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Muskloskeletal icd10

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TRANSITION TO icd10-cm

TRANSITION TO icd10-cm

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  • Custom animation effects: object spins on end(Advanced)To reproduce the background effects on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, and then select Solid fill in the Fill pane. Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).To reproduce the rectangle on this slide, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles click Rounded Rectangle (second option from the left). On the slide, drag to draw a rounded rectangle.Select the rectangle. Drag the yellow diamond adjustment handle to the left to decrease the amount of rounding on the corners. With the rounded rectangle still selected, under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 3.5”.In the Shape Width box, enter 0.25”.Under Drawing Tools, on the Format tab, in the bottom right corner of the Shape Styles group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane. In the Fill pane, select Solid fill, click the button next to Color, and then under Theme Colors click White, Background 1, Darker 15% (third row, first option from the left).Also in the Format Shape dialog box, click Line Color in the left pane. In the Line Color pane, select No line. Also in the Format Shape dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, under Outer select Offset Bottom (first row, second option from the left), and then do the following:In the Transparency box, enter 0%.In the Sizebox, enter 100%.In the Blur box, enter 8.5 pt.In the Angle box, enter 90°.In the Distance box, enter 1 pt.Also in the Format Shape dialog box, click 3-D Format in the left pane. In the 3-D Format pane, do the following:Under Bevel, click the button next to Top, and then under Bevel click Circle (first row, first option from the left). Next to Top, in the Width box, enter 5 pt, and in the Height box, enter 5 pt.Under Surface, click the button next to Material, and then under Standard clickMatte (first row, first option from the left).Click the button next to Lighting, and then under Neutral click Soft (first row, third option from the left).On the slide, select the rounded rectangle. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate.Select the duplicate rectangle. On the Home tab, in the Drawing group, do the following:Click the arrow next to Shape Fill, and then click No Fill.Click the arrow next to Shape Outline, and then click No Outline.Drag the second rectangle above the first rectangle until the lower edge overlays the top edge of the first rectangle. (Note: When the spinning animation effect is created later for these rectangles, the spin will center where the edges of the rectangles meet.)Press and hold CTRL, and then select both rectangles. On the Home tab, in the Drawing group, click Arrange, and do the following:Point to Align, and then click Align Selected Objects.Point to Align, and then click Align Center.Click Group. On the slide, drag the group until it is centered horizontally on the left edge of the slide (straddling the edge).On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Middle.To reproduce the dashed arc on this slide, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Arc (third row, 12th option from the left). On the slide, drag to draw an arc.Select the arc. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 7.5”.In the Shape Width box, enter 7.5”.With the arc still selected, on the Home tab, in the Drawing group, click the arrow next to Shape Outline,and then do the following:Under Theme Colors, click White, Background 1, Darker 15% (third row, first option from the left).Point to Dashes, and then click Dash (fourth option from the top).On the slide, drag the yellow diamond adjustment handle on the right side of the arc to the bottom of the arc to create a half circle.Drag the arc until the yellow diamond adjustment handles are on the left edge of the slide.With the arc still selected, on the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide. Click Align Middle. To reproduce the half circle on this slide, do the following:On the slide, select the arc. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate.Select the duplicate arc. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 3.33”.In the Shape Width box, enter 3.33”.With the second arc still selected, under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, and then under Theme Colors click White, Background 1, Darker 5% (second row, first option from the left).Under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Outline,and then click No Outline.Under Drawing Tools, on the Format tab, in the Shape Styles group, click Shape Effects, point to Shadow, and then click ShadowOptions. In the Format Shape dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, under Inner click Inside Right (second row, third option from the left), and then do the following:In the Transparency box, enter 86%.In the Blur box, enter 24 pt.In the Angle box, enter 315°.In the Distance box, enter 4 pt.On the slide, drag the second arc until the yellow diamond adjustment handles are on the left edge of the slide. On the Home tab, in the Drawing group, click Arrange, and then do the following:Point to Align, and then click Align to Slide. Point to Align, and then click Align Middle. Click Send to Back.To reproduce the button shapes on this slide, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Oval (first row, second option from the left). On the slide, drag to draw an oval.Select the oval. