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‘Bone’ Up on Your Anatomy and Physiology for ICD-10
By Betty Johnson, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC

With ICD-10 set to “go live” in 2013, offices and facilities are figuring out timelines to ensure they are ready for this change. Before learning the code set, though, time must be devoted to anatomy, physiology, medical terminology, and pathophysiology education. While the anatomy and physiology are not changing, the codes for ICD-10 (both CM and PCS) are much more specific, so a coder will need a more in-depth knowledge of the aforementioned topics.

Anatomy and Physiology
For proficiency with ICD-10, a good understanding of anatomy and physiology is important. A coder should know the organ systems and their components. For example, there are eight carpal bones that form the wrist: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate. Each of these carries a different ICD-10-CM code for a traumatic fracture. Let’s say that a physician documents “fracture, lunate and fall” as the diagnoses on the encounter form. If you look up “Fracture, lunate” in the ICD-10 alphabetic index, you will not find it. You have to go to “Fracture, traumatic, carpal bone(s), lunate” to find the code choices.  

From a procedural standpoint, consider a coronary artery bypass graft (CABG). ICD-9-CM contains nine codes to describe different versions of this procedure, while ICD-10-PCS components can be combined to produce 34 unique codes defining all significantly different versions of the comparable CABG procedure. All 34 codes specify the same four aspects of the procedure: the number of coronary artery sites bypassed, the approach to the procedure site, the type of graft (if used), and the origin of the bypass (source of the new blood flow). A coder would need a good understanding of the coronary anatomy to code these procedures correctly.

Pathophysiology
Many coders understand anatomy better than pathophysiology, but they need to learn as much as they can about diseases and disorders because the majority of codes in ICD-10-CM are designated for specific diseases or disorders and their manifestations. There are many more combination codes in ICD-10-CM, including the underlying condition as well as one or more manifestations, complications, or associated conditions. Knowledge of origins of disease, disease characteristics, progression, related conditions and complications, signs, symptoms, and manifestations of diseases is needed to code in the new system.

Consider the seventh-character extenders in ICD-10-CM. Seventh-character extenders are used on some code sets in ICD-10 that indicate initial encounter, subsequent encounter, or sequela. Understanding the disease process will be necessary to ensure proper assignment of these extenders.

Medical Terminology
ICD-10-PCS is very detailed. All codes are seven characters in length and include information on the organ system, body part, root operation, and approach. Standardized terminology is used throughout ICD-10-PCS to lessen confusion and support the capture of accurate data. The medical terminology in ICD-10-PCS may differ from what coders are currently used to seeing or using.

For example, there are codes for extirpation in PCS. Extirpation represents a range of procedures where the body part itself is not the focus of the procedure. Instead, the objective is to remove solid material such as a foreign body, a thrombus, or a calculus from the body part. This may be a term with which most coders are currently unfamiliar.

Additionally, to a coder, some familiar terms may carry different meanings in PCS. For example, there are excisions and resections in PCS. Today, some coders (and providers) may use these terms interchangeably, but in the PCS system, they carry two different meanings. An excision is removal by cutting out a portion of a body part, while a resection is removal by cutting out all of a body part. No eponyms are used in PCS, so coders will need to recognize a procedure by the root operation itself.

Preparation
So with all these changes, how does a coder best prepare? A general assessment of the current level of expertise should be taken of all coding staff. Perhaps a baseline quiz on the above topics could be given to get a good picture of everyone’s level of knowledge. At that point, education issues can be addressed and a plan can be made to ensure the staff is prepared when ICD-10 goes live.

Anatomy and terminology are definitely “use or lose it” topics. If it has been years since the staff received training on these subjects, expect some rusty responses. The good news is that ICD-10 is still a few years away, so education can be planned out at a pace that works for everyone.

The best way to deliver the education will depend on different factors, including the facility, budget concerns, and employment policies and procedures. Professional associations, such as the AAPC and the AHIMA, have assessment tools and will offer various educational opportunities that may be feasible for your clinic/facility. Most community colleges will offer anatomy and physiology and medical terminology courses, perhaps in the evening or online.

Coding staff will probably bear the primary responsibility of educating providers on ICD-10 and documentation issues. The sooner the staff gets the necessary education on the systems and the issues addressed in this article, the sooner they will be able to begin the process of working with the providers. The time to start is now.

— Betty Johnson, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC, is the Midwest regional director for AAPC Physician Services and has more than 20 years of experience in the healthcare field.