1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THE COMPLETE DIAGNOSIS CODING SOLUTION THIRD EDITION Chapter 17 Coding Skeletal Conditions 17-1

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes 17.1 Identify the components of the axial skeletal system. 17.2 Identify the components of the appendicular skeletal system. 17.3 Enumerate the types of fractures. 17-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes (cont.) 17.4 Differentiate between pathologic and traumatic fractures. 17.5 Identify the possible sequelae of fractured bones. 17.6 Recognize the use of seventh characters and what they report. 17-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Appendicular skeleton Articulation (joint) Axial skeleton Bony thorax Cancellous Cranium 17-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Diaphysis Epiphysis Fracture Intervertebral disc Laterality Malunion 17-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Nonunion Osseous Site Skull Sutures Tuberosity Vertebra 17-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction The skeleton of the human body provides its structure for both form and function. There are 206 bones in the adult body that comprise a framework hinged together at the articulations (joints) that is stabilized by muscles and connective tissue. 17-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Categories of Bones Bones are generally categorized by their shape. The medical term for the shaft of a long bone is diaphysis, and each end is known as an epiphysis. 17-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Axial Skeleton Of the 206 bones in the body, 80 make up the axial skeleton and are responsible for structure and support of the central segments of the body: the head (skull), spine (vertebral column), and rib cage (the bony thorax). Learning Outcome: 17.1 17-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Axial Skeleton (cont.) The skull is one of the most complex structures of the human skeleton and is made up of 22 bones. Learning Outcome: 17.1 17-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Axial Skeleton (cont.) 8 cranial bones –Parietal: 1 right and 1 left –Temporal: 1 right and 1 left –Frontal –Occipital –Sphenoid –Ethmoid Learning Outcome: 17.1 17-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Axial Skeleton (cont.) 14 facial bones - Mandible - Maxillary - Zygomatic bones - Nasal bones - Lacrimal bones - Palatine bones - Vomer - Inferior nasal conchae Learning Outcome: 17.1 17-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Bones of the Ear There are three bones located in the ear, all in the middle section: –Malleus –Incus –Stapes Learning Outcome: 17.1 17-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Hyoid Bone A small bone that sits in the ligaments of the neck just below the mandible. Also serves as an attachment for the muscles that enable swallowing. Learning Outcome: 17.1 17-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Spine Located in the neck, where the atlas (C1—the first vertebra) articulates with the skull, and all the way down the column to the coccyx, the spine is a long stack of individual bones called vertebrae, separated by intervertebral discs. Learning Outcome: 17:1 17-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Vertebrae A vertebra is a bone that is a part of the construction of the spinal column. Learning Outcome: 17.1 17-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Vertebrae (cont.) Vertebrae are identified by their location and position in each section of the spinal column. Cervical vertebrae (C1–C7) Thoracic vertebrae (T1–T12) Lumbar vertebrae (L1–L5) Sacrum (S1–S5) Coccyx (tailbone) Learning Outcome: 17.1 17-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Intervertebral Discs In between every two vertebrae is an intervertebral disc, a cushion made of fibrocartilage. The outer layer of the disc is called the annulus fibrosus, while the center of the disc is the nucleus pulposus, a soft gelatinous core consisting of about 75% water. Learning Outcome: 17.1 17-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Rib Cage (Bony Thorax) The skeletal structure of the torso is called the thoracic cage and is designed to protect the internal organs (heart, lungs, thymus, etc.). Consists of three sections: –Thoracic vertebrae: T1–T12 –Ribs, also known as the costae –Sternum, commonly called the breastbone Learning Outcome: 17.1 17-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Appendicular Skeleton The pectoral girdle is commonly known as the shoulder. The two parts of each pectoral girdle are: –Scapula –Clavicle Learning Outcome: 17.2 17-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Upper Limb Also known as the upper extremity or upper arm, the upper limb is made up of these bones: –Humerus (upper end or proximal end) –Elbow joint –Lower arm (forearm) –Radius Learning Outcome: 17.2 17-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Pelvic Girdle The Lower Limb Also known as the lower extremity, the lower limb consists of these bones: –Femur (thigh bone) –Patella (kneecap) –Tibia (shinbone) –Fibula Learning Outcome: 17.2 17-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Ankle and Foot The distal ends of the tibia and fibula, the medical malleolus and the lateral malleolus, meet the tarsus (ankle). Learning Outcome: 17.2 17-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Ankle and Foot The ankle is made up of seven bones: –Talus –Calcaneus –Cuboid –Navicular –Cuneiform bones (lateral, intermediate, and medial) Learning Outcome: 17.2 17-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Fractured Bones Fractures can result from trauma or a pathologic condition. When a bone fracture occurs, the coder must identify the segment of the bone that was affected. Learning Outcome: 17.3 17-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Types of Fractures One of the first factors needed to code a fracture is whether the fracture is open or closed. –Open is in conjunction with an open wound through which the bone may or may not extend. –Closed or simple fractures have no accompanying wound and remain within confines of the body. Learning Outcome: 17.3 17-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Skull Fracture Skull fractures are characterized differently and include the following: –Basal skull fracture –Blowout fracture –Depressed skull fracture –Stellate fracture Learning Outcome: 17.3 17-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Maxillary Fracture Facial trauma might result in a LeFort fracture, which is a bilateral maxillary fracture with involvement of the surrounding bone, including the zygomatic bones. Learning Outcome: 17.3 17-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathophysiological Fractures and Conditions Some conditions may affect any part of the skeletal system and therefore require that the specific anatomical location be documented. Learning Outcome: 17.4 17-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathophysiological Fractures and Conditions (cont.) Diseases and other conditions can create problems with the bones that may be caused by a congenital malformation, pathology, or traumatic event. Learning Outcome: 17.4 17-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathophysiological Fractures and Conditions (cont.) Some examples may include: –Developmental dysplasia of the hip (DDH) –Gout –Klippel-Feil syndrome –Kyphosis –Osteoarthritis Learning Outcome: 17.4 17-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathophysiological Fractures and Conditions (cont.) Some examples may include (cont.) –Osteochondrosis –Osteoitis deformans –Osteoporosis –Spina bifida Learning Outcome: 17.4 17-32

33. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Sequelae (Late Effects) of Fractures The most common types of late effects of fractures are malunion and nonunion. –Malunion of a fractured bone means that the pieces of the bone healed back together but not in an effective way. –Nonunion is when parts of a broken bone do not heal back together. Learning Outcome: 17.5 17-33

34. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Seventh Character Within the ICD-10-CM chapter on diseases of the musculoskeletal system and connective tissue, the appropriate seventh character is added to each code Learning Outcome: 17.6 17-34

35. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Seventh Character (cont.) Seven Characters: –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 Learning Outcome: 17.6 17-35

36. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary The 206 bones of the adult human skeleton provide the foundational structure for the components of the body. These bones protect internal organs as well as enable certain functions. 17-36