Title: The Skeletal and Urinary Systems
Course: Intermediate Coding and Classification Systems > Section: Module 10: The Skeletal and Urinary Systems

Introduction

This week you will learn about the Skeletal System (Chapter 16) and the Urinary System (Chapter 17). The skeletal system is classified according to the bones of the head and face, upper and lower bones, and upper and lower joints. It is necessary to review the terms to describe areas of the bone surfaces and skeletal bones to refresh your memory from your anatomy and physiology courses. Remember: The humerus has a head at the proximal end and epicondyle at the distal end of the bone. The femur has a head, neck and trochanter at the proximal end and condyles at the distal end.

Bones of the skull and facial bones consist of the orbit that is bordered by the frontal bone, the zygomatic bone, the maxilla, and the lacrimal bones, to name a few. Bones of the vertebra joints and body are shown in Figures 16.1- 16.10 for your review in your textbook.

Coding Guideline: Reduction of a displaced fracture is coded to the root operation Reposition, and the application of cast or splint in conjunction with the Reposition is not coded separately. Treatment of a non-displaced fracture is coded to the procedure performed. Be aware of the coding of bilateral body part guidelines (CG: B4.3).

In addition, procedures performed indirectly by the application of external force through intervening body layers are coded to the approach External. Example: Closed reduction of fracture is coded to the approach External. It is important to read the coding guideline regarding devices and materials used on vertebral joints to render the joint immobile. Coding guideline: ( B3.10c). Qualifiers are used in the coding of Fusion to describe the specific anatomical approach for the fusion.

Now referring to the Urinary System in Chapter 17, you will see that the body has two ureters and one urethra. Read the documentation carefully to review for the terms uretero- and urethro- to make sure you are coding the correct body part being stated.

Because many of the body structures in the urinary system are tubular, the root operations of Dilation, Occlusion, and Restriction are used frequently. Procedures performed on a device only and not body parts are specified in the root operation Change, Irrigation, Removal, or Revision. And if multiple tubular body parts are inspected, the most distal body part is coded.

Irrigation or flushing of previously-placed drains is coded to the root operation Irrigation of indwelling device in the Administration section of ICD-10-PCS.

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)
- Resolves discrepancies in medical documentation and accurate code assignment through the physician query process. (5)
- 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:

- Review the anatomy of the skeletal system including the unique classification method used in ICD-10-PCS for bones and joints.
- Describe the specific naming convention for vertebral bones.
- Discuss the types and functions of joints.
- Discuss the common root operations used in the skeletal system including the operations on the bones and joints.
- Describe the body part values available for the bones and joints and the coding guideline for procedures performed on a portion of a body part.
- Review the procedure used to locate values for body parts that do not have their own body part values.
- Describe the body part values for combinations of vertebrae.
- List the four available approaches used for the bones and joints.
- Describe the use of device values in the bones and joints including internal and external fixation devices.
- Identify the device value chosen for spinal fusion procedures that use more than one device.
- Discuss spinal stabilization devices and the use of these devices in spinal surgery
- Describe the three qualifiers for the specific anatomical approach in spinal fusion surgery.
- Discuss the use of qualifier and device values for multiple vertebral joints using a different device and/or qualifier.
- Review the anatomy of the urinary system including the portions involved in urine formation and excretion.
- Discuss the common root operations used in the urinary system including those performed on tubular body parts.
- Describe the body part values available for the urinary system and the coding guideline for procedures performed on a multiple body parts, bilateral body parts and “peri” body parts.
- Review the procedure used to locate values for body parts that do not have their own body part values.
- List the approaches used for the urinary system, including those through the skin or via the natural opening.
- Describe the use of device values in the urinary system including those for neurostimulators and artificial sphincters.
- Discuss the use of qualifier for the urinary system including those for kidney transplants and Bypass procedures.

Readings & Resources

- Chapters 16 and 17
- Complete all exercises and check your answers
- Review Coding Guidelines on root operations
- Read Coding Tips

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