PREPARING FOR ICD-10-CM

ANATOMY AND PATHOPHYSIOLOGY TRAINING

© RMACI, 2015

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INTRODUCTION TO ANATOMY AND PATHOPHYSIOLOGY The transition to the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) promises to be one of the most significant changes to the administration of healthcare billing and reimbursement process. The entire structure of the diagnosis reporting system will change, effective October 1, 2015. This Anatomy and Pathophysiology Training video and the accompanying manual is the first step in the transition process. ICD-10-CM is substantially different than ICD-9-CM in a number of ways. CHARACTERISTIC

ICD-9

ICD-10

Number of characters

3–5 digits in length 3–7 characters in length

Number of codes Approximately 13,000 codes

Approximately 68,000 available codes

Types of characters First digit can be alpha (E or V) or numeric; digits 2–5 are numeric; most codes are all numeric

Character 1 is alpha; character 2 is numeric;

characters 3–7 are alpha or numeric

Code capacity Limited space for adding new codes

Flexible for adding new codes

Specificity Lacks detail Very specific

Laterality designations (right vs. left vs. bilateral)

Lacks laterality Has laterality

These are very straightforward characteristics that can be easily identified when comparing the two coding systems. However, one major element that is not immediately recognizable is the fact that ICD-10-CM is more “clinically” driven. Health care is very different in the 21st century than it was in 1979, when ICD-9-CM was introduced. Illnesses and diseases that were not identified in 1979 are now treated on a regular basis. Medical tests, vaccines, and procedures are now performed daily that had never been conceived of at that time. One major reason for the change to ICD-10, in addition to the reasons indicated above, is to help health care providers use diagnosis codes that are more consistent with the daily reality of clinical practice. This means that ICD-10-CM code selection will be more intuitive for physicians and other health

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care providers because codes are organized more logically than they were organized in ICD-9. That logical organization is based on two factors—patient anatomy and pathophysiology. However, we must first define these terms. KEY DEFINITIONS Anatomy—The study of the structure of the human body. The study of anatomy is understanding all of the pieces that comprise the human body. This includes the bones, muscles, nerves, etc. that every human has, or should have. In order to properly select ICD-10-CM codes, one must have a basic understanding of the human anatomy because the codes are organized based by anatomical system and/or by anomalies (abnormalities) to that anatomy. Physiology—The study of the function of the human body. Whereas “anatomy” examines the parts of the body, physiology studies how those parts work. It is vital to understand how parts work normally in order to report the diagnosis(es) when there is a malfunction or dysfunction in the body. Pathophysiology—The physiology of abnormal states. Many times, the purpose of medical care is to diagnose and treat the abnormal function of a body system or systems. A basic understanding of common “pathologies” will help those involved in the billing/coding process more accurately assist in the use of the proper diagnosis code(s). THE BASICS OF MEDICAL TERMINOLOGY To those who have not undergone formal medical training, many “medical words” may seem difficult to understand and, in some cases, frightening. However, there are three common parts to almost all medical terms. Once we understand the basic structure, understanding what these medical terms mean becomes much easier. Almost all medical terminology has two or three parts. They are:

PREFIX + ROOT WORD + SUFFIX Almost all root words have their origin in either Greek or Latin. Every medical term has a root word and most have either a prefix or suffix. Some have both a prefix and suffix. By putting the pieces together and understanding the meanings of the prefixes, suffixes, and roots, you can understand the nature of the illness, even if you have not previously studied that specific word.

