Advanced Anatomy and Physiology for ICD-10-CM...

Advanced Anatomy and Physiology for

ICD-10-CM/PCSAn essential resource for diagnostic and procedural coding

S46.011 – Strain of muscle(s)and tendon(s) of the rotator

cuff of right shoulder

2010

R10.11 – Rightupper quadrant pain

T23.231 – Burn of seconddegree of muliple right

fingers (nail), not includingthumb

S0S.12 – Contusion of eyeballand orbital tissues, left eye

M80.022 – Age-relatedosteoporosis with currentpathological fracture,left humerus

0SRB0J6 – Replacement of left hip joint with syntheticsubstitute metal on metal, open approach

M06.042 – Rheumatoidarthritis without rheumatoid factor, lefthand

IntroductionCourse Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iThe Human Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iiAnatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii

Structural Organization . . . . . . . . . . . . . . . . . . . . . . . . . . .iiTerminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivPhysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivAnatomy and Physiology for ICD-10-CM/PCS . . . . . . . . . iv

ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivICD-10-PCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viOrganization of the Book . . . . . . . . . . . . . . . . . . . . . . . . . vi

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Section I – Anatomy and Physiology for ICD-10-CMTable 1 . Conventions Table . . . . . . . . . . . . . . . . . . . . . . . . . . . ixTable 2 . General Coding Guidelines . . . . . . . . . . . . . . . . . xiiiProcess For Code Selection . . . . . . . . . . . . . . . . . . . . . . . . xvii

Chapter 1 – Blood and Blood Forming OrgansChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Types of Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Differences Between ICD-9-CM and

ICD-10-CM Blood and Blood Forming Organs Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Diseases, Disorders, Injuries, and Other Conditions of the Blood, Blood Forming Organs, and Immune Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Other Disorders of the Blood . . . . . . . . . . . . . . . . . . . . . . . . 19Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 2 – Endocrine SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Hormones and Endocrine Glands . . . . . . . . . . . . . . . . . . . 25

The Pituitary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Parathyroid Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Adrenal Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Ovaries/Testes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Pineal Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Thymus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Endocrine Functions of Other Organs . . . . . . . . . . . . 30

Differences Between ICD-9-CM and ICD-10-CM Endocrine, Nutritional and Metabolic Diseases Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

New ICD-10-CM Documentation Elements Related to Endocrine, Nutritional, and Metabolic Diseases Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Diseases, Disorders, Injuries, and Other Conditions of the Endocrine System, and Nutritional and Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Chapter 3 – Nervous SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Neuroglia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Meninges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Cerebrospinal Fluid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Peripheral Nervous System . . . . . . . . . . . . . . . . . . . . . . 52Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Nerve Impulses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Nervous Tissue Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Differences Between ICD-9-CM and

ICD-10-CM Nervous System Coding Guidelines 55Diseases, Disorders, Injuries, and Other Conditions

of the Nervous System . . . . . . . . . . . . . . . . . . . . . . . 58Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Contents

Contents AdvancedAnatomyandPhysiologyforICD-10-CM/PCS

Chapter 4 – Eye and AdnexaChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Eye Anatomy and Function . . . . . . . . . . . . . . . . . . . . . . . . . 74

Conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Sclera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Cornea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Schlemm’s Canal and Trabecular Meshwork . . . . . 75Choroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Ciliary Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Iris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Retina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Anterior Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Aqueous Humor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Posterior Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Globe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Lacrimal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Vitreous Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Optic Nerve and Visual Pathways . . . . . . . . . . . . . . . . 78

Differences Between ICD-9-CM and ICD-10-CM Eye and Adnexa Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . 78

New ICD-10-CM Documentation Elements Related to Eye and Adnexa Coding . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Diseases, Disorders, Injuries and Other Conditions of Eye and Adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Retinal Detachments . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Disorders of Refraction and Accommodation . . . . 80Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Infectious Diseases of the Eye . . . . . . . . . . . . . . . . . . . 81Neoplasms of the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . 85Signs and Symptoms of the Eye . . . . . . . . . . . . . . . . . 86Blurred Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Scotomas (Blind Spots) . . . . . . . . . . . . . . . . . . . . . . . . . . 86Visual Impairment and Blindness . . . . . . . . . . . . . . . 86Visual Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Newborn and Congenital Conditions . . . . . . . . . . . 87Eye Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Postoperative Complications . . . . . . . . . . . . . . . . . . . . 90

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Chapter 5 – Ear and Mastoid ProcessChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Cells and Tissues of the Ear and Mastoid Process . . . . . 93

The External Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

External Auditory Canal (EAC) . . . . . . . . . . . . . . . 94Non-Acoustic Physiological Functions . . . . . . . 94Acoustic Function . . . . . . . . . . . . . . . . . . . . . . . . . . 94

The Middle Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Tympanic Membrane . . . . . . . . . . . . . . . . . . . . . . . 95Ossicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95The Eustachian Tube . . . . . . . . . . . . . . . . . . . . . . . 96

The Inner Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Vestibular Labyrinth System . . . . . . . . . . . . . . . . 96The Cochlear Labyrinth . . . . . . . . . . . . . . . . . . . . . 97

Mastoid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Differences Between ICD-9-CM and ICD-10-CM Ear

and Mastoid Process Coding Guidelines . . . . . . . . . . 98Diseases, Disorders, Injuries, and other Conditions

of the Ear and Mastoid . . . . . . . . . . . . . . . . . . . . . . . 98Infections of the Ear and Mastoid . . . . . . . . . . . 98Neoplasms of the Ear and Mastoid . . . . . . . . . . 99Other Diseases and Disorders of the Ear and

Mastoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100Conditions Arising in the Perinatal Period . .101Congenital Malformations of the Ear . . . . . . .102Signs, Symptoms, and Abnormal Findings .102Injuries, Poisonings, and Other External

Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Chapter 6 – Circulatory SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Blood Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110Circulatory Routes . . . . . . . . . . . . . . . . . . . . . . . . .111

Physiology of the Blood Circulatory System . . . . . 112Lymphatic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Lymphatic Vessels . . . . . . . . . . . . . . . . . . . . . . . . .112Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113Other Lymphatic Organs . . . . . . . . . . . . . . . . . . .113

Physiology of the Lymphatic Circulatory System 113Interstitial Fluid and Lymph . . . . . . . . . . . . . . . .113Lymph Capillaries and Digestion . . . . . . . . . . .113Defense Mechanisms of the Lymphatic

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114

Differences Between ICD-9-CM and ICD-10-CM Cardiovascular and Lymphatic Circulatory Systems Coding Guidelines . . . . . . . . . . . . . . . . . . 114

AdvancedAnatomyandPhysiologyforICD-10-CM/PCS Contents

New ICD-10-CM Documentation Elements Related to Cardiovascular and Lymphatic Circulatory Systems Coding . . . . . . . . . . . . .118

