Advanced Anatomy and Physiology for
ICD-10-CM/PCS
An essential resource for diagnostic and procedural coding
2012
Contents
Introduction
Course Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
The Human Body. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
Structural Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . ii
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Physiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Anatomy and Physiology for
ICD-10-CM/PCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
ICD-10-PCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Organization of the Book. . . . . . . . . . . . . . . . . . . . . . . . . vi
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Section I – Anatomy and Physiology for
ICD-10-CM
Table 1. Conventions Table. . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Table 2. General Coding Guidelines . . . . . . . . . . . . . . . . . . xiii
Process For Code Selection . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Chapter 1 – Blood and Blood Forming Organs
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Erythrocytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Leukocytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Thrombocytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Myeloid Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lymphatic Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Interstitial Fluid and Lymph. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Spleen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Immune System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Non-Specific Defenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Specific Defenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Types of Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Cell-Mediated Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Antibody-Mediated Immunity . . . . . . . . . . . . . . . . . . . . . 5
Immune Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Interaction of Immune System with the Circulatory
Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Comparison of ICD-9-CM and ICD-10-CM Blood and
Blood Forming Organs Coding Guidelines. . . . . . . . . . 5
ICD-10-CM Documentation Elements of Blood, Blood
Forming Organs, and Immune System . . . . . . . . . . . . . 6
Diseases, Disorders, Injuries, and Other Conditions
of the Blood, Blood Forming Organs, and Immune
Mechanism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Infectious/Parasitic Diseases . . . . . . . . . . . . . . . . . . . . . . 6
Section 1.1 – Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Section 1.2 – Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . 12
Section 1.4 – Multiple Myeloma and Malignant
Immunoproliferative Diseases . . . . . . . . . . . . . . . 14
Section 1.5 – Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Section 1.6 – Lymphoid and Hematopoietic
Neoplasms of Uncertain Behavior . . . . . . . . . . . . 16
Section 1.7a – Nutritional Anemia . . . . . . . . . . . . . . . 17
Section 1.7b – Hemolytic Anemia . . . . . . . . . . . . . . . 18
Section 1.7c – Aplastic Anemia, Other Anemias,
and Bone Marrow Failure Syndromes . . . . . . . . . 19
Hypocoagulation Disorders . . . . . . . . . . . . . . . . . . . . . 19
Hypercoagulation Disorders . . . . . . . . . . . . . . . . . . . . . 20
Disseminated Intravascular Coagulation . . . . . . . . . 20
Other Disorders of the Blood. . . . . . . . . . . . . . . . . . . . . 20
Section 1.11a – Immunodeficiencies . . . . . . . . . . . . . 21
Section 1.11b –Hyperglobulinemias . . . . . . . . . . . . . 22
Section 1.11c – Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . 22
Perinatal Hemolytic Disease . . . . . . . . . . . . . . . . . . . . . 22
Neonatal Disseminated Intravascular
Coagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Chapter 2 – Endocrine System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hormones and Endocrine Glands . . . . . . . . . . . . . . . . . . . .
The Pituitary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adenohypophysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neurohypophysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thyroid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thyroxine and Triiodothyrinine . . . . . . . . . . . . . . . . . .
Calcitonin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Parathyroid Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adrenal Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adrenal Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adrenal Medulla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Glucagon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ovaries/Testes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ovaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Testes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pineal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thymus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Endocrine Functions of Other Organs. . . . . . . . . . . .
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Contents
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Comparison of ICD-9-CM and ICD-10-CM Endocrine,
Nutritional and Metabolic Diseases Coding
Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
ICD-10-CM Documentation Elements of Endocrine,
Nutritional, and Metabolic Diseases . . . . . . . . . . . . . . . 40
Diseases, Disorders, Injuries, and Other Conditions
of the Endocrine System, and Nutritional and
Metabolic Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Pituitary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Parathyroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Ovaries/Testes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pineal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Thymus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Section 2.3a – Pituitary Diseases and Disorders . . . . . 42
Section 2.3b – Thyroid Diseases and Disorders . . . . . 43
Parathyroid Diseases and Disorders . . . . . . . . . . . . . . 43
Section 2.3c – Adrenal Diseases and Disorders . . . . 43
Section 2.3d – Pancreas Diseases and Disorders . . . . . 44
Section 2.3e – Ovaries/Testes Diseases and
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Pineal Diseases and Disorders . . . . . . . . . . . . . . . . . . . 46
Thymus Diseases and Disorders . . . . . . . . . . . . . . . . . 46
Section 2.3f – Polyglandular Dysfunction . . . . . . . . 46
Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Vitamin, Mineral and Other Nutritional
Deficiencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Complications of Hyperalimentation . . . . . . . . . . . . 47
Classic Phenylketonuria . . . . . . . . . . . . . . . . . . . . . . . . . 48
Lactose Intolerance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Familial Hypercholesterolemia . . . . . . . . . . . . . . . . . . 48
Hemochromatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Chapter 3 – Nervous System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neurons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neuroglia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Oligodendrocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Astrocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Microglia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schwann cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cerebrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cerebullum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Brain Stem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Spinal Cord. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meninges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cerebrospinal Fluid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Peripheral Nervous System. . . . . . . . . . . . . . . . . . . . . . .
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Somatic Nervous System . . . . . . . . . . . . . . . . . . . . . . . . 62
Autonomic Nervous System . . . . . . . . . . . . . . . . . . . . . 63
Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Sensory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Motor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Nerve Impulses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Irritability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Conductivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Nervous Tissue Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Comparison of ICD-9-CM and ICD-10-CM Nervous
System Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . . 64
ICD-10-CM Documentation Elements of Nervous
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Diseases, Disorders, Injuries, and Other Conditions of
the Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Other Nervous System Neoplasms . . . . . . . . . . . . . . . 69
Secondary Nervous System Neoplasms . . . . . . . . . . 69
Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Disorders of the Autonomic Nervous System . . . . 75
Acquired Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . 75
Complications of Procedures . . . . . . . . . . . . . . . . . . . 75
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 4 – Eye and Adnexa
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Fibrous Tunic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Vascular Tunic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Retina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Eye Segments, Globe and Ocular Adnexa. . . . . . . . . 96
Anterior Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Posterior Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Ocular Adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Eye Anatomy and Function . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Sclera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Cornea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Corneal Epithelium Layer . . . . . . . . . . . . . . . . . . . . . . . 97
Bowman’s Layer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Corneal Stroma Layer . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Descemet’s Membrane Layer . . . . . . . . . . . . . . . . . . . 97
Corneal Endothelium . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Schlemm’s Canal and Trabecular Meshwork . . . . . . 97
Choroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Ciliary Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Iris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Retina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Anterior Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Aqueous Humor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Posterior Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Globe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Lacrimal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Vitreous Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Optic Nerve and Visual Pathways . . . . . . . . . . . . . . . 100
Extraocular Muscles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Comparison of ICD-9-CM and ICD-10-CM Eye and
Adnexa Coding Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . 101
ICD-10-CM Documentation Elements of Eye and
Adnexa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Diseases, Disorders, Injuries and Other Conditions of
Eye and Adnexa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Bacterial Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . 96
Follicular Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . 96
Viral Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Viral Keratoconjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . 96
Cytomegalovirus (CMV) Retinitis . . . . . . . . . . . . . . . . 96
Eyelid Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Squamous Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Intraocular Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Orbital Dermoid Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Nevus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Giant Choroidal Nevi . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Entropion and Ectropion . . . . . . . . . . . . . . . . . . . . . . . . 98
Blepharoptosis and Blepharochalasis . . . . . . . . . . . . 98
Chalazion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Blepharitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Dacryoadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Dacryocystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Stenosis and Obstruction Lacrimal Passages . . . . . 99
Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Allergic Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . 100
Chemical Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . 100
Pterygium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Scleritis and Episcleritis . . . . . . . . . . . . . . . . . . . . . . . . 100
Staphyloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Keratoconjunctivitis and Keratitis . . . . . . . . . . . . . . . 101
Keratoconjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Keratitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Corneal Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Corneal Neovascularization . . . . . . . . . . . . . . . . . . . . 101
Iritis, Iridocyclitis, and Cyclitis . . . . . . . . . . . . . . . . . . . 102
Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Synechiae and Goniosynechiae . . . . . . . . . . . . . . . . 102
Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Infantile and Juvenile Cataracts . . . . . . . . . . . . . . . . 103
Cataracts with Neovascularization . . . . . . . . . . . . . . 103
Cataracts in Inflammatory Disorders and
Degenerative Diseases . . . . . . . . . . . . . . . . . . . . . .103
Drug-Induced Cataract . . . . . . . . . . . . . . . . . . . . . . . . . 103
ARMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Hereditary Macular Degeneration . . . . . . . . . . . . . . 105
Open-Angle Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . 105
Normal-Tension Glaucoma . . . . . . . . . . . . . . . . . . . . . 105
Closed-Angle Glaucoma . . . . . . . . . . . . . . . . . . . . . . . 105
Infantile Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Phacolytic Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Glaucoma Associated with Other Eye
Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Secondary Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Pseudoexfoliative Glaucoma . . . . . . . . . . . . . . . . . . . 106
Vitreous Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Endophthalmitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Strabismus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Contents
Myopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Hypermetropia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Amblyopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Blurred Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Diplopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Scotomas (Blind Spots) . . . . . . . . . . . . . . . . . . . . . . . . . 109
Visual Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Total Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Legal Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Nystagmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Intraoperative and Postoperative
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Keratopathy Following Cataract Surgery . . . . . . . . 110
Lens Fragments Following Cataract Surgery . . . . 110
Chorioretinal Scarring Following Detachment
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Coloboma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Retinopathy of Prematurity . . . . . . . . . . . . . . . . . . . . 111
Eye Abrasions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Foreign Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Eyelid and Ocular Lacerations . . . . . . . . . . . . . . . . . . 112
Ocular Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Chemical (Corrosive) Eye Injuries . . . . . . . . . . . . . . . 112
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Chapter 5 – Ear and Mastoid Process
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Cells and Tissues of the Ear and Mastoid Process. . . . . 121
The External Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