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We will begin with some common and general terms and then we will narrow our focus in the latter half of this video/manual to address issues specific to your specialty. ROOT WORDS Root words come from one of five places:

• Roots of the body • Roots of color • Roots of description • Roots of position • Roots of quantity

ROOTS OF THE BODY

Body part or component Greek root in English Latin root in English

abdomen lapar(o)- abdomin-

aorta aort(o)- aort(o)-

arm brachi(o)- -

artery arteri(o)- -

back - dors-

bladder cyst(o)- vesic(o)-

blood haemat-, hemat- (haem-, hem-) sangui-, sanguine-

blood clot thromb(o)- -

blood vessel angi(o)- vascul-, vas-

bone oste(o)- ossi-

bone marrow, marrow myel(o)- medull-

brain encephal(o)- cerebr(o)-, pector-

breast mast(o)- mamm(o)-

ear ot(o)- aur(i)-

eggs, ova oo- ov-

eye ophthalm(o)- ocul(o)-

eyelid blephar(o)- cili-, palpebr-

fallopian tubes salping(o)- -

fat, fatty tissue lip(o)- adip-

finger dactyl(o)- digit-

gallbladder cholecyst(o)- fell-

gland aden(o)- -

head cephal(o)- capit(o)-

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Body part or component Greek root in English Latin root in English

heart cardi(o)- cordi-

intestine enter(o)- -

kidney nephr(o)- ren-

liver hepat(o)-, (hepatic-) jecor-

lungs pneumon- pulmon(i)-, (pulmo-)

marrow, bone marrow myel(o)- medull-

mind psych- ment-

mouth stomat(o)- or-

muscle my(o)- -

nail onych(o)- ungui-

nerve; the nervous system neur(o)- nerv-

nose rhin(o)- nas-

ovary oophor(o)- ovari(o)-

rib cage thorac(i)-, thorac(o)- -

skin dermat(o)-, (derm-) cut-, cuticul-

skull crani(o)- -

stomach gastr(o)- ventr(o)-

testis orchi(o)-, orchid(o)- -

throat (upper throat cavity) pharyng(o)- -

throat (lower throat cavity/voice box]) laryng(o)- -

uterus hyster(o)-, metr(o)- uter(o)-

vagina colp(o)- vagin-

vein phleb(o)- ven-

vulva episi(o)- vulv-

wrist carp(o)- carp(o)-

Frequently, vowels (usually the letter “O”) are added to the end of the root in order to facilitate a connection to a suffix that begins with a consonant.

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ROOTS OF COLOR

Color Greek root in English Latin root in English

black melano- nigr-

blue cyano- –

green chlor(o)- vir-

red erythr(o)-, rhod(o)- rub-, rubr-

red-orange cirrh(o)- –

white leuc-, leuk- alb-

yellow xanth(o)- flav-, jaun- [French]

ROOTS OF DESCRIPTION

Description Greek root in English Latin root in English

bad, incorrect cac(o)-, dys- mal(e)-

bent, crooked ankyl(o)- prav(i)-

big mega-, megal(o)- magn(i)-

cold cry(o)- frig(i)-

dead necr(o)- mort-

female, feminine thely- -

fast tachy- celer-

flat platy- plan(i)-

great mega-, megal(o)- magn(i)-

hard scler(o)- dur(i)-

heavy bar(o)- grav(i)-

huge megal(o)- magn(i)-

incorrect, bad cac(o)-, dys- mal(e)-

long macr(o)- long(i)-

narrow sten(o)- angust(i)-

short brachy- brev(i)-

small micr(o)- parv(i)- (rare)

slow brady- tard(i)-

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ROOTS OF POSITION

Description Greek root in English Latin root in English

around peri- circum-

left levo- laev(o)-, sinistr-

middle mes(o)- medi-

right dexi(o)- dextr(o)-

surrounding peri- circum-

DESCRIPTIVE WORDS—POSITION

Description Definition

anterior/ventral at or near the front surface of the body

posterior/dorsal at or near the back surface of the body

superior above

inferior below

lateral side

distal farthest from center

proximal nearest to center

medial middle

supine face up or palm up

prone face down or palm down

sagittal vertical body plane, divides the body into equal right and left sides

transverse horizontal body plane, divides the body into top and bottom sections

coronal vertical body plane, divides the body into front and back sections

ROOTS OF QUANTITY

Description Greek root in English Latin root in English

double diplo- dupli-

equal iso- equi-

few oligo- pauci-

half hemi- semi-

many, much poly- multi-

twice dis- bis-

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COMMON PREFIXES AND SUFFIXES

