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MAXINE I COLLINS MBA, CPA, CMC, CMIS, CMOM

M COLLINS & CO PLLC

940-692-2733

• Anatomical terms come from Greek, Latin and sometimes Arabic origin

• Word origins often come from descriptive images

• Example: muscle – from Latin word “mus”, which is mouse.– Describes the movement of the muscle under

the skin, much like a mouse under a carpetSource: Medical Billing Basics, Ingenix Coding Lab, Chapter 1, p. 1.

• Converting Greek to Latin introduced new terms

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• Medical terms broken into basic word parts– Root term – the basic building block

• Basic meaning of the term• Often the body part

– Prefix – Appears before the root term• Further describes root term

– Location– Number– Color– Status

– Suffix – Appears after the root term• Usually, but not always denotes condition

– Can also describe procedure, disorder or disease

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• Common “root” terms– Card/i Heart– Nephr/o Kidney– My/o Muscle– Myel/o Spinal cord; bone marrow

• Common “prefixes”– Peri surrounding/around– Poly many– Dys difficult– Ante before

• Common “suffixes”◦ itis inflammation– osis abnormal condition– algia pain– centesis surgical puncture

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• Combining vowel is always used to form compound words when two are more root terms are combined– Cardio/o/pulmonary– Gastr/o/enteritis

• Combining vowel not used when suffix begins with a vowel (a,e,i,o,u)

Neur/itisGastr/it is

• Combining vowel is used when suffix begins with a consonant

Neur/o/plastyCardi/o/megaly

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• Anatomy - Study of human body structures– Greek – “Ana”, up; process of cutting– Morphologic structure of an organism– Foundation of medicine

• Physiology – Study of the functions of the structures– Greek – “physi” – nature; (normal vital processes of

living organisms and their functions)– Greek – “logos” – study; -ology – science/study of

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• Cells – smallest unit of living structure capable of independent existence; basic units of life– Composed of membrane-enclosed mass of

protoplasm and containing a nucleus or nucleoid

– Highly variable and specialized in both structure and function

– All must at some stage replicate (to produce ) proteins and nucleic acids, utilize energy, and reproduce themselves

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Blood Cells (2011, August jj), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

• Basophil – a white blood cell, granular with pale-staining nucleus; hormone producing

• Eosinophil – white blood cell, coarse, granular of uniform size, part of the immune system process

• Erythrocyte – red blood cell, contains hemoglobin, carries oxygen; one of the most common types of blood cells

• Lymphocyte – white blood cell, B & T cells; of importance in the immune system; produce antibody

• Monocyte – a single nucleus white blood cell; helps other white blood cells remove dead or dangerous tissues (e.g. cancer)

• Neutrophil – extracellular white blood cell; fights infections

• Platelet – irregular shaped, colorless body in blood, formed in bone marrow; helps blood to clot

• Thrombocytes – anucleated cell fragments that play a key role in blood clotting; platelets

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Blood Cells (2011, August jj), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

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Blood Cells (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

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Blood Cells (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

Tissues – groups of similar cells and the intercellular substances surrounding them◦ Latin – “texo” – to weave◦ Work together to perform similar tasks◦ 4 basic types:

epithelium connective tissues (including blood, bone, and

cartilage) muscle tissue nerve tissue

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Organ – two or more tissues◦ Latin – “organum”; Greek – “organon”, a tool,

instrument◦ Any part of the body exercising a specific function as

in respiration, secretion, or digestion◦ Together perform special body functions◦ Example: olfactory – the olfactory region is in the

superior portion of the nasal cavity; organum olfactus – of smell

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Tissues, (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

• Systems – A consistent and complex whole made up of correlated and semi-independent parts– Greek – “systema” – an organized whole– Usually Organs– Work together to perform complex body

functions– Example: alimentary – the digestive tract from

the mouth of the anus with all of its associated glands and organs; digestorium; systema alimentarium

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Alimentary System,(2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