External Auditory Canal (EAC) . . . . . . . . . . . . . . . . . . 122
The Middle Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Tympanic Membrane . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Ossicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
The Eustachian Tube . . . . . . . . . . . . . . . . . . . . . . . . . . 123
The Inner Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Vestibular Labyrinth System . . . . . . . . . . . . . . . . . . . . 124
The Cochlear Labyrinth . . . . . . . . . . . . . . . . . . . . . . . . 124
Mastoid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Comparison of ICD-9-CM and ICD-10-CM Ear and
Mastoid Process Coding Guidelines. . . . . . . . . . . . . . . 125
ICD-10-CM Documentation Elements of Nervous
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Diseases, Disorders, Injuries, and other Conditions
of the Ear and Mastoid. . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Serous Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Suppurative Otitis Media . . . . . . . . . . . . . . . . . . . . . . 126
Mastoiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Otitis Externa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Myringitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Malignant Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Benign Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Diseases of the External Ear . . . . . . . . . . . . . . . . . . . . 128
Middle Ear Diseases and Disorders . . . . . . . . . . . . . 129
Inner Ear Diseases and Disorders . . . . . . . . . . . . . . . 129
Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Perforated Eardrum . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Ototoxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Anatomy Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Contents
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Chapter 6 – Circulatory System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Pericardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Heart Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Heart Chambers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Heart Valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Blood Supply to the Heart . . . . . . . . . . . . . . . . . . . . . . 139
Heart Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Blood Vessels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Capillaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Circulatory Routes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Physiology of the Blood Circulatory System. . . . . . 142
Lymphatic System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Lymphatic Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Lymph Nodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Other Lymphatic Organs. . . . . . . . . . . . . . . . . . . . . . . . 143
Physiology of the Lymphatic Circulatory
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Interstitial Fluid and Lymph . . . . . . . . . . . . . . . . . . . . 143
Lymph Capillaries and Digestion . . . . . . . . . . . . . . . 144
Defense Mechanisms of the Lymphatic
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Comparison of ICD-9-CM and ICD-10-CM Circulatory
System Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . 144
ICD-10-CM Documentation Elements of Circulatory
System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Diseases, Disorders, Injuries and Other Conditions
of Cardiovascular and Lymphatic Circulatory
Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Pericarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Myocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Acute Rheumatic Fever and Chronic Rheumatic
Heart Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Hypertensive Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . 150
Angina Pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Atherosclerosis of Coronary Arteries . . . . . . . . . . . . 151
Pulmonary Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Cor Pulmonale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . 152
Pericardial Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Heart Valve Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Cardiomyopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Conduction Disorders and Dysrhythmias . . . . . . . 154
Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Nontraumatic Subarachnoid or Intracerebral
Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Cerebral Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Occlusion and Stenosis of Precerebral or Cerebral
Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Embolism and Thrombosis . . . . . . . . . . . . . . . . . . . . . 157
Phlebitis and Thrombophlebitis . . . . . . . . . . . . . . . . 157
Venous Thrombosis and Embolism . . . . . . . . . . . . . 157
Varicose Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Venous Insufficiency and Hypertension . . . . . . . . . 158
Diseases of Lymphatic Vessels and Lymph
Nodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Gangrene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Intraoperative and Postprocedural
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Conditions Affecting Newborns. . . . . . . . . . . . . . . . . 159
Defects of the Heart Valves . . . . . . . . . . . . . . . . . . . . . 160
Congenital Malformations of the Great
Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Other Congenital Malformations of the
Circulatory System . . . . . . . . . . . . . . . . . . . . . . . . . 161
Chest Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Enlarged Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . 161
Abnormal Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter 7 – Respiratory System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Specialized Cells of the Respiratory Tract . . . . . . . . . . . . 169
Cells of Respiratory Epithelium. . . . . . . . . . . . . . . . . . 169
Goblet Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Ciliated Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Basal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Clara Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Alveolar Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Type I Alveolar Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Type II Alveolar Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Alveolar macrophages . . . . . . . . . . . . . . . . . . . . . . . . . 170
Tissues of the Respiratory System. . . . . . . . . . . . . . . . . . . 170
Conductive Portion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Respiratory Epithelium . . . . . . . . . . . . . . . . . . . . . . . . 170
Lamina Propria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Submucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Cartilage and Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Respiratory Portion of Lungs . . . . . . . . . . . . . . . . . . . . 171
Organs of the Respiratory System and their
Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Nasal Cavity and Turbinates. . . . . . . . . . . . . . . . . . . . . 171
Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Tonsils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Larynx and Vocal Cords . . . . . . . . . . . . . . . . . . . . . . . . . 173
Airway Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Phonation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Trachea and Bronchi . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Anatomical Structure and Function . . . . . . . . . . . . 173
Neurochemical Control of Ventilation . . . . . . . . . . 173
Mechanics of Breathing . . . . . . . . . . . . . . . . . . . . . . . .175
Gas Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Pleura. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Comparison of ICD-9-CM and ICD-10-CM Respiratory
System Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
ICD-10-CM Documentation Elements of Respiratory
System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Diseases, Disorders, Injuries, and other Conditions of
the Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Pertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Acute Upper Respiratory Infections . . . . . . . . . . . . . 179
Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Lung Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Chronic Lower Respiratory Diseases . . . . . . . . . . . . 181
Congenital Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . 186
Meconium Aspiration Syndrome . . . . . . . . . . . . . . . 186
Transient Tachypnea of Newborn . . . . . . . . . . . . . . 187
Pneumothorax in Newborn . . . . . . . . . . . . . . . . . . . . 187
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . .188
Abnormal Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Anatomy Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Chapter 8 – Digestive System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Specialized Epithelial Cells of the Gastrointestinal
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Upper GI Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Mucous Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Taste Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Serous Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Enterocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Paneth Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Goblet Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Enteroendocrine Cells . . . . . . . . . . . . . . . . . . . . . . . . . 197
Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Surface Mucosal Cells . . . . . . . . . . . . . . . . . . . . . . . . . 197
Mucous Neck Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Parietal (Oxyntic) Cells . . . . . . . . . . . . . . . . . . . . . . . . . 197
Chief Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Gastric Endocrine Cells . . . . . . . . . . . . . . . . . . . . . . . . 197
Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Hepatocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Kupffer Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Exocrine Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Acinar Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Tissues and their Functions. . . . . . . . . . . . . . . . . . . . . . . . . 197
Mucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Mucous Epithelium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Lamina Propria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Muscularis Mucosae . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Submucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Muscularis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Serosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Organs of the Digestive System and their Functions . . 198
Oral Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Basic Structure and Function . . . . . . . . . . . . . . . . . . 198
Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Contents
Salivary Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Basic Structure and Function . . . . . . . . . . . . . . . . . . 199
Swallowing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Basic Structure and Function . . . . . . . . . . . . . . . . . . 200
Innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Gastric Motility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Secretion of Digestive Juices . . . . . . . . . . . . . . . . . . . 200
Small Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Basic Structure and Function . . . . . . . . . . . . . . . . . . 201
Innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Digestion of Chyme . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Intestinal Motility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Large Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Basic Structure and Function . . . . . . . . . . . . . . . . . . 202
Innervation and Motility . . . . . . . . . . . . . . . . . . . . . . . 203
Waste Elimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Basic Structure and Function . . . . . . . . . . . . . . . . . . 203
Bile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Gallbladder and Biliary Ducts . . . . . . . . . . . . . . . . . . . 204
Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Basic Structure and Function . . . . . . . . . . . . . . . . . . 204
Innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Differences Between ICD-9-CM and ICD-10-CM
Digestive System Coding Guidelines. . . . . . . . . . . . . . 205
ICD-10-CM Documentation Elements of Digestive
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Diseases, Disorders, Injuries, and Other Conditions of
the Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Enteritis/Colitis/Gastroenteritis . . . . . . . . . . . . . . . . . 206
Peritonitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Malignant Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Benign Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Diseases and Disorders of the Digestive System . 209
Gastroesophageal Reflux . . . . . . . . . . . . . . . . . . . . . . 209
Barrett’s Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Mallory-Weiss Syndrome . . . . . . . . . . . . . . . . . . . . . . . 209
Gastrointestinal Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . 209
Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Noninfectious Gastritis/Enteritis/Colitis . . . . . . . . . 210
Other Diseases of the Intestines . . . . . . . . . . . . . . . . 210
Diverticular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Diseases of the Gallbladder and Biliary Tract . . . . 212
Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Chapter 9 – Integumentary System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Epidermal Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Keratinocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Melanocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Langerhans Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Merkel Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Dermal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Fibroblasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Contents
Mast Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Macrophages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Hypodermal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Epidermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Dermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Hypodermis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Organ Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Epidermal Layers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Dermal Layers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Subcutaneous Layer. . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Comparison of ICD-9-CM and
ICD-10-CM Integumentary System Coding
Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
ICD-10-CM Documentation Elements of
Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Diseases, Disorders, Injuries, and other Conditions of
Integumentary System and Skin Appendages. . . . . 226
Dermatophytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Basal Cell and Squamous Cell Carcinomas . . . . . . 227
Melanomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Merkel cell carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Lipomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Pemphigus Vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Bullous pemphigoid . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Atopic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Seborrheic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Contact Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Papulosquamous Disorders . . . . . . . . . . . . . . . . . . . . 229
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Chapter 10 – Musculoskeletal System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Bone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Types of Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Cartilage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Bone Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Diaphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Epiphyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Articular Cartilage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Periosteum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Medullary Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Endosteum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Bone Formation and Growth. . . . . . . . . . . . . . . . . . . . 239