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 0.34”.In the Shape Width box, enter 0.34”.Under Drawing Tools, on the Format tab, in the Shape Styles group, click More, and then click Light 1 Outline, Colored Fill – Dark 1 (third row, first option from the left).Under Drawing Tools, on the Format tab, in the bottom right corner of the Shape Styles group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane. In the Fill pane, select Solid Fill. Click the button next to Color, and then under Theme Colors click Olive Green, Accent 3, Lighter 80°(second row, seventh option from the left).Also in the Format Shape dialog box, click Line Color in the left pane. In the Line Color pane, select No line. Also in the Format Shape dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, under Outer click Offset Bottom (first row, second option from the left), and then do the following:In the Transparency box, enter 0%.In the Size box, enter 100%.In the Blur box, enter 8.5 pt.In the Angle box, enter 90°.In the Distance box, enter 1 pt.Also in the Format Shape dialog box, click 3-D Format in the left pane, and then do the following in the 3-D Format pane:Under Bevel, click the button next to Top, and then under Bevel click Art Deco (third row, fourth option from the left). Next to Top, in the Width box, enter 5 pt, and in the Height box, enter 5 pt.UnderContour, click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left). In the Size box, enter 3.5 pt.Under Surface, click the button next to Material, and then under Standard click Matte (first row, first option from the left). Click the button next to Lighting, and then under Neutral click Soft (first row, third option from the left).On the slide, select the oval. Under Drawing Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Position tab, do the following:In the Horizontal box, enter 2.98”.In the Vertical box, enter 1.5”.Select the oval. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate.Select the duplicate oval. Under Drawing Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Position tab, do the following:In the Horizontal box, enter 3.52”.In the Vertical box, enter 2.98”. Repeat step 9 two more times, for a total of four ovals. Under Drawing Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Position tab, do the following to position the third and fourth ovals:Select the third oval on the slide, and then enter 3.52” in theHorizontal box and 4.27” in the Vertical box.Select the fourth oval on the slide, and then enter 2.99” in theHorizontal box and 5.66” in the Vertical box.To reproduce the text on this slide, do the following:On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box. Enter text in the text box and select the text. On the Home tab, in the Font group, do the following: In the Font list, select Corbel.In the Font Size list, select 22.Click the arrow next to Font Color, and then under Theme Colors click White, Background 1, Darker 50% (sixth row, first option from the left).On the Home tab, in the Paragraph group, click Align Text Left to align the text left in the text box.On the slide, drag the text box to the right of the first oval.Select the text box. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate. Click in the text box and edit the text. Drag the second text box to the right of the second oval.Repeat steps 5-7 to create the third and fourth text boxes, dragging them to the right of the third and fourth ovals. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click Custom Animation.On the Home tab, in the Editing group, click Select, and then click Selection Pane. In the Selection and Visibility pane, select the rectangle group. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Spin. Select the animation effect (spin effect for the rectangle group). Under Modify: Spin, do the following:In theStart list, selectWith Previous. In the Amount list, in the Custom box, enter 123°,and then press ENTER. Also in the Amount list, clickCounterclockwise.In the Speedlist, select Fast. On the slide, select the first oval. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Change Fill Color. Select the second animation effect (change fill color effect for the first oval). Under Modify: Change Fill Color, do the following:In the Startlist, select After Previous. In the Fill Color list, click More Colors. In the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 153, Blue: 117. In the Speedlist, select Very Fast.On the slide, select the first text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance,and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, clickFade. Select the third animation effect (fade effect for the first text box). Under Modify: Fade, do the following:In theStart list, selectWith Previous.In the Speed list, select Very Fast. In the Selection and Visibility pane, select the rectangle group. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Spin. Select the fourth animation effect (spin effect for the rectangle group). Under Modify: Spin, do the following:In theStart list, selectOn Click. In the Amount list, in the Custom box, enter 22°, and then press ENTER. Also in the Amount list, click Clockwise.In the Speed list, select Very Fast.On the slide, select the second oval. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Change Fill Color. Select the fifth animation effect (change fill color effect for the second oval). Under Modify: Change Fill Color, do the following:In the Startlist, select After Previous. In the Fill Color list, click More Colors. In the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 153, Blue: 117. In the Speedlist, select Very Fast.On the slide, select the second text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, clickFade. Select the sixth animation effect (fade effect for the second text box). Under Modify: Fade, do the following:In theStart list, selectWith Previous.In the Speed list, select Very Fast. On the slide, select the third oval. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Change Fill Color. Select the seventh animation effect (change fill color effect for the third oval). Under Modify: Change Fill Color, do the following:In the Startlist, select After Previous. In the Fill Color list, click More Colors. In the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 153, Blue: 117. In the Speedlist, select Very Fast.On the slide, select the third text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, clickFade. Select the eighth animation effect (fade effect for the third text box). Under Modify: Fade, do the following:In theStart list, selectWith Previous.In the Speed list, select Very Fast. On the slide, select the fourth oval. In the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Change Fill Color. Select the ninth animation effect (change fill color effect for the fourth oval). Under Modify: Change Fill Color, do the following:In the Startlist, select After Previous. In the Fill Color list, click More Colors. In the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 153, Blue: 117. In the Speedlist, select Very Fast.On the slide, select the fourth text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance,and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, clickFade. Select the 10th animation effect (fade effect for the fourth text box). Under Modify: Fade, do the following:In theStart list, selectWith Previous.In the Speed list, select Very Fast.
