Anatomy and Physiology skills required for successful transition to ICD-10
The transition from ICD-9-CM to ICD-10-CM/PCS will require a strong foundation in Anatomy and Physiology for professionals involved in medical coding to receive their ICD-10-CM/PCS certification by October 1, 2015. ICD-9 diagnosis codes are not as anatomically specific when it comes to where on the body the procedure is taking place, due to lack of specificity in the information conveyed through the current ICD-9 codes. Refreshing anatomy and physiology information will be especially important for coders working in specialty clinics who spend their time focused on one or two body systems. ICD-10-CM certification will require knowledge of the anatomy and physiology, disease processes and procedures for different body systems. This will not only help the coding professionals in refining their knowledge of anatomy and physiology, but will also help in improving clinical documentation practices. The greater level of detail in ICD-10 demands that coders have an in-depth knowledge of anatomy, physiology and pathophysiology, and that the documentation helps in selection of the most appropriate code(s).
Procedure Coding:
Anatomy and physiology knowledge are important to both ICD-10-CM and PCS coding, but the logic is applied differently for coding procedures and coding the diagnoses. The ICD-10-PCS code set is made up of tables containing various characters, seven of which make up each ICD-10-PCS code. Many of these code elements such as:
Body system, root operation, body part, approach, device and sometimes the qualifier requires that the coder be knowledgeable about anatomy, physiology, and disease pathology. It is not necessary that physicians and other providers will use the same terminology in their documentation that is used in the ICD-10-PCS tables. In addition to basic medical terminology, human anatomy also helps in assigning a more precise diagnosis code. It’s also very important for assigning procedure codes, which are specific to certain parts of the body in many cases.
The anatomy of the human body is made up of a number of different systems of organs. The following is a list of body systems which you’ll need to know, as well as a brief description of their related codes.
Integumentary System: This system includes the skin, nails, hair, sweat and oil glands, and mammary glands.
Simple incision and drainage of fluid-filled cysts to skin grafts and removal of cancerous lesions are the procedures related to the integumentary system
Muskuloskeletal System: This body system consists of the entire skeleton, which is made up of bones attached to other bones with joints and skeletal muscles attached to the skeleton with tendons and ligaments.
Fracture repair codes, casting, relocation of dislocated joints, and other musculoskeletal repair codes are the procedure codes related to the musculoskeletal system.
Respiratory System: The respiratory system is made up of the nose and nasal cavity, pharynx, larynx, trachea, bronchi, and lungs. Removals of foreign body from the nose to surgical closure of a tracheotomy are procedure codes related to the respiratory system.
Cardiovascular System: The cardiovascular system is made up of the heart, arteries, and veins that run throughout the body. Veinipunture to take a blood sample, to a heart transplant are the procedure codes related to the cardiovascular system.
Lymphatic System: This system consists of the lymph nodes, ducts, tissues, capillaries and vessels that transport lymph fluid to the circulatory system. Removal of the spleen, biopsy, and excision of lymph nodes are the procedure codes related to the lymphatic system.
Digestive System: The digestive system begins at the mouth and runs all the way through the body to the anus. There are many codes that can be identified in these systems, including diagnosis codes relating to upset stomach or nausea, to repair or incision of tongue, mouth, liver, and appendix.
Urinary System: The urinary system includes the kidneys, ureter, bladder and urethra. Urinary tract infections to bed-wetting and procedure codes range from insertion of catheters to surgical removal of kidney stones are the codes relating to the urinary system.
Reproductive System: The reproductive systems are divided into the male and female organs and vary greatly. Circumcisions to artificial insemination are the procedure codes relating to the reproductive organs.
Nervous System: The nervous system is divided into the central and the peripheral parts. It includes the brain, spine, nerves and neurons. Checking a patient’s reflexes to placement of a spinal cord shunt are the procedure codes relating to the nervous system.
Auditory and Ocular System: The auditory and ocular, or eye, systems are generally grouped together as they are both sensory organ systems. Diagnosis and procedure codes within this sensory system range from Otitis Media to surgical repairs of the cornea.
Immune System: The immune system is made up of all the molecular and genetic components that defend the body from foreign organisms. Since, the immune system is located within the blood, many of the procedure and diagnosis codes related to it are also related to the blood, such as a complete blood count (CBC).
Anatomy of the human body is an essential skill set for medical coder. Medical coders should be familiar with every body system. The elements to understand are how everything works together as well as how they are related to each other.