HIT220.221 Coding Handbook Chapter 23 Part 1 - MS System and Connective Tissue (Updated 2017)

Author: ACC HIT Program

Hello, today we’re going to look at Chapter 23, which is diseases of the muscular/skeletal system and connective tissue. And this corresponds to Chapter 13 in the ICD-10-CM Codebook. This chapter has a lot of medical terms, and anatomy, that you’d only be lost if you can’t remember your anatomy of the muscular/skeletal system.

So, having said that, if you still have your medical terminology textbook that is based on medical system – body systems, I would suggest pulling it out, and looking at bones, joints, connective tissue, just to kind of familiarize yourself with this – this body system. The medical terms here, I’m not going to read them to you. As you know, these PowerPoints are available for you to review, both for studying, for the exams, as well as just for your personal knowledge.

Coders are excellent at anatomy and physiology. They understand body systems; they understand the way, the physiology of how the body works to maintain homeostasis. Remember that word, which is a stableness. For the body to maintain the same stability of its systems, a lot of things have to work in concert with one another, and that’s why it’s important to understand all the body systems, and how they work together.

The next slide talks about coding acute, traumatic conditions, versus chronic or recurrent conditions. Chapter 13 in in a codebook contains the bone, joint, muscle systems that are the result of healed injuries, as well as recurrent conditions. Current traumatic or acute injuries are coded in chapter 19. So, that is important when you’re reading the diagnosis statement. You’re going to look for terms like old injury, or current injury, because that is going to really help you know which chapter in the ICD-10 codebook you’re going to be looking at. If you cannot tell from your documentation if it’s an old or a new injury, that’s when you’re going to have to do a query, and just ask the provider which it is.

HIT220.221 Coding Handbook Chapter 23 Part 1 - MS System and Connective Tissue (Updated 2017)

Back disorders, or spinal disorders, are also included in this chapter. It is important to understand degeneration of the disc is not the same as herniation or displacement of the disc. Degeneration is something that we all have, that loss of cushioning between our vertebrae.

Many times related to aging, although it can be an injury that causes that cushioning to be decreased. I – when I was working in a hospital, I had a patient who fell – a truck fell on him. And when it fell, it crushed his vertebrae by just compressing them, causing that cushioning to just shoot out, so it was – his was more, I guess, of a herniation, now that I think about it, because it actually pushed the center part of his vertebrae down and completely severed his spinal cord. So, he left the hospital as a paraplegic, but thankful to be alive.

In his case, he was a young man. I have this picture here of a herniated disc, condition in which that tough outer wall of the disc has been weakened, and that allows the softer insides to deform the shape, and that often compresses on those nerves, and that’s what causes pain. The picture here shows a gentleman lifting a heavy rock. Really, many times, anyone who is in heavy lifting as part of their jobs, will herniate their disc. The types of fractures that you’re going to be looking at are stress, pathological and traumatic. And depending on the type of fracture it is, you have different options for your seventh character.

So, let me just show you one, I think I have it here. No I don’t. This particular condition is collapsed vertebrae. And you see, the pink box is more than just the ones we’ve seen in the past, where we saw the initial, the subsequent, and the sequelae. In this case, this particular code, you have the initial encounter, the subsequent, with the routine healing, and the subsequent with the delayed healing. So, a different option there. And then the sequelae.

Here’s another one. This is osteoporosis with a current fracture. A current pathological fracture, and these are your options for your seventh character. Many more than we’ve had in the past. We have the subsequent encounter with the routine healing – subsequent encounter with delayed healing, subsequent encounter with nonunion, meaning it won’t heal at all. And subsequent encounter for malunion, meaning it’s not healed the way it’s supposed to. And then, of course, the sequelae. So, depending the code, you’re going to have different options for your seventh character.

