The recent buzz surrounding the ICD-10 seems to be about knowing your anatomy.

Because the codes are much more specific coders are going to have to brush up on their gross anatomy, common medical terms, and even some pathology.

This post will be dedicated to pointing out ICD-10-CM and ICD-9-CM cross-walk codes, why knowing your anatomy will be important, and how your physician documentation will need to change.

When thinking about how knowing your anatomy will affect your ICD-10-CM code selection Fracture coding is the first thing that comes to mind.

In the ICD-9-CM fracture codes are located in the 800 series. In the ICD-10-CM they are S codes.

When looking up a fracture code in the ICD-9-CM index you refer to the term “Fracture” and then the anatomical location.

When looking up a fracture code in the ICD-10-CM index there are two options:

~“Fracture, Pathological”
~“Fracture, Traumatic”

A pathological fracture is a fracture that occurs in a weakened area of a bone, and is often caused by pressure or stress. Pathological fractures are also called compression fractures or stress fractures.

A traumatic fracture is a fracture caused by a sudden (acute) blow, crush, or impact that results in the breaking of a bone.

Weather a fracture is pathological or traumatic is something physicians will need to document clearly.

Example:

Looking up the anatomical term “acetabulum” under “Fracture” in the ICD-9-CM we are provided with the following options:

Fracture

            Acetabulum (with visceral injury) (closed) 808.0

                        Open 808.1

Looking up the anatomical term “acetabulum” under “Fracture, Traumatic” in the ICD-10-CM we are provided with the following options:

Fracture, Traumatic

            Acetabulum S32.409

                        Column

                                    Anterior (displaced) (iliopubic) S32.409

                                                Nondisplaced S32.44-

                                    Posterior (displaced) (ilioscial) S32.443

                                                Nondisplaced S32.44-

                        Dome (displaced) S32.48

                                    Nondisplaced S32.48

                        Specified NEC S32.49-

                        Transverse (displaced) S32.45-

                                    With associated posterior wall fracture (displaced) S32.46-

                                                Nondisplaced S32.46-

                                    Nondisplaced S32.45-

                        Wall

                                    Anterior (displaced) S32.41-

                                                Nondisplaced S32.41

                                    Medial (displaced) S32.47-

                                                Nondisplaced S32.47-

                                    Posterior (displaced) S32.42

                                                With associated transverse fracture (displaced) S32.46-

                                                            Nondisplaced S32.46 –

                                                Nondisplaced S32.42 –

We can see that in order to select the proper fracture code we will need to know more about the anatomy of our acetabulum, such as what is the dome? what is the column? etc. The physician will need to document the specifics about the fracture more clearly as well.

The majority of the fracture codes are similar to this example. But what about other organ systems?

Sprains and Strains and also more specific to the ligament or tendon that was injured.

Example:

Looking up the anatomical term “ankle” under “Sprain, strain” in the ICD-9-CM we are provided with the following options:

Ankle 845.00

            And foot 845.00

Looking up the anatomical term “ankle” under “Sprain” in the ICD-10-CM we are provided with the following options:

Ankle S93.409

            Calcaneofibular ligament S93.41-

            Deltoid ligament S93.42-

            Internal collateral ligament – see sprain, ankle, specified ligament NEC

            Specified ligament NEC – S93.49-

            Talofibular ligament – see Sprain, ankle, specified ligament NEC

            Tibofibular ligament – S93.43-

Although I hate to repeat myself, this too is going to require more specific documentation and a greater knowledge of anatomy.

Disease codes are also more anatomically specific

Example

If a physician documents a patient having Paget’s Disease of the bone we would look up the term “Paget’s disease” and indented beneath it we would locate the term “bone” (in the ICD-9-CM). Doing this we would be provided with the following options:

Paget’s Disease (osteitis deformans) 731.0

            Bone (731.0)
                       
                     Osteosarcoma in (M9184/3) see Neoplasm, bone, malignant

In the ICD-10-CM we would also look up the term “Paget’s Disease” and indented beneath it we would locate the term “bone”. Doing this we would be provided with the following options:

Paget’s Disease

            Bone M88.9

                        Carpus M88.84-

                        Clavicle M88.81-

                        Femur M88.85-

                        Fibula M88.86-

                        Finger M88.84-

                        Humerus M88.82-

                        Ilium M88.85-

                        In neoplastic disease – see Osteitis, deformans, in neoplastic disease

                        Ischium M88.85-

                        Metacarpus M88.84-

                        Metatarsus M88.87-

                        Multiple sites M88.89

                        Neck M88.88

                        Radius M88.83-

                        Rib M88.88

                        Scapula M88.81-

                        Skull M88.0

                        Tarsus M88.87-

                        Tibia M88.86-

                        Toe M88.87-

                        Ulna M88.83-

                        Vertebra M88.88

Given these options make selecting a code more tricky in two ways.