• Integumentary– Integument – the enveloping membrane of the body; includes, in

addition to the epidermis and dermis, all of the derivatives of the epidermis such as skin, sweat glands, sebaceous (oil) glands, hair and nails

– Example: “Derma” – root word – skin; Dermatology – study of skin

– CPT code range – Surgery/Integumentary – 10040-19499; reports procedures performed on the skin, subcutaneous tissue and accessory organs, nails, pilonidal cysts, and breasts, including repair of lacerations, repair, closure, removal of lesions, and reconstruction

– ICD-9-CM code range – Codes appear throughout ICD-9-CM as this system includes the outer covering of the body as well as the covering for internal organs. However, for infection, inflammation and other diseases of the skin and subcutaneous tissues of the outer layer of the body, codes will be found at code range 680-709.

– ICD-10-CM code range- Corresponding code range in ICD-10-CM is L00-L99

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HORNY LAYER

Integumentary System(2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.org

• Stratum – layers of differentiated tissue, the aggregate of which forms any given stucture

• Corneum – the outer layer of the epidermis composed of several layers of flat keratinized non-nucleated cells – horny layer of epidermis

• Basale - the deepest layer of the epidermis, composed of dividing stem cells and anchoring cells, basale cell layer – growing layer

• Sudoriferous – Latin – “sudor” – sweat + “fero” – to bear; sweat glands

• Adipose – Latin – “adipis” – fatty tissue; akin to Greek – “lipo”

• Subucanteous – Latin – “sub” – below + “cutis” – skin

• Sebaceous – Latin – “sebaceus” – relating to the sebum; oily, fatty; “sebum” – secretion of sebaceous glands; Latin – “tallow”- the rendered fat from mutton suet –(kidneys of cattle and sheep)

• Gland – Latin – “glans”, acorn – an organized aggregation of cells functioning as a secretory or excretory organ

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• L08.1Erythrasma• L10.0Pemphigus vulgaris• L11.9Acantholytic disorder, unspecified• L21.0Seborrhoea capitis• L30.1Dyshidrosis {pompholyx}• L57.1Actinic reticuloid• L60.2Onychogryposis• L70.2Acne varioliformis• L81.1Chloasma• L90.6Striae atrophicae• L98.5Mucinosis of skin

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• L08.1 – Erythrasma – a skin disease that causes brown, scaly skin patches caused by the gram positive bacterium Corynebacterium minutissimum. It is a chronic superficial infection of the intertriginous areas of skin. Usually presents in the axillae and groin area.

• The bacteria invades the upper third of the stratum corneum under favorable conditions such as heat and humidity. Organisms proliferate and the stratum corneum becomes thickened.

• The organisms dissolve the keratin fibrils. Coral-red fluorescence of the scales seen under the Wood lights is secondary to production of porphyrin by diptheroids.

• Erythromycin is the drug of choice. Therapy must be comprehensive and cover all likely pathogens.

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• Erythraino – Greek – to redden• Gram positive – Latin – “granum”-grain; refers to the ability of a bacterium to

resist decolorization with alcohol after being treated with Gram crystal violet stain

• Keratin fibrils – keratin – Greek – “keras” – horn; collective name for group of proteins that form the intermediate filaments in epithelial cells. fibril – Latin – “fibrilla” – a minute fiber or component of a fiber

• Porphyrin –pigments widely distributed • Immuno-compromised – “immune” – Latin – free from service;

immunocomprised – denoting an individual that is deficient in immunity• Intertriginous – inter – between + Latin – “tero” – to rub; a scaling of the skin;

irritant dermatitis appearing between the folds of skin• Diptheroids- dipthera – Greek – leather + “eidos” – Greek – resemblance; One

of a group of local infections suggesting diptheria, but caused by microorganisms other than Corynebacterium diphtheria.