Axial and Appendicular Skeleton. . . . . . . . . . . . . . . . 240
Joints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Fibrous Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Cartilaginous Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Synovial Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Muscular System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Skeletal Muscle Tissue . . . . . . . . . . . . . . . . . . . . . . . . . .245
Smooth Muscle Tissue . . . . . . . . . . . . . . . . . . . . . . . . . 246
Cardiac Muscle Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Skeletal Muscles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Comparison of ICD-9-CM ICD-10-CM
Musculoskeletal System Coding. . . . . . . . . . . . . . . . . . 249
ICD-10-CM Documentation Elements of
Muscoloskeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . 250
Diseases, Disorders, Injuries and Other Conditions
of Musculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . 250
Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Pyogenic Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Infectious Myositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Malignant Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Benign Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . .252
Enteropathic Arthropathies . . . . . . . . . . . . . . . . . . . . 253
Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Villonodular synovitis . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Acquired Deformities . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Old Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Non-traumatic Joint Dislocation . . . . . . . . . . . . . . . . 254
Other Joint Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Polyarteritis Nodosa . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Systemic Lupus Erythematosis . . . . . . . . . . . . . . . . . 254
Systemic Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Sicca Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Lordosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Spondylolysis, Spondylolisthesis, and
Spondylitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Spinal Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Fatigue Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Collapsed Vertebrae . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Intervertebral Disc Disorders . . . . . . . . . . . . . . . . . . . 256
Myositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Tendonitis, Tenosynovitis, Synovitis, and
Bursitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Muscle Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Tendon Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Fibromyalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Disorders of Bone Density and Structure . . . . . . . . 258
Cartilage Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Conditions Affecting Newborns. . . . . . . . . . . . . . . . . 259
Congenital Hip Dysplasia and Dislocation . . . . . . .259
Deformities of the Feet . . . . . . . . . . . . . . . . . . . . . . . . . 259
Polydactyly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Syndactyly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Symptoms, Signs, and Abnormal Findings. . . . . . . 260
Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Crush Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Traumatic Amputations . . . . . . . . . . . . . . . . . . . . . . . . 263
Other and Unspecified Injuries of the
Musculoskeletal System . . . . . . . . . . . . . . . . . . . . 263
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter 11 – Genitourinary System
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Urinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Kidneys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Kidney Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Kidney Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Kidney Blood Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Ureters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Urinary Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Urethral Sphincter Muscles . . . . . . . . . . . . . . . . . . . . . 274
Bladder Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Urethra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Male Genital System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Penis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Testes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Seminiferous Tubules . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Leydig Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Epididymis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Vas deferens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Spermatic Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Prostate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Bulbourethral Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Female Genital System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Hymen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
External Genitalia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Labia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Uterus and Cervix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Uterine Corpus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Vagina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Ovaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Fallopian Tubes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Fallopian Tube Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Pregnancy, Childbirth and the Puerperium. . . . . . . . . . 282
Conception. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Pregnancy Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Gravid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Pregnancy Trimesters . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
First Trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Second Trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Third Trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Puerperium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Comparison of ICD-9-CM and ICD-10-CM
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Pregnancy, Childbirth and the Puerperium . . . . . . 284
ICD-10-CM Documentation Elements. . . . . . . . . . . . . . . 290
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Pregnancy, Childbirth and the Puerperium
Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Section 11.1 – Infectious Diseases of the Urinary
and Reproductive Systems. . . . . . . . . . . . . . . . . . . . . . . 291
Genitourinary Sexually Transmitted Diseases . . . . 291
Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Herpes Simplex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Human Papilloma Virus . . . . . . . . . . . . . . . . . . . . . . . . 292
Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Trichomoniasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Other Geniturinary Tract Infections. . . . . . . . . . . . . . 292
Urinary Tract Infection (UTI) . . . . . . . . . . . . . . . . . . . . 292
Urethritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Contents
Pyelonephritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Epididymitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
Pelvic Inflammatory Disease (Disorder) (PID) . . . . 293
Other Sexually Transmitted Diseases . . . . . . . . . . . . 293
Human Immunodeficiency Virus . . . . . . . . . . . . . . . 293
Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Maternal Infection Affecting the Fetus. . . . . . . . . . . 294
Toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Rubella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Cytomegalovirus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Section 11.2 – Neoplasms of the Urinary and
Reproductive Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Renal Cyst. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Renal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Wilms Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Transitional Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . 295
Other Bladder Malignancies. . . . . . . . . . . . . . . . . . . . . 295
Bladder Polyps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Prostate Malignancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Testicular Malignancy. . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Breast Malignancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Malignant Neoplasms Uterus and Uterine Cervix. . 296
Uterine Fibroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Section 11.3 – Other Diseases and Conditions of the
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Diseases of the Urinary System. . . . . . . . . . . . . . . . . . 297
Glomerular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Renal Tubule-Interstitial Diseases . . . . . . . . . . . . . . . 298
Vesicoureteral Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Chronic Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . 298
Urolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Interstitial and Irradiation Cystitis . . . . . . . . . . . . . . . 299
Bladder diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Overactive bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Urethral Stricture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Enlarged Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300
Prostatic Intraepithelial Neoplasia . . . . . . . . . . . . . . 300
Hydrocele and Spermatocele . . . . . . . . . . . . . . . . . . . 300
Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Phimosis and Paraphimosis . . . . . . . . . . . . . . . . . . . . 301
Fibrocystic Breast Disease . . . . . . . . . . . . . . . . . . . . . . 302
Fibroadenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Gynecomastia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Complications of Breast Augmentation and
Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Genital Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Endometrial Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . 303
Female Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Urinary Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Stress Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Urge Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Functional Incontinence . . . . . . . . . . . . . . . . . . . . . . . 304
Overflow Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . 305
Transient Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . 305
Hypospadias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Chordee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Contents
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Undescended Testicles . . . . . . . . . . . . . . . . . . . . . . . . . 305
Klinefelter’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 305
Renal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Testicular Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Intraoperative Injury of Geniturinary Tract . . . . . . 306
Section 11.10 – Pregnancy and Pregnancy-Related
Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Pregnancy with Abortive Outcome. . . . . . . . . . . . . . 306
Ectopic Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Hydatidiform Mole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Blighted Ovum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Missed Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Spontaneous Abortion . . . . . . . . . . . . . . . . . . . . . . . . . 307
Induced Termination of Pregnancy . . . . . . . . . . . . . 308
Complications of Abortive Outcome . . . . . . . . . . . . 308
Gestational Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Gestational Proteinuria . . . . . . . . . . . . . . . . . . . . . . . . .309
Hypertension in Pregnancy . . . . . . . . . . . . . . . . . . . . 309
Section 11.13 – Other Maternal Disorders
Related to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 309
Threatened Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Gestational Diabetes Mellitus (GDM) . . . . . . . . . . . 310
Multiple Gestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Malpresentation of Fetus . . . . . . . . . . . . . . . . . . . . . . . 310
Disproportion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Fetal Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Polyhydramnios and Oligohydramnios . . . . . . . . . 311
Premature Rupture of Membranes . . . . . . . . . . . . . . 312
Preterm Rupture of Membranes . . . . . . . . . . . . . . . . 312
Preterm (Premature) Labor . . . . . . . . . . . . . . . . . . . . . 313
Abnormalities of the Forces of Labor . . . . . . . . . . . 313
Obstructed Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Failed Trial of Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Umbilical Cord Complications . . . . . . . . . . . . . . . . . . 314
Cord Entanglement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Vasa Previa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Vascular Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Obstetric Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Intrapartum or Postpartum Hemorrhage . . . . . . . 314
Amniotic Fluid Embolism . . . . . . . . . . . . . . . . . . . . . . 315
Postpartum Mood Disturbance . . . . . . . . . . . . . . . . . 315
Anatomy Quiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Section II – Anatomy and Physiology for
ICD-10-PCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
New for 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Chapter 1 – Sections
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medical and Surgical Section . . . . . . . . . . . . . . . . . . . . . . . . .
Obstetrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Measurement and Monitoring . . . . . . . . . . . . . . . . . . . .
Extracorporeal Assistance and Performance . . . . . . .
Extracorporeal Therapies. . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
1
2
3
3
3
4
4
Osteopathic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nuclear Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Radiation Oncology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Physical Rehabilitation and Diagnostic Audiology. .
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse Treatment. . . . . . . . . . . . . . . . . . . . . . .
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
5
5
6
6
6
7
7
8
9
Chapter 2 – Body Systems and Body Parts
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Body System Designations for Medical
Surgical Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Anatomical Regions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Body Part Designations for Medical Surgical
Section. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
General Body Part Designation. . . . . . . . . . . . . . . . . . . . . . . 13
Portion of Body Part. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Designation of Body Part With Prefix “Peri”. . . . . . . . . . . . 13
Specific Body Part Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Body System Designations in the Medical SurgicalRelated and Ancillary Sections. . . . . . . . . . . . . . . . . 16
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 3 – ICD-10-PCS – Root Operations and
Approaches
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Root Operations in the Medical Surgical Section. . . . . .
Root Operation Definitions . . . . . . . . . . . . . . . . . . . . . .
Repair Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Root Operation Groups . . . . . . . . . . . . . . . . . . . . . . . . .
Root Operation Values . . . . . . . . . . . . . . . . . . . . . . . . . .
Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Root Operations in the Medical Surgical-Related
Sections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Root Types in the Ancillary Sections. . . . . . . . . . . . . .
