One of my favorite places in school was the cadaver lab. If I were not a chiropractic physician, I think I would have become a forensic anthropologist. I never get squeamish around organs of the deceased or dismembered body parts. I always have found the human body to be fascinating. I also love to teach, and I can think of no better way to learn anatomy than to be in the lab.
Unfortunately, most coders do not have that kind of hands-on experience with anatomy. Some have on-the-job experience, and many have completed online courses, but neither of these can offer a full appreciation of the human body. I visited a cadaver lab for my local AAPC chapter meeting recently. I guarantee it was the first time most of these professional coders have ever touched actual human organs. It can be an almost spiritual experience.
Many of the challenges of ICD-10-CM coding relate to human anatomy. There are five times as many diagnosis codes in ICD-10-CM, because it conveys a deeper and more accurate understanding of anatomy than ICD-9. One classic example is the ICD-10-CM code for fracture of the head and neck of the femur.
Taking into account all the specific details that can be indicated using the available additional digits in Category S72.0, the total number of codes indicating specific fractures of the femoral head or neck exceeds 550.
- 48 specific codes for fracture of an unspecified part of the neck or femur
- 48 specific codes for unspecified intracapsular fracture (of the femur)
- 96 codes for epiphyseal fractures (48 displaced, 48 undisplaced)
- 96 codes for mid-cervical fractures (48 displaced, 48 undisplaced)
- 96 codes for fractures of the base of the neck (48 displaced, 48 undisplaced)
- 48 codes for unspecified fractures of the head of the femur
- 96 codes for articular fractures of the femoral head (displaced and undisplaced)
- 48 codes for “other fractures of the head and neck of the femur”
Considering all possible codes for femur fractures occurring between the proximal and distal aspects of both legs, the number of possible fractures that can be described using properly extended ICD-10-CM codes may approach 2,500!
Compare this to only 12 codes in ICD-9-CM. Will coders be able to identify the right code in ICD-10-CM? They will need to know the difference between epiphyseal fractures and mid-cervical fractures. More importantly, the physician will need to communicate this information clearly. We can assume that physicians know the anatomy, but we also can assume that they never have needed to document with so much detail before.
The coder, therefore, has two challenges: a) understand the anatomy; and b) convince the physician to document services in a manner that aligns with the new codes.
For the first challenge, the solution is simple enough if the coder works in a specialized field — simply find a training course and become an expert on that body system. A better approach would be to find a college course in which the studies involve cadaver specimens. Again, there is no substitute for this kind of experience. An even better approach would be for the coder to ask the physician to describe what he or she does. The material will apply directly to the skills the coder needs to develop. And hopefully, the physician will recognize the monetary value in such a relationship as well.
The key to the second challenge is a little tougher. Since I am a physician, I know how prideful we can be. Old dogs often have a hard time learning new tricks, it’s true. It is not uncommon for a physician to say “I have done it this way for 15 years, and it has always worked.” There are two possible paths to take to encourage change: a coder could try the scare tactic and illuminate threats of lost reimbursement and denied claims. Or, a coder could try to stoke the ego of the almighty doctor by encouraging him or her to show their wisdom by documenting all they know. It can be a challenge to put a positive spin on ICD-10-CM as it pertains to the physician, but it might be worth a try.
In the end, ICD-10-CM requires everyone to be a bit smarter. We have a couple of years to prepare. Find some cadavers and dig in.
There is no better way to learn anatomy.
About the Author
Dr. Gwilliam holds multiple coding certifications and graduated from the Palmer College of Chiropractic in 2003 as valedictorian. He teaches seminars across the country for chiropractic offices and is the director of consulting for the ChiroCode Institute.
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