Okay, here’s some more medical terms related to fractures. You got displaced, where the bone is actually snapped in two, and now the two ends are not lined up anymore. Comminuted is a very common displaced fracture. The nondisplaced is when the bone is cracked, but it hasn’t moved. So, it’s still in its proper alignment, but it’s cracked, or – part of the way or all the way through. An open fracture, the bone is actually come through the skin. And closed, the bone could break, but there’s no puncture or open wound in the skin. Sometimes, with the open fractures also, the bone pierces the skin, but then it goes back in from the injury itself.

There’s a force that causes it to come through the skin and then reciprocal movement in the other direction that causes the bone to come back through the skin, so it’s just a very traumatic injury that also predisposes a patient to infections. Some fracture types you may remember from your medical terminology course. The greenstick, very common in children. Transverse, oblique, comminuted, and the buckled. And the buckled is what you often see in the arm fractures in children.

So, just – if you still have your medical terminology textbooks, and if not, you can certainly google these online. And look at these types of fractures and what they look like. It might be very helpful to you to help you remember them if you have a visual. I just went over some of these, in the picture that we showed for pathological fractures, so, I won’t review them.

But, just remember, you can always print out these PowerPoints if you want to have them for reference in the future, or to study for exams. That’s why they’re there. So, feel free to print them out, put them in your notebook. Whatever you’re using. A couple of notes you’re going to always remember as a coder, and these are at the beginning of the chapter. Chapter 13. Just to review, a fracture not indicated as displaced or nondisplaced is coded as displaced.

So, that’s an important thing to remember. The open fracture designations are based on Gustilo, which we will go over in a few minutes. And a fracture not indicated as open or closed is coded as closed. So, those are important generalities that when you’re coding, that’s just the assumption you make. You’re going to follow the rules, and these are the rules. I went through a few of these, I’ve created the PowerPoint, obviously, before I recorded this, so I’ve already gone through some of these additional seven characters.

I’m not going to go through those again. But I did want you to see that some of the fractures, like S72, actually has 16 options, including whether the fracture is open or closed. So, you really have to read all of those seventh character descriptions before you select your final code. The Gustilo Open Fracture Classification, we’re going to look at on the next slide. It actually uses the amount of energy that caused that break, the extent of the soft tissue that accompanies that breaks, and how much it is contaminated because of coming through the skin. Any time you have a progression from grade 1 to grade 3C in your classification, it implies a higher degree of energy is involved in the injury, therefore, you’ve got more soft tissue and bone damage and a much high potential for complications. And, recognize that the great 3C, which is your highest classification fracture, implies vascular or blood vessel injury as well.

Very serious injuries. And here is the Gustilo, again, I mentioned a few slides ago, print these out, put them in your notebook so that you have something to refer to. This is not – I didn’t find it in a codebook. I found this online by googling Gustilo Open Fracture Classification. But, it may be in the codebook and I just missed it. So, if you find it, let me know, and I’ll put references there for future classes.

Also remember that pathological fractures can be due to cancers, to neoplasms. If the focus of treatment is the fracture, then you’re going to use a fracture code. In this case, it is M84.5, fracture due to neoplasm. Followed by the code for the neoplasm. But if your focus of treatment is the malignancy itself with an associated fracture, you’re going to code the cancer diagnosis first, then the M84.5 as the secondary diagnosis. This is a coding guideline that often comes up when you’re coding malignancies because of how common it is for the patient to have breaks, or fractures, because the bones we can typically bring – excuse me – bone cancer.

A few more rules about coding. Fractures that are spontaneous, or the physician has documented spontaneous fracture health too, you know that those are pathological fractures. And you should never code a traumatic fracture and a pathological fracture on the same bone. Either one or the other. If the documentation isn’t clear, it is appropriate to query the provider to find out if you are dealing with a traumatic fracture, or a pathological fracture.

Okay, a lot of review there. But it’s important for this chapter, especially, to go over those things.

HIT220.221 Coding Handbook Chapter 23 Part 1 - MS System and Connective…

Hello, today we’re going to look at Chapter 23, which is diseases of the muscular/skeletal system and connective tissue. And this corresponds to Chapter 13 in the ICD-10-CM Codebook.…

By: ACC HIT Program
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