Terminology, Anatomy and Physiology: What is the REAL challenge in preparation for ICD-10?

October 1, 2013 - the looming ICD-10 implementation date - is merely a couple of years from now, so how do we really need to focus our efforts with respect to terminology and anatomy and physiology (A&P)?

Last time I checked, we all still have the same anatomical parts that we did while coding in ICD-9-CM and they function in the same capacity. By the same token, medical terminology hasn't changed from its mostly Latin origin. But as we all start to prepare for the transition to ICD-10, coders will find that there are certain aspects in relation to terminology and anatomical references that will be useful in a successful transition and application of the codes. 

Gauging current A&P knowledge is considered a key element in most preparation or implementation checklists for ICD-10. Concern has likely blossomed for a variety of reasons, but one major reason is that coding is still a role that is often primarily based on on-the job ("OJT") training. In this day and age, OJT may or may not involve formal classes on medical terminology and/or human A&P -topics that are currently an integral part of the curriculum for two-year or four-year health information management programs. Rather than run to the nearest college, some organizations may find it a better option to invest in existing, competent employees who may possibly be  promoted from within. This positive practice is certainly a great mechanism to reward valuable employees and definitely helps when there is a shortage of qualified and experienced coders.

New concepts in ICD-10
In the past, the ICD-9-CM code sets weren't as burdensome because they had less detail. Some transitioned coders may have evolved from serving in another role in the HIM department, such as transcription. Since transcription includes A&P within operative notes, progress notes and history and physicals, it is a helpful foundation towards basic medical terminology. But for those with limited clinical knowledge-especially in A & P-they may struggle with new concepts in the ICD-10 system. Testing staff to gauge their understanding is essential, whether you have coders on your team with extensive clinical knowledge or coders with limited expertise. It isn't as if we don't need to know medical terminology and A&P now to correctly assign codes, but it's important as a manager to recognize the spectrum of knowledge across your coding team.

For ICD-10-CM, the diagnosis codes will require added specificity. This particular concept is not a news flash because most who now work in a coding-related field at least know that when it comes to ICD-10, there are many more options for code assignment. The code set will increase from approximately 14,000 diagnosis codes to approximately 72,000 in ICD-10-CM. Many code series have added information specific to anatomical sites such as code assignment for strokes. These codes will identify not only the cause (hemorrhagic versus ischemic) but also can identify down to the detail of what vessel was involved (e.g., vertebral artery).

I think it is important, however, to point out that just like in ICD-9-CM, we can only code what is documented, therefore if the provider documents that the patient had a nontraumatic intracerebral hemorrhage, there is still a code for an unspecified site (I61.9). The increased familiarity with the anatomy in relation to the code category can facilitate posing valid queries for added specificity.

ICD-10-PCS is the system I personally think is going to present the most unique obstacles. The ICD-10-PCS coding system is drastically different in structure and will require a more in-depth knowledge of how procedures are performed. This knowledge will be integral to certain characters in the ICD-10-PCS coding system. For example, the specific body part is one of the characters in the seven-character PCS code. The selection of the body part (character 4) identifies the specific body part on which the procedure was performed (e.g., esophagus versus the ileum).

As mentioned, medical terminology hasn't changed, but how certain terms are defined within the ICD-10-PCS system is the culprit of the confusion. It's almost as if we need to focus on ICD-10-PCS "terminology" not necessarily "medical" terminology. In medical terminology, we learn that when the medical term "pancreatectomy" is documented, pancrea/o means pancreas and ectomy means to surgically remove/excise. Yet in ICD-10-PCS, being able to break down a word to define it isn't always going to determine how that procedure is coded in the PCS system.

In order to assign the correct code for this procedure, we would need to know whether it was a complete excision of the pancreas (which is defined as the root operation of a resection) versus a partial excision (which is defined as the root operation of an excision). Selecting the correct root operation is directly linked to assigning the correct code for the procedure.

There are different PCS tables for resection versus excision of the pancreas, so failure to understand how these terms are defined in ICD-10-PCS will result in an error. Similarly, knowing medical terminology could in some cases hinder us in ICD-10-PCS. For example, we know the medical term of -lysis means to destroy, but in ICD-10-PCS, lysis of adhesions is not defined as destruction; it's defined as a release. ICD-10-PCS procedure codes are assigned based on the objective of the procedure which may or may not be based on the medical terminology definition of the words contained in the procedure line.  It is not the physician's responsibility to alter the way that they document their procedure notes so we cannot put the onus on them.

Based off the ICD-10-PCS guidelines, it is the coder's responsibility to determine how a particular procedure is classified within the PCS system. So for a pancreatectomy, the physician can identify in their operative report that the entire pancreas was removed so the coder can define this procedure in the system as the root operation of a resection to assign the correct code.

These examples are just a few ways that the successful transition to ICD-10-CM and ICD-10-PCS will be directly related to a coder's knowledge of medical terminology and ICD-10-PCS specific terminology.  Human A&P as it relates to how procedures are performed and the associated diagnoses also plays an important role. The good news is that we have a couple of years to prepare for this exciting new system. Focusing on honing in on your own particular level of knowledge will ensure your success with the ICD-10 system.

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, is the Director of HIM and Coding for HCPro, Inc. She is the lead instructor of the Certified Coder Boot Camp® and serves as the manager of the Certified Coder Boot Camp® programs. She is an AHIMA-certified ICD-10 trainer and developed the HCPro ICD-10 Basics Boot Camp®. She is also the lead instructor and developer of the Certified Coder Boot Camp® Online, the Certified Coder Boot Camp® Online -Inpatient Version and the Evaluation & Management Boot Camp - Professional Services Version.