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  • Transcript

    • 1. 1
    • 2. Chapter outlines Physiological functions of the skeletal system Main anatomical components of the skeletal system General Histological aspects. Types of bone tissues and types of cartilage tissues Categories and examples of bones , bone markings (projections and depressions) Anatomy of the skeleton ( bone , cartilage) The joint (articulation ) anatomy and different joints types The muscular system : -Functions of muscular system. -Histological and anatomical aspects , -Types of muscle tissues -Properties of muscle tissue 2
    • 3. 3 Exhibit 1
    • 4. The skeletal system consists of : Bone Cartilag e Skeletal system 4
    • 5. Skeletal system construction • Starting from the basic functional and structural unit of organism which is the cell Cell tissue organs system organism 5
    • 6. 6
    • 7. Bone Composition Matrix •Calcium carbonate and calcium phosphate: •Make up 60-70% of bone weight •Provide much of the bone’s stiffness and resistance to pressing or squeezing forces •Collagen (a protein): •Gives bone its characteristic flexibility and contributes to its ability to resist pulling and stretching forces •With aging, collagen is lost progressively and bone becomes more brittle. •Water Bone consists of much smaller proportion of water than other body parts Scattered cells The matrix is filled with living bone cells; such as: 1- osteoblasts: bone forming cells that cover new bone. Make up the matrix . 2- osteocytes: these are mature osteocytes buried in the matrix in small cavities called lacunae , and they maintain bone structure interconnected with other osteocytes by their cytoplasmic processes (gap junction formation)through canaliculi , also they act as mechanosensory cells that sense mechanical stress, respond by stimulating osteoblasts and osteoclasts  remolding 3- osteoclasts: large multinucleated absorbs and remove osseous tissue. By (collagenase & acids) As well as blood vessels that supply the cells with nutrients 7
    • 8. Bone marrow • Highly specialized connective tissue • There are 2 types of bone marrow : Red marrow Yellow marrow Blood cell formation occurs in red bone Store fat for the body ,found mainly in marrow , which is primarily stored in the hollow spaces in the long bones of spongy bone adults 8
    • 9. Cartilage 9
    • 10. • Types of bones tissues Bone •Porosity •High (Low mineral content and high collagen) •Low (High mineral content and low collagen) •Structure •Honey comb •Compact •Characteristic •Provides more flexibility but is not as stress resistant •Stiffer and can resist greater stress but less flexible •Function •Shock absorption due to its better ability to change shape are important •It contains red marrow. •Withstanding stress in body areas that are subject to higher impact loads •e.g., vertebrae , ribs, skull , sternum, and pelvis of adults •Long bones (e.g., bones of the arms and legs) •Location 10
    • 11. Hyaline cartilage Fibrocartilage Elastic Cartilage Most abundant in the body Provide support and flexibility It is strong and rigid Provides strength and maintains shape in the structures it forms. -Covers bone end ( articular cartilage) -At the end of the ribs its called costal cartilage -Forms part of the nose , larynx , trachea , bronchi , and bronchial tubes. It joins the anterior pelvic bones at the symphysis pubis It forms the discs that lie between the vertebrae Found in larynx , external ear , and Eustachian tubes Bluish white in color , has glossy appearance. Transparent collagenous fibers, lacunae have abundance of chondrocytes Formed of bundles of visible collagenous fibers with chondrocytes scattered throughout Has threadlike elastic fibers that contain chondrocytes 11 scattered throughout the lacunae
    • 12. Hyaline cartilage Histological appearance And sites Fibrocartilage Histological appearance And sites Elastic Cartilage Histological appearance And sites 12
    • 13. Categories and example of bones 13
    • 14. Example: the femur, tibia, and fibula of the legs; the humerus, radii, and ulnae of the arms; metacarpals and metatarsals of the hands and feet, the phalanges of the fingers and toes, and the clavicles or collar bones. Mainly made of spongy bone , and contains bone marrow Periosteum : dense white fibrous membrane that covers the external surface of the bone Middle section of long bone Made mainly of compact bone 14
