Comprehensive Anatomy and Physiology for ICD-10-CM Coding

2011

Comprehensive Anatomy and Physiology for ICD-10-CM Coding Your guide to the anatomical and physiological specificity of ICD-10-CM coding NEW! See sample pages of this new product.

A full suite of resources including the latest code set, mapping products, and expert ICD-10 training to help you make a smooth transition. www.shopingenix.com/ICD10 Comprehensive Anatomy and Physiology for ICD-10-CM Coding Skeletal System and Articulations

Synovial Joint Structures Injuries Injuries to the skeletal system are quite common as it is a rigid structure. The DEFINITIONS Muscle joints are also fairly susceptible to injury because part of their purpose is to maintain alignment, regardless of extraneous external forces. fracture—Break in bone or cartilage. Synovium Fractures, or breaks in the bone, are a common injury. There are roughly 6.8 osteoporosis—Disorder Articular joint capsule around million fractures reported in the United States annually. characterized by bone degeneration. Synovial cavity Osteoporosis is caused by the Understand where ICD-10-CM (with fluid) In ICD-9-CM, the appropriate fracture code depends on the bone fractured, breakdown of the bony matrix Articular whether the fracture was pathological or traumatic, and whether it was without equivalent regeneration, requires a deeper understanding cartilage considered open or closed. ICD-10-CM requires much more information than resulting in a weak, porous, fragile of anatomy. Sharpen the skills bone structure. Ligament does ICD-9-CM. needed for front-line, everyday pathological—Relating to a coding challenges with ICD-10-CM. For discussion purposes, ICD-9-CM and ICD-10-CM coding of a closed condition that is caused by or Muscle fracture of the greater tuberosity of the humerus will be compared. A difference involves a disease process. Bone covered in coding can be spotted immediately just by looking at the ICD-10-CM and with ICD-9-CM alphabetic index. In ICD-10-CM, the fracture must be identified as periosteum traumatic or pathological before proceeding any further in code selection. In ICD-9-CM, the site of the fracture may be selected first, followed by whether it is pathological in nature. In ICD-9-CM, an injury is assumed to be traumatic Synovial joints can be further classified by the movements they allow, including: unless further clarified. With the information provided, code 812.03 Fracture of CODING AXIOM humerus, upper end, closed, greater tuberosity, may be assigned in ICD-9-CM. • Ball-and-socket: Head of a long bone (“ball”) and depression of another ICD-10-CM Official Coding Guideline bone (“socket’) join. The shoulder (humeral head and glenoid In ICD-10-CM, the above information is not sufficient for code section I.C.19.c.1. states, “A code from depression of the scapula) and hip joints (femoral head and acetabulum assignment—there are two more considerations. First, is the fracture traumatic category M80 Osteoporosis with of a coxa bone) are ball-and-socket articulations. current pathological fracture, not a or pathological? Second, does the patient also have a diagnosis of osteoporosis? If traumatic fracture code, should be Get the anatomical • Condyloid: Protrusion of one bone meets a depression of another to the patient does have osteoporosis, according to ICD-10-CM coding guidelines, used for any patient with known basics and the relevant form this type of joint. Examples are the wrist (radius and carpals) and the fracture should automatically be reported as a pathological fracture of the osteoporosis who suffers a fracture.” knuckles (metacarpal and proximal phalange). humerus, regardless of whether it is specified as such. For demonstration details you will need Hinge: purposes, assume the fracture is specified as traumatic, which leads us to for ICD-10-CM coding. • Convex portion of a bone meets with the concave part of another to form a hinge joint. The elbow and knee are large hinge joints. category S42.25 Fracture of greater tuberosity of humerus. • Pivot: Rounded or pointed protrusion of one bone fits into a ring Traumatic fractures must be further clarified with the following information: composed of bone or bone and ligaments of another bone. The • Is the bone displaced? If this is unspecified, ICD-10-CM Coding articulation between the C1 and C2 vertebrae that allows the head to Guidelines direct the coder to assume the fracture is displaced. move back and forth is a pivot joint. • Planar: Flat surfaces of two bones glide against one another. The joints • On which side of the body did the injury occur? between the short carpals (intercarpal joint) and tarsals (intertarsal joint) These two answers determine the sixth digit of the ICD-10-CM code. However, are planar. since fracture codes require a seventh character, even more information is CODING AXIOM DEFINITIONS • Saddle: One bone has a depression shaped somewhat like an equestrian needed. This alphabetic character is based on multiple factors as listed below: saddle; the joint is formed by a second bone straddling that depression. ICD-10-CM Official Coding Guideline opposition—Act of touching the • Is this the initial encounter for the fracture? If yes, is the fracture: section I.C.19.c. states, “A fracture not thumb to the tips of each finger on An example of this type of articulation is where the trapezium meets the indicated as open or closed should the same hand. metacarpal of the thumb. This joint allows the unique opposition of the – open be coded to closed. A fracture not human thumb. indicated whether displaced or not – closed displaced should be coded to displaced.” • Is this a subsequent encounter? If yes: – Is the healing of the fracture routine or delayed? – Is there a nonunion or malunion? – Is there a sequela or late effects of the fracture? Due to the extensive nature of code selection for a fracture in ICD-10-CM, there is a “one-to-many” match between the two coding classification systems as demonstrated in the table below.