• Pathogens - path – Greek – feeling + “gen” – Greek – to produce – any virus, micro-organism or other substance causing disease

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Pemphigus Vulgaris◦ Pemphigus- Greek- “Pemphix”; blister, (Autoimmune bullous

diseases with acantholysis)

◦ “Vulgus”- Latin; a crowd (A serious form of Pemphigus) Bullous- “bull”, “bullae”- Latin; boiling ( A fluid filled blister

greater than 100cm appearing in a circumscribed area of separation from the epidermis)

Acantholysis- Greek- “Acantho”; a thorn: “lysis”- Greek- a loosening (Separation of individual epepidermal kerainocytes from their neighbor, such as Pemphigus Vulgaris and Darier Disease)

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Musculoskeletal System, (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.

• Includes soft tissue (deep fascia, muscles, tendons, and ligaments), joints, bursa, cartilage and bones

– Tendons are fibrous cords that vary in length and are found at the ends of muscles and connect muscles to bones

– Ligaments are bands of fibrous tissue that connect two or more bones or cartilage

– Joints – area of contact between two bones, holding the bones together and allowing articulation (movement) between cartilage and bones

– Bursa – consist of a sac that contains synovial fluid within a synovial membrane lining. Found at friction points between tendons and muscles.

– Cartilage – a type of connective tissue (hyaline, elastic, and fibrocartilage) that is found in joints.

• Three types of muscle tissue: skeletal, cardiac, and visceral− Muscles consist of specialized cells that allow contraction to

produce voluntary or involuntary movement of body parts.

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• Bones – classified by either shape; long, short, flat, and irregular, or by location: sutural, and sesamoid bones:– Long bones: humerus, tibia, and femur– Short bones: wrist and ankle– Flat bones: sternum, scapula, and ribs– Irregular bones: vertebra column and some

facial bones– Sutural bones: specific cranial bones– Sesamoid bones: patella and in tendons where

there is pressure ( e.g. wrist)

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• M02.1 Postdysenteric arthropathy• M05.9 Seropositive rheumatoid arthritis,

unspecified• M10.0 Idiopathic gout• M12.2 Villonodular synovitis• M16.1 Other primary coxarthrosis• M16.3 Other dysplastic coxarthrosis• M17.4 Other secondary gonarthrosis,

bilateral• M24.6 Ankylosis of joint• M62.0 Diastasis of muscle

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• Arthropathy – “arthron”-Greek – a joint; pathy – Greek, “pathos” – feeling, suffering, disease

• Idiopathic – “idio”- Greek –private, peculiar; pathos – disease– Denoting a disease of unknown origin

• Villonodular –nodular projections

• Coxarthrosis – “coxa” – Latin –hip; arthr – joint; osis – abnormal condition– Abnormal condition of the hip joint

• Gonarthrosis – “gony” – Greek – knee

• Ankylosis – “anklyos” – Greek – bent

• Diastasis – “dia” – Greek – through; Any simple separation of normally jointed parts

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• The nose, pharynx, larynx, trachea, bronchus (bronchial tubes) and lungs.

• Pulmonology – the science or study of the pulmonary system

• Brings oxygen-rich air into the body for delivery to the blood cells

• Expels waste products (carbon dioxide and water ) that have been returned to the lungs by the blood

• Produces the air flow through the larynx that makes speech possible

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31Respiratory System, (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.

• Heart, blood vessels, lymphatic (immune system) and blood (hematology)

• Cardiovascular – pertaining to the heart and blood vessels– Heart – a muscular organ located between the lungs and

above the diaphragm

– Pericardium – double-walled membraneous sac – encloses the heart

– Coronary arteries and veins supply blood to the myocardium.

– Atria – two upper chambers – receive blood; separated by the interatrial septum or wall

– Ventricle – lower two chambers of the heart on the right and left – separated by the interventricular septum; the pumping chambers

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• Right atrium receives oxygen-poor blood from all tissues, except lungs through the superior and inferior venae cavae. Blood flows out of the RA through tricuspid valve (controls the opening between right atrium and right ventricle) into right ventricle.

• RV pumps the oxygen-poor blood through the pulmonary valve into pulmonary artery, which carries it to the lungs.

• Pulmonary semilunar valve – located between the right ventricle and pulmonary artery.