Diseases, Disorders, Injuries and Other Conditions of Cardiovascular and Lymphatic Circulatory Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Chapter 7 – Respiratory SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Specialized Cells of the Respiratory Tract . . . . . . . . . . . 133

Tissues of the Respiratory System . . . . . . . . . . . . . . 134Conductive Portion . . . . . . . . . . . . . . . . . . . . . . .134Respiratory Epithelium . . . . . . . . . . . . . . . . . . . .134

Organs of the Respiratory System and their Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Nasal Cavity and Turbinates . . . . . . . . . . . . . . .135Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . .136Tonsils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136Pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137Larynx and Vocal Cords . . . . . . . . . . . . . . . . . . . .137Trachea and Bronchi . . . . . . . . . . . . . . . . . . . . . .137Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138Pleura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

Differences Between ICD-9-CM and ICD-10-CM Respiratory System Guidelines . . . . . . . . . . . . . . 141

New ICD-10-CM Documentation Elements Related to Endocrine, Nutritional and Metabolic Diseases Coding . . . . . . . . . . . . .143

Diseases, Disorders, Injuries, and other Conditions of the Respiratory System . . . . . . . . . . . . . . . . . . . 143

Infectious/Parasitic Diseases . . . . . . . . . . . . . . .143Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145Diseases and Disorders of the Respiratory

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145Respiratory System Conditions Arising in the

Perinatal Period . . . . . . . . . . . . . . . . . . . . . . . .147Congenital Malformations of the Respiratory

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Signs, Symptoms, and Abnormal Findings . . . . . . 148

Respiratory System Injuries, Poisonings, and Other External Causes . . . . . . . . . . . . . . . . .149

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Chapter 8 – Digestive SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Specialized Epithelial Cells of the Gastrointestinal

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Upper GI Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Mucous Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154Taste Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154Serous Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155Exocrine Pancreas . . . . . . . . . . . . . . . . . . . . . . . . .156

Tissues and their Functions . . . . . . . . . . . . . . . . . . . . . 156Mucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156Submucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156Muscularis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156Serosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156

Organs of the Digestive System and their Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158Small Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . .159Large Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . .160Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163

Differences Between ICD-9-CM and ICD-10-CM Digestive System Coding Guidelines . . . . . . . . . 164

New ICD-10-CM Documentation Elements Related to Digestive System Coding . . . . . . . . . . . . . . . . . 164

Diseases, Disorders, Injuries, and other Conditions of the Digestive System . . . . . . . . . . . . . . . . . . . . . 164

Infectious/Parasitic Diseases . . . . . . . . . . . . . . .165Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165Diseases and Disorders of the Digestive

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166Digestive System Conditions Arising in the

Perinatal Period . . . . . . . . . . . . . . . . . . . . . . . .167Congenital Malformations, Deformations and

Chromosome Abnormalities Affecting the Digestive System . . . . . . . . . . . . . . . . . . . . . . .168

Signs, Symptoms, and Abnormal Findings .168Digestive System Injuries, Poisonings, and

Other External Causes . . . . . . . . . . . . . . . . .169Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Chapter 9 – Integumentary SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Epidermal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Keratinocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Melanocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Langerhans Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Merkel Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Dermal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174


Fibroblasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174Mast Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174Macrophages . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174Hypodermal Cells . . . . . . . . . . . . . . . . . . . . . . . . .175

Tissues and their Function . . . . . . . . . . . . . . . . . . . . . 175Epidermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175Dermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175Hypodermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176

Organ Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Epidermal Layers . . . . . . . . . . . . . . . . . . . . . . . . . .176Dermal Layers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176

Differences Between ICD-9-CM and ICD-10-CM Integumentary System Coding Guidelines . . . 177

New ICD-10-CM Documentation Elements Related to Integumentary System Coding . . . . . . . . . . . . 178

Diseases, Disorders, Injuries, and other Conditions of Integumentary System and Skin Appendages .178

Infectious/Parasitic Diseases . . . . . . . . . . . . . . . . . . . 178Pressure Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180Conditions Affecting the Integumentary System

Originating During Perinatal Period . . . . . . . . . 181Congenital Malformations, Deformations and

Chromosome Abnormalities Affecting the Integumentary System . . . . . . . . . . . . . . . . . . . . . . 181

Integumentary System Injuries, Poisonings, and Other Consequences of External Causes . . . . . 182

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Chapter 10 – Musculoskeletal SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186Bone Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . .187Bone Formation and Growth . . . . . . . . . . . . . . .187Axial and Appendicular Skeleton . . . . . . . . . . .188Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191

Muscular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192Skeletal Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . .193

Differences Between ICD-9-CM and ICD-10-CM Musculoskeletal System Coding Guidelines . . 196

New ICD-10-CM Documentation Elements Related to Muscoloskeletal System Coding . . . . . . . . . . 198

Diseases, Disorders, Injuries and Other Conditions of Musculoskeletal System . . . . . . . . . . . . . . . . . . 198

Infectious/Parasitic Diseases . . . . . . . . . . . . . . .198Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199Systemic Connective Tissue Disorders . . . . . .202Dorsopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203Soft Tissue Disorders . . . . . . . . . . . . . . . . . . . . . . .204Conditions Affecting Newborns . . . . . . . . . . . .207Congenital Malformations and Deformations of

the Musculoskeletal System . . . . . . . . . . . .207Symptoms, Signs, and Abnormal Findings . .208Injuries, Poisonings, and Other Consequences

of External Causes . . . . . . . . . . . . . . . . . . . . . .208Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Chapter 11 – Genitourinary SystemChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215Urinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Kidneys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217Kidney Structure . . . . . . . . . . . . . . . . . . . . . . . . . .217Kidney Function . . . . . . . . . . . . . . . . . . . . . . . . . . .217Kidney Blood Supply . . . . . . . . . . . . . . . . . . . . . .217Ureters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217Urinary Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . .218Urethral Sphincter Muscles . . . . . . . . . . . . . . . .218Bladder Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . .218Urethra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219

Male Genital System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219Penis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219Testes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

Seminiferous Tubules . . . . . . . . . . . . . . . . . . . . . .221Leydig Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221

Epididymis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221Vas deferens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221Spermatic Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222Bulbourethral Glands . . . . . . . . . . . . . . . . . . . . . . . . . . 222

Female Genital System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222Hymen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222External Genitalia [unbold . . . . . . . . . . . . . . . . . . . . . 222

Labia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222Uterus and Cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Uterine Corpus . . . . . . . . . . . . . . . . . . . . . . . . . . . .224Cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224Vagina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224Ovaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224

Fallopian Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . .225

AdvancedAnatomyandPhysiologyforICD-10-CM/PCS Contents

Breasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225Pregnancy, Childbirth and the Puerperium . . . . . . . . . 226

Conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227Pregnancy Detection . . . . . . . . . . . . . . . . . . . . . . . . . . 227Gravid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227Pregnancy Trimesters . . . . . . . . . . . . . . . . . . . . . . . . . . 227

First Trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227Second Trimester . . . . . . . . . . . . . . . . . . . . . . . . .227Third Trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . .227

Pregnancy, Childbirth and the Puerperium . . . . . 228Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228Childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228Puerperium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228

Differences Between ICD-9-CM and ICD-10-CM Genitourinary Guidelines . . . . . . . . . . . . . . . . . . . . . . . 228

Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . 228Pregnancy, Childbirth and the Puerperium . . . . . 229

New ICD-10-CM Documentation Elements Related to Genitourinary Coding . . . . . . . . . . . . . . . . . . . . . . . . . . 236

New ICD-10-CM Documentation Elements Related to Pregnancy, Childbirth and the Puerperium Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Infectious Diseases of the Urinary and Reproductive Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Urinary Tract Infection (UTI) . . . . . . . . . . . . . . . .236Epididymitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237Pelvic Inflammatory Disease (Disorder) (PID) . . .

238Neoplasms of the Urinary and Reproductive

Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238Bladder Malignancy . . . . . . . . . . . . . . . . . . . . . . .238

Prostate Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 238Testicular Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . 238Breast Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Benign Conditions of the Uterus . . . . . . . . . . .239Fibroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239

Other Diseases and Conditions of the Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Chronic Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . 240Nephrolithiasis, Ureterolithiasis and Urolithiasis 240Vesicoureteral Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . 240Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240Testicular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Testicular Trauma . . . . . . . . . . . . . . . . . . . . . . . . . .241Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Endometrial Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . 241Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242Urinary Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Stress Incontinence . . . . . . . . . . . . . . . . . . . . . . . .242Urge Incontinence . . . . . . . . . . . . . . . . . . . . . . . . .242Overactive Bladder . . . . . . . . . . . . . . . . . . . . . . . .242Functional Incontinence . . . . . . . . . . . . . . . . . . .242Overflow Incontinence . . . . . . . . . . . . . . . . . . . .243Transient Incontinence . . . . . . . . . . . . . . . . . . . .243

Congenital Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Hypospadias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Chordee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Undescended Testicles . . . . . . . . . . . . . . . . . . . . . . . . . 243Klinefelter’s syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 243

Pregnancy and Pregnancy-Related Disorders . . . . . . . 243Ectopic Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Spontaneous Miscarriage/Abortion . . . . . . . . . . . . 244High Risk Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 244Gestational Diabetes Mellitus (GDM) . . . . . . . . . . . 245Preterm (Premature) Labor . . . . . . . . . . . . . . . . . . . . . 245

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

Section II – Anatomy and Physiology for ICD-10-PCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

Chapter 1 – SectionsChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Medical and Surgical Section . . . . . . . . . . . . . . . . . . . . . . . . .1

Obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Measurement and Monitoring . . . . . . . . . . . . . . . . . . . .3Extracorporeal Assistance and Performance . . . . . . .4Extracorporeal Therapies . . . . . . . . . . . . . . . . . . . . . . . . . .4Osteopathic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Physical Rehabilitation and Diagnostic Audiology . .7Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Chapter 2 – Body Systems and Body PartsChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Body System Designations . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Specific Body System Designations . . . . . . . . . . . . . . 12Anatomical Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Body Part Designations . . . . . . . . . . . . . . . . . . . . . . . . . 13

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17


Chapter 3 – ICD-10-PCS – Root Operations and ApproachesChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Root Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Root Operation Definitions . . . . . . . . . . . . . . . . . . . . . . 19Repair Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . 20Root Operation Groups . . . . . . . . . . . . . . . . . . . . . 20Root Operation Values . . . . . . . . . . . . . . . . . . . . . . 21

Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Approach Definitions . . . . . . . . . . . . . . . . . . . . . . 22

Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 4 – ICD-10-PCS – Devices and QualifiersChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Devices Take the Place of All or a Portion of a Body Part . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Devices That Assist or Prevent a Physiological Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Therapeutic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Mechanical or Electronic Appliances . . . . . . . . . . . . . 26New Device Without a More Specific Device Value 26Procedures That Have a Specific Qualifier Value . . 28Procedures That Do Not Have a Specific Qualifier

Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Chapter 5 – ICD-10-PCS ApplicationsChapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendix A – Official Coding GuidelinesICD-9-CM Official Coding Guidelines . . . . . . . . . . . . . . . . 37

Appendix B – Official Coding GuidelinesICD-10-CM Official Coding Guidelines/Reporting . . . . 75

© 2010 Contexo Media i

The Advanced Anatomy and Physiology for ICD-10-CM/PCS is designed to introduce medical coders to the new ICD-10-CM/PCS system, the differences between ICD-9-CM and ICD-10-CM, and additionally to provide a more advanced understanding of body systems, diseases/disease processes, and anatomy.

Each chapter in this book contains a systemized approach to learning. Course objectives begin each chapter followed by an overview of the given chapter topic. A thorough discussion provides the reader with the specifics of advanced coding in ICD-10-CM and how it relates to the ICD-9-CM system. A side-by-side comparision is noted of Offical Coding Guidelines between the two coding systems. Questions are provided to evoke thoughtful consideration of effective coding. Additionally, chapter-specific terminology are defined to foster greater learning. A quiz ends each chapter allowing the reader to test their knowledge. Quiz answers can be found on the following web site: www.codingbooks.com/API10/

Refer to the end of this chapter for a detailed summary of the organization of this book.

Course ObjectivesThis course is designed to provide:

• A solid foundation in basic human anatomy and physiology

• A review of each body system with in-depth information on cells, tissues, and organs that comprise each body system

• In-depth information on the function of cells, tissues, organs, and body systems and the roles they play in maintaining homeostasis and health

• An overview of diseases and disease processes specific to each body system

• A discussion of the effects of diseases and disease processes on multiple body systems

• Information on multi-system diseases and disease processes

• Advanced medical terminology specific to each body system

• The relations between anatomy and physiology and code capture in diagnosis and procedure coding

• New anatomical and physiological documentation requirements for code capture in ICD-10-CM and ICD-10-PCS

OverviewDeveloping an understanding of anatomy and physiology from a coding perspective is one challenge coders face. Most anatomy and physiology courses begin with general information on structural organization and function beginning with an overview of the chemical level (atoms and molecules), cellular level, tissue level, organ level, and proceed to the body system level. Even after taking introductory anatomy and physiology courses, many coders have difficulty identifying the correct diagnosis or procedure code. This difficulty is due to a number of factors, not the least of which is the organization of the coding systems themselves.