    • 15. Sesamoid bones is a unique type of bone that forms within tendons small rounded , including: In the knee : the patella (within the quadriceps tendon). In the hand — two sesamoid bones are commonly found in the distal portions of the first metacarpal bone (within the tendons of adductor pollicis and flexor pollicis brevis). There is also commonly a sesamoid bone in distal portions of the second metacarpal bone. In the foot - the first metatarsal bone usually has two sesamoid bones at its connection to the big toe (both within the tendon of flexor hallucis brevis) 16
    • 16. Bone Markings types of bone markings: • Projections (aka processes) that grow out from the bone • Depressions (cavities) that indent the bone 17
    • 17. Projections Ligaments & tendons projections Joints projections 1) Condyle: Rounded articular projection 2) Head: bony expansion on a narrow neck 1) Crest: Narrow ridge of bone 2) Epicondyle: Raised area on or above a condyle 3) Tubercle: Small rounded projection 3) Facet: smooth, nearly flat articular surface 4) Ramus: Armlike bar of bone 4) Tuberosity: large rounded or roughened projection 5) Trochanter: very large, blunt projection (only on femur) 18
    • 18. Other bone markings important for coding It is a prominent projection Round opening through a bone 19
    • 19. The skeleton The appendicular skeleton: refers to the upper and lower limbs appendicul ar The axial skeleton: is formed by the bones and cartilaginous tissue in the skull , vertebral column , and thoracic cage skeleton axial 20 Exhibit 4
    • 20. 21
    • 21. 22
    • 22. The Facial bones • The facial bones provide the facial structure and provide attachments for the muscles that control facial and jaw movement. The face consists • mobile bone. of 13 stationary bones and one • The mandible (jawbone) is the only facial bone that moves and is also the largest and strongest bone of the face. The remaining bones of the face are: 23
    • 23. 1. 2. 3. Two palatine 4. 5. 6. Two lacrimal 7. Two maxilla Two zygomatic (cheekbones) Two nasal Two inferior nasal concha (thin, curved bones that form the lateral walls of the nasal cavity Vomer (located along the midline of the nasal cavity forming part of the nasal septum) 24
    • 24. 2-The vertebral column composed of 26 individual bones. Of these bones, 24 are vertebrae that are separated by cartilage called intervertebral discs. supports the head and trunk of the body and protects the spinal cord. Exhibit 4 25
    • 25. The parts of vertebra common structure consisting of a body, pedicles, and lamina that form the vertebral arch. The body and arch come together and form an opening called the vertebral foramen, through which the spinal cord passes 26
    • 26. 27
    • 27. -12 pairs of flat bones known as the ribs articulate with the thoracic vertebrae . -The first seven pairs of ribs meet up with the sternum directly via costal cartilage. The cartilage for the next three pairs of ribs joins with the costal cartilage of the seventh rib. The last two rib pairs do not join the sternum at all (called floating ribs) 28 Exhibit 5
    • 28. Function of thoracic cage • It also supports the shoulders and upper limbs. • It protects important internal organs ;as the heart and the lung • It gives attachments to muscles of the upper limb and shoulder Exhibit 6 29
    • 29. 30
    • 30. The upper limb + shoulder girdle Exhibit 7 31
    • 31. The wrist The wrist is composed of eight short bones called carpals that meet with the radius and ulna. 32
    • 32. The lower limb and pelvic Girdle(hip) Exhibit 8 Bones of the foot (tarsal , metatarsal , phalanges ) 33 Exhibit 9
