Chapter 13: Musculoskeletal review

Chapter 13: Musculoskeletal review

Exam Preparation

Anatomy

Musculoskeletal System and Connective Tissue

AXIAL BONES

• Skull (Cranium)

• Ossicles (inner ear)

• Hyoid bone

• Rib cage (Thoracic cage)

• Vertebral Column (spinal cord)

SKULL

• Frontal bone

• Parietal bone

• Occipital bone

• Temporal bone

RIB CAGE (THORACIC CAGE)

• Costal Cartilage

• Sternum

• Ribs

VERTEBRAL COLUMN (SPINAL CORD)

• Cervical

• Thoracic

• Lumbar

• Sacrum

• Coccyx (tail bone)

APPENDICULAR BONES

• Shoulder girdle

• Arm

• Hand

• Leg

• Foot

• Pelvic girdle

SHOULDER GIRDLE

• Clavicle

• Scapula

ARM

• Humerus

• Ulna

• Radius

HAND

• Phalanges

• Metacarpals

• Carpals

HIP (PELVIS)

• Ilium

• Ischium

• Pubis

LEG

• Femur

• Patella

• Tibia

• Fibula

FOOT

• Cuneiforms

• Metatarsal

• Phalanges

MUSCLES

• Temporalis

• Frontalis

• Rectus femoris

• Rectus Abdominus

• Trapezius

• Pectoralis major

• Deltoid

MEDICAL TERMINOLOGY

PREFIXES (beginning)

• osteo - bones

• arthro - joints

• dorso - back

• myelo - spinal cord

• radic/ radiculo - nerve root

• necro - death (gangrene)

• patho - disease

SUFFIXES (end)

• itis - inflammation

• oma - tumor/ abnormal growth

• pathy - disease

• porous - porous

MEDICAL TERMS

• Arthropathy: disorder of the joint 

• Arthritis: inflammation of the joint 

• Dorsopathy: disorder of the back

• Myelopathy: disorder of the spinal cord

• Osteonecrosis: death of bone tissue 

• Radiculopathy: problem in which one or more nerves are affected, resulting in pain (radicular pain),weakness, numbness, or difficulty controlling specific muscles.

CODING GUIDELINES

Chapter 13: Musculoskeletal System and Connective tissue

Site and laterality

Most of the codes within chapter 13 have site and laterality designations.

The site refers to the BONE, JOINT, or MUSCLE involved. 

For some conditions in which more than one bone, joint, or muscle is usually involved (e.g., osteoarthritis), a code is available for “multiple sites.”

If no multiple sites code is provided and if more than one bone, joint, or muscle is involved, separate codes should be used to indicate the different sites involved.

Bone Versus Joint

Bone may be affected at the upper and lower end

Portion of the bone affected may be at the joint, the site designation will be the BONE, not the joint

Acute Traumatic versus Chronic or Recurrent Musculoskeletal Conditions

Chapter 13 of ICD-10-CM contains bone, joint, or muscle conditions that are the result of a HEALED INJURY as well as RECURRENT CONDITIONS of these sites. 

Coding of Pathologic Fractures

Pathological fractures occur in bones that are weakened by disease.

These fractures are usually spontaneous but sometimes occur in connection with slight trauma (such as a minor fall) that ordinarily would not result in a fracture in normal, healthy bone. 

7th character extension (type of encounter)

• A Initial encounter for fracture (ACTIVE TREATMENT)

• D Subsequent encounter for fracture with routine healing 

• G Subsequent encounter for fracture with delayedhealing 

• K Subsequent encounter for fracture with nonunion

• P Subsequent encounter for fracture with malunion

• S Sequela (late effect)

SEQUENCING

Sequencing of codes for pathological fractures depends on the circumstances of admission. A pathological fracture is designated as the principal diagnosis only when the patient is admitted solely for treatment of the pathological fracture. 

ASSIGNING

NEVER assign a code for both a traumatic fracture and a pathological fracture of the same bone; one or the other is assigned. 

NOTE: Fractures can be stress fractures, pathological fractures, or traumatic fractures

Pathological fracture due to OSTEOPOROSIS 

Osteoporosis is a systemic condition that affects all bones of the musculoskeletal system and leads to an increased risk of pathological fractures. In osteoporosis, the bones are thinner and weaker than normal.

Osteoporosis WITHOUT Pathologic Fracture (M81)

used for patients with osteoporosis who DO NOT currently have a pathologic fracture due to the osteoporosis, even if they have had a fracture in the past. For patients with a history of osteoporosis fractures, status code Z87.310, Personal history of (healed) osteoporosis fracture, should follow the code from M81.

Because osteoporosis is a systemic condition, site is NOT a component of the codes under category M81

Osteoporosis WITH current pathological fracture (M80)

is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.

Pathological fracture due to NEOPLASM 

If the focus of treatment is the fracture, a code from subcategory M84.5, Pathological fracture in neoplastic disease, should be sequenced first, followed by the code for the neoplasm. 

If the focus of treatment is the neoplasmwith an associated pathological fracture, the neoplasm code should be sequenced first, followed by a code from M84.5 for the pathological fracture. 

OSTEOARTHRITIS

Osteoarthritis is the most common form of arthritis; it is also called polyarthritis, degenerative arthritis, and hypertrophic arthritis. 

Can be PRIMARY (unknown cause) or SECONDARY (caused by other disease or injury)

When the type of osteoarthritis is not specified, “primary” is the default.

BACK DISORDERS

Back pain described as lumbago or low back pain

The presence or absence of myelopathy is an important distinction to be made in assigning codes for certain back disorders.

Degeneration of the disc is not the same condition as displacement (herniation) of the disc, and each requires a different code.

REVIEW QUESTIONS

Multiple Choice

The anatomical name for the thigh bone is

• Tarsal

• Humerus

• Femur

• Radius

Multiple Choice

The anatomical name for part of the skull is the

• Patella

• Phalanges

• Ulna

• Cranium

Multiple Choice

The anatomical name for the armbone (upper) is

• Ulna

• Tibia

• Humerus

• Radius

Multiple Choice

The term unilateral means?

• one sided

• unspecified

• two sided

• none of the above

Multiple Choice

When the type of osteoarthritis is not specified, you code it as?

• Secondary

• Initial

• Primary

• Bilateral

Multiple Choice

Dorsopathy means

• disorder of the neck

• disorder of the back

• inflammation of the back

• disorder of the leg

Multiple Choice

Arthropathy means

• disorder of the foot

• disorder of the hand

• disorder of the joint

• inflammation of the hip

When answering with the codes. Use a comma to separate multiple codes

example: M84.551A, C90.00

Fill in the Blank

A 65 year old postmenopausal woman with osteoporosis presents to the emergency room with a pathological fracture of the left wrist.

Fill in the Blank

A patient is treated with medication for postmenopausal osteoporosis. The patient had a pathologic fracture 1 year ago, and the physician is following her condition every 3 months.

Fill in the Blank

A patient presents with complaints of generalized muscle pain and stiffness in both shoulders. The physician determines that the patient is suffering from myositis due to poor posture.

Fill in the Blank

A woman was diagnosed with cervical spondylosis with spondylogenic compression of the cervical spinal cord (myelopathy).

Fill in the Blank

A 70-year-old patient is diagnosed with rheumatoid myopathy with rheumatoid arthritis of the right and left hip.