• LA receives oxygen-rich blood from lungs the four pulmonary veins. Blood flows out of the LA through the mitral valve (bicuspid valve – located between the left atrium and left ventricle) and into left ventricle.

• LV receives oxygen-rich blood from left atrium. Blood flows out of the LV through aortic valve and into aorta which carries it to all parts of the body, except the lungs

• Aortic semilunar valve – located between the left ventricle and the aorta.• Oxygen-poor blood is returned by the venae cavae to the right atrium and the

cycle continues• Electrical impulses from nerves stimulate the myocardium of the chambers of

the heart. The conduction system or electrical impulses are controlled by the sinoatrial (S-A) node, atrioventricular (A-V) node and bundle of HIS.

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RED – BUNDLE OF HIS

Cardiovascular System, (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wikipedia.

Question: The spinal cord ends in a tuft of spinal nerves. What imaginative name was given to this tangle of branches?

Sacral Dendron Spinal Candelabrum Neuroalluvium Cauda Equina

Source: FunTrivia.com: Anatomy and Physiology

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Cauda Equina“Cauda Equina” means horse tail

◦Do you know any “horse’s tails”?

Source: FunTrivia.com: Body Parts with Silly Names

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What is the function of the “amygdala”? Secretion of steroid hormones Memory and emotion Concentrating bile Production of seminal fluid

Source: FunTrivia.com: Anatomy & Physiology

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Memory and emotion◦ Part of the limbic system, (“limbic” comes from Latin, limbus– “border” or

“edge”) the amygdala is important in Pavlovian classical conditioning. ◦ A set of brain structures including the hippocampus, amygdala, anterior

thalamic nuclei, spetum, limbic cortext and formic, which reportedly support a variety of functions including emotion, behavior, long term memory, and olfaction. Ivan Pavlov (1927) researched respondent conditioning to measure the

behavioral response to stimuli.

Source: FunTrivia.com: Anatomy & Physiology

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Amygdala, , (2011, August 11), In Wikipedia, The Free Enclycopedia. From Wikipedia contributors, http://en.wiki

What is another name for hypoperfusion? Cardiac Arrest Hyperventilation Shock Myocardial Infarction

Source: FunTrivia.com: Anatomy & Physiology

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Shock

◦Treatment for shock includes: Depends on the type of shock

Hypovolemic – most common-insufficient circulating volume

Cardiogenic Septic Anaphylactic Neurogenic Other

Trandelenberg position (legs elevated), oxygen therapy, keeping warm and intravenous fluids.

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What is the name of the bone in the upper arm?

Brachial Femur Humerus Forearm

Source: FunTrivia.com: Anatomy & Physiology

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Humerus◦And, of course, your “funny bone” is at the end of the humerus. That is kind of humerous, don’t you think?

Source: FunTrivia.Com; Body Parts with Silly Names

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By what name is the “axilla” more commonly known?

Windpipe Jawbone Belly button Armpit

Source: FunTrivia.Com: Anatomy & Physiology

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Armpit◦Comes from the Greek. Probably relates to the word “axis” since it occurs at the joining of the arm and torso.

◦Don’t confuse “axilla “with “maxilla” which is the upper bone of the jaw.

Source: FunTrivia.com; Body Parts with Silly Names

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What is the popular name of the tendon that connects the calf to the heel?

Source: FunTrivia.com: Anatomy Alphabet

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Achilles & Achilles tendon◦Named after a hero from the Trojan War whose only place of weakness was his heel.

Source: FunTrivia.com: Anatomy Alphabet

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Which is one of the bones of the wrist?

Cochlea Coccyx Capitate Cranium

Source: FunTrivia.com: Alphabet Anatomy

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Capitate◦There are 8 bones in the wrist.◦The cranium is part of the skull◦The cochlea is a spiral shaped chamber in the inner ear.

◦The coccyx is the tailbone

Source: FunTrivia.com: Alphabet Anatomy

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• The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings.

