ICD-10 Anatomy & Pathophysiology:
Vital Lessons Learned from
over 700 Coders
Presented by:
Karen Youmans, MPA, RHIA, CCS
President
YES HIM Consulting, Inc.
December 5, 2012
SLIDE 1
Disclaimer
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Panacea has prepared this seminar using official Centers for Medicare and Medicaid Services (CMS) documents
and other pertinent regulatory and industry resources. It is designed to provide accurate and authoritative
information on the subject matter. Every reasonable effort has been made to ensure its accuracy. Nevertheless,
the ultimate responsibility for correct use of the coding system and the publication lies with the user.
Panacea, its employees, agents and staff make no representation, warranty or guarantee that this information is
error-free or that the use of this material will prevent differences of opinion or disputes with payers. The company
will bear no responsibility or liability for the results or consequences of the use of this material. The publication is
provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied
warranties or merchantability and fitness for a particular purpose.
The information presented is based on the experience and interpretation of the publisher. Though all of the
information has been carefully researched and checked for accuracy and completeness, the publisher does not
accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation.
Current Procedural Terminology (CPT ®) is copyright 2011 American Medical Association. All Rights Reserved. No
fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for
the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
CPT® is a trademark of the American Medical Association.
Copyright © 2012 by Panacea. All rights reserved.
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No part of this presentation may be reproduced in any form whatsoever without written permission from the
publisher
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Published by Panacea, 287 East Sixth Street, Suite 400, St. Paul, MN 55101
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 2
Learning Objectives
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Review the CMS, AHIMA, and AAPC
recommendations regarding biomedical science
refresher training in preparation for ICD-10.
Examine the importance of medical terminology,
anatomy, pathophysiology, and pharmacology in
coding today.
Analyze the essentials for coder “refresher”
training in the biomedical sciences in
preparation for ICD-10 training.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 3
Learning Objectives
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Differentiate results of more than 700+ coders’
assessments.
Compare coder experience, education,
credential, and job title to their assessment
scores.
Identify steps your organization can take to
increase coder knowledge in the biomedical
sciences prior to the implementation of ICD-10.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 4
Industry Recommendations
CMS: The final rule implementing ICD-10-CM and
ICD-10-PCS identifies the need for 50 hours of
training for inpatient coders to learn the ICD-10CM and ICD-10-PCS systems. This recommended
50 hours of training presumes that coding
professionals already possess the required
knowledge in the biomedical sciences (anatomy,
physiology, pathophysiology, pharmacology, and
medical terminology) that will be needed to
correctly apply codes using the ICD-10-CM and
ICD-10-PCS systems.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 5
Industry Recommendations
AHIMA: For successful transition to ICD10, the
challenge for inpatient coders is to:
• Ensure they have sufficient foundational
knowledge of the biomedical sciences
• Learn how to apply both ICD-10-CM and ICD10- PCS codes correctly on inpatient encounters
• Understand how to apply maps and crosswalks
between ICD-9-CM and the ICD10 systems
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 6
Industry Recommendations
AHIMA estimates that approximately 16 hours of
coding training are likely needed for each
outpatient coder to learn ICD-10-CM. However,
coders may need additional training to refresh
or expand knowledge in the biomedical
sciences.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 7
Industry Recommendations
AAPC: Due to the clinical nature of ICD-10-CM a
strong understanding of, or experience in anatomy
and/or physiology will be required
From AAPC website
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 8
Reasons Why Biomedical Sciences
is Essential for ICD-10
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ICD-9-CM contains14,315 three- to five-character
numeric diagnosis codes (plus V and E codes).*
•
ICD-10-CM contains ~69,099 three- to sevencharacter alphanumeric diagnosis codes.*
*2012 data
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 9
ICD-9-CM Structure - Format
Numeric or
Alpha
(E or V)
Numeric
Etiology, anatomic site,
manifestation
Category
4 2 7
3
1
3 – 5 Characters
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 10
ICD-10-CM Coding Examples
Examples:
• A78 – Q fever
• C11.0 Malignant neoplasm of superior wall of
nasopharynx
• A69.21 – Meningitis due to Lyme disease
• E09.351 Drug or chemical induced diabetes
mellitus with proliferative diabetic retinopathy
with macular edema
• S52.131a – Displaced fracture of neck of right
radius, initial encounter for closed fracture.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 11
Reasons Why Biomedical Sciences
is Essential for ICD-10
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For procedures, ICD-9-CM contains 3,838 three- to fourcharacter numeric procedure codes. *
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And, ICD-10-PCS contains 71,918 seven-character
alphanumeric procedure codes.*
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61,896 are in the Medical/Surgical Section
*2012 data