Diagnostic and procedural coding systems are not organized in the same fashion as most anatomy and physiology texts. Instead, diagnostic coding systems are organized by the disease or disease process which may sometimes be found under a body system but may also be found under different designations such as neoplasms, infections, or signs and symptoms. CPT procedure codes are organized by type of service or procedure (e.g., evaluation and management, surgical, radiological, etc) and then depending on the section may be organized by body system (surgical section), physician specialty (medicine section), or more specific types of service (radiology section). ICD-9-CM Volume 3 was organized by the body system on which the procedure was performed, but because the available code numbers in some body systems were exhausted years ago, some new procedures on specific body systems are listed in the tabular sections under Procedures and Interventions Not Elsewhere Classified or Miscellaneous Procedures. ICD-10- PCS is organized in sections for the general type of procedure performed (e.g., Medical/Surgical, Obstetrics, Placement, Administration, etc.), then by body system, root operation, body part, approach, device, and qualifier.

In this course, each body system will be covered in a separate chapter with the chapter objectives identified at the beginning. The chapters will first discuss pertinent information starting at the chemical level and then progress through each level to the body system level. Both structure and function will be discussed. Within each chapter, the diseases, disease processes, conditions, and symptoms related to the body system will be discussed.

Specific medical terminology required to identify diagnosis and procedure codes correctly will be reviewed. New documentation requirements needed to capture codes in ICD-10-CM and ICD-10-PCS will also be covered. Each chapter will end with a

Introduction

Introduction AdvancedAnatomyandPhysiologyforICD-10-CM/PCS

ii © 2010 Contexo Media

quiz whereby students can test their proficiency as it relates to anatomy, physiology, and medical coding for the specific body system discussed.

This introductory chapter provides basic anatomy, physiology, and coding information that lays the foundation for the more advanced discussion that follows in subsequent chapters.

The Human BodyThe human body is an organism that consists of millions of cells that are organized to form tissues, organs, and body systems. The sciences of anatomy and physiology, along with many other branches of science, contribute to our knowledge of the human body. An understanding of anatomy and physiology is essential to understanding both how the healthy body works and what happens when the body is injured, diseased, or subjected to stress.

AnatomyAnatomy is the study of the structure of the body as well as the relationships between body structures. Anatomy is divided into a number of subcategories including gross anatomy, regional anatomy, systemic anatomy, developmental anatomy, pathological anatomy, and histology. Medical coding requires some understanding of all of these subcategories and this course will cover pertinent information related to the various subcategories.

Structural OrganizationThe human body has different levels of structural organization:

• Chemical

• Cellular

• Tissue

• Organ

• System

Chemical LevelThe first level of structural organization is the chemical level, which is composed of the chemicals essential to maintaining a living organism. Chemicals are composed of atoms that join to form molecules which in turn combine to form cells.

An understanding of the chemical level of organization is important to the medical coder for reporting conditions such as respiratory conditions with changes in blood gases, electrolyte imbalances, and hormone imbalances.

Cellular LevelCells are the basic structural and functional elements of a living organism. There are many different types of cells that serve different functions in the body. For example, the nervous tissue is composed of nerve cells, also called neurons. The specialized

function of nerve cells is to conduct impulses from one part of the body to another. In contrast, the stomach is composed of a number of different cell types including mucous cells, parietal cells, and chief cells which each serve different functions.

An understanding of the cellular level of organization is important in understanding a number of diseases and disease processes, such as cellulitis, blood cancers and other malignant neoplasms, and genetic anomalies.

Tissue LevelCells, even though highly organized, do not function in isolation. Cells are joined together to form tissues that perform specific functions such as protection, support, filtration, absorption, secretion, and movement. An understanding of tissue is important to the coder because tissue injury interferes with the function of the tissue, whether the injury is caused by a disease or disease process, an infection, trauma, or other condition. Tissue injury can result in inflammation, infection, and/or necrosis. Coders must be familiar with the various types of tissue injury. Examples include osteomyelitis, crushing injuries, arteriolitis, myocardial infarction, and spinal cord injury with complete or incomplete transverse lesion.

There are four principle types of tissues: epithelial, connective, muscular, and nervous.

Epithelial TissueThere are two types of epithelial tissue: covering/lining epithelium, and glandular epithelium. Covering and lining epithelium covers the external body surfaces and some internal organs, including the respiratory and digestive tracts, blood vessels, and ducts. Covering and lining epithelium, along with nervous tissue, makes up parts of the sense organs. The secreting portion of glands is comprised of glandular epithelium. Epithelium lies above and adheres to connective tissue. This holds the epithelium in place and prevents it from tearing.

Connective TissueConnective tissue is the binding and supporting tissue of the body and is also the body’s most abundant tissue type. Connective tissue protects, supports, and binds together the body organs, and is subdivided based on the kinds of cells present and the type of intracellular substance. There are a number of types of connective tissue which include:

• Connective tissue proper

• Cartilage

• Bone

• Vascular tissueConnective tissue proper is connective tissue that has a fluid intracellular substance and a fibroblast. Types of tissues included in this category are loose connective or areolar tissue, adipose tissue, collagenous connective tissue, elastic connective tissue, and reticular connective tissue.

Advanced Anatomy and Physiology for ICD-10-CM/PCS Diseases of the Nervous System

© 2010 Contexo Media 53

Spinal NervesThe spinal nerves are named for the region of the vertebral column from which they emerge. There are 8 pairs of cervical nerves, 12 pairs of thoracic nerves, 5 pairs of lumbar nerves, 5 pairs of sacral nerves, and 1 pair of coccygeal nerves. Each spinal nerve is a mixed nerve that is indirectly attached to the spinal cord by two short roots. The dorsal root, also referred to as the posterior or sensory root, contains afferent nerve fibers that conduct impulses into the spinal cord. The ventral root, also referred to as the anterior or motor root, contains axons of motor neurons that conduct impulses away from the spinal cord. Before leaving the spinal canal via the intervertebral foramen, the two roots combine to form the spinal nerve. After the spinal nerve leaves the spinal canal it divides into dorsal (posterior), ventral (anterior), and visceral branches. The dorsal and ventral branches are part of the somatic nervous system while the visceral branches are part of the autonomic nervous system.

Nerve PlexusOnly the ventral branches of spinal nerves T2-T12 are distributed directly to the skin and muscle. The other spinal nerves combine to form plexuses which are complex networks of nerve fibers. The cervical plexus is formed by spinal nerves C1-C4; the brachial plexus is formed by spinal nerves C5-T1; the lumbar plexus is formed by spinal nerves L1-L4; the sacral plexus is formed by spinal nerves L5-S3; and the coccygeal plexus by spinal nerves S4-C1. Nerves that emerge from these plexuses are generally named for the regions they supply. Each of these nerves is subdivided into branches that are usually named for the specific structures they supply.