    • 33. Articulations (joint) Articulations, or joints, join two bones together and allow for movement in response to muscle contractions Fibrous Cartilaginous held together by dense tissue joined by cartilage Synovial have a fluid-filled cavity separating the bones it joins; called the synovial cavity fluid is Synovial fluid The joint cavity is surrounded by a twolayer capsule called the articular capsule. limited in movement 1-sutures: or seams, bones held together by connective tissue, such as those found in the cranium. 2-Gomphosis:found only as a tooth in its socket 3-syndesmoses:bones joined by a ligament as articulation between the tibia and fibula Do provide for some free moving and therefore structurally movement more complex The first rib to the majority of joints in the human body sternum It is reinforced by ligaments 35
    • 34. Fibrous joints Suture joint of the skull Gomphosis joint Syndesmoses 36
    • 35. Cartilaginous joint Joints between the ribs and the sternum 37
    • 36. 38
    • 37. 2- Condyloid •These types of joints move in all directions. •An example is the hip joint ; •Articulation between the head of the femur and the acetabulum •Protrusion of one bone meets a depression of another to form this type of joint. •Examples are the wrist (radius and carpals) and Knuckles ) metacarpal and proximal phalanges. • Convex portion of a bone meets with the concave part of another to form a hinge joint. •It allows movement in one axis •Example: The elbow and knee are large hinge joints. Rounded or pointed protrusion of one bone moves back and forth is a pivot •Flat surfaces of 2 flat bones glide against one another •examples  The joints between the short carpals ( intercarpals )  The joints between the short tarsals ( intertarsals ) •One bone has a depression shaped somewhat like an equestrian saddle. • the joint is formed by a second bone straddling that depression. •Allows the unique opposition of the human thumb. joint 39 Exhibit 10 Exhibit 11 Exhibit 12 Exhibit 13 Exhibit 14 Exhibit 15
    • 38. 40
    • 39. Functions of the muscular system 41
    • 40. Muscles construction • Starting from the basic functional and structural unit of organism which is the cell Cell (fibers)  tissue  organs  system  organism 42 Exhibit 16
    • 41. Properties of muscle tissue • Irritability : Ability to electrically respond to stimuli • Contractility : Ability to shorten and thicken when sufficient stimulus is received • Extensibility : Ability to be stretched when pulled. • Elasticity : Ability to return to their original shape after contraction or extension 43
    • 42. Types of Muscle Tissue Types and Importance of each : Skeletal muscles Attached to the skeleton (bones) Responsible for voluntary movement Striated,cylindrical, multinucleated Cardiac muscles no Responsible for heart contraction (involuntary) Striated,single nucleus, branching , intercalated discs smooth muscles no Responsible for involuntary movement of the GIT Non striated,spindle shap,centrally located nucleus 44
    • 43. • Skeletal muscles : 1. They are voluntary muscles . 2. attached to bone (Skeleton) 3. Attached to the articulating bones that form joints. Proximal , more stationary bone Distal . More mobile 45
    • 44. • • Skeletal muscles produce movement by pulling on: 1-Tendons. 2-aponeurosis. NB: Tendons are strong sheets of connective tissue, and are identical to ligaments. Tendons attach muscle to bone and ligaments attach bone to bone 3-Other connective tissue structures which in turn pull on bones or other muscles The place where a tendon attaches to the more stationary bone is called the origin • and the attachment to the more movable bone is called the insertion. Usually the tendon origin is the more proximal point of attachment and the insertion is the more distal. The fleshy part of the muscle between the two bones is called the belly or gaster 46
    • 45. There are nearly 700 skeletal muscles in the human body. These muscles are named based on one or more of the following criteria: 1- Direction of muscle fibers, such as rectus, transverse, oblique 2-Location, such as temporalis, tibialis 3-Size, such as maximus, minimus, brevis, longus 4-Number of origins, such as biceps, triceps, quadriceps. 5-Site of origin and insertion, such as brachioradialis 6-Shape, such as deltoid, trapezius 7- Action, such as flexor, extensor, abductor, adductor 47
    • 46. • For coding purpose , it is more important to know the general location of muscles since diseases, disorders, and injuries of the muscles are generally reported using the site of the disorder rather than the specific muscle. • For example, a muscle contracture is reported by laterality (right or left side) and by general region (shoulder, upper arm, forearm, hand, thigh, lower leg, ankle, foot). 48