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
19
19
19
20
20
21
21
22
22
23
24
Chapter 4 – ICD-10-PCS – Devices and Qualifiers
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Devices That Take the Place of All or a Portion of a
Body Part . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Devices That Assist or Prevent a Physiological
Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Therapeutic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Mechanical or Electronic Appliances . . . . . . . . . . . . . 26
New Device Without a More Specific Device Value 26
Devices in the Placement Section . . . . . . . . . . . . . . . 27
Medical Surgical Procedures That Have a Specific
Qualifier Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Obstetric Procedures That Have a Specific Qualifier
Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Procedures That Do Not Have a Specific Qualifier
Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Contents
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 5 – ICD-10-PCS Applications
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Applications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
33
33
34
37
Chapter 6 – Medical and Surgical Section Coding
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Medical and Surgical Section . . . . . . . . . . . . . . . . . . . . . . . . 39
Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . 40
Peripheral Nervous System . . . . . . . . . . . . . . . . . . . . . . 42
Circulatory System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Heart and Great Vessels . . . . . . . . . . . . . . . . . . . . . . . . . 43
Upper Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Lower Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Upper Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Lower Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Lymphatic and Hemic Systems. . . . . . . . . . . . . . . . . . . 52
Eye. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Ears, Nose, and Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Mouth and Throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Gastrointestinal System. . . . . . . . . . . . . . . . . . . . . . . . . . 58
Gastrointestinal Body System . . . . . . . . . . . . . . . . . . . . 59
Hepatobiliary System and Pancreas . . . . . . . . . . . . . . 60
Endocrine System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Skin and Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Subcutaneous Tissue and Fascia . . . . . . . . . . . . . . . . . 63
Musculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . 65
Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Tendons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Bursae and Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Head and Facial Bones . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Upper Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Lower Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Upper Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Lower Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Urinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Female Reproductive System . . . . . . . . . . . . . . . . . . . . 80
Male Reproductive System . . . . . . . . . . . . . . . . . . . . . . 81
Anatomical Regions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Upper Extremities Anatomical Regions . . . . . . . . . . 82
Lower Extremities Anatomical Regions . . . . . . . . . . 83
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Coding Practice Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 7 – Coding in Medical/Surgical-Related
Sectgions
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Section 1 Obstetrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Obstetrics Coding Guidelines . . . . . . . . . . . . . . . . . . . . 95
Obstetrics Root Operations . . . . . . . . . . . . . . . . . . . . . . 96
Delivery vs Cesarean Section . . . . . . . . . . . . . . . . . . . . 96
Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Body System and Body Part in Obstetrics. . . . . . . . . 96
Obstetric Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Obstetric Qualifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Section 2 Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Placement Root Operations. . . . . . . . . . . . . . . . . . . . . . 97
Immobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Traction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Placement Body Systems and Body Regions. . . . . . 98
Placement Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Placement Section Devices. . . . . . . . . . . . . . . . . . . . . . . 98
Section 3 Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Administration Root Operations. . . . . . . . . . . . . . . . . . 99
Administration Body Systems and Body Regions.100
Approach in Administration Section. . . . . . . . . . . . . 100
Substances Administered. . . . . . . . . . . . . . . . . . . . . . . 100
Administrative Qualifiers. . . . . . . . . . . . . . . . . . . . . . . . 101
Section 4 Measurement and Monitoring . . . . . . . . . . . . 102
Measurement and Monitoring Root Operations. . 102
Body Systems of Measurement and Monitoring. . 102
Approach for Measurement and Monitoring. . . . . 102
Functions or Devices Being Monitored and/or
Measured. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Qualifier for Function/Device in Measurement and
Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Section 5 Extracorporeal Assistance and
Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Root Operations and Body Systems in
Extracorporeal Assistance and Performance. . 103
Extracorporeal Body System Designations. . . . . . . 103
Duration and Function of Extracorporeal
Assistance and Performance. . . . . . . . . . . . . . . . . . 104
Extracorporeal Assistance and Performance
Qualifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Section 6 Extracorporeal Therapies. . . . . . . . . . . . . . . . . . 105
Root Operations in Extracorporeal Therapies. . . . . 105
Body Systems in Extracorporeal Therapies. . . . . . . 105
Duration and Qualifiers for Extracorporeal
Therapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Section 7 Osteopathic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Body System and Root Operation for Osteopathic
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Osteopathic Body Regions, Approach, and
Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Section 8 Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . . 107
Body Systems and Root Operations for Other
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Method and Qualifier for Other Procedures. . . . . . 107
Section 9 Chiropractic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Body System and Root Operation for Chiropractic
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Chiropractic Body Regions, Approach, and Method. . 108
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Chapter 8 – Coding in the Ancillary Sections
Chapter Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Contents
Section B Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Imaging Root Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Contrast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Imaging Body Systems and Body Parts . . . . . . . . . . 112
Imaging Qualifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Section C Nuclear Medicine. . . . . . . . . . . . . . . . . . . . . . . . . 113
Nuclear Medicine Root Types. . . . . . . . . . . . . . . . . . . . 113
Nuclear Medicine Body Systems and Body Parts. 114
Radionuclide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Section D Radiation Oncology. . . . . . . . . . . . . . . . . . . . . . 115
Root Types of Radiation Oncology. . . . . . . . . . . . . . . 116
Radiation Oncology Root Types . . . . . . . . . . . . . . . . . 116
Body Systems and Treatment Site . . . . . . . . . . . . . . . 116
Modality Qualifier for Radiation Oncology. . . . . . . 116
Isotope. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Section F Physical Rehabilitation and Diagnostic
Audiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Advanced Anatomy and Physiology for ICD-10-CM/PCS
Root Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Physical Rehabilitation Root Types . . . . . . . . . . . . . . 117
Diagnostic Audiology Root Types . . . . . . . . . . . . . . . 118
Type Qualifier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Section G Mental Health and Section H Substance
Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Root Types in Mental Health. . . . . . . . . . . . . . . . . . . . . 120
Type Qualifiers in Mental Health. . . . . . . . . . . . . . . . . 120
Root Types in Substance Abuse Treatment. . . . . . . 121
Type Qualifiers in Substance Abuse Treatment. . . 121
Mental Health Coding Examples . . . . . . . . . . . . . . . . 121
Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Appendix A – Official Coding Guidelines
ICD-10-CM Official Coding Guidelines/Reporting. . . . . . 1
Introduction
The Advanced Anatomy and Physiology for ICD-10-CM/PCS is
designed to introduce health care professionals to the new ICD10-CM and PCS systems, to identify differences between ICD9-CM and ICD-10-CM and ICD-10-PCS, 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 PCS and how it relates to the ICD-9-CM
systems. Official Coding Guidelines for both coding systems
are listed side-by-side to allow easy comparison of similarities
and changes. Coding Practices are provided, followed by
questions 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.contexodata.com/API10/
Refer to the end of this chapter for a detailed summary of the
organization of this book.
Course Objectives
This 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 ICD10-PCS
Overview
Developing 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-9CM 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
quiz whereby students can test their proficiency as it relates to
i
Section I
Advanced Anatomy and Physiology for ICD-10-CM
Table 2. General Coding Guidelines
B. ICD-9-CM General
Coding Guidelines
1. Use of Both Alphabetic
Index and Tabular List
B. ICD-10-CM General
Coding Guidelines
1. Locating a code in
the ICD-10-CM
Use both the Alphabetic Index
and the Tabular List when locating
and assigning a code. Reliance
on only the Alphabetic Index or
the Tabular List leads to errors
in code assignments and less
specificity in code selection.
To select a code in the classification
that corresponds to a diagnosis
or reason for visit documented in
a medical record, first locate the
term in the Index, and then verify
the code in the Tabular List. Read
and be guided by instructional
notations that appear in both
the Index and the Tabular List.
2. Locate each term in the
Alphabetic Index
Locate each term in the Alphabetic
Index and verify the code selected
in the Tabular List. Read and be
guided by instructional notations
that appear in both the Alphabetic
Index and the Tabular List.
It is essential to use both the Index
and Tabular List when locating and
assigning a code. The Index does
not always provide the full code.
Selection of the full code, including
laterality and any applicable 7th
character can only be done in the
Tabular list. A dash (-) at the end
of an Index entry indicates that
additional characters are required.
Even if a dash is not included at
the Index entry, it is necessary to
refer to the Tabular list to verify
that no 7th character is required.
3. Level of Detail in Coding
2. Level of Detail in Coding
Diagnosis and procedure codes
are to be used at their highest
number of digits available.
Diagnosis codes are to be used
and reported at their highest
number of digits available.
ICD-9-CM diagnosis codes are
composed of codes with 3, 4, or 5
digits. Codes with three digits are
included in ICD-9-CM as the heading
of a category of codes that may be
further subdivided by the use of
fourth and/or fifth digits, which
provide greater detail.
ICD-10-CM diagnosis codes are
composed of codes with 3, 4, 5, 6
or 7 digits. Codes with three digits
are included in ICD-10-CM as the
heading of a category of codes that
may be further subdivided by the use
of fourth and/or fifth digits, which
provide greater detail.
B. ICD-9-CM General
Coding Guidelines
B. ICD-10-CM General
Coding Guidelines
A three-digit code is to be used only
if it is not further subdivided. Where
fourth-digit subcategories and/
or fifth-digit subclassifications are
provided, they must be assigned. A
code is invalid if it has not been coded
to the full number of digits required
for that code. For example, Acute
myocardial infarction, code 410,
has fourth digits that describe the
location of the infarction (e.g., 410.2,
Of inferolateral wall), and fifth digits
that identify the episode of care. It
would be incorrect to report a code
in category 410 without a fourth and
fifth digit.
A three-digit code is to be used only if
it is not further subdivided. A code is
invalid if it has not been coded to the
full number of characters required
for that code, including the 7th
character, if applicable.
Section I
General coding guidelines in ICD-10-CM have also undergone
changes when compared to ICD-9-CM. Table 2 below again
provides a side-by-side comparison of the general guidelines so
that differences can be easily identified.
ICD-9-CM Volume 3 procedure codes
are composed of codes with either 3
or 4 digits. Codes with two digits are
included in ICD-9-CM as the heading
of a category of codes that may be
further subdivided by the use of third
and/or fourth digits, which provide
greater detail.
4. Code or codes from
001.0 through V89.09
3. Code or codes from A00.0
through T88.9, Z00-Z99.8
The appropriate code or codes from
001.0 through V89.09 must be used
to identify diagnoses, symptoms,
conditions, problems, complaints or
other reason(s) for the encounter/
visit.
The appropriate code or codes from
A00.0 through T88.9, Z00-Z99.8
must be used to identify diagnoses,
symptoms, conditions, problems,
complaints or other reason(s) for the
encounter/visit.
