCA vary among institutions: most centers use temperature criteria, some use electroencephalography, and a minority use jugular bulb oxyhemoglobin saturation SjO(2) criteria. The purpose of this study was to determine whether the use of SjO(2) monitoring to guide the onset of DHCA was associated with better post-operative neuropsychological outcome.