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. 10 © 2011 Ingenix © 2011 Ingenix 11 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 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.