5. Selection of codes
001.0 through 999.9
The selection of codes 001.0
through 999.9 will frequently be
used to describe the reason for the
admission/encounter. These codes
are from the section of ICD-9-CM
for the classification of diseases and
injuries (e.g., infectious and parasitic
diseases; neoplasms; symptoms,
signs, and ill-defined conditions,
etc.).
xiii
Endocrine System
Advanced Anatomy and Physiology for ICD-10-CM
Hormones are classified as either proteins, amines (protein
derivatives), or steroids. All hormones in the body except sex
hormones and those secreted by the adrenal cortex are protein or
protein derivatives.
Protein and protein derivative hormones react with receptors on
the surface of the cell and the changes these proteins set in motion
are relatively rapid. Steroid hormones react with receptors inside
the cells and this process generally requires protein synthesis which
results in slower changes in cellular activity.
Hormones are potent substances that require regulation to
maintain them within the very narrow parameters necessary to
maintain homeostasis. When regulatory mechanisms fail, hormone
imbalances can occur causing a variety of disorders.
The Pituitary
2. Endocrine System
The pituitary gland, also called the hypophysis, is a small gland,
about 1 cm in size. It is located in the sella turcica, which is a
depression in the sphenoid bone. It is attached to the hypothalamus
of the brain by a slender stalk called the infundibulum. The
infundibulum penetrates the dura mater.
The pituitary gland is divided into anterior and posterior lobes,
called the adenohypophysis and the neurohypophysis respectively,
which are different structurally and functionally.
Pituitary gland
Neurosecretory
cells
Capillaries
Artery
infundibulum. Secretions from the hypothalamus are delivered to
and stimulate the adenohypophysis as follows:
1. Chemicals released from the hypothalamus diffuse across
the capillary membranes and enter the blood.
2. The capillaries unite to form portal veins that carry blood
and the chemical secretions from the hypothalamus to the
anterior lobe of the pituitary gland.
3. When the anterior lobe receives the chemicals, the pituitary
gland then secretes one of six hormones from three
types of glandular cells called acidophils, basophils, and
chromophobes.
4. Hormones secreted from the different glandular cells are as
follows:
• Growth hormone
• Thyroid stimulating hormone
• Adrenocorticotropic hormone
• Follicle stimulating hormone
• Leuteinizing hormone
• Prolactin
Growth hormone is also referred to as somatotropin or
somatotrophic hormone (STH). It is a protein hormone that
stimulates the growth of hard and soft tissues including bones,
muscles, and body organs. Once full growth is attained, growth
hormone helps to maintain the size of the hard and soft tissues. Too
little growth hormone in a child can cause pituitary dwarfism. Too
much growth hormone may result in gigantism. Growth hormone
has two other important functions. It causes cells to switch from
burning carbohydrates to burning fats and it accelerates the rate
at which glycogen stored in the liver is converted to glucose and
released into the blood thereby increasing blood sugar.
Thyroid stimulating hormone (TSH), also referred to as
thyrotropin, stimulates the synthesis and secretion of hormones
from the thyroid gland.
Portal
system
Adrenocorticotropic hormone (ACTH) has two functions. Its
primary function is to regulate the adrenal glands which produce
and secrete adrenal cortex hormones. A second function is to
stimulate the liver to remove glucose from the blood thereby
decreasing blood sugar.
Anterior
lobe
Pituitary
gland vein
Follicle stimulating hormone (FSH) affects ovarian and testicular
function. In females, it stimulates ova to develop and cells in the
ovaries to secrete estrogens. In males, it stimulates the testes to
produce sperm and cells in the testes to secrete testosterone.
Posterior
lobe
Pituitary
fossa
Adenohypophysis
The adenohypophysis is the glandular part of the pituitary containing
glandular epithelial cells. It is connected to the hypothalamus by blood
vessels and releases hormones that regulate many bodily activities.
Release of hormones from the adenohypophysis is controlled by
chemical secretions from the hypothalamus. The hypothalamus lies
just above the infundibulum and receives blood from the superior
hypophyseal arteries that form a network of capillaries in the
32
Luteinizing hormone (LH) affects sexual and reproductive
functions in both males and females. It stimulates the ovary in
females to release the mature ovum and prepares the uterus for
implantation of a fertilized ovum. It also stimulates the secretion of
progesterone which prepares the mammary glands for production
of milk. In males, it stimulates the interstitial cells in the testes to
synthesize and secrete testosterone.
Prolactin initiates milk secretion from the mammary glands.
Circulatory System
Advanced Anatomy and Physiology for ICD-10-CM
The table below lists the aortic divisions, first order branches off
each division, and major second order branches.
Table 6.1 Aorta and Branches
Aortic Divisions
First Order Branches
Ascending aorta
Coronary arteries
Brachiocephalic
(innominate)
Second Order Branches
Right common carotid
6. Circulatory System
Left common carotid
Left subclavian
Intercostal arteries
Thoracic aorta
The capillaries then flow into venules and veins. Venules
and veins are not dependent on blood pressure to promote
circulation. Instead, the return of venous blood to the heart
is dependent on skeletal muscle contraction, respiratory
movements, and constriction of smooth muscle tissue in the
venous walls.
Superior phrenic
arteries
Bronchial arteries
Esophageal arteries
Inferior phrenic arteries
Celiac
Lymphatic System
Hepatic
The lymphatic system consists of lymphatic fluid, lymphatic
vessels, and masses of lymphatic tissue in the lymph nodes,
tonsils, thymus, and spleen.
Left gastric
Splenic
Superior mesenteric
Lymphatic Vessels
Suprarenal arteries
Abdominal aorta
Lymphatic vessels serve as conduits that transport fluid away
from body tissues. Lymphatic vessels are distributed throughout
most of the body and begin as microscopic open-ended sacs
called lymphatic capillaries located in the tissue spaces. The only
regions of the body that do not contain lymphatic capillaries are
the bone marrow, central nervous system, and body tissues that
do not contain blood vessels.
Renal arteries
Testicular/Ovarian
arteries
Inferior mesenteric
Common iliac arteries
External iliac arteries
Internal iliac arteries
There are a number of subdivisions to the systemic circulation
including:
• Coronary circulation – blood vessels that run from the aorta
to the heart
• Portal circulation – blood vessels that run from the digestive
tract to the liver
• Cerebrovascular circulation – blood vessels that run from
the aorta to the brain
Physiology of the Blood Circulatory System
The primary function of the blood circulatory system is to
deliver oxygen and nutrients to body tissues and remove waste.
This process begins with the heart which is responsible for
providing the pumping force necessary to circulate blood to
all tissues and cells of the body. The arteries channel blood to
all parts of the body. Blood is channeled through ever smaller
arteries until it reaches arterioles and then capillaries.
Blood flow from the heart is dependent on the pressure exerted
against the artery walls, and like all liquids, blood flows from an
area of higher pressure to an area of lower pressure. Therefore
blood pressure against the artery walls is highest in the large
vessels and lowest in the capillaries. As blood pressure decreases,
blood flow slows.
142
• Exchange of gases
• Exchange of nutrients
• Removal of metabolic waste
These substances pass through the capillary wall by means of
diffusion in the case of gases, and osmosis and hydrostatic pressure
in the case of fluids. The combination of hydrostatic and osmotic
pressures allows substances to leave and enter the capillary.
Right subclavian
Aortic arch
By the time blood reaches the capillaries, blood flow has
slowed to a point where essential metabolic functions can
occur. Essential metabolic functions carried out by capillary
microcirculation include:
Lymphatic vessels
Artery
Tissue cells
Lymph capillary
Capillaries
Tissue spaces
Tissue fluid
Lymphatic
vessel
Lymph node
Vein
Skin and Subcutaneous Tissue
Advanced Anatomy and Physiology for ICD-10-CM
These projections give texture to the skin surface and form what
are called rete pegs. Loss of the rete pegs occurs with aging as the
skin becomes structurally thinner and that loss gives the skin a
smooth, shiny, paper-thin appearance.
Stratum layers of the skin
Stratum
corneum
Stratum
lucidium
The rest of the connective tissue in the dermis is the reticular
layer. Each different layer in the skin represents a progressive
stage of cell differentiation as they move upward, becoming
keratinized and flattened as they replace the cells that are shed
from the surface.
Stratum
granulosum
Stratum
spinosum
Stratum
basale
Subcutaneous Layer
The subcutaneous layer lies below the dermis and is called the
hypodermis. It has a layer of cushioning fat at the base and is
also considered the superficial fascia that connects the overlying
dermis to underlying muscle.
Basement
membrane
Epidermal Layers
The epidermis has five layers:
• The stratum corneum
• The stratum lucidum
• The stratum granulosum
• The stratum spinosum
• The stratum basale
The stratum corneum is the outermost layer of the skin.
It offers the body’s first layer of defense against invading
microorganisms, ultraviolet light, chemical infiltration, and
heat. This is the toughest layer composed of flat, dead skin cells
that have become cornified and filled with keratin.
The stratum lucidum is a clear layer of cells containing a
substance that becomes keratin as the cells ascend up to the
corneal layer. The prekeratin substance is called eleidin and is
found mostly in the palms and soles.
The stratum granulosum is the next layer of flattened cells
named for its granular appearance due to the substance
keratohyalin, which also later becomes keratin.
The stratum spinosum is a larger layer that produces keratin
for the epidermis and has spinous processes projecting between
adjacent, newly formed keratinocytes.
9. Skin and
Subcutaneous Tissue
The stratum basale, also called the germinativum, is the last
layer of the epidermis composed of a single layer of cuboidal
and columnar cells that undergo mitosis. This is where the
keratinocytes divide and begin to move upward, becoming
cornified as they replace cells from the more superficial layers.