Prefix/Suffix Meaning Examples a-/an- without/none anemia, anencephalic -algia pain neuralgia arth-/arthro- pertaining to the joints or limbs arthritis -asthenia weakness myasthenia -centesis puncture a cavity to remove fluid amniocentesis -ectomy to cut out (remove) appendectomy, tonsillectomy -emia blood anemia -gram image (X-ray, CT, MRI, Ultrasound) mammogram -graphy/-graph recording an image mammography hyper- excessive, above hypergastric hypo- deficient, below hypogastric -ia/-iasis condition, abnormality pneumonia -itis inflammation tonsillitis, appendicitis macro- large macrostomia mega-/-megaly enlarged organomegaly micro- small microstomia -ology/-ologist to study/specialize in cardiologist, nephrologist -oma/-omata tumor, bulk, volume melanoma -opathy disease of arthropathy -opexy surgical fixation nephropexy -oplasty surgical repair rhinoplasty -orrhaphy surgical repair/suture herniorrhaphy -orrhea flow or discharge amenorrhea -osis abnormal condition cyanosis -ostomy to make a mouth (opening) colostomy -otomy to cut into tracheotomy -otripsy crushing, destroying lithotripsy -pepsia digestion dyspepsia -phagia eating polyphagia -plasia growth hyperplasia -plegia paralysis paraplegia -pnea breathing apnea -scopy/-scopic to look, observe colonoscopy

More specific roots, prefixes, and suffixes will be discussed when we begin to address the anatomy and pathophysiology associated with individual specialties.

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REVIEW ITEMS

1. When a patient has inflammation of the kidney, what is it called?

___________________________________________

2. What does it mean when a patient has a colposcopy?

___________________________________________

3. When a patient has a vesical fistula, what organ is affected?

___________________________________________

4. When a patient has a blood disorder, what type of specialist will they most likely

see? _______________________________________

5. When a patient has thrombophlebitis, what does it mean?

___________________________________________

6. What does pneumonia mean?

___________________________________________

7. What organ system is affected by arteriosclerosis?

___________________________________________

8. What is wrong with the patient when they have a megaloureter?

___________________________________________

9. How is pharyngitis different than laryngitis?

___________________________________________

10. When a patient has polycystic ovaries, what abnormality is occurring?

___________________________________________

11. What does it mean when a patient has arthropathy?

___________________________________________

12. What does it mean if the patient reports polyphagia?

___________________________________________

(Answers are found on page 12.)

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THE ORGANIZATION OF ICD-10-CM AND ITS RELATIONSHIP TO ANATOMY AND PATHOPHYSIOLOGY As indicated previously, ICD-10-CM is much more clinically oriented than ICD-9-CM. That is not to say that the organization of ICD-10-CM is dramatically different. The following chart illustrates the comparison between the two code sets.

ICD-10 Chapter

Description

Code

Range

Equivalent ICD-9 Codes

1 Certain Infectious and Parasitic Diseases A00-B99 001-139

2 Neoplasms C00-D49 140-239 3 Disease of the Blood and Blood Forming

Organs and Certain Disorders Involve the Immune Mechanism

D50-D89 280-289

4 Endocrine, Nutritional, and Metabolic Diseases E00-E89 240-279 5 Mental and Behavior Disorders F01-F99 290-319 6 Diseases of the Nervous Systems G00-G99 320-389 7 Diseases of the Eye and Adnexa H00-H59 320-389 8 Diseases of Ear and Mastoid Process H60-H95 320-389 9 Diseases of the Circulatory System I00-I99 390-459

10 Diseases of the Respiratory System J00-J99 460-519 11 Diseases of the Digestive System K00-K95 520-579 12 Diseases of the Skin and Subcutaneous Tissue L00-L99 680-709 13 Diseases of the Musculoskeletal System and

Connective Tissue M00-M99 710-739

14 Diseases of the Genitourinary System N00-N99 580-629 15 Pregnancy, Childbirth, and the Puerperium O00-O9A 630-679 16 Certain Conditions Originating in the Perinatal