1) A physician may not document anything other than “bone”. In this scenario we would either be forced to submit an unspecified code (M88.9) which may be rejected by the insurance company, or we can request more specific documentation from the physician.

 2) A physician may document something like “Paget’s disease of the acromion”. In this scenario you would need to know on which bone the acromion is located since it is not an option on our list. (The acromion is the summit of the shoulder and part of the scapula) and then select the proper code (M88.0).

Another example of how diseases and conditions may be more specific to anatomical locations is "meningococcal infection of the heart".

Looked up in the ICD-9-CM under “Infection, Meningococcal” you are provided with the following options:

Infection

Meningococcal (see also condition) 036.9

                        Brain 036.1

                        Cerebrospinal 036.0

                        Endocardium  036.42

                        Generalized 036.2

                        Meninges 036.0

                        Meningococcemia 036.2

                        Specified site NEC 036.89

Since there is not a specific code for the heart we would use code 036.89, (specified site NEC).

Looked up in the ICD-10-CM under “Infection, Meningococcal” you are provided with these options:

Infection

            Meningococcal (see also condition) A39.9

                        Adrenals A39.1

                        Brain A39.81

                        Cerebrospinal A39.0

                        Conjunctiva A39.89

                        Endocardium A39.51

                        Heart

                                    Endocardium A39.51

                                    Myocardium A39.52

                                    Pericardium A39.53

                        Joint A39.83

                        Meninges A39.0

                        Meningococcemia A39.4

                                    Acute A39.2

                                    Chronic A39.3

                        Myocardium A39.52

                        Pericardium A39.53

                        Retrobulbar neuritis A39.82

                        Specified site NEC A39.89

The anatomical location “heart” is available in these choices but in addition you will need to know which specific part of heart is infected; the Endocardium (inner most layers of tissue lining the heart chambers), the Myocardium (striated cardiac muscle that makes up the walls of the heart), or the Pericardium (the two layered fluid filled sac surrounding the heart).

Another example is Kissing spine.

When looking up kissing spine in the ICD-9-CM there are three options under “Kissing”

Kissing

            Osteophyte 721.5

            Spine 721.5

            Vertebra

When looking up kissing spine in the ICD-10-CM you would look up “Kissing Spine” instead of just “Kissing” with an indent. “Kissing Spine” provides the following options.

Kissing Spine M48.20

            Cervical region M48.22

            Cervicothoracic region M48.23

            Lumbar region M48.26

            Lumbrosacral region M48.27

            Occipito-atlanto-axilia region M48.21

            Thoracic region M48.24

            Thoraciclumbar region M48.25

In order to select the correct code here you would not only need adequate documentation but also know that there are 24 vertebra in the body; 7 cervical (C1 – C7), 12 thoracic (T1 –T12), 5 lumbar (L1 – L5), 5 sacral (S1- S5), and 3-5 coccygeal (fused to form tailbone). In addition you would also need to know that names like cervicothoracic pertain to both the cervical and thoracic vertebra and therefore should only be used when both types of vertebra are documented as being affected.

Some codes in the ICD-10-CM are just simply new and anatomically specific.

Examples of these codes include:

Pyogenic infection of the occipito-atlanto-axial region M46.31

*Occipito-atlanto is a joint articulation that joins the atlas and the occipital bone, the atlanto-axial is a joint articulation that joins the atlas with the axis (C1 and C2).

Congenital malformation of the corpus callosum Q04.0

*The corpus callosum, also known as the colossal commissure, is a wide, flat bundle of neural fibers beneath the cortex in the eutherian brain eutherian at the longitudinal fissure. It connects the left and right cerebral hemispheres and facilitates interhemisphic communication.

Tentorial tear due to birth injury P10.4

* The tentorium cerebelli or cerebellar tentorium, is an extension of the dura that separates the cerebellum from the inferior portion of the occipital lobes.

While numerous examples can be found in the ICD-10-CM, the point is that there is a need for coders to brush up on some gross anatomy.

While coders who are already certified through the AAPC will need to take a comprehensive exam over the ICD-10 once, the daily need to know the entire structure of the human body is unlikely.

I suggest making a list of common ICD-9-CM codes that you use on a daily basis in your specific specialty.

Next, make your own cross-walk for those codes creating a second list for ICD-10 codes. Read over your ICD-10-CM list and look up each code’s definition in the tabular. Highlight and/or make a list of any anatomical term that you do not recognize.

Finally, do some surfing in the web or pull out some anatomy books and do some research. Find out what is included in the description of each code on your ICD-10 list.

If you are in a specialty that has extensive details consider purchasing some detailed, specialty specific, anatomical charts.