Spinal nerves/nerve plexus

Cervicle nerves

Thoracic nerves

Lumbar nerves

Sacral/coccygeal

nerves

C1C2C3C4C5C6C7C8T1T2T3T4T5T6T7T8T9

T10T11T12

L1

L2

L3

L4

L5

S1S2

S3S4

S5Coccygeal nerve

Lumbarplexus

Cervicalplexus

Spinal cord

Brachialplexus

Sacralplexus

Autonomic Nervous SystemThe autonomic nervous system controls the smooth muscle, cardiac muscle, and glands. It functions automatically and involuntarily and is regulated by centers in the brain, including the cerebral cortex, hypothalamus, and the medulla oblongata. The autonomic nervous system affects visceral functions and consists entirely of motor fibers that transmit impulses from the CNS to smooth muscle, cardiac muscle, and glandular epithelium.

Examples of visceral functions affected by the autonomic nervous system include:

• Dilation and constriction of blood vessels

• Control of the force and rate of heartbeats

• Relaxation of bladder to allow urination

• Regulation of gastric peristalsis

• Regulation of glandular secretions

The autonomic nervous system is subdivided into parasympathetic and sympathetic functions. Generally the parasympathetic division works to restore and conserve energy while the sympathetic division expends just enough energy to maintain homeostasis. However, in a situation of extreme threat, the sympathetic division dominates the parasympathetic producing the “fight or flight” response.

Autonomic Nerve PathwaysThe autonomic nerve pathways always consist of two neurons. The cell body of the first neuron, also called the preganglionic neuron, is contained in the brain or spinal cord. The axon of the first neuron, also called preganglionic fiber, passes out of the CNS as part of a cranial or spinal nerve. It then separates from the somatic nerve and runs to an autonomic ganglion. There it synapses with the second neuron, also called the postganglionic neuron. The postganglionic axon or fiber then transmits the impulse to the smooth muscle, cardiac muscle, or glandular epithelium.

FunctionAs was stated earlier, the nervous system is the control, regulatory, and communication center of the body. Nervous system tissue is defined by two distinctive characteristics. The first is its ability to carry electrical messages called nerve impulses to and from the CNS. The second is the very limited ability of nervous tissue to regenerate.

The nervous system has three general overlapping functions: sensory, integrative, and motor.

SensorySensory input is gathered by millions of sensory receptors that detect changes occurring inside and outside the body. These sensory receptors monitor external stimuli such as temperature,

Diseases of the Nervous System Advanced Anatomy and Physiology for ICD-10-CM/PCS

54 ©2010ContexoMedia

light, and sound, as well as internal stimuli such as blood pressure, pH, and carbon dioxide concentration.

IntegrationThe sensory input is then converted into nerve impulses which are electrical signals that are transmitted to the central nervous system. These nerve impulses create sensations, produce thoughts, or add to memory. Conscious and unconscious decisions are then made in the central nervous system which is the integrative function of the nervous system.

MotorOnce the central nervous system has integrated the sensory input, the nervous system initiates a response by sending signals to tissues, organs, or glands which elicit a response such as muscle contraction or gland secretion. Tissues, organs, and glands are called effectors because they cause an effect in response to directions received from the central nervous system. This response is referred to as motor output or motor function.

Nerve ImpulsesNerve cells respond to stimuli and convert them into nerve impulses. This is called irritability. Once the stimuli are converted into a nerve impulse, the nerve cells have the ability to transmit that impulse to another nerve cell or to another tissue. This is called conductivity.

IrritabilityAny stimulus that is strong enough to initiate transmission of a nerve impulse is referred to as a threshold impulse. A stimulus that is too weak to initiate a response is called a subthreshold stimulus. However, a series of subthreshold stimuli that are applied quickly to a neuron can have a cumulative effect that may initiate a nerve impulse. This is called summation of inadequate stimuli.

The speed with which an impulse is transmitted depends on the size, type, and condition of the nerve fiber. Myelinated fibers with larger diameters transmit nerve impulses faster than mid-sized and small fibers or unmyelinated fibers. Sensory and motor fibers that detect and respond to potentially dangerous situations in the outside environment are generally larger in diameter than those that control or respond to less critical stimuli.

ConductivityConductivity is the ability of the nerve cell to transmit an impulse to another nerve cell or another tissue via a conduction pathway. The reflex arc is the most basic type of conduction pathway. There are five basic components to a reflex arc that are required to transmit an impulse.

1. A receptor consisting of the distal end of a dendrite of a sensory neuron responds to a stimulus in the internal or external environment and produces a nerve impulse.

2. The impulse is passed by the receptor to the CNS.

3. The incoming impulse is directed to a center usually within the CNS where it is blocked, transmitted, or rerouted. This is usually accomplished with an association neuron that lies between the sensory neuron and the motor neuron.

4. The motor neuron transmits the impulse to the tissue, organ, or gland that must respond to the stimulus.

5. The tissue, organ, or gland, called an effector, responds to the stimulus.

The axons of neurons in a reflex arc do not ever touch the dendrites of the adjacent neuron in the nerve conduction pathway. The impulse must travel across a minute gap called a synapse. In addition, impulses can travel in only one direction from axon to synapse to dendrite.

Nucleus

Nucleolus

Synapse

Axon

Dendrite

Myelinsheath

Schwanncell

Axon/synapse/dendrite

Synaptic cleftSynaptic vesicles

Receptor

Neuro-transmitter Neurofibrils

Axon

Dendrite

Nervous Tissue InjuryUnlike other tissues, nervous tissue has a very limited ability to regenerate. Specifically, if the cell body of a neuron is destroyed, the neuron cannot regenerate nor can other neurons reproduce and replace the damaged neuron. However, the human body is able to repair damaged nerve cells in which the cell body is intact and the axon has a neurilemma. Nerve cells in the peripheral nervous system generally have axons with a neurilemma while those in the brain and spinal cord do not. This means that a

Advanced Anatomy and Physiology for ICD-10-CM/PCS Digestive System


Organs of the Digestive System and their Functions The organs of the digestive system consist of the mouth or oral cavity, the esophagus, the stomach, the small and larges intestines, and the accessory organs of digestion: the liver, gallbladder, and exocrine pancreas. The individual organs, some considered glands, or having glandular functions, are discussed here in their role in digestion.

Oral Cavity

Oral cavity anatomy

Teeth

Palatine tonsil

Lingual tonsil

Epiglottis

Uvula Lips

Tongue

Hard palateSoft palate

Basic Structure and Function The oral cavity is the beginning of the GI tract where the first stages of the digestive process occur. The oral cavity is equipped with different structures specialized for sensory discrimination in tasting, the mechanical digestion of food in chewing, and the chemical, or enzymatic digestion of food in the secretion of saliva. The general appearance of the oral mucosa is a visible sign of health or an indication of disease processes such as infections or ulcers.

Among the structures found in the oral cavity, the tongue and salivary glands, along with the teeth, play the most important roles in digestion.