Synovial Joint Structures Injuries Injuries to the skeletal system are quite common as it is a rigid structure. The DEFINITIONS Muscle joints are also fairly susceptible to injury because part of their purpose is to maintain alignment, regardless of extraneous external forces. fracture—Break in bone or Provides ICD-10-CM cartilage. Synovium coding-speciﬁ Fracturesc anatomy, or breaks in the bone, are a common injury. There are roughly 6.8 osteoporosis—Disorder Articular joint capsule around and physiologymillion information fractures reported in the United States annually. characterized by bone degeneration. Synovial cavity Osteoporosis is caused by the (with fluid) targeting the clinicalIn ICD-9-CM, areas the appropriate fracture code depends on the bone fractured, breakdown of the bony matrix Articular where ICD-10-CMwhether requires the fracture was pathological or traumatic, and whether it was without equivalent regeneration, cartilage considered open or closed. ICD-10-CM requires much more information than resulting in a weak, porous, fragile deeper understanding of bone structure. Ligament does ICD-9-CM. anatomy. pathological—Relating to a For discussion purposes, ICD-9-CM and ICD-10-CM coding of a closed condition that is caused by or Muscle fracture of the greater tuberosity of the humerus will be compared. A difference involves a disease process. Bone covered in coding can be spotted immediately just by looking at the ICD-10-CM and with ICD-9-CM alphabetic index. In ICD-10-CM, the fracture must be identified as periosteum traumatic or pathological before proceeding any further in code selection. In ICD-9-CM, the site of the fracture may be selected first, followed by whether it is pathological in nature. In ICD-9-CM, an injury is assumed to be traumatic Synovial joints can be further classified by the movements they allow, including: unless further clarified. With the information provided, code 812.03 Fracture of CODING AXIOM humerus, upper end, closed, greater tuberosity, may be assigned in ICD-9-CM. • Ball-and-socket: Head of a long bone (“ball”) and depression of another ICD-10-CM Official Coding Guideline bone (“socket’) join. The shoulder (humeral head and glenoid In ICD-10-CM, the above information is not sufficient for code section I.C.19.c.1. states, “A code from depression of the scapula) and hip joints (femoral head and acetabulum assignment—there are two more considerations. First, is the fracture traumatic category M80 Osteoporosis with of a coxa bone) are ball-and-socket articulations. current pathological fracture, not a or pathological? Second, does the patient also have a diagnosis of osteoporosis? If traumatic fracture code, should be • Condyloid: Protrusion of one bone meets a depression of another to the patient does have osteoporosis, according to ICD-10-CM coding guidelines, used for any patient with known form this type of joint. Examples are the wrist (radius and carpals) and the fracture should automatically be reported as a pathological fracture of the osteoporosis who suffers a fracture.” knuckles (metacarpal and proximal phalange). humerus, regardless of whether it is specified as such. For demonstration • Hinge: Convex portion of a bone meets with the concave part of purposes, assume the fracture is specified as traumatic, which leads us to category S42.25 Fracture of greater tuberosity of humerus. another to form a hinge joint. The elbow and knee are large hinge joints. This is not your typical • Pivot: Rounded or pointed protrusion of one bone fits into a ring Traumatic fractures must be further clarified with the following information: anatomy and physiology composed of bone or bone and ligaments of another bone. The • Is the bone displaced? If this is unspecified, ICD-10-CM Coding articulation between the C1 and C2 vertebrae that allows the head to handbook. This resource was Guidelines direct the coder to assume the fracture is displaced. move back and forth is a pivot joint. created speciﬁ cally for coders. • Planar: Flat surfaces of two bones glide against one another. The joints • On which side of the body did the injury occur? between the short carpals (intercarpal joint) and tarsals (intertarsal joint) These two answers determine the sixth digit of the ICD-10-CM code. However, are planar. since fracture codes require a seventh character, even more information is CODING AXIOM DEFINITIONS • Saddle: One bone has a depression shaped somewhat like an equestrian needed. This alphabetic character is based on multiple factors as listed below: saddle; the joint is formed by a second bone straddling that depression. ICD-10-CM Official Coding Guideline opposition—Act of touching the • Is this the initial encounter for the fracture? If yes, is the fracture: section I.C.19.c. states, “A fracture not thumb to the tips of each finger on An example of this type of articulation is where the trapezium meets the indicated as open or closed should the same hand. metacarpal of the thumb. This joint allows the unique opposition of the – open be coded to closed. A fracture not human thumb. indicated whether displaced or not – closed displaced should be coded to displaced.” • Is this a subsequent encounter? If yes: – Is the healing of the fracture routine or delayed? – Is there a nonunion or malunion? – Is there a sequela or late effects of the fracture? Due to the extensive nature of code selection for a fracture in ICD-10-CM, there is a “one-to-many” match between the two coding classification systems as Focus on the conditions, demonstrated in the table below. terminology and anatomy needed to code accurately in ICD-10-CM.