Period P00-P96 760-779

17 Congenital Malformations, Deformations, and Chromosomal Abnormalities

Q00-Q99 740-759

18 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified

R00-R99 780-799

19 Injury, Poisoning, and Certain Other Consequences of External Causes

S00-T88 800-999

20 External Causes of Morbidity V01-Y99 E800-E999

21 Factors Influencing Health Status and Contact with Health Services

Z00-Z99 V01-V91

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The fundamental structures of the code sets are not vastly different. ICD-9-CM has 17 chapters and 2 chapters of supplementary classifications (the V & E codes). ICD-10-CM has 21 chapters. The differences are as follows:

• The former supplementary chapters have been incorporated as an integral part of the code set (chapters 20 & 21).

• Chapter 6 in ICD-9-CM (Diseases of the Nervous System and Sense Organs) has been split into three chapters in ICD-10-CM.

o Chapter 6—Diseases of the Nervous Systems o Chapter 7—Diseases of the Eye and Adnexa o Chapter 8—Diseases of the Ear and Mastoid Process

• The chapters have been slightly reordered. The chapters that require significant anatomic knowledge are:

6 Diseases of the Nervous Systems 7 Diseases of the Eye and Adnexa 8 Diseases of Ear and Mastoid Process 9 Diseases of the Circulatory System

10 Diseases of the Respiratory System 11 Diseases of the Digestive System 12 Diseases of the Skin and Subcutaneous Tissue 13 Diseases of the Musculoskeletal System and

Connective Tissue 14 Diseases of the Genitourinary System 15 Pregnancy, Childbirth, and the Puerperium 16 Certain Conditions Originating in the Perinatal

Period 17 Congenital Malformations, Deformations, and

Chromosomal Abnormalities

The chapters that require significant knowledge concerning pathophysiology are:

1 Certain Infectious and Parasitic Diseases

5 Mental and Behavioral Disorders 18 Symptoms, Signs, and Abnormal Clinical and

Laboratory Findings, Not Elsewhere Classified 19 Injury, Poisoning, and Certain Other

Consequences of External Causes 20 External Causes of Morbidity

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The chapters that require a combination of anatomy and pathophysiology knowledge are:

2 Neoplasms

3 Disease of the Blood and Blood Forming Organs and Certain Disorders Involve the

Immune Mechanism 4 Endocrine, Nutritional, and Metabolic Diseases

21 Factors Influencing Health Status and Contact with Health Services

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ANSWERS TO REVIEW ITEMS

1. When a patient has inflammation of the kidney, what is it called?

_______nephritis_____________________________

2. What does it mean when a patient has a colposcopy?

_______to look at or observe the vagina (& cervix)__

3. When a patient has a vesical fistula, what organ is affected?

___________bladder _________________________

4. When a patient has a blood disorder, what type of specialist will they most likely

see? ________hemotologist____________________

5. When a patient has thrombophlebitis, what does it mean?

___inflammation of the vein caused by a blood clot__

6. What does pneumonia mean?

__condition/abnormality of the lungs_____________

7. What organ system is affected by arteriosclerosis?

______cardiovascular (arteries)__________________

8. What is wrong with the patient when they have a megaloureter?

_______an enlarged ureter_____________________

9. How is pharyngitis different than laryngitis?

_upper throat inflammation vs. lower throat inflammation_

10. When a patient has polycystic ovaries, what abnormality is occurring?

_multiple cysts formed on the ovaries_____________

11. What does it mean when a patient has arthropathy?

____abnormality of a joint___________________

12. What does it mean if the patient reports polyphagia?

____excessive eating/appetite_________________

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ANATOMY AND PATHOPHYSIOLOGY FOR GENERAL SURGERY

The General Surgeon provides a wide variety of surgical services, with most tending to focus on the chest and abdomen. The approach to the anatomy and physiology training for this specialty will be as follows:

• Anatomy—what are the major organs that are part of the system and how are they supposed to work?

• Terminology—what are the major medical terms associated with these organs/this system?

• Pathophysiology—what are the common diseases or dysfunctions that occur in association with these organs?

