Understanding the Musculoskeletal System for Better Medical Billing and Coding

Surgical procedures make up a great chunk of the medical services provided in the US. These procedures can be performed in several sites; in the physician’s office settings, the emergency room of the hospital, outpatient clinics, endoscopy suites, etc. For every procedure, it is important to collect the information needed to select the correct procedure code.

Since billing and coding are such an integral part of the medical industry, it is important to keep track of and document a patient’s health conditions. For instance, when dealing with cardiology medical billing, the coder should have visibility of the patient’s medical history for a better picture of the overall case. 

The musculoskeletal system is one of the densest sections of surgical procedures. The CPT manual has a large numeric range dedicated to musculoskeletal procedures and services, i.e., 2000-2999. The reason it is so dense is due to the procedures listed involving every bone and muscle in the human body. Overwhelmed by the number of codes? Outsourcing the billing and coding process to an experienced medical billing company can help you save administrative time and let you focus on your patients.

To be a successful medical coder, it is crucial to have at least a basic knowledge of human anatomy. More importantly, the medical coder should be well versed in the musculoskeletal system so that they can have a better understanding of the procedures being documented. In this article, we dive into the musculoskeletal system to get a better understanding as well the importance it plays in medical billing and coding.

What is the Musculoskeletal System?

The musculoskeletal system consists of the bones, ligaments, cartilage, tendons, and connective tissues. At the base are the bones that make up your skeleton. The skeleton is the framework on which the muscles and tissues build. This combined framework is responsible for supporting body weight, maintaining posture, and enabling movement.

A number of conditions and disorders are associated with problems to the musculoskeletal system. These include injuries, birth defects, and aging, among others.

The key to having a healthy musculoskeletal system is to keep tabs on overall health. Eating a balanced diet, exercising regularly, and maintaining a healthy weight can keep the musculoskeletal system going.

 

Parts of the musculoskeletal system

The human adult body consists of 206 bones and over 600 muscles that are connected with tendons, soft tissue, and ligaments. This network makes up the musculoskeletal system that allows you to sit, walk, stand and move. For a medical coder, it is important to have a basic understanding of the musculoskeletal system.

Bones: Bones are the supporting structure of the body. They protect the organs and tissues and are tasked with storing calcium as well as developing blood cells. Bones provide form and overall structure to the body. To help in movement, bones team up with tendons, muscles, and other connective tissue in the body. A bone typically has a hard outside shell and a spongy center underneath.

Muscles: Muscles are made of fibers that allow them to move and stay upright. Muscles also help to walk, dance, and lift.

Cartilage: Cartilage is a type of connective tissue. It is found inside the joints, in the ribcage, and along the spine. The cartilage’s firm and rubbery structure allow it to protect bones from rubbing against each other. Cartilage is also found in the ears, nose, lungs, and pelvis.

Joints: Joints are formed when bones join together. Some joints, like the ball and socket shoulder joint, have a large range of motions. Others have more limited movement, such as the knee and elbow.

Ligaments: Ligaments connect the bones and help stabilize the joints. They are made of tough collagen fibers.

Tendons: Tendons are made of fibrous collagen and tissue. They are very tough but not much stretchy and are used to connect bones and muscles.

 

Conditions Affecting the Musculoskeletal System

While doing medical billing and coding for the musculoskeletal system, it is important to be aware of the conditions and disorders that cause problems behind it. Below are some of the most common causes of musculoskeletal movement problems and pain:

Aging: As the human body ages, the bones become less dense. Once the density lessens, it can lead to bone fractures and osteoporosis. The muscles also lose their mass as the cartilage shows wear. This means that the body is more prone to pain, stiffness, and a decrease in range of motion. The body does not heal as quickly as before too.

Arthritis: Arthritis causes joint stiffness, inflammation, and pain. This is a condition that most often plagues older people as a result of cartilage inside joints breaking down.

Back Problems: A herniated disk or muscle strain can lead to muscle spasms and back pain. Conditions such as scoliosis and spinal stenosis cause structural problems for the back, due to which patients feel pain and limited mobility.

Cancer: Bone cancer, among others, is a leading factor that affects the musculoskeletal system. Other conditions include tumors that develop in the sarcomas (connective tissue), leading to problems when moving.

Birth Defects: Also known as congenital abnormalities, birth defects affect the structure and functions of the body. One of the most common disorders is ‘Clubfoot’ which causes reduced range of motion and stiffness.

Injuries: There are dozens of injuries that affect the parts involved in the musculoskeletal system. These include bursitis, tendonitis, and carpal tunnel syndrome. Injuries to tendons, bones, and ligaments such as sprains and fractures are a result of trauma and accidents.

 

Importance of Accurate Diagnostic Coding

The process of medical coding is essential for documenting medical records for medical billing. The process allows for the translation of important medical information into simple codes. The advantage of accurate coding is that it allows a seamless transfer of medical records as well as an efficient analysis of patient health records.

Medical billing and coding are major factors when it comes to recording and obtaining correct insurance reimbursement. Once a claim is coded accurately, the insurance payer knows exactly the services that were provided for the particular medical condition.

The most common musculoskeletal procedures performed in the US are knee arthroplasty, spinal fusion, and hip replacement. These three procedures constitute more than 1.3 million patient cases.