Tongue The tongue consists mainly of striated muscle fibers arranged perpendicularly, transversely and longitudinally, that are supplied by bundles of myelinated nerve fibers. The mass of muscle moves the food around for effective chewing. Filiform papillae are the “white fuzz” visible on the tongue. The epithelial cells of these papillae are partially keratinized at the tips to provide a small degree of roughness to the tongue. Scattered among these papillae are the fungiform papillae containing the taste buds. Taste buds are clusters of cells extending through the epithelium, connected to the facial and glossopharyngeal nerve at one end, and having a taste pore at the external surface, where each cell’s microvilli make contact with food. These chemoreceptors for taste help initiate both salivation and the secretion of gastric acid for further digestion.

Salivary Glands

Salivary glands

Parotid gland

Submandibulargland

Accessoryparotid gland

Parotid duct

Sublingual gland

The salivary glands secrete up to a litre of saliva each day. Saliva is a mixture of water with mucus (released by mucous cells) and digestive enzymes (released by serous cells), such as ptyalin, which initiates the chemical digestion of carbohydrates in the mouth, or amylase, which breaks down starch into maltose. Saliva also contains amounts of electrolytes like potassium, chloride, and sodium. Saliva also contains bicarbonate, which sustains the pH of saliva at about 7.4. This pH level neutralizes bacterial acids and helps prevent tooth decay and infection.

Salivary glands may be composed mainly of serous or mucous cells, or they may be mixed glands. There are three main pairs of salivary glands:

• Submandibular glands – located under the floor of the mouth below the mandible on each side of the jaw. These are large seromucous or mixed glands that release their secretion into the oral cavity through a duct opening on a small papilla beside the lingual frenum.

• Sublingual glands – located under the tongue in front of the submandibular glands, beneath the mucous membrane of the floor of the mouth. These are classified as mixed glands, but secrete mainly mucous and drain into the mouth through 8-20 excretory ducts.

• Parotid glands – the largest salivary glands located just under and in front of the ear. They are composed entirely of serous cells that drain into the oral cavity near the upper teeth through the Stensen’s duct. These glands make about 25% of the saliva. The glands are palpable and contain lymph nodes that enlarge during infection and cause a painful swelling.

Abnormalities of the salivary glands may appear as obstruction of the flow of saliva, inflammation, infection, or tumors. The formation of stones or constrictions blocking the ducts occurs most commonly in the parotid and submandibular glands. Inflammation occurs when saliva is blocked, causing swelling and severe pain, particularly while eating or with the

Digestive System Advanced Anatomy and Physiology for ICD-10-CM/PCS

158 © 2010 Contexo Media

involvement of autoimmune disorders. Infection or abscess may develop from pooled saliva or secondarily from infected adjacent lymph nodes. Mumps is the most common salivary gland infection, involving the parotid glands. Tumors also appear most commonly in the parotid gland.

Esophagus

Esophagus

Epiglottis

Pharyngoesophageal sphincter

Pharyngeal constrictors

Trachea

Stomach

Diaphragm

Gastroesophageal sphincter

Esophageal anatomyLateral view Front view

Basic Structure and Function The esophagus is a hollow, muscular tube about 25 cm long that moves food particles from the oral cavity down to the stomach for further digestion. Peristalsis is the muscular action that moves the swallowed food into the stomach by a series of contractions and relaxations of the outer longitudinal and inner circular layers of muscle. Peristalsis occurs when stretch receptors in the esophageal wall are stimulated by an increase in wall tension as food passes, which causes an increase in impulses from the brain. Each end of the esophagus is opened and closed by a sphincter. The upper esophageal sphincter prevents air from entering the esophagus during respiration and the lower esophageal sphincter, also called the cardiac sphincter, prevents food in the stomach from re-entering the esophagus.

Swallowing Swallowing is more complex than appears at first and occurs in two stages – the voluntary, or oropharyngeal phase, and the involuntary, or esophageal phase. In the voluntary phase, a bolus of food is moved toward the pharynx by the tongue pushing up on the hard palate. The pharyngeal muscle then contracts, preventing the food from entering the nasopharynx. Food is propelled into the esophagus, while respiration is inhibited, through a series of coordinated events. The second, involuntary phase of swallowing begins after the food bolus enters the esophagus. Primary peristalsis begins. The waves of relaxation first allow food to pass while the following contraction waves push the food farther along. The lower sphincter relaxes just before the arrival of a peristaltic wave. After the bolus of food passes into the stomach, the sphincter muscles return to their resting muscle tone. Both neural and hormonal stimulation can change the muscle tone of the lower sphincter.

The faulty coordination of muscle action resulting from another disorder that impairs motility causes many esophageal disorders. For instance, neural and muscular dysfunctions cause achalasia and dysphagia. Obstructions, such as tumors, also cause dysphagia. Gastric esophageal reflux occurs when the sphincter relaxes, allowing gastric contents to regurgitate back into the esophagus.

Stomach Basic Structure and Function The stomach is the muscular, bag-like structure that holds food during eating, secretes the digestive juices that are mixed with the food, and then moves the liquefied, partially digested food, called chyme, into the duodenum in the small intestine for further digestion and absorption by the body. Food enters the stomach through the lower esophageal sphincter into the fundus, through the body, and down to the antrum, or lower third portion. Chyme is moved out into the duodenum through the pyloric sphincter, the ring of muscle that controls this action within the pyloric canal.

Stomach

Esophagus

Cardia Muscularis externa:

Serosa

Longitudinal layer Circular layer Oblique layer

Rugae of mucosa

Fundus

Body

Greater curvature

Lesser curvature

Esophagus

Pylorus

Pyloric canal Pyloric

region Pyloric antrum

Cardiac orifice in cardiac region

Pyloric sphincter

Duodenum

Innervation Gastric motility used for mechanical digestion and the secretion of gastric juices for chemical digestion are both influenced by nerves of the autonomic nervous system. Extrinsic nerve fibers originate outside the stomach and are under the control of the

Advanced Anatomy and Physiology for ICD-10-CM/PCS Genitourinary System


Overflow IncontinenceIf the bladder does not empty properly, urine may overflow. This may be caused by weak bladder muscles, a blocked urethra due to a urinary calculi or nerve damage from diabetes or another disease.

Transient IncontinenceUrine leaks due to a temporary cause, such as an infection, new medication, restricted mobility and colds.

Coding Practice

Condition ICD-9-CM ICD-10-CM

Stress incontinence of 38-year-old woman

625.6 N39.3

Urge incontinence 788.31 N39.41

Overactive bladder 596.51 N32.81

Mixed incontinence 788.33 N39.46

Overflow incontinence 788.38 N39.490

QuestionsFor ICD-9-CM, urinary incontinence was coded from Chapter18: Symptoms, Signs, and Ill-Defined Conditions. Where has it moved to in ICD-10-CM?

