Brush up on anatomy and physiology for ICD-10-CM/PCS

Shin bone’s connected to the knee bone
Knee bone’s connected to the thigh bone

You may have heard that coders will need to brush up on anatomy and physiology before the switch to ICD-10-CM/PCS and you may be wondering why. After all, the anatomy and physiology aren’t changing. The shin bone still connects to the knee bone (the tibia connects to the patella) and the knee bone still connects to the thigh bone (the patella connects to the femur). What is changing is the system coders use to identify diseases and illnesses.

So what does all this mean for you as a coder? While you should already have a good fundamental understanding of anatomy and physiology, the application of it is going to be different in ICD-10-CM/PCS, says June Bronnert, RHIA, CCS, CCS-P, director of Professional Practices Resources for the American Health Information Management Association (AHIMA) in Chicago.

For example, when coding an inpatient arterial bypass, coders need to know which artery the physician bypassed at a high level, such as peripheral, intra-abdominal, or carotid to code the procedure in ICD-9-CM, Bronnert says. However, with the way ICD-10-CM/PCS is structured, the new codes require a greater level of detail in order to assign the appropriate code. Using the same procedure, you will need to know if the artery an internal iliac artery, external iliac artery or a common iliac artery.
For a procedure involving an artery, for example, coders will need to know which artery is involved, where it is located in the body, what approach the physician used, what type of repair the he or she performed, and whether the physician used any device.

Anatomy is the study of form, and physiology is the study of function. Because form and function go hand-in-hand, you study the two in tandem as part of a medical curriculum.
“You really have to understand the disease process that is going on with that record. If there is a surgical procedure, you have to understand how that procedure is being performed in order to determine the most accurate and appropriate code and anatomy and physiology are a very fundamental part of that,” Bronnert says.

Understand the changes ICD-10-CM/PCS will bring
Before you started coding, you may have taken some kind of anatomy and physiology course. If you haven’t already taken a course, it would be good idea to do so, says JoAnn Baker, CCS, CPC-H, CPC, CHCC, CPC-I, an AHIMA-approved ICD-10-CM/PCS trainer and customer support coding analyst at CodeRyte in Bethesda, MD.

Building a solid foundation of anatomy and physiology will help prepare you for the switch to ICD-10-CM/PCS. “The anatomy and physiology are part of learning the new code systems,” Bronnert says. Knowing the anatomy and physiology ahead of time will help during the transition.

For ICD-10-CM, it is important to remember that the rules, conventions, and guidelines in ICD-10 are very similar to what is currently in ICD-9, with few changes. You will need to know trimesters, lateralities, and whether the encounter is initial, subsequent, or sequela. You are likely already familiar with those ideas, but may not be accustomed to looking for them.

Consider the codes for an acute venous embolism and thrombosis of the deep veins of the upper extremities. In ICD-9-CM, you would assign code 453.82 (acute venous embolism and thrombosis of deep veins of upper extremity). In ICD-10-CM, you would have to choose between four different codes:

• I82.621, acute embolism and thrombosis of the deep veins of right upper extremity
• I82.622, acute embolism and thrombosis of the deep veins of left upper extremity
• I82.623, acute embolism and thrombosis of the deep veins of upper extremity, bilateral
• I82.629, acute embolism and thrombosis of the deep veins of unspecified upper extremity

If the physician documents left upper extremity, you should be able to find the correct code without a problem. But what happens though if the physician documents acute embolism and thrombosis of the right brachial vein? If you know where the brachial vein is, you’re all set. If you don’t, you’ve got a problem.

If you work only with the diagnosis codes (ICD-10-CM) and already have a strong anatomy and physiology background, you should have a relatively easy time with the transition, Baker says. However, if you will be working with ICD-10-PCS at all, get ready for a significant challenge.

Right now, inpatient coders don’t have code at a high level of specification, Baker says. ICD-9-CM contains a lot of unspecified codes. ICD-10-PCS contains fewer unspecified codes and requires a higher level of detail. You’ll need to find that specificity in the medical records and use it to locate the most accurate code.

If the documentation is insufficient, you may have to query the physician as well. That’s where you’ll benefit from a strong foundation in anatomy and physiology. Without a strong anatomy and physiology background, you might also struggle with the root operations in ICD-10-PCS, Baker says. “PCS is going to be totally foreign to inpatient coders, uniquely different than any other coding system used today.”

Coders will need to understand body systems, root operations, body parts, approach, and devices. Root operations could pose serious issues for coders who do not have thorough understanding of anatomy and procedural terminology and how procedures are performed. For example, coders will be required to differentiate between excision or resection, occlusions or restrictions, release or division.
Even outpatient coders would do well to ensure they are comfortable with anatomy and physiology. You never know when you may end up coding an inpatient record or a procedure outside of your normal area of expertise.

Start with a self-assessment
So how much do you need to study? A good way to figure that out is by doing a self-assessment, Bronnert says.

Coders work in a variety of settings and specialties, so their comfort level with various aspects of anatomy and physiology is different.
“Someone may feel strong in one area of a disease process and anatomy because they’ve worked in that for the past 10 years, whereas they might not feel as strong in another,” Bronnert says. “So it’s really important to do your self-assessment. Let the assessment results prioritize your additional training and education.”

But don’t limit yourself to studying one area of anatomy and physiology just because you generally code records in that area. The body systems work together so brushing up on all systems will help you, Bronnert says.

Build on your foundation
Consider your background and determine what you really understand now as far as anatomy, disease processes, and various procedures, Bronnert says.

Know your limitations when it comes to anatomy and physiology, Baker says. Because she teaches anatomy and physiology, she is more familiar with it than others might be. Sometimes, she’ll mention a body part to a student she knows is generally familiar with anatomy, and the person will not be sure what the body part is.

HIM professionals who are in administration or auditing may not be as familiar or as comfortable with anatomy and physiology Your familiarity with anatomy and physiology is especially important if you are auditing records so you can be sure you are looking at the same body part the coder did.

So even though you know anatomy and physiology and have been trained on it, consider how long ago that training was. Was it 10 years, 20 years? Are you actively coding? That makes a big difference, Baker says.

Visit the websites for the various professional associations, such as AAPC and AHIMA, for assessment tools. You can also check with a local community college that offers anatomy and physiology courses.

If you are sitting down by yourself, consider your background and determine what you really understand now as far as anatomy, disease processes, and various procedures, Bronnert says.

One fun way to brush up on anatomy and physiology is to buy an anatomy and physiology coloring book at a local bookstore or from a site such as, Baker says. You can fill in the blanks and color in the anatomy. That will help you determine how well you know the anatomy and physiology.

Another idea is to use sample records to practice ICD-10-CM/PCS coding. That will also help you figure out where your limitations are. Just don’t wait until August 2013 to do so, Baker says.

And, at the end of the day, Bronnert says, additional education is always a good thing. “It’s an investment in yourself.”

E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at

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