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Muskloskeletal icd10


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Muskloskeletal icd10

  1. 1. 1
  2. 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. 3 Exhibit 1
  4. 4. The skeletal system consists of : Bone Cartilag e Skeletal system 4
  5. 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. 6
  7. 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. 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. 9. Cartilage 9
  10. 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. 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. 12. Hyaline cartilage Histological appearance And sites Fibrocartilage Histological appearance And sites Elastic Cartilage Histological appearance And sites 12
  13. 13. Categories and example of bones 13
  14. 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. 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. 16. Bone Markings types of bone markings: • Projections (aka processes) that grow out from the bone • Depressions (cavities) that indent the bone 17
  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. 18. Other bone markings important for coding It is a prominent projection Round opening through a bone 19
  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. 20. 21
  21. 21. 22
  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. 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. 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. 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. 26. 27
  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. 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. 29. 30
  30. 30. The upper limb + shoulder girdle Exhibit 7 31
  31. 31. The wrist The wrist is composed of eight short bones called carpals that meet with the radius and ulna. 32
  32. 32. The lower limb and pelvic Girdle(hip) Exhibit 8 Bones of the foot (tarsal , metatarsal , phalanges ) 33 Exhibit 9
  33. 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. 34. Fibrous joints Suture joint of the skull Gomphosis joint Syndesmoses 36
  35. 35. Cartilaginous joint Joints between the ribs and the sternum 37
  36. 36. 38
  37. 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. 38. 40
  39. 39. Functions of the muscular system 41
  40. 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. 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. 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. 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. 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. 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. 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. 47. Diseases and Injuries of the skeletal system 49
  48. 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. 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. 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. 51. Fractures Pathological Traumatic Relating to a condition that is caused by or Involves a disease process. Osteoporosis others Infection Neoplastic 53
  52. 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. 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. 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. 55. Some important definitions: • Displaced fracture: Bone break in which the two broken ends are separated. 57
  56. 56. Some important definitions: malunion 58
  57. 57. Some important definitions: nonunion 59
  58. 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. 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. 60. 62
  61. 61. Greenstick fracture Incomplete fracture In which the bone Is bent but fractured only on the outer arc of the bend. 63
  62. 62. spiral fracture. • Bone break in which the disruption of the bone is spiral to the shaft of the bone. 64
  63. 63. Monteggia's fracture. • Break in the proximal half of the ulna accompanied by A radial dislocation of the radial head 65
  64. 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. 65. Salter-Harris fracture Fractures through a growth plate. Salter-Harris fracture 67
  66. 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. 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. 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. 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. 70. example : M 8 4. 4 7 5 A 72
  71. 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. 72. 74
  73. 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. 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. 75. 77
  76. 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. 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. 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. 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. 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. 81. osteoporosis without current pathological fracture M81 83
  82. 82. 84
  83. 83. • It is the point of articulation between 2 bones as mentioned before . Joint between the sternum and the clavicle. 85 Exhibit 17
  84. 84.  86
  85. 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. 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. 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. 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. 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. 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. 91. S 4 3. 0 1 2 D 93
  92. 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. 93. 95
  94. 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. 95. Types of osteoarthritis 97
  96. 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. 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. 98. Neuropathy inflammation and disfigurement of the joints, causing compression and entrapment of nerves 100
  99. 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. 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