Although the epidermis is very thin (about 0.12mm), it is capable
of thickening and forming calluses and corns for greater protection
in areas that experience constant friction or pressure. The epidermal
cells are constantly replaced from deeper skin layers. The average
turnover time for the epidermis is about 30 days.
Dermal Layers
The dermis has two layers:
• Papillary
• Reticular
The uppermost region of the dermis is the papillary layer that
contains fingerlike projections interfacing with the epidermis.
224
Comparison of ICD-9-CM and
ICD-10-CM Integumentary System Coding
Guidelines
The Official Coding Guidelines in ICD-9-CM and ICD-10CM contain instructions on coding pressure ulcers. These
instructions have changed as follows:
• In ICD-10-CM a single code reports both the site and the
stage of the pressure ulcer while in ICD-9-CM two codes
are required
• In ICD-10-CM there are more specific codes for bilateral
pressure ulcers of the same site (e.g. hip, buttock, etc),
making it easier to identify the site and stage of the pressure
ulcer on each side of the body. Detailed instructions on
reporting bilateral pressure ulcers using ICD-9-CM are no
longer required in ICD-10-CM.
ICD-9-CM – Chapter 12:
Diseases of the Skin and
Subcutaneous Tissue (680-709)
ICD-10-CM – Chapter
12: Diseases of Skin and
Subcutaneous Tissue (L00-L99)
a. Pressure ulcer stage codes
a. Pressure ulcer stage codes
1. Pressure ulcer stages
1) Pressure ulcer stages
Two codes are needed to completely
describe a pressure ulcer: A code from
subcategory 707.0, Pressure ulcer,
to identify the site of the pressure
ulcer and a code from subcategory
707.2, Pressure ulcer stages.
The codes in subcategory 707.2,
Pressure ulcer stages, are to be used
as an additional diagnosis with a
code(s) from subcategory 707.0,
Pressure Ulcer. Codes from 707.2,
Pressure ulcer stages, may not be
assigned as a principal or first-listed
diagnosis. The pressure ulcer stage
codes should only be used with
pressure ulcers and not with other
types of ulcers (e.g., stasis ulcer).
The ICD-9-CM classifies pressure
ulcer stages based on severity,
which is designated by stages
I-IV and unstageable.
Codes from category L89,
Pressure ulcer, are combination
codes that identify the site
of the pressure ulcer as well
as the stage of the ulcer.
The ICD-10-CM classifies
pressure ulcer stages based on
severity, which is designated
by stages 1-4, unspecified
stage and unstageable .
Assign as many codes from
category L89 as needed to
identify all the pressure ulcers
the patient has, if applicable.
Genitourinary System
Advanced Anatomy and Physiology for ICD-10-CM
Overflow Incontinence
Undescended Testicles
If 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.
Also called cryptorchidism, undescended testicles do not
descend from the abdomen as they should before birth.
Transient Incontinence
Urine leaks due to a temporary cause, such as an infection, new
medication, restricted mobility and colds.
Coding Practice 11.7
ICD-9-CM
ICD-10-CM
Stress incontinence of
38-year-old woman
625.6
N39.3
Overactive bladder with
urge incontinence
596.51
N32.81, N39.41
Mixed incontinence
788.33
N39.46
Overflow incontinence
788.38
N39.490
Questions 11.7
Does gender make a difference in ICD-10-CM code selection?
Klinefelter’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 11.8
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
11. Genitourinary
System
Condition
Klinefelter’s Syndrome
Questions 11.8
When coding undescended testicles in ICD-10-CM, does
laterality make a difference in code selection?
Urge incontinence may be a symptom of overactive bladder
and general coding guidelines indicate that symptoms of an
established condition are not reported additionally. Why is urge
incontinence reported with overactive bladder?
Section 11.8 – Congenital Anomalies
Hypospadias
Hypospadias 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.
Chordee
Chordee is where the head of the penis is curved downwards
or upwards. This occurs when the connective tissue between
the urethral opening and the glans and/or the urethra is shorter
than normal.
Section 11.9 – Injuries of the
Genitourinary Tract
Contusions and lacerations are the most common types of
injuries to genitourinary tract organs. Lacerations may result
from closed injuries or penetrating open wounds. The external
genitalia are also subject to crushing and traumatic amputation
injuries. Another cause of injury particularly to the ureters is
accidental puncture or laceration during a surgical procedure.
Renal Trauma
Contusion or laceration of the kidney due to blunt or
penetrating trauma is the most common type of urinary tract
injury. Motor vehicle accidents are the most common cause of
renal trauma. Falls from a height and assault are also associated
with renal trauma but are less common. Injuries to the kidneys
are categorized as minor, moderate or major depending on
the extent of the injury which is determined by the size of the
contusion or the length of the laceration.
Testicular Trauma
The testicles are located in the scrotum, which is on the external
portion of the body and can be easily subjected to outside
trauma because of a lack protection from muscles or bones. This
makes it easier for them to be struck, hit, or crushed, especially
during contact sports. Injury to the testes can cause severe pain,
bruising and/or swelling.
305
Anatomy and Physiology
for ICD-10-PCS
Introduction
Section II provides an overview of ICD-10-PCS and identifies
some of the basic coding principles related to this entirely new
inpatient procedural coding system.
During the development of ICD-10-PCS the goal was to
incorporate four major attributes into the coding system –
completeness, expandability, multiaxial, and standard terminology.
Each of these goals are defined as follows:
Completeness – The ability to assign a unique code for all
substantially different procedures, including unique codes for
procedures that can be performed using different approaches
Expandability – The ability to add new unique codes to the
coding system in the section and body system where they
should reside
Multiaxial – The ability to assign codes using independent
characters around each individual axis or component of the
procedure. For example, if a new surgical approach is used for
one of the root operations on a specific body part, a value for the
new surgical approach can be added to the approach character
without a need to add or change other code characters.
Standardized Terminology – The ability to assign a specific
meaning to each term. Even though many medical terms have
multiple meanings in everyday usage, in ICD-10-PCS each
term has been specifically defined and the definition provided
for that term is the only definition used in ICD-10-PCS.
For example, the term ‘excision’ is defined in most medical
dictionaries as the surgical removal of part or all of a structure or
organ. However, in ICD-10-PCS excision is defined as “cutting
out or off, without replacement, a portion of a body part.” If all
of a body part is surgically removed without replacement, the
procedure is defined as a ‘resection’ in ICD-10-PCS.
In addition, some of the additional anatomy and physiology
components that are part of the procedure codes in this new
coding system have been introduced.
Key elements of ICD-10-PCS include:
• Multiaxial seven character alphanumeric code structure
• Unique code for all substantially different procedures
• Easy incorporation of new codes for new procedures
Key elements related to code content include:
• Diagnostic information is not included in the procedure
description. For example, there are no codes used exclusively
Section II
Section II
for aneurysm, cleft lip, neoplasms, or hernias. Diagnostic
information is provided by the corresponding ICD-10-CM
diagnosis code
• Limited use of “not otherwise specified” (NOS) procedure
codes. All existing and new procedures can be reported with
at least some level of specificity
• Limited use of “not elsewhere classified” (NEC) procedure
codes. All significant components of a procedure can be
reported using ICD-10-PCS, so NEC procedures codes or
values are generally not needed. The exception is the device
character. New devices that are not described by any of the
existing device values are reported with a value for “other
device.” However, in this instance only the device value is
specified as “not elsewhere classified.” Other characters still
contain precise values for the procedure performed.
• All currently performed procedures can be specified in
ICD-10-PCS. The frequency with which a procedure
is performed is not a deciding factor in whether or not a
precise code can be assigned.
As was stated earlier, the ICD-10-PCS section is intended to
provide only an overview of this new inpatient coding system.
Medicare currently has a 238 page manual developed to provide
additional guidance on the use of ICD-10-PCS for reporting
of inpatient procedures, and other payers will likely provide
additional input into reporting guidelines once this coding
system is in use.
As you study Section II, remember that this coding system
replaces only ICD-9-CM Volume 3. CPT codes will still be used
for physician coding and facility coding of outpatient services,
and HCPCS Level II codes will continue to be used for supplies
and other items or services that cannot be captured using CPT.
New for 2012
Although the greatest percentage of codes will be reported
within the Medical and Surgical Section beginning with the
section value of ‘0,’ and it is important to begin with a firm
understanding of assigning codes within that section, ICD-10PCS provides two other groups of sections with additional root
operations specific to those sections.
For the 2012 book, additional material is being presented
within existing chapters that enhances and expands the
discussion covering the sections, root operations, and body
systems that compose the first basic building blocks of ICD-
i
Body Systems and Body Parts
Advanced Anatomy and Physiology for ICD-10-PCS
Body Part Designations for Medical
Surgical Section
In the Medical and Surgical Section, the 4th character
represents body parts. These body parts are specific to ICD-10PCS and do not necessarily represent body parts as described
in anatomy books or in ICD-10-CM. For example, the liver,
which is normally 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 Designation
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 value assigned
in ICD-10-PCS. However, in other cases, the body part preceded
by the prefix “peri” may not have a specific value as is the case
with 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 value for
the body part.
Example
Procedure
Percutaneous needle biopsy right perirenal mass
0TB03ZX
Excision of Right Kidney, Percutaneous
Approach, Diagnostic
Each value has the following meaning in reference to the
procedure described above:
Portion of Body Part
Value
Character Definition
Procedure
When the documentation describes a portion of a body part
and the body part does not have a specific designation in ICD10-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.
0
Section
Medical and Surgical
T
Body System
Urinary System
B
Root Operation
Excision
0
Body Part
Right Kidney
3
Approach
Percutaneous
Z
Device
No Device
Example
X
Qualifier
Diagnostic
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:
Specific Body Part Rules
There are specific coding rules for some body parts in four
body systems—cardiovascular, nervous, musculoskeletal, and
integumentary.