Coding for Closed Fracture of Greater Tuberosity of the Humerus ICD-9-CM ICD-10-CM DEFINITIONS ICD-9-CM ICD-10-CM 733.44 Aseptic necrosis of M87.074 Idiopathic aseptic necrosis of right foot closed fracture—Bone fracture not talus M87.075 Idiopathic aseptic necrosis of left foot accompanied by a break in skin. 812.03 Fracture of greater S42.251A Displaced fracture of greater tuberosity tuberosity of humerus, of right humerus, initial encounter for M87.076 Idiopathic aseptic necrosis of displaced—Bone break in which the closed closed fracture unspecified foot two broken ends are separated. S42.252A Displaced fracture of greater tuberosity M87.174 Osteonecrosis due to drugs, right foot malunion—Fractured bone that has of left humerus, initial encounter for M87.175 Osteonecrosis due to drugs, left foot healed or is healing in an incorrect closed fracture M87.176 Osteonecrosis due to drugs, unspecified position. S42.253A Displaced fracture of greater tuberosity foot nonunion—Fractured bone that has of unspecified humerus, initial M87.274 Osteonecrosis due to previous trauma, failed to heal. encounter for closed fracture right foot open fracture—Fracture in which the S42.254A Nondisplaced fracture of greater M87.275 Osteonecrosis due to previous trauma, tuberosity of right humerus, initial left foot broken end or ends of the bone have encounter for closed fracture pierced the skin. M87.276 Osteonecrosis due to previous trauma, S42.255A Nondisplaced fracture of greater unspecified foot tuberosity of left humerus, initial encounter for closed fracture M87.374 Other secondary osteonecrosis, right foot S42.256A Nondisplaced fracture of greater tuberosity of unspecified humerus, M87.375 Other secondary osteonecrosis, left foot initial encounter for closed fracture M87.376 Other secondary osteonecrosis, unspecified foot M87.874 Other osteonecrosis, right foot Note that in ICD-9-CM, if a fracture is specified as complicated by a malunion M87.875 Other osteonecrosis, left foot Content speciﬁ cally or nonunion, the fracture site is irrelevant as there are only two applicable codes: M87.876 Other osteonecrosis, unspecified foot designed to focus on 733.81 Malunion of fracture, and 733.82 Nonunion of fracture. However, the detail of conditions, documentation of the site, laterality, and type of complication is imperative in Sometimes the normal curvatures in the spine become deformed. There are terminology and ICD-10-CM, as the same traumatic fracture codes are used but with a seventh character identifying malunion or nonunion. three types of these deformities: anatomy needed to code • Scoliosis, a lateral curvature of the spine accurately in ICD-10-CM Additionally, to appropriately assign a seventh digit for malunion or nonunion of an open fracture, a coder must be aware of the differences between the types • Kyphosis, an abnormal posterior convex curvature of the spine of open fractures as described below: • Lordosis, an exaggerated inward curvature of the lower back • Type I: The wound is less than 1 cm in length and clean.