The component parts/functions of the system that will be addressed are as follows:

• Digestive System • Neoplasms of the Digestive System • Female Breast

DIGESTIVE SYSTEM

ANATOMY The digestive system is a group of organs working together to convert food into energy and basic nutrients to feed the entire body. Food passes through a long tube inside the body known as the alimentary canal or the gastrointestinal tract (GI tract). The alimentary canal is made up of the oral cavity, pharynx, esophagus, stomach, small intestines, and large intestines. In addition to the alimentary canal, there are several important accessory organs that help your body to digest food but do not have food pass through them. Accessory organs of the digestive system include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas. To achieve the goal of providing energy and nutrients to the body, six major functions take place in the digestive system:

• Ingestion • Secretion • Mixing and movement • Digestion • Absorption • Excretion

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Esophagus The esophagus is a muscular tube connecting the pharynx to the stomach that is part of the upper gastrointestinal tract. It carries swallowed masses of chewed food along its length. At the inferior end of the esophagus is a muscular ring called the lower esophageal sphincter or cardiac sphincter. The function of this sphincter is to close of the end of the esophagus and trap food in the stomach. Stomach The stomach is a muscular sac that is located on the left side of the abdominal cavity, just inferior to the diaphragm. In an average person, the stomach is about the size of their two fists placed next to each other. This major organ acts as a storage tank for food so that the body has time to digest large meals properly. The stomach also contains hydrochloric acid and digestive enzymes that continue the digestion of food that began in the mouth. Small Intestine The small intestine is a long, thin tube about 1 inch in diameter and about 10 feet long that is part of the lower gastrointestinal tract. It is located just inferior to the stomach and takes up most of the space in the abdominal cavity. The entire small intestine is coiled like a hose and the inside surface is full of many ridges and folds. These folds are used to maximize the digestion of food and absorption of nutrients. By the time food leaves the small intestine, around 90% of all nutrients have been extracted from the food that entered it. Liver and Gallbladder The liver is a roughly triangular accessory organ of the digestive system located to the right of the stomach, just inferior to the diaphragm and superior to the small intestine. The liver weighs about 3 pounds and is the second largest organ in the body. The liver has many different functions in the body, but the main function of the liver in digestion is the production of bile and its secretion into the small intestine. The gallbladder is a small, pear-shaped organ located just posterior to the liver. The gallbladder is used to store and recycle excess bile from the small intestine so that it can be reused for the digestion of subsequent meals.

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Pancreas The pancreas is a large gland located just inferior and posterior to the stomach. It is about 6 inches long and shaped like short, lumpy snake with its “head” connected to the duodenum and its “tail” pointing to the left wall of the abdominal cavity. The pancreas secretes digestive enzymes into the small intestine to complete the chemical digestion of foods.

Large Intestine The large intestine is a long, thick tube about 2 ½ inches in diameter and about 5 feet long. It is located just inferior to the stomach and wraps around the superior and lateral border of the small intestine. The large intestine absorbs water and contains many symbiotic bacteria that aid in the breaking down of wastes to extract some small amounts of nutrients. Feces in the large intestine exit the body through the anal canal. PHYSIOLOGY OF THE DIGESTIVE SYSTEM The digestive system is responsible for taking whole foods and turning them into energy and nutrients to allow the body to function, grow, and repair itself. The six primary processes of the digestive system include:

Ingestion The first function of the digestive system is ingestion, or the intake of food. The mouth is responsible for this function, as it is the orifice through which all food enters the body. The mouth and stomach are also responsible for the storage of food as it is waiting to be digested. This storage capacity allows the body to eat only a few times each day and to ingest more food than it can process at one time.

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Secretion In the course of a day, the digestive system secretes around 7 liters of fluids. These fluids include saliva, mucus, hydrochloric acid, enzymes, and bile. Saliva moistens dry food and contains salivary amylase, a digestive enzyme that begins the digestion of carbohydrates. Mucus serves as a protective barrier and lubricant inside of the GI tract. Hydrochloric acid helps to digest food chemically and protects the body by killing bacteria present in our food. Enzymes are like tiny biochemical machines that disassemble large macromolecules like proteins, carbohydrates, and lipids into their smaller components. Finally, bile is used to emulsify large masses of lipids into tiny globules for easy digestion. Mixing and Movement The digestive system uses 3 main processes to move and mix food:

• Swallowing. Swallowing is the process of using smooth and skeletal muscles in the mouth, tongue, and pharynx to push food out of the mouth, through the pharynx, and into the esophagus.