• Diagnosis coding under this system uses 3 -7 alpha and numeric digits and full code titles, but the format is much the same as ICD-9-CM

• ICD-10 medical terms are more specific and clinical in nature

• The medical coder will have to continue to increase their knowledge of anatomy/physiology and medical terminology!

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DATE COMPLIANCE STEP

January 1, 2010 Payers and Providers should begin internal testing of Version 5010 standards for electronic claims

December 31, 2010 Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance

January 1, 2011 • Payers and Providers should begin external testing of Version 5010 for electronic claims• CMS begins accepting Version 5010 claims• Version 4010 claims continue to be accepted

December 31, 2011 • External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance

January 1, 2012 • All electronic claims must use Version 5010• Version 4010 claims are no longer accepted

October 1, 2014 • Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures• CPT codes will continue to be used for outpatient services

Source: Website: http://www.cms.gov?ICD10/03_ICD-10andVersion5010ComplianceTimeles.asp50

While ICD-10 has organizational changes and new features, its format and conventions remain much the same as ICD-9.

ICD-10 consists of 21 chapters “V” and “E” codes as used in ICD-9 are no

longer supplementary classifications and become other codes

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A78 Q fever A69.32 – Meningitis due to Lyme

disease S52.131A – Displaced fracture of neck of

right radius, initial encounter for closed fracture

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Become - ICD-10-CMs “Z” Codes◦ Used in all healthcare settings

Factors influencing health status and contact with health services:

Z00-Z99Examples:

Contact/ExposureInoculations/vaccinationsStatus codesHistory ofScreeningObservationAftercareFollow-upOthers…….

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Become - ICD-10-CMs “V” – “Y” Codes External Causes of Morbidity

◦ V01-Y99◦ Use full range of External Cause codes to :

Completely describe the cause, the intent, the place of occurrence and, if applicable, the activity at the time of the event, and the patient’s status, for all injuries, and other health conditions due to an external cause.

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Preparations are being done now to transition from “9” to “10”

Over 100 new “Activity” codes were added to “E” codes in 2010

Changes are also seen in the ICD-9-CM codes effective 10/01/2010.◦ New codes for foreign bodies and complications

of medical care Continual increase in acceptance of “V” and “E”

codes by carriers

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ICD-10 distinguishes between burns and corrosions:◦ Burn codes are for thermal burns, except sunburns, that

come from a heat source, such as fire or hot appliance. Also for burns resulting from electricity and radiation

◦ Corrosions are burns due to chemicals◦ Encounters for treatment of late effects of burns or

corrosions should be coded with a burn or corrosion code with the 7th character of “S” – sequlae

◦ An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred.

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Codes in categories T36-T65:◦ Are combination codes that include the substances

related to adverse effects, poisoning, toxic effects and underdosing, as well as the external cause.

◦ Sequence the T36-T65 codes first, followed by the code(s) that specify the nature of the adverse effect, poisoning, or toxic effect.

◦ Do not code directly from the Table of Drugs – always refer back to the Tabular List.

◦ Use as many codes as necessary to describe completely all drugs, medicinal or biological substances

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ICD-10-CM CHAPTER-SPECIFIC GUIDELINES

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CHAPTER 1:

CERTAIN INFECTIONS AND PARASITIC DISEASES

CODE RANGE:

A00-B99

CHAPTER 1-SPECIFIC GUIDELINES

• HIV• Infectious agents as cause of diseases classified to other chapters• Infections resistant to antibiotics• Sepsis, Severe Sepsis and Septic Shock

CMS◦ General ICD-10 Information

http://www,cms.hhs.gov/ICD10◦ ICD-10 Notice of Proposed Rulemaking

http://www.cms.hhs.gov/TransactionCodeSetsStands/01_TransactionsandCodeSetsRegulations.asp

◦ ICD-10-CM Coding System http://www.cms.hhs.gov/ICD10/03 ICD 10 CM.asp#

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• Q & A ?

• THANK YOU!!

• Soon you will be able to view my website for additional tools and resources. Until then feel free to contact me

at my email address:• MCMCOLLINSCO@AOL.COM

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