Cardiovascular System
Value
Character Definition
Procedure
0
Section
Medical and Surgical
N
Body System
Head and Facial Bones
B
Root Operation
Excision
T
Body Part
Right Mandible
3
Approach
Percutaneous
Coronary Arteries
In 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.
Z
Device
No Device
Example 1
X
Qualifier
Diagnostic
Procedure
Percutaneous transluminal coronary artery
angioplasty (PTCA) with stent placement, left
anterior descending and left circumflex arteries
02713DZ
Dilation of Coronary Artery, Two Sites with
Intraluminal Device, Percutaneous Approach
Note: Biopsies are reported with a code for excision which is defined
in ICD-10-PCS 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
2. Body Systems and
Body Parts
General 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.
identifies this procedure as a biopsy since biopsy is performed for
diagnostic rather than therapeutic purposes. Core needle biopsy
“cuts out” a small amount of alveolar bone. It is considered a
percutaneous procedure because it is performed through the skin
without direct visualization of the bone.
13
Chapter 4
Devices and Qualifiers
Chapter Objectives
After studying this chapter, you should be able to:
• Define the terms Device and Qualifier as they are used in
ICD-10-PCS
• Explain how device and qualifier values differ from values
for the first five characters in the code
• Explain what the value ‘Z’ means when assigned as the
value for a device (6th character) or a qualifier (7th
character.
• Identify the four general types of devices
• Provide specific examples of each general type of device
• Identify items that are not considered devices for ICD-10PCS coding purposes
• Identify the root operations that always require a specific
value for the device character
• Identify root operations that may require a specific value
for the device character
• Provide examples of root operations that may require the
use of a qualifier
• Explain how a biopsy is identified when the root operation
is Excision
• Provide examples of the types of attributes that are
captured by the qualifier value
Overview
Device
In the medical and surgical, obstetrics, and placement sections
of ICD-10-PCS, the 6th character indicates whether a device
was used or placed in the body during the procedure. In order
to qualify as a device, the device must remain in place after
completion of the procedure.
As with most terms in ICD-10-PCS, the term device is used to
describe some items that have not traditionally been considered
devices. For example, a biological graft, such as a skin graft, is
considered a device for ICD-10-PCS coding purposes.
Not all procedures require the use of a device, so the value ‘Z’ is
used to indicate “no device” if the device value does not apply
to the procedure performed.
Most devices have a specific value that describes the device.
However, new devices are frequently developed so there is an
“other device” value that should be used until a more specific
new device value can be added to the coding system. The value
‘Y’ is used when none of the available device values describe the
device used. The ‘Y’ is used for other devices until ICD-10-PCS
is updated with a specific value for the new device.
There are four general types of devices, which are classified based
on the function the device performs. Types of devices include:
• Biological or synthetic material that takes the place of all or
a portion of a body part
• Biological or synthetic material that assists or prevents a
physiological function
• Therapeutic material that is not absorbed by, eliminated
by, or incorporated into a body part
• Mechanical or electronic appliances used to assist, monitor,
take the place of, or prevent a physiological function
Examples are provided in the next sections of root operations
that require the use of a device to perform the functions
described above.
4. Devices and
Qualifiers
This chapter provides information on devices and qualifier
values used in ICD-10-PCS. Device and qualifier characters
are used to identify additional attributes of the procedure.
In the medical and surgical section, as well as the obstetrics
and placement sections, devices are represented by the 6th
character in the code and qualifiers by the 7th character. A
device character is assigned when a device is used or placed
in the body during the procedure and remains in the body at
the completion of the procedure. A qualify is used to identify
any additional attributes of the procedure that have not been
captured by the first 6 characters of the code.
All codes are assigned a specific value for the 1st through 5th
characters. The device and qualifier characters are the only
characters that do not have a specific value for every procedure, because the device (6th character) and the qualifier (7th
character) are not applicable to all procedures. In ICD-10-PCS
when a device is not used or a qualifying attribute does not
exist, the value ‘Z’ is used for the 6th and/or 7th characters.
When a ‘Z’ is present in the 6th character it indicates that no
device was used. When a ‘Z’ is present in the 7th character it
indicates that there are no additional qualifying attributes of
the procedure. In other words, the value ‘Z’ in the 6th and/or
7th character of the code indicates that a specific device and/or
qualifier does not apply to the procedure.
25
Medical and Surgical Section Coding
Advanced Anatomy and Physiology for ICD-10-PCS
6. Medical and Surgical
Section Coding
• Endocrine
• Integumentary
– Skin and breast
– Subcutaneous tissue and fascia
Value Body Part
• Musculoskeletal System
– Muscles
– Tendons
– Bursae and ligaments
– Head and facial bones
– Upper bones
– Lower bones
– Upper joints
– Lower joints
3
Epidural Space
Cranial epidural space
Extradural space
Spinal epidural space
4
Subdural Space
Cranial subdural space
Spinal subdural space
5
Subarachnoid Space
Cranial subarachnoid space
Spinal subarachnoid space
6
Cerebral Ventricle
Aqueduct of Sylvius
Cerebral aqueduct (sylvius)
Choroid plexus
Ependyma
Foramen of Munro (intraventricular)
Fourth ventricle
Interventricular foramen (Munro)
Left lateral ventricle
Right lateral ventricle
Third ventricle
7
Cerebral Hemisphere
Frontal lobe
Occipital lobe
Parietal lobe
Temporal lobe
8
Basal Ganglia
Basal nuclei
Claustrum
Corpus striatum
Globus pallidus
Substantia nigra
Subthalamic nucleus
• Genitourinary system
– Urinary system
– Female reproductive system
– Male reproductive system
• Anatomical Regions
– General
– Upper Extremities
– Lower Extremities
Nervous System
Included Structures/
Synonymous Terms
In ICD-10-PCS, nervous system medical and surgical
procedures are those performed on the central nervous system
(0) and the peripheral nervous system (1). Both of these body
systems are then subdivided into body parts. The body part
designations include branches or portions of the body part that
do not have a more specific designation of their own. The tables
in this section include all body part values for the designated
ICD-10-PCS body system being discussed. These tables can be
used along with an ICD-10-PCS coding reference to identify
the correct code for medical and surgical procedures described
in this section.
9
Thalamus
Epithalamus
Geniculate nucleus
Metathalamus
Pulvinar
A
Hypothalamus
Mammillary body
Central Nervous System
B
Pons
Apneustic center
Basis pontis
Locus ceruleus
Pneumotaxic center
Pontine tegmentum
Superior olivary nucleus
C
Cerebellum
Culmen
D
Medulla Oblongata
Myencephalon
E
Cranial Nerve
N/A
F
Olfactory Nerve
CN I
First cranial nerve
Olfactory bulb
G
Optic Nerve
CN II
Optic chiasma
Second cranial nerve
H
Oculomotor Nerve
CN III
Third cranial nerve
The central nervous system contains the following body parts as
defined in ICD-10-PCS:
Value Body Part
0
Brain
Included Structures/
Synonymous Terms
Cerebrum
Corpus callosum
Encephalon
1
Cerebral Meninges
Arachnoid mater
Leptomeninges
Pia Mater
2
Dura Mater
Cranial dura mater
Dentate ligament
Diaphragma sellae
Falx cerebri
Spinal dura mater
Tentorium cerebelli
40
Advanced Anatomy and Physiology for ICD-10-PCS
Substances Administered in Circulatory Body System
Bone Marrow
(G)
Fresh Plasma (L)
White Cells (Q)
Antihemophilic
Factors (V)
Whole
Blood (H)
Plasma
Platelets (R)
Cryoprecipitate (M)
Factor IX (W)
Serum
Albumin (J)
Red Blood Cells (N) Globulin (S)
Stem Cells, Cord
Blood (X)
Frozen
Plasma (K)
Frozen Red Cells (P) Fibrinogen (T)
Stem Cells,
Hematopoietic (Y)
Injectable steroids (anti-inflammatories), reported with
value 3, are often mixed with a local anesthetic (value B) and
administered for pain control. When the substance is mixed,
the correct value is still 3 for anti-inflammatory as the local
anesthetic is only added to control or lessen the pain of the
steroid injection itself.
Administrative Qualifiers
Additional qualifier values for character 7 that further identify the
substance reported with character 6 are shown below.
Substance
Qualifier
Antineoplastic
2 High Dose Interleukin-2
3 Low Dose Interleukin-2
4 Liquid Brachytherapy Radioisotope
5 Other Antineoplastic
M Monoclonal Antibody
P Clofarabine
Thrombolytic
6 Recombinant Human-Activated Protein C
7 other Thrombolytic
Anti-infective
8 Oxazolidinones
9 Other Anti-infectives
Other Therapeutic
Substance
B Recombinant Bone Morphogenetic Protein
C Other Substance
Gas
D Nitric Oxide
F Other Gas
Hormone
G Insulin
H Human B-Type Natriuretic Peptide
J Other Hormone
Immunotherapeutic
K Immunostimulator
L Immunosuppressive
Pancreatic Islet Cells
0 Autologous
1 Nonautologous
Coding Examples
Whole blood transfusion through line in peripheral vein of right arm:
CODE 30233H0
3 Administration
0 Circulatory
2 Transfusion
3 Peripheral Vein
3 Percutaneous
H Whole Blood
0 Autologous
Autologous bone marrow transplant via previously inserted central venous
catheter:
CODE 30243G0
3 Administration
0 Circulatory
2 Transfusion
4 Central Vein
3 Percutaneous
G Bone Marrow
0 Autologous
Nasal spray flu vaccination against H1N1 virus:
CODE 3E0974Z
3 Administration
E Physiological Systems and Anatomical Regions
0 Introduction
9 Nose
7 Via Natural or Artificial Opening
4 Serum, Toxoid and Vaccine
Z No Qualifier
Peritoneal dialysis:
CODE 3E1M39Z
7. Coding in the Medical/
Surgical-Related Sections
As in other sections, qualifiers provide additional information
about the procedure that is not fully captured in the other
components. In the administration section, the qualifiers
identify the type of substance more specifically within the
broad category reported in character 6. For substances reported
with transfusion in the circulatory system, the qualifier values
of 0 and 1 identify the blood or blood component as either
autologous or nonautologous, respectively.