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 12
Reasons Why Biomedical Sciences
is Essential for ICD-10
NO unspecified codes
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 13
ICD-9 Procedure to ICD-10-PCS
Comparison
ICD-9-CM Angioplasty 1 code (39.50)
ICD-10-PCS Angioplasty codes - 854 codes
specifying body part, approach, & device,
including:
• 047K04Z – Dilation of right femoral artery with
drug-eluting intraluminal device, open approach
• 047K34Z – Dilation of right femoral artery with
drug-eluting intraluminal device, percutaneous
approach
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 14
Reasons Why Biomedical Sciences
is Essential for ICD-10
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 15
Reasons Why Biomedical Sciences
is Essential for ICD-10
Lessons learned from Canada -- Canada
experienced a 50% reduction in coding
productivity the first three months and then
10-25% reduction in productivity thereafter
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 16
Phased Educational Approach for Coding Staff
Example: target date to start dual code - July 2014
Assess
Basic assessments:
Med Term, A&P,
Pathophysiology,
Pharmacology (baseline)
Q-4 2012
Jan-Feb
2013
Vendor Selection
Review contracts,
finalize budgets
Project Planning
Develop strategic
timeline
Educate
Coder Clinical Concept
courses (with ICD-10
concepts)
Detailed study guides
Feb
2013
March-June
2013
Review
Review reports,
knowledge base and
gaps, (detailed reports
provided)
Overview workshop
Overview ICD-10CM/PCS coder
education for the Adult
Learner
July -Aug
2013
Aug-Nov
2013
Advanced Assessments
(ICD-10 concepts readiness),
Detailed Reports with gap
analysis, Reviews/retake couse
units (if needed)
©2012 PANACEA Healthcare Solutions, Inc.
Jan-Jun
2014
Train
In depth ICD-10
CM/PCS coder
training for the Adult
Learner
SLIDE 17
Phased Adult Learning: Education
Approach
Assess
• Individual Baseline Assessment
• 4 Assessments: Biomedical Sciences
Review
• Review knowledge base and gaps
• Detailed reports
Educate
Re-Assess
Overview
Train
• Coder Clinical Concepts courses/webinars
• Study Guides
• Advanced Assessments (4 Biomedical
sciences) and ICD-10 Readiness
• Overview ICD-10-CM/PCS coder education for
the Adult Learner
• In-depth ICD-10-CM/PCS coder training for
the Adult Learner
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 18
Example: Baseline Assessment
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 19
Example: Baseline Assessment
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 20
Immediate Results
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 21
Phased Adult Learning: Education
Approach
Assess
Review
Educate
Re-Assess
Overview
Train
• Individual Baseline Assessment
• 4 Assessments: Biomedical Sciences
• Review knowledge base and gaps
• Detailed reports
• Coder Clinical Concepts courses
• Study Guides
• Advanced Assessments (4 Biomedical
sciences)
• ICD-10 Readiness
• Overview ICD-10-CM/PCS coder education for
the Adult Learner
• In-depth ICD-10-CM/PCS coder training for
the Adult Learner
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 22
Assessment Summary
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 23
Example: Reporting
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 24
Example: Reporting
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 25
Baseline Assessment Averages
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 26
Baseline Assessment –
Average Scores
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 27
Phased Adult Learning: Education
Approach
Assess
• Individual Baseline Assessment
• 4 Assessments: Biomedical Sciences
Review
• Review knowledge base and gaps
• Detailed reports
Educate
Re-Assess
• Coder Clinical Concepts courses/webinars
• Study Guides
• Advanced Assessments (4 Biomedical sciences)
ICD-10 Readiness
Overview
• Overview ICD-10-CM/PCS coder education for
the Adult Learner
Train
• In-depth ICD-10-CM/PCS coder training for the
Adult Learner
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 28
Medical Terminology
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 29
Medical Terminology
Root
operation
Excision
Objective of
procedure
Cutting out/off without
replacement
Resection
Site of procedure Example
Some of a body
part
Breast lumpectomy
Cutting out/off without
replacement
All of a body part
Total mastectomy
Detachment
Cutting out/off without
replacement
Extremity only,
any level
Amputation above
elbow
Destruction
Eradicating without
replacement
Pulling out or off without
replacement
Some/all of a body Fulguration of
part
endometrium
Some/all of a body Suction D&C
part
Extraction
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 30
Anatomy
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 31
Anatomy
Knee Side View
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 32
Anatomy
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 33
Pathophysiology
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 34
Pathophysiology
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Pressure (decubitus) ulcer
wounds caused by
unrelieved pressure on the
skin usually develop over
bony prominences, such as
the elbow, heel, hip,
shoulder, and back
ICD-10-CM Classification
• Stage 1 pre-ulcer skin changes
limited to persistent focal edema
• Stage 2 abrasion, blister, partial
thickness skin loss involving
epidermis and/or dermis
• Stage 3 full thickness skin loss
involving damage or necrosis of
subcutaneous tissue
• Stage 4 necrosis of soft tissues
through to underlying muscle,
tendon, or bone
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 35
Pathophysiology
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 36
Pharmacology
Receptor - target substance with which drugs interacts
Response - desired and beneficial effect
Action – where and how drug combines with tissues
Biotransformation – if drug is chemically changed
Tolerance - drug effects diminish during treatment