    • 47. Diseases and Injuries of the skeletal system 49
    • 48. Comparison of ICD-9-CM/ICD-10-CM Musculoskeletal System Coding (Chapter 13) ICD-9-CM (710-739) • Site and Laterality • Bone, joint or muscle • Multiple sites codes • Bone versus Joint e.g. osteoporosis M80, M81 • Acute traumatic versus chronic or recurrent MS conditions • Chapter 13 versus Chapter 19 50
    • 49. Comparison of ICD-9-CM/ICD-10-CM Musculoskeletal System Coding (Chapter 13) ICD-9-CM (710-739) • Pathologic #s ICD-10-CM (M00-M99) • Pathologic #s • Acute vs. aftercare • 733.1; V54.0, V54.2…. • Coding includes 7th digit extension for episode of care • A= Active care; D=after active treatment; others are subsequent encounters and sequela (S) • Open/closed • 51
    • 50. Comparison of ICD-9-CM/ICD-10-CM Musculoskeletal System Coding (Chapter 13) ICD-9-CM (710-739) ICD-10-CM (M00-M99) • Osteoporosis • “Site” applicable if + pathologic fracture • a: without pathological # • Category M81 • b: with current pathological # • M80 • Site (of #) is included • Every patient with osteoporosis 52
    • 51. Fractures Pathological Traumatic Relating to a condition that is caused by or Involves a disease process. Osteoporosis others Infection Neoplastic 53
    • 52. 54 Injuries to the skeletal system are quite common as it is a rigid structure. The joints are also fairly susceptible to injury
    • 53. Fracture • A break or crack in the bone caused when physical force exerted on the bone is stronger than the bone itself 55
    • 54. Some important definitions: • Closed fracture: Bone fracture not accompanied by a break in skin. • open fracture. Fracture in which the broken end or ends of the bone have pierced the skin. 56
    • 55. Some important definitions: • Displaced fracture: Bone break in which the two broken ends are separated. 57
    • 56. Some important definitions: malunion 58
    • 57. Some important definitions: nonunion 59
    • 58. Some important definitions: torus fracture. the bone with little or no displacement at Buckling or bowing of the end and no breakage, usually occurring in children due to softer bone tissue. 60 Torus Fracture of the wrist
    • 59. Apophyseal fracture • Avulsion fracture in which a bony prominence, such as a process or tuberosity removed from its bone at a point of strong tendinous attachment 61
    • 60. 62
    • 61. Greenstick fracture Incomplete fracture In which the bone Is bent but fractured only on the outer arc of the bend. 63
    • 62. spiral fracture. • Bone break in which the disruption of the bone is spiral to the shaft of the bone. 64
    • 63. Monteggia's fracture. • Break in the proximal half of the ulna accompanied by A radial dislocation of the radial head 65
    • 64. Neoplastic lesion may results in fracture Relating to any abnormal growth of new tissue, benign or malignant; in this case, usually a malignancy. 66
    • 65. Salter-Harris fracture Fractures through a growth plate. Salter-Harris fracture 67
    • 66. To code for a pathological fracture in ICD10-CM, the followings are necessary: 1. 2. 3. 4. Anatomic site Laterality Underlying condition Episode of care (assigned as the seventh character extension) Next : Episode of care (assigned as the seventh character extension) • • • • • • A = initial encounter for fracture D = subsequent encounter for fracture with routine healing G = subsequent encounter for fracture with delayed healing K = subsequent encounter for fracture with nonunion P = subsequent encounter for fracture with malunion S = sequel 68
    • 67. ICD 10 approach to Pathological fractures • There are three subcategories for pathological fractures in ICD-10-CM M 8 4. Pathological fracture, not elsewhere classified Pathological fracture in neoplastic disease Pathological fracture in other disease 69
    • 68. By determining the location & laterality of the pathological fracture 2 more characters are added M M M M M M M M M 8 8 8 8 8 8 8 8 8 4. 4. 4. 4. 4. 4. 4. 4. 4. 4 4 4 4 4 4 4 4 4 7 7 7 7 7 7 7 7 7 1 2 3 4 5 6 7 8 9 70 -
