Health Information Management

Understand circulatory system anatomy to prepare for ICD-10-CM/PCS conversion

JustCoding News: Inpatient, March 17, 2010

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Dust off your medical terminology book. Reviewing anatomy and physiology may be the best advice for coders as they prepare for ICD-10-CM and ICD-10-PCS, experts say.

Coders shouldn’t underestimate the breadth of anatomy, physiology, and medical terminology they’ll need to know to code properly under the new system, says Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, president of Safian Communications Services, Inc., in Orlando, FL.

Some coding programs simply don’t place sufficient emphasis on these content areas that will essentially become the foundation for compliant coding under ICD-10-CM and ICD-10-PCS, says Safian.

When ICD-10 takes effect October 1, 2013, this lack of emphasis may become a major problem—and negatively affect coding compliance, she explains.

Even though ICD-10-CM and ICD-10-PCS will require coders to extract more anatomical details from physician documentation, the anatomy that coders must understand for the new coding system is not very different from what they must know today, says Safian. “We have to remember that there are still only 206 bones in the body. ICD-10-CM and ICD-10-PCS didn’t invent more arteries and veins. You just have to know more detail,” she explains.

The new codes present greater challenges than coders have experienced with ICD-9-CM. Assigning a code in ICD-10-CM or ICD-10-PCS without having greater in-depth knowledge of the anatomy to which the condition or procedure pertains will be virtually impossible, says William E. Haik, MD, FCCP, director of DRG Review, Inc., in Fort Walton Beach, FL. ICD-9-CM is often vague, thereby allowing “coders to skate through without having to really understand anatomy,” Haik says.

But where does one begin when tackling the daunting task? The circulatory system is a good place to start when reviewing anatomy and physiology because ICD-10-CM diagnosis and ICD-10-PCS procedure codes in this content area tend to be particularly anatomically driven, says Darren Carter, MD, president and CEO of Provistas in Bismarck, ND. “It’s pretty substantially different [from ICD-9-CM],” Carter says.

Understanding the brain’s anatomy, the arteries and nerve conduction of the heart, the cerebrovascular arteries, and circulation of blood flow through the heart can help ensure correct code assignment both now and particularly when the new system becomes effective.

Know how to code intracerebral hemorrhages
In ICD-10-CM, many conditions will rely more heavily on anatomical specificity. For example, in ICD-9-CM, code 431 denotes an intracerebral hemorrhage, a type of intracranial hemorrhage that occurs within the brain tissue.

However, when assigning this condition in ICD-10-CM, coders first must distinguish between traumatic and nontraumatic hemorrhages. Report traumatic hemorrhages (e.g., those due to brain trauma) with a code from the S06 category. Report nontraumatic hemorrhages (e.g., those due to spontaneous strokes) with one of nine codes in the I61 category that distinguish between the specific area of the brain in which the hemorrhage occurred. For example, note the following codes:

  • I61.0 for an intracerebral hemorrhage in the subcortical hemisphere
  • I61.3 for an intracerebral hemorrhage in the brain stem
  • I61.4 for an intracerebral hemorrhage in cerebellum

“From a research standpoint, [this information] is invaluable,” says Carter. ICD-10-CM generally will allow researchers to track and analyze such data points as sequelae of particular diseases, recoveries, age-related variables, underlying diseases, and more, he explains. More detailed anatomical information may also lead to a better understanding of how costs relate to the intensity of care required for particular conditions. “It’s possible that some of these distinguishing characteristics may come into play with future MS-DRGs,” he says.

Know how to code atherosclerosis
Atherosclerosis, or hardening of the arteries, is another condition that requires greater anatomical specificity. For example, ICD-9-CM maps atherosclerosis of the native arteries of the extremities (including arms and legs) to code category 440.2. In ICD-10-CM, coders can report one of several codes in the I70.2 category that distinguish between the left leg, right leg, bilateral legs, or other extremities. Both ICD-9-CM and ICD-10-CM require coders to identify other concurrent problems, such as pain at rest, ulceration, gangrene, and claudication (i.e., tightness and pain in the calves when walking).
Consider these tips
The following tips can help build a more solid foundation of anatomical knowledge:

  • Accumulate educational resources. There’s no time like the present to start building a library of medical dictionaries, anatomy books, and online courses to which you can refer now and in the future, says Safian. Use these resources now when reading operative reports to start learning more about the procedures and conditions detailed in physician documentation.
  • Start practicing. Review the current draft of ICD-10-CM and ICD-10-PCS to determine which conditions and procedures will require additional documentation. If you tend to code a particular specialty, such as diseases of the circulatory system, focus on those sections of the ICD-9-CM Manual to note the differences between the two coding systems.
  • Get physicians on board. “Most physicians don’t even realize that [ICD-10-CM] is happening. They probably don’t know ICD-9-CM all that well and have no idea how extensively different ICD-10-CM and ICD-10-PCS will be,” says Carter.

    Hospitals that already focus on documentation improvement may find it easier to persuade physicians to provide documentation that more closely aligns with ICD-10-CM and ICD-10-PCS code descriptions. “It takes a while to build a habit. Now is the time to start inching [physicians] toward that information,” says Safian. For example, ask physicians who don’t typically document the approach of certain procedures or the type of tissue used for a graft to get in the habit of doing so now.
    Safian advises focusing on three important factors when obtaining physician buy-in:
    • The federal government requires providers to change to ICD-10-CM/PCS. This is not voluntary.
    • The two systems differ substantially with respect to code assignment logic.
    • Be certain that physicians are aware of changes that may affect documentation and the types of queries they receive.

  • Tap into physician knowledge. For example, schedule an appointment to have the physician explain the mechanics of performing a coronary artery bypass, suggests Safian. Not only does this open the lines of communication, it also helps build mutual respect, provides a rapport for future queries, and enhances continuity of care.

Editor’s note: This article was originally published in the March issue of Briefings on Coding Compliance Strategies. E-mail your questions to Contributing Editor Lisa Eramo at

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