Title: The Integumentary and Muscular Systems
Course: Intermediate Coding and Classification Systems > Section: Module 9: The Integumentary and Muscular Systems

Introduction

You are doing a great Job! Keep up the good work. Chapters 14 and 15 address the Integumentary and Muscular systems. ICD-10-PCS divides the integumentary system into two parts: the skin and breast and the subcutaneous tissue and fascia. There is a clear distinction between skin and subcutaneous tissue in coding. The subcutaneous tissue is the layer below the dermis.

If a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision, or resection at the same procedure site, both the biopsy and more definitive procedure are coded.

Table 14.1 gives root operation values for the Integumentary system. If the documentation includes an eponym (procedure named for a person) and the intent of the procedure is not clear, then query the physician for more information. Make sure you read your coding Guidelines (CG) noted in chapter 14 focusing on body parts, overlapping layers, and devices for the subcutaneous tissues and fascia.

The muscular system includes the muscles, tendons, bursae and ligaments and holds the bones and joints together. Some of the common procedures performed on the tendons are tenolysis which would be coded to Release, tenotomy which is coded to Division, and Tenodesis which is coded to Reposition. As you see, knowing your root operations is key to getting the correct codes. It is important to know the difference between release and division and the actual intent or objective of the operation to assign the correct codes here.

Coding Guideline: If a body system does not contain a separate body part for fingers, procedures performed on the fingers are then coded to the hand.

The operative Approaches are basically the same for the muscles, tendons and ligaments with device values for the muscular system limited to seven values.

Course Outcomes

- Describes the basic coding steps for coding medical procedures in both ICD-9-CM and ICD-10-PCS. (1)
- Interprets the basic coding guidelines established by the American Hospital Association for both ICD-9-CM and ICD-10-PCS. (2)
- Converts medical documentation into both ICD-9-CM and ICD-10-PCS codes. (3)
- Applies the official coding guidelines to the coding of medical procedures for all body systems (circulatory, respiratory, musculoskeletal, urinary, blood organs, reproductive, gastrointestinal, etc.) (4)
- Analyzes medical documentation to assign accurate codes for reimbursement of health care services. (6)
- Evaluates and assigns accurate medical procedure codes through analysis of case studies. (7)
- Compares and contrasts the differences between the ICD-9-CM and ICD-10-PCS classification systems. (8)

Objectives

Upon completion of this module you should be able to:

- List the basic functions and organization of the integumentary system.
- Review the anatomy of the integumentary system, including the layers of the skin, the portions of the breast and parts of the nails.
- Discuss the common root operations used in the integumentary system.
- Describe the body part values available in the circulatory integumentary system and the coding guidelines specific to procedures performed on skin, subcutaneous tissue and fascia overlying a joint, and overlapping layers of the musculoskeletal system.
- Review the procedure used to locate values for body parts that do not have their own body part values.
- List the applicable approaches used in the integumentary system.
- Describe the device values common to the integumentary system and some devices that can be implanted in subcutaneous pockets.
- Discuss the use of qualifier values for procedures in the integumentary system, including those for skin graft Replacement and Transfer procedures.
- List the basic functions of the muscular system.
- Describe the organization of the muscular system; muscles, tendons, bursae and ligaments.
- Review the anatomy of the muscular system.
- Discuss the common root operations used in the muscular system including the operations on the tendons, muscles and bursa.
- Describe the body part values available in the muscular system and the coding guidelines for procedures performed on tendons, ligaments bursae and fascia versus the joint structures.
- Review the procedure used to locate values for body parts that do not have their own body part values.
- List the four available approaches used for the muscles, tendons, bursae and ligaments.
- Describe the limited use of device values in the muscles, tendons, bursae and ligaments.
- Discuss the use of qualifier values for Transfer procedures of the muscles.

Readings & Resources

- Chapters 14 and 15
- Complete all exercises and check your answers
- Review Coding Guidelines on root operations
- Read Coding Tips