• Type II: The wound is greater than 1 cm in length, clean, and there is Kyphosis and Lordosis minimal to no soft tissue injury. • Type III: The wound is greater than 1 cm in length, and there is significant soft tissue injury. Type III fractures can be further classified Kyphosis as: (hump) – IIIA: There is enough local soft tissue to cover the wound and bone Know the level of Lordosis without the need for skin grafting. (concave) detail that clinicians will need to provide in – IIIB: The injury to the soft tissue is significant enough that skin grafting is necessary to cover the bone. their documentation. – IIIC: The injury is associated with an arterial injury that requires Scoliosis and Kyphoscoliosis repair. The differences in coding for malunion and nonunion are captured in the table below. Please note that due to extensive mapping, the table is a sample of the ICD-10-CM codes that represent the various concepts. SAMPLE PAGE FROM THE NEW COMPREHENSIVE ANATOMY AND

PHYSIOLOGY FOR ICD-10-CM CODING Scoliosis Kyphoscoliosis Call 1.800.INGENIX (464.3649) or visit www.shopingenix.com12 to order. © 2011 Ingenix © 2011 Ingenix 37 Comprehensive Anatomy and Physiology for ICD-10-CM Coding Skeletal System and Articulations

Coding for Closed Fracture of Greater Tuberosity of the Humerus ICD-9-CM ICD-10-CM DEFINITIONS ICD-9-CM ICD-10-CM 733.44 Aseptic necrosis of M87.074 Idiopathic aseptic necrosis of right foot closed fracture—Bone fracture not talus M87.075 Idiopathic aseptic necrosis of left foot accompanied by a break in skin. 812.03 Fracture of greater S42.251A Displaced fracture of greater tuberosity tuberosity of humerus, of right humerus, initial encounter for M87.076 Idiopathic aseptic necrosis of displaced—Bone break in which the closed closed fracture unspecified foot two broken ends are separated. S42.252A Displaced fracture of greater tuberosity M87.174 Osteonecrosis due to drugs, right foot malunion—Fractured bone that has of left humerus, initial encounter for M87.175 Osteonecrosis due to drugs, left foot healed or is healing in an incorrect closed fracture M87.176 Osteonecrosis due to drugs, unspecified position. S42.253A Displaced fracture of greater tuberosity foot nonunion—Fractured bone that has of unspecified humerus, initial M87.274 Osteonecrosis due to previous trauma, failed to heal. encounter for closed fracture right foot open fracture—Fracture in which the S42.254A Nondisplaced fracture of greater M87.275 Osteonecrosis due to previous trauma, See the one-to-many tuberosity of right humerus, initial left foot broken end or ends of the bone have encounter for closed fracture relationship of key pierced the skin. M87.276 Osteonecrosis due to previous trauma, S42.255A Nondisplaced fracture of greater unspecified foot ICD-9-CM codes to tuberosity of left humerus, initial encounter for closed fracture M87.374 Other secondary osteonecrosis, right ICD-10-CM codes. foot S42.256A Nondisplaced fracture of greater tuberosity of unspecified humerus, M87.375 Other secondary osteonecrosis, left foot initial encounter for closed fracture M87.376 Other secondary osteonecrosis, unspecified foot M87.874 Other osteonecrosis, right foot Note that in ICD-9-CM, if a fracture is specified as complicated by a malunion M87.875 Other osteonecrosis, left foot or nonunion, the fracture site is irrelevant as there are only two applicable codes: M87.876 Other osteonecrosis, unspecified foot 733.81 Malunion of fracture, and 733.82 Nonunion of fracture. However, documentation of the site, laterality, and type of complication is imperative in ICD-10-CM, as the same traumatic fracture codes are used but with a seventh Sometimes the normal curvatures in the spine become deformed. There are character identifying malunion or nonunion. three types of these deformities: Additionally, to appropriately assign a seventh digit for malunion or nonunion • Scoliosis, a lateral curvature of the spine of an open fracture, a coder must be aware of the differences between the types • Kyphosis, an abnormal posterior convex curvature of the spine of open fractures as described below: • Lordosis, an exaggerated inward curvature of the lower back • Type I: The wound is less than 1 cm in length and clean.

– IIIC: The injury is associated with an arterial injury that requires Scoliosis and Kyphoscoliosis repair. The differences in coding for malunion and nonunion are captured in the table below. Please note that due to extensive mapping, the table is a sample of the ICD-10-CM codes that represent the various concepts.