• Addiction
• Dependence
• Controlled Substances
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 37
Pharmacology - ICD-10-CM
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Underdosing
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New concept
Taking less of medication than is prescribed by
provider or manufacturer’s instruction
Needs 3 codes
Definitions
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Adverse effect
Poisoning
Underdosing
Toxic effect
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 38
Pharmacology
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 39
Phased Adult Learning: Education
Approach
Assess
• Individual Baseline Assessment
• 4 Assessments: Biomedical Sciences
Review
• Review knowledge base and gaps
• Detailed reports
• Coder Clinical Concepts courses
• Study Guides
Educate
Re-Assess
• Advanced Assessments (4 Biomedical
sciences) and ICD-10 Readiness
Overview
• Overview ICD-10-CM/PCS coder education for
the Adult Learner
Train
• In-depth ICD-10-CM/PCS coder training for the
Adult Learner
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 40
Example: Advanced Assessment
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 41
Example: Advanced Assessment
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 42
Example: Advanced Assessment
Results
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 43
Example: Advanced Assessment
Results
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 44
Advanced Assessment Averages
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 45
Advanced Assessment
Average Scores
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 46
Advanced Assessment Averages
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 47
Example: Basic vs. Advanced
Results
11%
overall
increase
©2012 PANACEA Healthcare Solutions, Inc.
12%
overall
increase
SLIDE 48
Example: Basic vs. Advanced Results
Average
Average
Basic Assessments Advanced Assessments Increase
Medical Terminology
74%
61 Coders/CDS
Anatomy
84%
10%
*note high score 98%
69%
61 Coders/CDS
75%
6%
*note high score 95%
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 49
Example: Basic vs. Advanced Results
74% and below scores
Basic Anatomy 2010
39%
31 out of
80
scored
75%…
61%
49 out of
80
scored
74%…
74% and below score
ADV Anatomy 2012
81%
(60 out of
74)
scored
75% or
higher
19 %
(14 out of
74)
scored
74% or
below
Overall
Increase
of 12%
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 50
Survey Results Based On
“Credentials”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 51
Averages – Medical Terminology
“Credentials”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 52
Averages - Anatomy
“Credentials”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 53
Averages - Pathophysiology
“Credentials”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 54
Averages - Pharmacology
“Credentials”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 55
Survey Results Based On
“Years of Experience”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 56
Averages – Medical Terminology
“Years of Experience”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 57
Averages - Anatomy
“Years of Experience”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 58
Averages - Pathophysiology
“Years of Experience”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 59
Averages - Pharmacology
“Years of Experience”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 60
Survey Results Based On
“Highest Level of Education”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 61
Averages – Medical Terminology
“Highest Level of Education”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 62
Averages - Anatomy
“Highest Level of Education”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 63
Averages - Pathophysiology
“Highest Level of Education”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 64
Averages - Pharmacology
“Highest Level of Education”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 65
Survey Results Based On
“Current Position Held”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 66
Averages – Medical Terminology
“Current Position Held”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 67
Averages - Anatomy
“Current Position Held”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 68
Averages - Pathophysiology
“Current Position Held”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 69
Averages - Pharmacology
“Current Position Held”
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 70
Industry Recommendations
AHIMA: Phase 1 for inpatient coders includes:
• Understand the ICD-10 final rule and its
implications to your coding position.
• Learn about the structure, organization, and
unique features of ICD-10-CM and ICD-10-PCS.
• Use assessment tools to identify areas of
strength/weakness in the biomedical
sciences (e.g. anatomy and
pathophysiology).
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 71
Industry Recommendations
AHIMA: Phase 1 for inpatient coders includes:
• Review and refresh knowledge of biomedical
sciences as needed based on the
assessment results.
• Begin studying ICD-10-PCS definitions (root
operations and approaches).
• Begin learning about the general equivalence
mappings (GEMs) between ICD-9-CM, ICD-10CM, and ICD-10-PCS.
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 72
Industry Recommendations
AHIMA: Phase 1 for outpatient coders includes:
• Ensure they have sufficient foundational
knowledge of the biomedical sciences
• Learn how to apply ICD-10-CM codes correctly
on outpatient encounters
• Understand how to apply maps and crosswalks
between ICD-9-CM and ICD-10-CM
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 73
Website References
www.cms.gov
www.aapc.com
www.ahima.org
www.cdc.gov
www.himss.org
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 74
Thank You For Attending!
©2012 PANACEA Healthcare Solutions, Inc.
SLIDE 75