Does gender make a difference in ICD-10-CM code selection?

Congenital AnomaliesHypospadiasHypospadias is a congenital anomaly in the urethra of a male in which the urinary meatus is abnormally placed. Instead of the opening at the tip of the glans of the penis, it will be anywhere along the ventral aspect (underside) of the shaft, to the junction of the penis and scrotum or perineum. Hypospadias is commonly associated with chordee and possibly undescended testes.

There are different degrees of hypospadias:

First degree. The opening is somewhere on the glans penis, but not in the normal area where it is typically located.

Second degree. The opening is on the shaft of the penis.

Third degree. The opening is on the perineum.

ChordeeChordee is where the head of the penis is curbed downwards or upwards. This occurs when the connective tissue between the urethral opening and the glans and/or the urethra is shorter than normal.

Undescended TesticlesAlso called cryptorchidism, undescended testicles do not descend from the abdomen as they should before birth.

Klinefelter’s syndromeKlinefelter’s syndrome involves abnormal sex chromosomes. In males, there is one X chromosome and one Y chromosome. The Y chromosome contains genetic material with the codes that determine the male gender and related masculine characteristics and other male developmental features. In this syndrome, there is the presence of an extra X chromosome, meaning these individuals have 47 chromosomes instead of 46, which causes abnormal development of the testicles.

Coding Practice

Condition ICD-9-CM ICD-10-CM

Hypospadias 752.61 Q54.9

Two-year-old with chordee 752.63 Q54.4

Bilateral undescended testicles 752.51 Q53.20

Klinefelter’s syndrome 758.7 Q98.4

QuestionsWhen coding undescended testicles in ICD-10-CM, does laterality make a difference in code selection?

Pregnancy and Pregnancy-Related DisordersEctopic PregnancyA pregnancy that implants outside the uterus is considered an ectopic pregnancy. A majority of these pregnancies are not viable, with only a few surviving. They typically occur in the Fallopian tube, but a few do implant in other locations, such as the cervix, ovaries and abdomen.

The embryo that has been fertilized adheres to the lining of the Fallopian or other location. This can affect the blood vessels in the area it has implanted and can cause bleeding. This bleeding may be heavy enough to threaten the well being of the woman. There may be pain, which is caused by prostaglandins released at the implant site and by blood in the peritoneal cavity.

Most ectopic pregnancies will resolve spontaneously through a through a tubal abortion. If the Fallopian tube ruptures, medical intervention is required.

Some of the risk factors for the potential for an ectopic pregnancy include:

• Pelvic inflammatory disease

• Infertility

Genitourinary System Advanced Anatomy and Physiology for ICD-10-CM/PCS


• Intrauterine contraception device use

• Tubal surgery

• Previous ectopic pregnancy

• Fallopian tube cilia damage

Sites of ectopic pregnancy

Vagina

Cervix

Ovary

Largeintestine

Abdomen

Uterus

Ovarian

Cervical

Abdominal

Tubal

Fallopiantube

Spontaneous Miscarriage/AbortionThreatened abortion or miscarriage is where there is a chance that an embryo will become dislodged from the uterine wall and pass through the vagina and cervix to the outside prior to 20 weeks after conception.

Causes of the miscarriage may be determined by when it takes place. Spontaneous miscarriages caused by chromosomal defects often occur during 4 to 8 weeks of gestation. Genetic etiologies (most common are trisomy anomalies) typically happen in the first trimester, but can during the entire course of the pregnancy. Also, other first trimester pregnancy loss may be caused by environmental, infectious, or immunologic factors. In the second trimester, anatomical defects may cause spontaneous miscarriages. Fibrogen and factor XIII deficiencies can be associated with recurrent spontaneous miscarriages.

There are different types of miscarriages/abortions:

Threatened miscarriage/abortion. One-fourth to one-third of all pregnant women experience vaginal bleeding in the first two trimesters. About one-half of these will progress to an actual miscarriage. There is vaginal bleeding, pelvic and/or abdominal pain of varying degrees. The internal cervical os is closed and there is no tenderness or embryonic tissue found, but there is uterine and/or adnexal tenderness. But even though there are symptoms, the other half of women experiencing threatened abortion will have a full-term pregnancy and deliver the baby.

Inevitable miscarriage (missed abortion). There are two types of situations where an inevitable miscarriage occurs prior to the twentieth week of gestation. In the first, the size of the embryo/fetus does not change over a two-week period, the physician is unable to hear an embryonic/fetal heart tone, and the hCG levels are decreasing. In the other situation, there is vaginal bleeding (more severe than a threatened miscarriage), abdominal pain and cramping, and dilation of the cervical os.

Incomplete miscarriage. The cervical os may be closed or open, with products of conception being passed. There is bleeding and cramping and eventually and some of the products of conception are retained the uterus. The body may pass the tissue naturally, making it a complete miscarriage. However, if it does not pass naturally and bleeding and cramping are occurring, a dilation and curettage (D & C) can be performed.

Complete miscarriage (spontaneous abortion). There is a history of bleeding, abdominal pain and all products of conception are expelled through the cervix prior to the twentieth week of pregnancy. If the bleeding and pain have subsided and if an ultrasound is taken and the uterus is vacant, it is a complete miscarriage. Most of these types of miscarriages happen before the twelfth week of pregnancy.

Septic Miscarriage. A rare infectious condition of the uterus that may develop when a miscarriage takes place. There are chills, a fever, fatigue, abdominal pain, vaginal bleeding and a thick vaginal discharge with an unpleasant odor. This condition requires immediate medical intervention to prevent damage to the uterus, tubes and ovaries.

High Risk PregnancyHigh-risk pregnancies are defined as those in which the woman needs additional attention due to the risk that the mother or baby is likely to become ill or die and there is a chance that there will be complications prior to, during or after delivery.

Risk factors are certain conditions or characteristics that make a pregnancy higher risk. What medical care the mother and baby receive is dependent on the presence or absence of these risk factors. Some of these risk factors are:

• Age of the mother – 15 years or younger; 35 years or older

• Weight – overweight or underweight

• Pregnancy has more than one fetus

• Development of gestational diabetes

• Previous fetal loss

• History of complications with pervious pregnancies

• Previous birth of a child with a birth defect

• A pre-existing condition that is chronic, such as high blood pressure, heart disease or diabetes

Advanced Anatomy and Physiology for ICD-10-CM/PCS Body Systems and Body Parts


Character DescriptionW Anatomical regions, general

X Anatomical regions, upper extremities

Y Anatomical regions, lower extremities

Body Part DesignationsIn the Medical and Surgical Section, the 4th character represents body parts. These body parts are specific to ICD-10-PCS and do not necessarily represent body parts as described in anatomy books or in ICD-10-CM. For example, in ICD-10-PCS, the liver, which is considered one organ and as such a single body part in most classification systems, has three possible body part designations in ICD-10-PCS. These include:

• Right lobe

• Left lobe

• Liver

General Body Part DesignationGeneral body part characters are considered “not otherwise specified” codes, also referred to as NOS codes. When the organ or body part has been subdivided into more specific parts, the most specific value should be assigned whenever possible. The general body part designation should only be used when the documentation does not support assignment of a more specific code. For example, the general body part value, liver, should only be assigned when the documentation in the medical record does not indicate the precise part of the liver and the detail cannot be obtained from the physician.