Scoliosis Kyphoscoliosis

For the most part, ICD-10-CM mimics ICD-9-CM when it comes to coding 20. The three types of spinal curvature abnormalities are: kyphosis and lordosis, having equivalent one-to-one mapping or, if there is a one-to-many match, the classification is simply divided by spinal region (i.e., a. ______cervical, thoracic, or lumbar). However, there are a few distinct differences b. ______surrounding the crosswalk for scoliosis and kyphoscoliosis, category 734.3 in ICD-9-CM. In order to appropriately assign a code for (kypho-) scoliosis in c. ______ICD-10-CM, the coder must understand the different physiologies of the Shows where to disease. KNOWLEDGE REVIEW ANSWERS: SKELETAL SYSTEMS AND focus documentation There are four major types of scoliosis: improvement efforts and ARTICULATIONS • Congenital educates clinical staff 1. True or false. The mandible is the only bone in the face that moves. Tr u e • Neuromuscular, which is due to spinal muscle weakness or nerve about areas that will need Rationale: damage The face consists of 13 stationary bones and one that is mobile. additional documentation The mandible (jawbone) is the only facial bone that moves, and it is also the necessary for coding • Degenerative largest and strongest bone of the face. accuracy. • Idiopathic, which has an unknown cause and is the most common form 2. The bony spine is also called the vertebral column, named after the 24 of the disease. It can be divided by the age of the patient: individual bones that it comprises.

– infantile: birth to 3 months Rationale: The vertebral column is the support for the head and trunk of – juvenile: 3 months to 9 years the body, as well as protection for the spinal cord. It is composed of 26 individual bones. Of these bones, 24 are vertebrae that are separated by – adolescent: 10 to 18 years cartilage called intervertebral discs. ICD-9-CM does distinguish between infantile and other types of idiopathic 3. There are how many vertebrae in each section of spine? scoliosis, as well as whether the infantile disease is progressive or resolving. In ICD-10-CM, however, the distinction between the age classifications is further a. 7 cervical specified, and juvenile and adolescent idiopathic scoliosis are also given their b. 12 thoracic own categories, but the detail of whether the disease is progressing or resolving is lost in ICD-10-CM. c. 5 lumbar In addition to codes clarifying idiopathic scoliosis, codes have been added in Rationale: The vertebrae can be divided into three groups: 7 cervical ICD-10-CM for neuromuscular and other secondary forms of scoliosis, such as (C1-C7; C1 is also known as atlas, C2 as axis), 12 thoracic (T1-T12), 5 that caused by disc herniation. lumbar (L1-L5). Coding for (Kypho-) Scoliosis 4. The clavicle and scapula form the shoulder girdle.

ICD-9-CM ICD-10-CM Rationale: The shoulder girdle consists of two bones on each side, the clavicle, or collar bone, and the scapula, or shoulder blade. The clavicle is 737.30 Scoliosis, idiopathic M41.112 Juvenile idiopathic scoliosis, cervical region found on the anterior side of the shoulder and the scapula on the posterior. M41.113 Juvenile idiopathic scoliosis, 5. What is the lowest portion of the coxal bones called? ischium cervicothoracic region M41.114 Juvenile idiopathic scoliosis, thoracic Rationale: region This area is identified in the illustration of the pelvis. M41.115 Juvenile idiopathic scoliosis, 6. The acetabulum is where the head of the femur sits to form the hip joint. thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar Rationale: Where the three parts of the pelvic bone fuse together is referred region to as the acetabulum. It is a deep-seated pocket that accepts the rounded M41.117 Juvenile idiopathic scoliosis, lumbosacral region upper epiphysis of the thigh bone, or femoral head, to form the hip joint. M41.119 Juvenile idiopathic scoliosis, site unspecified 7. True or false. Both the thumb and big toe have more phalanges than the False M41.122 Adolescent idiopathic scoliosis, cervical other toes. region M41.123 Adolescent idiopathic scoliosis, Rationale: There are three phalanges in all fingers, except thumbs, which (Continued on next page) cervicothoracic region have only two. Similar to the fingers, all of the toes have three phalanges—proximal, middle, and distal—with the exception of the great toe, or hallux.

For the most part, ICD-10-CM mimics ICD-9-CM when it comes to coding 20. The three types of spinal curvature abnormalities are: kyphosis and lordosis, having equivalent one-to-one mapping or, if there is a one-to-many match, the classification is simply divided by spinal region (i.e., a. ______cervical, thoracic, or lumbar). However, there are a few distinct differences b. ______surrounding the crosswalk for scoliosis and kyphoscoliosis, category 734.3 in ICD-9-CM. In order to appropriately assign a code for (kypho-) scoliosis in c. ______ICD-10-CM, the coder must understand the different physiologies of the Each chapter includes disease. an extensive knowledge KNOWLEDGE REVIEW ANSWERS: SKELETAL SYSTEMS AND There are four major types of scoliosis: assessment with 15 questions or more. ARTICULATIONS • Congenital 1. True or false. The mandible is the only bone in the face that moves. Tr u e • Neuromuscular, which is due to spinal muscle weakness or nerve Rationale: damage The face consists of 13 stationary bones and one that is mobile. The mandible (jawbone) is the only facial bone that moves, and it is also the • Degenerative largest and strongest bone of the face. • Idiopathic, which has an unknown cause and is the most common form 2. The bony spine is also called the vertebral column, named after the 24 of the disease. It can be divided by the age of the patient: individual bones that it comprises.