    • 69. By determining the episode of care : 7th digit is added. • A = initial encounter for fracture • D = subsequent encounter for fracture with routine healing • G = subsequent encounter for fracture with delayed healing • K = subsequent encounter for fracture with nonunion • P = subsequent encounter for fracture with malunion • S = sequel 71
    • 70. example : M 8 4. 4 7 5 A 72
    • 71. NB: • Sometimes when there is not enough digits seventh charter, require placeholders so that the seventh digit extension falls to the seventh character. Example: Code M84.48—Pathological fracture, other site, requires a seventh character to make it a complete code; however there are only five characters currently. The appropriate code for the initial episode of care would be M 8 4. 4 8 X A The “X” must be added as a placeholder in order to have the “A” fall into the seventh character field. The seventh character extender must always remain at the 7th character. 73
    • 72. 74
    • 73. Disorder characterized by bone degeneration. Osteoporosis Is caused by the breakdown of the bony matrix without equivalent regeneration, resulting in a weak, porous, fragile bone structure. It is the most common type of bone disease as studies indicate that about one in five American women over the age of 50 is affected by A bone Has bony matrix made of protein Minerals calcium and phosphates compounds osteoporosis. half of these women will have a fracture of the hip, wrist, or vertebra 75
    • 74. Causes of osteoporosis: The leading causes of osteoporosis are • a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Other causes include: • Confinement to a bed. • Chronic rheumatoid arthritis • Chronic kidney disease. • Eating disorders • Certain corticosteroids. 76
    • 75. 77
    • 76. To code osteoporosis in ICD-10-CM the following is necessary: • Type of osteoporosis • With or without pathological fracture • With pathological fracture - Site of fracture must be identified • Without pathological fracture • Episode of care (assigned as a seventh digit extension) • • • • • • A = initial encounter for fracture D = subsequent encounter for fracture with routine healing G = subsequent encounter for fracture with delayed healing K = subsequent encounter for fracture with nonunion P = subsequent encounter for fracture with malunion S = sequela (late effect) 78
    • 77. The ICD-10-CM code range for Disorders of bone density and structure is M80–M85. Osteoporosis with current pathological fracture Osteoporosis without current pathological fracture Adult osteomalacia Disorder of continuity of bone Other disorders of bone density and structure 79
    • 78. The documentation in the clinical record will be the guide for the selection of the most appropriate character. According to the official ICD-10-CM guidelines, osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. Site is not a component of the codes under category M81, osteoporosis without current pathological fracture. The site codes under category M80, osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis 80
    • 79. Age-related osteoporosis with current pathological fracture right shoulder M 8 0. 0 1 1 A initial episode of care Age-related osteoporosis with current pathological fracture left shoulder Subsequent encounter for fracture with malunion Age-related osteoporosis with current pathological fracture Unspecified shoulder Sequela M 8 0. 0 1 2 K M 8 0. 0 1 9 S 81
    • 80. Other osteoporosis with current pathological fracture right shoulder M 8 0. 8 1 1 A initial episode of care Other osteoporosis with current pathological fracture left shoulder Subsequent encounter for fracture with malunion Other osteoporosis with current pathological fracture Unspecified shoulder Sequela M 8 0. 8 1 2 K M 8 0. 8 1 9 S 82
    • 81. osteoporosis without current pathological fracture M81 83
    • 82. 84
    • 83. • It is the point of articulation between 2 bones as mentioned before . Joint between the sternum and the clavicle. 85 Exhibit 17
    • 84.  86
    • 85. • Dislocations can occur in , , , in the joints. , and as well as When a dislocation occurs, the joint can’t be moved. Dislocated joints often are swollen, very painful, and visibly out of place. • • • manipulations to reposition the bones. medicine. a splint or sling, and rehabilitation. 87