• Peristalsis. Peristalsis is a muscular wave that travels the length of the GI tract, moving partially digested food a short distance down the tract. It takes many waves of peristalsis for food to travel from the esophagus, through the stomach and intestines, and reach the end of the GI tract.

• Segmentation. Segmentation occurs only in the small intestine as short segments of intestine contract like hands squeezing a toothpaste tube. Segmentation helps to increase the absorption of nutrients by mixing food and increasing its contact with the walls of the intestine.

Digestion Digestion is the process of turning large pieces of food into its component chemicals. Mechanical digestion is the physical breakdown of large pieces of food into smaller pieces. This mode of digestion begins with the chewing of food by the teeth and is continued through the muscular mixing of food by the stomach and intestines. Bile produced by the liver is also used to mechanically break fats into smaller globules. While food is being mechanically digested it is also being chemically digested as larger and more complex molecules are being broken down into smaller molecules that are easier to absorb. Chemical digestion begins in the mouth with salivary amylase in saliva splitting complex carbohydrates into simple carbohydrates. The enzymes and acid in the stomach continue chemical digestion, but the bulk of chemical digestion takes place in the small intestine thanks to the action of the pancreas. The pancreas secretes an incredibly strong digestive cocktail known as pancreatic juice, which is capable of digesting lipids, carbohydrates, proteins and nucleic acids. By the time food has left the duodenum, it has been reduced to its chemical building blocks—fatty acids, amino

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acids, monosaccharides, and nucleotides. Absorption Once food has been reduced to its building blocks, it is ready for the body to absorb. Absorption begins in the stomach with simple molecules like water and alcohol being absorbed directly into the bloodstream. Most absorption takes place in the walls of the small intestine, which are densely folded to maximize the surface area in contact with digested food. Small blood and lymphatic vessels in the intestinal wall pick up the molecules and carry them to the rest of the body. The large intestine is also involved in the absorption of water and vitamins B and K before feces leave the body. Excretion The final function of the digestive system is the excretion of waste in a process known as defecation. Defecation removes indigestible substances from the body so that they do not accumulate inside the gut. The timing of defecation is controlled voluntarily by the conscious part of the brain, but must be accomplished on a regular basis to prevent a backup of indigestible materials.

TERMINOLOGY Term Meaning Examples Gastr/o Stomach Gastritis, Gastrectomy Hepat/o Liver Hepatitis (inflammation of), hepatoma (tumor

of) Chol/e Gall, bile Cholecystitis, cholecystectomy (inflammation

of, removal of gallbladder) Emes/o Vomit Emesis (vomiting), emetic (stimulating

vomiting), antiemetic (stopping vomiting) Lith/o Stone Cholelithotomy (removal of gall stones) Lapar/o Abdominal wall Laparotomy (cutting into the abdomen) -centesis To puncture Abdominocentesis (puncturing and draining) -tripsy To crush Cholelithotripsy (smashing gall stones with

sound waves) -rrhea Flow, discharge Diarrhea -iasis, (-osis) Abnormal condition Cholelithiasis (presence of gall stones causing

symptoms)

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PATHOPHYSIOLOGY Some of the common diseases or dysfunctions of the digestive system are as follows: Gastroesophageal Reflux Disease (GERD) -Severe “heartburn” in laymen’s language. Weakness of the valve between the esophagus and stomach may allow stomach acid to reflux (regurgitate, backup) into the esophagus and irritate and inflame the lining. This results in chest pain which can mimic that of angina (pain of cardiac ischemia or an MI).