Coding in the Medical/Surgical-Related Sections
3 Administration
E Physiological Systems and Anatomical Regions
1 Irrigation
M Peritoneal Cavity
3 Percutaneous
9 Dialysate
Z No Qualifier
Epidural cortisone injection with local anesthetic for pain control of sciatica
from herniated lumbar disc:
CODE 3E0S33Z
3 Administration
E Physiological Systems and Anatomical Regions
0 Introduction
S Epidural Space
3 Percutaneous
3 Anti-inflammatory
Z No Qualifier
101
Coding in the Medical/Surgical-Related Sections
Advanced Anatomy and Physiology for ICD-10-PCS
Section 6 Extracorporeal Therapies
The seven characters that comprise codes in the extracorporeal
therapies section are:
Character Character Character Character Character Character Character
1
2
3
4
5
6
7
Section
Body
Root
Body
System Operation System
Duration Function Qualifier
The extracorporeal therapies section contains 6 of the 7
components that compose codes in the extracorporeal assistance
and performance section, except that character 6 does not need
to describe any function being performed or assisted. Character
6 is designated as another qualifier, but functions basically like
a kind of place holder for the sixth character in that it contains
only one value, ‘Z’ for no qualifier, since there is no additional
information to be reported for therapies in this section by
character 6.
Root Operations in Extracorporeal Therapies
This section is composed of 10 root operations that are unique
to this section:
Decompression describes an individual occurrence procedure
done in a hyperbaric chamber to treat one specific diagnosis—
decompression sickness, or the bends, in divers. Although
hyperbaric oxygenation is also done for therapeutic purposes in
wound care, that is considered assisting the circulatory system
in its basic function of oxygenating the blood, and not for
eliminating undissolved gases from body fluids, and is coded to
the extracorporeal assistance section.
Whole body hyperthermia is a treatment used for two purposes—
both to correct temperature imbalance and as an adjunct
treatment for cancer patients receiving radiation. Hyperthermia
Phototherapy treatment may be done on the skin or on the
circulatory system by exposing the blood to light rays outside
the body via a machine that recirculates the blood and
returns it to the body after the light exposure. This is different
from ultraviolet light therapy, often called ultraviolet light
phototherapy, which is performed only on the skin using the
therapeutic properties of the electromagnetic radiation in
ultraviolet light with a wavelength shorter than that of visible
light (beyond what is perceptible to humans as the color violet),
but longer than that found in x-rays. Light therapy that involves
the use of visible light rays on the skin is coded to phototherapy.
Pheresis is done for two main reasons—to separate out a blood
component that is produced in excess by the body in certain
diseases, such as leukemia or thrombocytosis, and to remove a
blood product from a donor for transfusion. Pheresis includes
the separation and removal of a given blood component. The
term photopheresis is often used to describe the ultraviolet
radiation of blood that is removed from the patient, separated
by centrifugation, exposed to ultraviolet light, and then infused
back into the patient. This is coded as phototherapy of the
circulatory system in ICD-10-PCS, not as pheresis.
Extracorporeal shock wave therapy (ESWT) in this section
encompasses only that which is performed on the musculoskeletal
system for conditions such as plantar fasciitis, soft tissue injuries,
or calcifying tendinitis. This is also known as orthotripsy. ESWT
used as lithotripsy in treating kidney stones is coded to the root
operation fragmentation in the medical and surgical section.
7. Coding in the Medical/
Surgical-Related Sections
• Atmospheric Control (0)—Extracorporeal control of
atmospheric pressure and composition
• Decompression (1) —Extracorporeal elimination of
undissolved gas from body fluids
• Electromagnetic Therapy (2) —Extracorporeal treatment
by electromagnetic rays
• Hyperthermia, Whole Body (3) —Extracorporeal raising
of body temperature
• Hypothermia (4) —Extracorporeal lowering of body
temperature
• Pheresis (5) —Extracorporeal separation of blood products
• Phototherapy (6) —Extracorporeal treatment by light rays
• Ultrasound Therapy (7) —Extracorporeal treatment by
ultrasound
• Ultraviolet Light Therapy (8) —Extracorporeal treatment
by ultraviolet light
• Shock Wave Therapy (9) —Extracorporeal treatment by
shock waves
These therapies are defined for ICD-10-PCS purposes with
meanings that remain consistent with what is commonly
understood in the medical practice community. For the
coder, there are some very important points to note about the
definitions of these root operations. The coder must understand
these differences in definition in order to assign the correct code
in the right section to the right root operation.
is used to enhance the effective of cancer treatments by making
some of the cancer cells more susceptible to radiation as well
as harming some other cancer cells that the radiation cannot
damage. When whole body hyperthermia is used for this
purpose, it is not coded in this section as an extracorporeal
therapy, but in the ancillary group of codes within section D,
Radiation Oncology. Only hyperthermia performed to treat
body temperature imbalance, such as in prolonged exposure to
the elements or extreme cold, is coded in this section.
Body Systems in Extracorporeal Therapies
There is a single body system for all extracorporeal procedures.
The only one identified is ‘Physiological Systems,’ reported with
value ‘A’ as the second character. Since there are only a few types
of extracorporeal therapies performed on certain body systems,
there are only a few values for identifying more specific body
systems reported in character 4, which are:
•
•
•
•
•
Value 0—Skin
Value 1—Urinary
Value 2—Central Nervous
Value 3—Musculoskeletal
Value 5—Circulatory
Duration and Qualifiers for Extracorporeal
Therapies
Character 5 reports the duration of the extracorporeal
therapeutic procedure by reporting whether it was a single
occurrence (value 0) or a multiple occurrence (value 1). These
are the only two values for character 6 in this section.
105
Coding in the Ancillary Sections
Advanced Anatomy and Physiology for ICD-10-PCS
procedure may be. The values listed for character 4 do not always
identify one specific organ, or a separate bone or gland normally
considered as an individual anatomical part of the system. For
example, the skin, subcutaneous tissue, and breast body system
includes values for single and multiple mammary ducts of the
left and right. Tendons of the upper and lower extremities are
included in the connective tissue system. The urinary system
includes a unique value for ileal diversion loop and one for ileal
loop, ureters, and kidneys.
Imaging Qualifiers
Both character 6 and character 7 identify qualifiers that may
add more information about the imaging procedure. For most
imaging codes, the qualifier reported with character 7 is not
specified, but occasionally it is reported to define whether the
procedure was intraoperative, intravascular, or transesophageal.
It may also specify densitometry or guidance.
A character 6 qualifier is used mainly to report when the
image was taken without contrast followed by another image
with contrast—value 0 Unenhanced and Enhanced. Character
6 qualifiers also report the use of laser (1), and intravascular
optical coherence (2).
Coding Examples
X-ray right wrist:
CODE BP0LZZZ
0 Imaging
P Non-Axial Upper Bones
0 Plain Radiography
L Wrist, Right
Z No Contrast
Z No Qualifier
Z No Qualifier
Section C Nuclear Medicine
The seven characters that comprise codes in the nuclear
medicine section are:
Character Character Character Character Character Character Character
1
2
3
4
5
6
7
Section
Transesophageal echocardiogram:
CODE B246ZZ4
B Imaging
2 Heart
4 Ultrasonography
6 Heart, Right and Left
Z No Contrast
Z No Qualifier
4 Transesophageal
Qualifier
Nuclear Medicine Root Types
Nuclear medicine codes represent procedures that introduce
radioactive material into the body in order to create an image
for diagnosis, assessing metabolic functions, and for treating
diseased conditions. There are seven root types of procedures
defined in nuclear medicine and reported with character 3:
Value Root Operation
Definition
1
Planar Nuclear
Medicine Imaging
Introduction of radioactive materials
into the body for single plane display
of images developed from the
capture of radioactive emissions
2
Tomographic
(Tomo) Nuclear
Medicine Imaging
Introduction or radioactive materials
into the body for three-dimensional
display of images developed from the
capture of radioactive emissions
3
Positron Emission
Tomography (PET)
Introduction of radioactive materials
into the body for three-dimensional
display of images developed from the
simultaneous capture, 180 degrees
apart, of radioactive emissions
4
Nonimaging Nuclear
Medicine Uptake
Introduction of radioactive materials
into the body for measurements of
organ function, from the detection
of radioactive emissions
5
Nonimaging Nuclear
Medicine Probe
Introduction of radioactive
materials into the body for the
study of distribution and fate
of certain substances by the
detection of radioactive emissions
from an external source
6
Nonimaging Nuclear
Medicine Assay
Introduction of radioactive materials
into the body for the study of body
fluids and blood elements, by the
detection of radioactive emissions
7
Systemic Nuclear
Medicine Therapy
Introduction of unsealed radioactive
materials into the body for treatment
8. Coding in the
Ancillary Sections
B Imaging
0 Central Nervous System
2 Computerized Tomography
0 Brain
1 Low Osmolar
0 Unenhanced and Enhanced
Z No Qualifier
Device
The seven characters that compose nuclear medicine codes
differ from those that compose imaging codes in the meaning of
character 5. In this section, character 5 defines the radionuclide
used in the nuclear medicine procedure instead of reporting
contrast material. The other definitions remain the same
although qualifier values in characters 6 and 7 are not specified
in nuclear medicine codes and always retain a value of Z, no
qualifier.
CT Scan of the brain without contrast followed by images with low osmolar
contrast:
CODE B02010Z
Body Root Type Body Part RadionuSystem
clide
Understanding the differences in the root types of operations
is critical for assigning the correct code so the coder should
carefully review the definitions and purposes of the nuclear
113