Portion of Body PartWhen the documentation describes a portion of a body part and the body part does not have a specific designation in ICD-10-PCS, the whole body part designation is used. For example, if the body part on which the medical or surgical procedure is performed is designated as the alveolar process of the mandible, the character for mandible is assigned because the alveolar process is not specifically identified as a separate body part.

Example:

Procedure Percutaneous core needle biopsy right alveolar process of mandible

0NBT3ZX Excision of Right Mandible, Percutaneous Approach, Diagnostic

Each value has the following meaning in reference to the procedure described above:

Value Character Definition Procedure0 Section Medical and Surgical

N Body System Head and Facial Bones

B Root Operation Excision

T Body Part Right Mandible

3 Approach Percutaneous

Z Device No Device

X Qualifier Diagnostic

Note: Biopsies are reported with a code for excision which is defined in ICD-10-PCS. Excision is defined as “cutting out or off, without replacement, a portion of a body part.” Biopsies are included in excision because a portion of the body part is cut out. The qualifier ‘X’ is what identifies this procedure as a biopsy since biopsy is a procedure performed for diagnostic rather than therapeutic purposes. Core needle biopsy “cuts out” a small amount of bone. It is considered a percutaneous procedure because the procedure is performed through the skin without direct visualization of the bone.

Designation of Body Part With Prefix “Peri”The prefix “peri” means around or surrounding. In some cases there may be a specific character for a body part with the prefix “peri.” For example, the pericardium or pericardial sac is designated as a specific body part and has a specific a specific character assigned in ICD-10-PCS. However, in other cases, the body part preceded by the prefix “peri” may not have a specific character as is the case with a body part described as perirenal. When a body part is described with the prefix “peri” in the operative report and does not have a specific body part designation in ICD-10-PCS, it is reported with the character for the body part.

Example:

Procedure Percutaneous needle biopsy right perirenal mass

0TB03ZX Excision of Right Kidney, Percutaneous Approach, Diagnostic



T Body System Urinary System

B Root Operation Excision

0 Body Part Right Kidney


Z Device No Device

X Qualifier Diagnostic

Body Systems and Body Parts Advanced Anatomy and Physiology for ICD-10-CM/PCS


Specific Body Part RulesThere are specific coding rules for some body parts in four body systems, cardiovascular, nervous, musculoskeletal, and integumentary.

Cardiovascular SystemCoronary ArteriesIn ICD-10-PCS, the coronary arteries are classified as a single body part, not by the specific coronary artery treated. This means that there are no separate values for the major coronary arteries. There are, however, separate values that identify the number of arteries treated when the same procedure is performed on multiple coronary arteries.

Example 1:

Procedure Percutaneous transluminal coronary artery angioplasty (PTCA) with drug-eluting stent placement, left anterior descending and left circumflex arteries

027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach



2 Body System Heart and Great Vessels

7 Root Operation Dilation

1 Body Part Coronary Artery, Two Sites


4 Device Drug-eluting intraluminal device

Z Qualifier No qualifier

A single code is used for procedures on multiple coronary arteries only when the same procedure is performed on both arteries. If different procedures are performed, multiple codes are needed to describe the procedures.

Example 2:

Procedure 1 PTCA without stent left anterior descending artery

Procedure 2 PTCA with a stent left circumflex artery

Procedure 1

02703ZZ Dilation of Coronary Artery, One Site, Percutaneous Approach

Each value has the following meaning in reference to procedure 1 described above:




0 Body Part Coronary Artery, One Site


Z Device No device


Procedure 2

02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach

Each value has the following meaning in reference to procedure 2 described above:




0 Body Part Coronary Artery, One Site


4 Device Intraluminal device


Blood vesselsNot all blood vessels are identified by a specific body part value. Vessels with separate body part values are obviously reported with the specific body part value in ICD-10-PCS. Vessels not identified by a separate body part value are reported with the code that identifies the closest proximal branch identified by a specific body part value. For example, there is no specific value for the ileocolic artery. The most proximal branch identified with a specific body part value is the superior mesenteric artery. A procedure performed n the ileocolic artery is reported with the code for the superior mesenteric artery.

Example:

Procedure Open repair of lacerated ileocolic artery

04Q50ZZ Repair Superior Mesenteric Artery, Open Approach

Advanced Anatomy and Physiology for ICD-10-CM/PCS Root Operations and Approaches


Quiz1. Whatrootoperationisperformedwhenabodypartiscut

intoinordertoseparateortransectthebodypartwithoutdrainingfluidsorgases?

a.Incision

b.Separation

c.Alteration

d.Division

2. Which root operation does NOT involve taking out oreliminatingsolids,fluid,orgasesfromabodypart?

a.Drainage

b.Extirpation

c.Extraction

d.Fragmentation

3. Mammaplasty describes a specific type of root operation.TrueorFalse?

a.True

b.False

4. Which root operation is considered a “not otherwisespecified”procedureinICD-10-PCS?

a.Anastomosis

b.Inspection

c.Repair

d.Division

5. The root operation “Map” is a type of __________procedure.

a.Examination

b.Inspection

c.Control

d.Alteration

6. Thereare_____approachvalues.

a.6

b.7

c.8

d.9

7. What approach value should be assigned for a vaginalhysterectomyperformedwithendoscopicassistance?

a.4

b.8

c.F

d.X

8. WhatisthedefinitionoftherootoperationReposition?

a.Movingtoitsnormallocationorothersuitablelocationalloraportionofabodypart

b.Moving,withouttakingout,alloraportionofabodyparttoanotherlocationtotakeoverthefunctionofalloraportionofabodypart

c.Putting in or on all or a portionof a livingbodyparttaken fromanother individualor animal tophysicallytaketheplaceand/or functionofalloraportionofasimilarbodypart

d.Alteringtherouteofpassageofthecontentsofatubularbodypart

9. The root operation is the ___________ character in theprocedurecode.

a.2nd

b.3rd

c.4th

d.5th

10.What approach value would be assigned for a procedureperformed though a puncture or minor incision withoutdirectvisualizationoftheproceduresite?

a.3

b.4

c.F

d.X

Advanced Anatomy and Physiology for ICD-10-CM...

Documents

Transcript of Advanced Anatomy and Physiology for ICD-10-CM...