Jaundice - Literally means “yellow” in French. Yellowing of the skin and whites of the eyes from a backup of bile metabolic by-products from the blood into body tissues. May result from blockage of the ducts draining bile from the liver into the intestines or excessive breakdown of red blood cells. Hemoglobin from destroyed RBCs is broken down, and in part, ends up in bile secretions. Diverticulosis/diverticulitis – Small pouches may form along the walls of the large intestine called diverticuli which if symptomatic, causing discomfort to the patient, is called diverticulosis. These abnormal outpocketings may collect and not be able to empty fecal material which can lead to inflammation, diverticulitis. Cirrhosis - Literally, “orange-yellow” in Greek. A degenerative disease of the liver that often develops in chronic alcoholics, but can have other causes. The name refers to the gross appearance of the organ.

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Portal hypertension – A potential complication of chronic alcoholism resulting in liver damage and obstruction of venous blood flow through the liver. The rising blood pressure in the veins between the gastrointestinal tract and liver causes engorgement of veins around the umbilicus (navel). The characteristic radiating pattern of veins is called a “caput medusae” (head of Medusa). Medusa was the “snake-haired lady” in Greek mythology. Esophageal varices – bulging, engorged veins in the walls of the esophagus are often a complication of chronic alcoholism (see portal hypertension). The thin-walled, swollen veins are at risk of tearing resulting in severe, possibly fatal, bleeding. Crohn’s Disease - a chronic inflammatory disease primarily of the bowel. Typical symptoms are abdominal pain, weight loss, diarrhea. There may also be rectal bleeding that can lead to anemia. Special X-rays and tests are needed to differentiate Crohn’s from other diseases with similar symptoms. Peritonitis - Inflammation of the lining of the abdominal cavity. Before antibiotics, people would die from peritonitis if an inflamed appendix burst. Indications of peritonitis are called “peritoneal signs”: tender abdomen, rebound pain (pain when manual pressure released from examining abdomen), board-like rigidity of abdominal muscles, no bowel sounds (gurgles). The peritoneal membrane is very sensitive to exposure to foreign substances. Contact with blood, bile, urine, pus will cause peritoneal signs

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NEOPLASMS OF THE DIGESTIVE SYSTEM

Neoplasms are an abnormal new growth of tissue that grows by cellular proliferation more rapidly than normal, continues to grow after the stimuli that initiated the new growth cease, shows partial or complete lack of structural organization and functional coordination with the normal tissue, and usually forms a distinct mass of tissue which may be either benign or malignant. There are four classifications of neoplasms:

• Benign--A benign neoplasm is a mass of cells (tumor) that lacks the ability to invade neighboring tissue or metastasize. These characteristics are required for a tumor to be defined as cancerous and therefore benign tumors are non-cancerous. Also, benign tumors generally have a slower growth rate than malignant tumors and the tumor cells are usually more differentiated (cells have normal features). Benign tumors are typically surrounded by an outer surface (fibrous sheath of connective tissue) or remain with the epithelium.

Although most benign tumors are not life-threatening, many types of benign tumors have the potential to become cancerous (malignant) through a process known as tumor progression. For this reason and other possible negative health effects, some benign tumors are removed by surgery.

• Malignant—Malignant neoplasms are a mass of cells (tumor) that have the

ability to invade neighboring tissue or metastasize to other organs. These are commonly known as “cancer.” Neoplasms are generally named after the type of cell from which they arise.

• Carcinoma in situ-- a cluster of malignant cells that has not yet invaded the deeper epithelial tissue or spread to other parts of the body. If untreated long enough, it can spread to other organs.

• Uncertain—Early in the diagnostic process, some neoplasms have characteristics of both benign and malignant neoplasms. Therefore, until further diagnostic tests occur, a physician may not be able to be more specific in diagnosis assignment.

• Unspecified—This classification of neoplasm is used when a neoplasm is identified, but no additional information is yet available to establish a diagnosis.

Coding for neoplasms of the digestive system is based on its location(s) in the system and the type of neoplasm. Neoplasms can be found in any of the gastrointestinal organs. The National Cancer Institute estimates that 25% of all malignant neoplasms are gastrointestinal, with the majority of these occurring in the colon and rectum (colorectal cancers). The next sites

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most commonly affected by GI neoplasms are the pancreas, stomach, liver, and esophagus.