    • 86. Strains , Sprains , Tears sprain It is an injury to a ligament strain Tear It is an injury to either a muscle or a tendon. Tearing (part or all) of the muscle fibers and the tendons attached to the muscle. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear. The tearing of the muscle can also damage small blood vessels, causing local bleeding (bruising) and pain Site : The most commonly injured ligaments are in the ankle, knee, and wrist. It involve a stretching or a tearing of this tissue. 88
    • 87. To code for dislocations in ICD-10-CM the following is necessary 1-Anatomic site 2-Laterality 3-Type of injury [Dislocation o Subluxation o Sprain ] 4. Episode of care (assigned as the seventh digit extension) A = initial encounter D = subsequent encounter S = sequel 89
    • 88. ICD 10 approach to Dislocation S S S S S S S S S S 0 1 2 3 4 5 6 7 8 9 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 90
    • 89. We will pick up Dislocation and sprain of joints and ligaments of shoulder girdle S43. category By determining direction of subluxation 2 more characters are added S 4 3. 0 0 S 4 3. 0 1 S 4 3. 0 2 S 4 3. 0 3 S 4 3. 0 8 91
    • 90. By determining laterality and distinguishing between subluxation and dislocation: 1 more character is added S 4 3. 0 1 1 S 4 3. 0 1 2 S 4 3. 0 1 3 S 4 3. 0 1 4 S 4 3. 0 1 5 - S 4 3. 0 1 6 - 92
    • 91. S 4 3. 0 1 2 D 93
    • 92. 94 Arthritis is a group of conditions involving damage to the joints of the body. There are over 100 different forms of arthritis. The most common type is osteoarthritis A common type is rheumatoid arthritis
    • 93. 95
    • 94. • also known as inflammatory degenerative joint disease. Causes : which can result from trauma to the joint, infection of the joint, or age (It affects the elderly and cannot be cured.) Symptoms: The most common symptom of arthritis is constant pain, The pain it causes can be debilitating and prevent one from doing any type of activity. Pathophysiology : Osteoarthritis can affect both the larger and smaller joints of the body, including the hands, feet, back, hip, or knee. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other, acquired from daily wear and tear of the joint. Prevention and treatment: It can be prevented from worsening through weight loss, and muscle strengthening. In the very advanced stages, surgery may be required to include joint replacement. 96
    • 95. Types of osteoarthritis 97
    • 96. Exhibit 18 • RA is chronic inflammation and destruction of the joint tissues due to an autoimmune disorder. • RA can also affect other body systems and organs and is, therefore, sometimes considered a systemic disease. • most damage occurs to the joint lining and cartilage, which eventually results in erosion of two opposing bones. 98
    • 97. • Rheumatoid arthritis is an autoimmune disease that affects joints in the fingers, wrists, knees, and elbows. The disease can lead to severe deformity within a few years if not treated. • Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities 1-Joint pain and swelling 2-Stiffness, especially in the morning or after sitting for long periods 3-Fatigue. 4-Firm bumps of tissue under the skin. 99
    • 98. Neuropathy inflammation and disfigurement of the joints, causing compression and entrapment of nerves 100
    • 99. The ICD-10-CM codes for osteoarthritis are found in sections M15.– M19. • To code for arthritis in ICD-10-CM, the following is necessary: - Type of osteoarthritis - primary. - secondary. - traumatic - Laterality 101
    • 100. osteoarthritis of knee Primary--Bilateral Unilateral primary osteoarthritis. unspecified knee Unilateral primary osteoarthritis Right knee Unilateral primary osteoarthritis left knee Osteoarthritis of knee Secondary Post-traumatic Bilateral Unilateral post-traumatic osteoarthritis unspecified knee Unilateral post-traumatic osteoarthritis right knee Unilateral post-traumatic osteoarthritis left knee Osteoarthritis of knee Secondary Due to other cause Bilateral unilateral secondary osteoarthritis Due to other cause M M M M M M M M 1 1 1 1 1 1 1 1 7. 7. 7. 7. 0 1 0 1 1 1 2 7. 7. 7. 7. 2 3 0 3 1 3 2 M 1 7. 4 M 1 7. 5 102

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