Health Information Management

Prepare for ICD-10 with anatomy/physiology education

JustCoding News: Outpatient, November 18, 2009

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Do you know what the Billroth II procedure is? If you don’t, you may have a hard time coding it after CMS/HHS implements the ICD-10-PCS system October 1, 2013.

In the ICD-10 coding system, neither the procedure nor the diagnosis indexes will include eponyms (terms derived from the name of a person) such as the Billroth II procedure (ICD-9 procedure code 43.7). Instead, the names will have more specific descriptions of what the procedure entails, says Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association in Chicago. 

In this example, the coder would need to know that a Billroth II procedure is a partial gastrectomy with anastomosis to jejunum. 

The transition to the ICD-10-CM and ICD-10-PCS system, which is far more specific and includes thousands more codes than the ICD-9-CM system, will require an increased understanding of anatomy and physiology, medical terminology, and disease process, says Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM at Kaiser Permanente in Oakland, CA.

“ICD-10 is more specific, not only in diagnosis but in procedure coding as well,” Bryant says. “Coders need to understand the medical details [of diagnoses and procedures] to better capture the specific code.”

Prepare for greater specificity, more codes
A lack of eponyms is not the only change coders will notice in the ICD-10 system. Capturing an ICD-10 code may require knowledge of very specific details about a diagnosis or procedure that wasn’t necessary under the ICD-9 system.

For example, a coder reporting an angioplasty under ICD-9 must know whether the physician repaired a vessel in the heart or elsewhere to choose the right code. However, in ICD-10, the coder will need to know the specific vessel the physician worked on. ICD-10-PCS includes more than 1,000 codes for angioplasty, all specified by individual vessels.

Another example is the suturing of an artery. In ICD-9, there is only one code for this procedure—code 39.31—and it does not require any information on where the artery is located. In ICD-10-PCS, there are 276 codes, specifying where in the body the vessel is located.

“You would have to know the different names for the different vessels,” Leon-Chisen says.

Much of the information coders will need should be in the record documentation. However, a deeper knowledge of anatomy, physiology, and medical terminology will make the ICD-10 transition far smoother, Bryant says.

During a visit to British Columbia, Canada, in October 2008, Bryant interviewed a group of hospital coders who have been using the ICD-10 system for several years.
Although the coders all agreed that ICD-10 has some challenging aspects to learn as far as understanding procedures and anatomy/physiology, they also agreed that they would “never go back to ICD-9,” Bryant says.

ICD-10’s detailed coding system will help staff members more easily gather data on their facility as well as its practices and patient population. Facilities use coded data for several purposes, such as outcome statistics, which will also be greatly enhanced by the ICD-10 coding system, Bryant says.

For example, if a coding manager asked a coder to look at the surgical outcomes for vessel repairs in legs, under the ICD-9 system, that coder would need to sift through the documentation for each record, determining which procedures the physician performed in the leg. In the ICD-10 system, the coder will easily be able to retrieve these data, since the code specifies where the physician made the repair.

Educate your coders
As part of your preparation for ICD-10, consider ways to offer coders more education on anatomy, physiology, and medical terminology. “Now would be a good time to put into your budget money for this type of education,” Bryant says.

Seasoned coders who are used to the current ICD-9 code descriptions will especially need refresher education, Leon-Chisen says. However, “new coders shouldn’t have a problem,” she adds. “You normally have to take anatomy and physiology for a coding course, so it’s all fresh.”

If you’re not sure about your coders’ needs, conduct an internal survey to gauge their thoughts. Ask them how comfortable they are with anatomy and physiology in relation to the transition to ICD-10, as well as what kind of education they prefer. Some might prefer to take a class, whereas others might prefer online education.

“Ask the coders and get their input,” Leon-Chisen says. “Look for tools that would be helpful.”

Editor’s note: E-mail Leon-Chisen at 

E-mail Bryant at

This story was originally published in the November issue of Briefings on Coding Compliance Strategies.

Learn about the latest ICD-10 news as well as strategies for implementation by accessing ICD-10 Watch.

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