Malignant Neoplasms Types of Neoplasms Esophageal cancer Squamous cell carcinoma Adenocarcinoma Stomach cancer Adenocarcinoma Liver cancer Angiosarcoma Hepatoblastoma Cholangiocarcinoma Hepatocellular carcinoma (hepatoma) Gallbladder cancer Adenocarcinoma Squamous cell carcinoma Carcinosarcoma Small cell (oat cell) carcinoma Pancreatic cancer Adenocarcinoma Insulinoma

Gastrinoma Glucagonoma

Vipoma

Somatostinoma Acinar cell carcinoma Cystic tumors Papillary tumors Pancreatoblastoma Colorectal cancer Adenocarcinoma Carcinoid tumors

Gastroinstestinal stromal tumors Lymphomas

Anal cancer Squamous cell carcinoma Basal cell carcinoma

Melanoma Adenocarcinoma

FEMALE BREASTS

In the upper abdomen and chest, the female reproductive system is primarily represented by the breasts. The breasts serve a number of functions, mainly after pregnancy: the mammary glands are accessory organs of the female reproductive system which are specialized to secrete milk following pregnancy. A nipple is located

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near the tip of each breast, and it is surrounded by a circular area of pigmented skin called the areola.

The location of malignant neoplasms are classified by their location in the breast. The chart above illustrates the sectors. This information is necessary in order to select the correct ICD-10 code. Another sector not reflected in this chart is the axillary tail, which extends from the upper outer quadrant toward the armpits. The frequency of malignant neoplasms by sector is illustrated in the chart below.

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Breast The most common pathophysiological issues associated with the female breast are:

• Cyst(s) in the breast--this can occur with single cysts, numerous small cysts, or benign breast lesions that occur throughout the breasts.

• Malignant neoplasms of the breast—typically known as breast cancer, this is the result of abnormally growing tissue that has the potential of growing and expanding throughout the breast or the rest of the body.

• Inflammatory disorders—any portion of the breast can be inflamed and/or infected.

• Abnormalities of function—this can include painful breast, cracking of the nipple, non-pregnancy related nipple discharge, etc.

PHYSIOLOGY AND PATHOPHYSIOLOGY ISSUES FOR ICD-10 The introduction of ICD-10 will produce a substantial increase in specificity related to certain conditions and situations. Some of the issues include: Laterality In many cases, ICD-10 requires the physician and coder to indicate which side of the body is being treated

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When laterality is reported, “left” always means the patient’s left side and “right” always means the patient’s right-side. The diagram immediately above illustrates how “side” is defined. The medical record must indicate side, whenever possible, to facilitate appropriate code selection. However, laterality is not required in every circumstance. In fact, laterality is usually reportable only in these circumstances:

1. When the patient has (or should have) two identical organs on opposite sides of the body.

2. All issues related to malignant neoplasms (e.g. breast cancer, ovarian cancer, etc.)

Acute or Chronic In a number of situations, ICD-10-CM requires the physician or coder to report whether the patient’s condition is “acute” or “chronic.” The definitions of these terms are as follows:

• Acute—of abrupt onset. Typically refers to an illness that is of a short duration, rapidly progressive, or in need of urgent care.

• Chronic or subacute—an illness of undefined, indefinite, or extended duration and/or is a condition that is relatively stable.

When the medical record does not clearly state whether it is acute or chronic, the default code will be “chronic” or “subacute,” unless “unspecified” is a coding option. Specificity is important because some payers may resist paying for “unspecified” conditions—especially when defining the condition as either acute or chronic is not

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difficult. The provider is ultimately responsible for determining whether a condition is “acute” or “chronic.” Post-procedural Complications and Disorders In ICD-10-CM, there are a substantial number of codes available to report both intra-operative and post-procedural complications and disorders that are unique to the digestive system and other procedures common in the field of General Surgery. However, not every disorder that occurs after a procedure is necessarily a complication directly related to that procedure. For that reason, the documentation must clearly indicate whether or not it is an issue related to the procedure.