– infantile: birth to 3 months Rationale: The vertebral column is the support for the head and trunk of – juvenile: 3 months to 9 years the body, as well as protection for the spinal cord. It is composed of 26 individual bones. Of these bones, 24 are vertebrae that are separated by – adolescent: 10 to 18 years cartilage called intervertebral discs. ICD-9-CM does distinguish between infantile and other types of idiopathic 3. There are how many vertebrae in each section of spine? scoliosis, as well as whether the infantile disease is progressive or resolving. In ICD-10-CM, however, the distinction between the age classifications is further a. 7 cervical specified, and juvenile and adolescent idiopathic scoliosis are also given their b. 12 thoracic own categories, but the detail of whether the disease is progressing or resolving is Answer key and lost in ICD-10-CM. answer rationale c. 5 lumbar In addition to codes clarifying idiopathic scoliosis, codes have been added in are presented in a Rationale: The vertebrae can be divided into three groups: 7 cervical ICD-10-CM for neuromuscular and other secondary forms of scoliosis, such as separate appendix. (C1-C7; C1 is also known as atlas, C2 as axis), 12 thoracic (T1-T12), 5 that caused by disc herniation. lumbar (L1-L5). Coding for (Kypho-) Scoliosis 4. The clavicle and scapula form the shoulder girdle.

ICD-9-CM ICD-10-CM Rationale: The shoulder girdle consists of two bones on each side, the clavicle, or collar bone, and the scapula, or shoulder blade. The clavicle is 737.30 Scoliosis, idiopathic M41.112 Juvenile idiopathic scoliosis, cervical region found on the anterior side of the shoulder and the scapula on the posterior. M41.113 Juvenile idiopathic scoliosis, 5. What is the lowest portion of the coxal bones called? ischium cervicothoracic region M41.114 Juvenile idiopathic scoliosis, thoracic Rationale: region This area is identified in the illustration of the pelvis. M41.115 Juvenile idiopathic scoliosis, 6. The acetabulum is where the head of the femur sits to form the hip joint. thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar Rationale: Where the three parts of the pelvic bone fuse together is referred region to as the acetabulum. It is a deep-seated pocket that accepts the rounded M41.117 Juvenile idiopathic scoliosis, SAMPLE PAGE FROM THE NEW upper epiphysis of the thigh bone, or femoral head, to form the hip joint. lumbosacral region Tests with answer M41.119 Juvenile idiopathic scoliosis, site COMPREHENSIVE ANATOMY AND unspecified rationale sharpen 7. True or false. Both the thumb and big toe have more phalanges than the other toes. False M41.122 Adolescent idiopathic scoliosis, cervical the skills needed for PHYSIOLOGY FOR ICD-10-CM CODING region front-line, everyday M41.123 Adolescent idiopathic scoliosis, Rationale: There are three phalangesCall in all fingers,1.800.INGENIX except thumbs, which (464.3649) o r (Continued on next page) cervicothoracic region coding challenges. have only two. Similar to the fingers, all of the toes have three phalanges—proximal, middle,visit and dist www.shopingenix.comal—with the exception of the great to order. toe, or hallux.

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Target your ICD-10-CM training efforts efficiently. The higher degree of specificity in the ICD-10-CM code set is going to require more documentation and more coding precision. Coders will need to have a strong command of human anatomy and physiology to code accurately in the new coding system. Where the knowledge of anatomy will really count is in the thousands of ICD-10-CM codes that don’t have a one-to- one match with the ICD-9-CM codes. This new ICD-10 coding tool from Ingenix will help you to focus your anatomical lessons on those areas that offer multiple ICD-10-CM code choices. You’ll be able to use your new understanding of anatomy to assign the correct ICD-10-CM codes NEW! See inside for sample pages of this new product Save up to 30% on the NEW Comprehensive Anatomy and Physiology for ICD-10-CM Coding.

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