Musculoskeletal System. CPT® copyright 2012 American Medical Association. All rights reserved. Fee...

Musculoskeletal SystemMusculoskeletal System

Musculoskeletal System

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

• Understand the components of the musculoskeletal system

• œDefine key terms• œUnderstand the most common pathologies affecting

these organs• œUnderstand orthopedic surgeries and how they relate to

pathologies• œRecognize common eponyms and acronyms• œIdentify when other sections of CPT® or ICD-9-CM

should be accessed• œKnow when HCPCS Level II codes or modifiers are

appropriate

Objectives

• Skeleton– Axial

• Skull• Chest• Spine

– Appendicular• Upper and lower limbs• Shoulders• Pelvis

Anatomy

• Skeleton– Body’s framework– Bones store calcium and produce blood cells

• Muscles– Assist with heat production– Posture

• Ligaments – attach bones to other bones• Tendons – attach muscles to bones• Cartilage – Acts as a cushion between bones in a

Anatomy

• Types of Muscles– Striated– Smooth– Cardiac

Muscles

• Naming Conventions– Size– Shape– Location– Action– Number of attachments– Direction of fibers

• Armpit area

• Anatomic Landmarks– Posterior axillary fold– Anterior axillary fold

Axilla

• Colles’ Fracture• Smith’s Fracture• Jones’ Fracture• Salter-Harris Fracture• Dupuytren’s Fracture• Monteggia’s Fracture

Fracture Eponyms

• Manipulation• Reduction• Fixation• Internal • External

• Cast application

Treatments

Fifth Digit Specification0—Site unspecified1— Shoulder region (Acromioclavicular joint, Clavicle, Glenohumeral joint(s),

Scapula, Sternoclavicular joint(s))2— Upper arm (Elbow joint, Humerus)3—Forearm (Radius, Ulna, Wrist joint)4— Hand (Carpus, Metacarpus, Phalanges (fingers))5— Pelvic region and thigh (Buttock, Femur, Hip joint)6— Lower leg (Fibula, Knee joint, Patella, Tibia)7— Ankle and foot (Ankle joint, Digits (toes), Metatarsals, Phalanges, foot, Tarsus,

Other joints in foot)8— Other specified sites (Head, Neck, Ribs, Skull, Trunk, Vertebral column)9—Multiple sites

ICD-9-CM Coding

• Systemic lupus erythematosus• Arthropathy– Rheumatoid arthritis– Osteoarthritis

• Internal derangements of the knee– MCL and ACL– Bucket handle tear

Arthropathies and Related Disorders

• 4th digit – type of disorder• 5th digit – area of spine• Diseases– Spondylosis– Displacement of vertebral disc– Degenerative disc disease– Spinal stenosis– Symptoms

Dorsopathies

• Enthesopathies– Capsulitis– Tendonitis– Tenosynovitis– Bursitis– Synovitis

• Compartment Syndrome• Bunion

Rheumatism, Excluding Back

• Osteomyelitis• Osteochondrosis• Osteoporosis• Curvature of the spine

Osteopathies, Chondropathies, and Acquired Musculoskeletal Deformities

• Sprains and Strains• Fractures

– Comminuted– Impacted– Simple– Greenstick– Pathologic– Impacted or Compression– Torus or Incomplete

Injury and Poisoning

• Compartment Syndrome

• Rotator Cuff Tear

• Nursemaid’s Elbow

Injury and Poisoning

• Table of Contents– Listing of headings and subheadings

• Anatomic Illustrations– Useful when coding from this subsection

• Knowledge of anatomy and terminology will be key

• Formatted by anatomic site– General– Head, Neck (soft tissues) and Thorax– Back and Flank– Spine (vertebral column)– Abdomen– Shoulder, Humerus and Elbow– Forearm and Wrist– Hand and Fingers– Pelvis and Hip Joint– Femur and Ankle Joint– Foot and Toes– Application of Casts and Strapping– Endoscopy/Arthroscopy

• “General” subheading– Many different anatomic sites

• Other subheadings– Divided by anatomic site, procedure type,

condition and description• Incision, Excision, Introduction or Removal,

Repair, Revision and/or Reconstruction, Fracture and/or Dislocation, Arthrodesis, Amputation

• Types of fracture treatment

– Closed means the fracture site is not surgically exposed

– Three methods• Without manipulation• With manipulation• With or without traction

Guidelines

• Types of Fracture Treatment (cont)– Open – used when fractured bone is surgically

exposed• Internal fixation may be used

• Percutaneous skeletal fixation– Not open or closed

• Pin placed across the fracture site

Guidelines

• Traction– The application of a pulling force to hold a bone in

alignment

• Skeletal– Use of internal devices

• Skin– Strapping or tape

Guidelines

• Not specific to anatomic site

• Incision of soft tissue abscess– Associated with deep tissue

• Wound Exploration– Traumatic wounds – Include surgical exploration/enlargement,

debridement, removal of foreign bodies, ligation/coagulation minor blood vessels

General

• Excision Category– Biopsy

• Muscle or Bone

– Typically includes• Local anesthesia• Incision• Removal of tissue, sutures

General

• Introduction or Removal Category– Aspiration, Insertion, Application

• Removal foreign body muscle/tendon sheath• Injections into tendon, ligament, ganglion cyst• Aspiration/injection into joint• Insertion pins/wires• Grafts/Implants

General

• Grafts– Bone– Cartilage– Fascia Lata

• Taken from thigh area– Tendon– Tissue

• Fat, dermis, fatty tissue from tendon compartment

General

• Other Procedures• Bone Grafts– Based on where graft is obtained

• Free osteocutaneous flaps– Based on part of the body flap is taken from

• Monitoring of interstitial fluid pressure

General

• Based on anatomic site

• Divided based on procedure– Incision– Excision– Fracture

• Read notes carefully

Anatomical Subheadings

• Cervical C1-C7– C1 Atlas– C2 Axis

• Thoracic T1-T12

• Lumbar L1-L5

• Segmental– Attachment at each end of repair area and at

least one other attachment in the area being repaired

• Non-segmental– Attachment of device at each end of the area

being repaired

Spinal Instrumentation

• Use these codes when physician

– Applies an initial cast/strapping/splint prior to definitive treatment by another physician

– Applies a subsequent cast, strapping or splint

– Treats a sprain and doesn’t expect to provide other type of treatment

Application of Casts and Strapping

• Divided by body area– Elbow– Shoulder– Knee

• Surgical endoscopy/arthroscopy includes a diagnostic endoscopy/arthroscopy

• Multiple surgical procedures performed through scope may be reported

• “Separate procedure” – included in more extensive procedures

Endoscopy/Arthroscopy

• Orthotic and Prosthetic • Basic Orthopedic Supplies– Crutches– Canes– Walkers– Traction Devices– Wheelchairs– Other orthopedic supplies

HCPCS Level II

• 50 – Bilateral– RT – right– LT – left

• 59 – Distinct Procedural Service• FA-F9 – Specifies Finger• TA-T9 – Specifies Toe

Modifiers

The End

Musculoskeletal System. CPT® copyright 2012 American Medical Association. All rights reserved. Fee...

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