TRANSITION TO icd10-cm

1. 1

2. Chapter outlines
Physiological functions of the skeletal system
Main anatomical components of the skeletal system
General Histological aspects.
Types of bone tissues and types of cartilage tissues
Categories and examples of bones , bone markings
(projections and depressions)
Anatomy of the skeleton ( bone , cartilage)
The joint (articulation ) anatomy and different joints types
The muscular system : -Functions of muscular system.
-Histological and anatomical aspects ,
-Types of muscle tissues
-Properties of muscle tissue
2

3. 3
Exhibit 1

4. The skeletal system consists of :
Bone
Cartilag
e
Skeletal system
4

5. Skeletal system construction
• Starting from the basic functional and structural unit
of organism which is the cell
Cell
tissue
organs
system
organism
5

6. 6

7. Bone Composition
Matrix
•Calcium carbonate and calcium
phosphate:
•Make up 60-70% of bone weight
•Provide much of the bone’s stiffness and
resistance to pressing or squeezing forces
•Collagen (a protein):
•Gives bone its characteristic flexibility and
contributes
to its ability to resist pulling and stretching
forces
•With aging, collagen is lost progressively
and bone becomes more brittle.
•Water
Bone consists of much smaller proportion
of water than other body parts
Scattered
cells
The matrix is filled with living bone cells; such as:
1- osteoblasts: bone forming cells that cover new
bone. Make up the matrix .
2- osteocytes: these are mature osteocytes buried
in the matrix in small cavities called lacunae , and
they maintain bone structure interconnected with
other osteocytes by their cytoplasmic processes
(gap junction formation)through canaliculi , also
they act as mechanosensory cells that sense
mechanical stress, respond by stimulating
osteoblasts and osteoclasts  remolding
3- osteoclasts: large multinucleated absorbs and
remove osseous tissue. By (collagenase & acids)
As well as blood vessels that supply the cells
with nutrients
7

8. Bone marrow
• Highly specialized connective tissue
• There are 2 types of bone marrow :
Red marrow
Yellow marrow
Blood cell formation occurs in red bone Store fat for the body ,found mainly in
marrow , which is primarily stored in
the hollow spaces in the long bones of
spongy bone
adults
8

9. Cartilage
9

10. • Types of bones tissues
Bone
•Porosity
•High (Low mineral content and
high collagen)
•Low (High mineral content
and low collagen)
•Structure
•Honey comb
•Compact
•Characteristic
•Provides more flexibility but is
not as stress resistant
•Stiffer and can resist
greater stress but less
flexible
•Function
•Shock absorption due to its
better ability to change shape
are important
•It contains red marrow.
•Withstanding stress in
body areas that are subject
to higher impact loads
•e.g., vertebrae , ribs, skull ,
sternum, and pelvis of adults
•Long bones (e.g., bones of
the arms and legs)
•Location
10

11. Hyaline cartilage
Fibrocartilage
Elastic Cartilage
Most abundant in the body
Provide support and flexibility
It is strong and rigid
Provides strength and
maintains shape in the
structures it forms.
-Covers bone end ( articular
cartilage)
-At the end of the ribs its called
costal cartilage
-Forms part of the nose , larynx
, trachea , bronchi , and
bronchial tubes.
It joins the anterior pelvic
bones at the symphysis
pubis
It forms the discs that lie
between the vertebrae
Found in larynx , external ear
, and Eustachian tubes
Bluish white in color , has
glossy appearance.
Transparent collagenous fibers,
lacunae have abundance of
chondrocytes
Formed of bundles of visible
collagenous fibers with
chondrocytes scattered
throughout
Has threadlike elastic fibers
that contain chondrocytes 11
scattered throughout the
lacunae

12. Hyaline cartilage
Histological appearance
And sites
Fibrocartilage
Histological appearance
And sites
Elastic Cartilage
Histological appearance
And sites
12

13. Categories and
example of bones
13

14. Example: the femur, tibia, and
fibula of the legs; the humerus,
radii, and ulnae of the arms;
metacarpals and metatarsals of
the hands and feet, the phalanges
of the fingers and toes, and the
clavicles or collar bones.
Mainly made
of spongy bone
, and contains
bone marrow
Periosteum :
dense white
fibrous
membrane that
covers the
external surface
of the bone
Middle
section of
long bone
Made
mainly of
compact
bone
14

16. Sesamoid bones is a unique type of bone that forms
within tendons small rounded , including:
In the knee : the patella (within the quadriceps
tendon).
In the hand — two sesamoid bones are commonly
found in the distal portions of the first metacarpal
bone (within the tendons of adductor pollicis and
flexor pollicis brevis). There is also commonly a
sesamoid bone in distal portions of the second
metacarpal bone.
In the foot - the first metatarsal bone usually has
two sesamoid bones at its connection to the big toe
(both within the tendon of flexor hallucis brevis)
16

17. Bone Markings
types of bone markings:
• Projections (aka processes) that grow out from the
bone
• Depressions (cavities) that indent the bone
17

18. Projections
Ligaments & tendons
projections
Joints projections
1) Condyle: Rounded articular projection
2) Head: bony expansion on a narrow
neck
1)
Crest: Narrow ridge of bone
2) Epicondyle:
Raised area on or above a condyle
3) Tubercle: Small rounded projection
3)
Facet: smooth, nearly flat articular
surface
4) Ramus: Armlike bar of bone
4) Tuberosity: large rounded or
roughened projection
5) Trochanter: very large, blunt
projection (only on femur)
18

19. Other bone markings important for
coding
It is a prominent projection
Round opening through a bone
19

20. The skeleton
The appendicular
skeleton:
refers to the upper and lower limbs
appendicul
ar
The axial skeleton:
is formed by the bones and cartilaginous tissue in
the skull , vertebral column , and thoracic cage
skeleton
axial
20
Exhibit 4

21. 21

22. 22

23. The Facial bones
• The facial bones provide the facial structure and
provide attachments for the muscles that control
facial and jaw movement.
The face consists
• mobile bone. of 13 stationary bones and one
• The mandible (jawbone) is the only facial bone that
moves and is also the largest and strongest bone of
the face. The remaining bones of the face are:
23

24. 1.
2.
3.
Two palatine
4.
5.
6.
Two lacrimal
7.
Two maxilla
Two zygomatic
(cheekbones)
Two nasal
Two inferior nasal concha
(thin, curved bones that
form the lateral walls of
the nasal cavity
Vomer (located along the
midline of the nasal cavity
forming part of the nasal
septum)
24

25. 2-The vertebral column
composed of 26
individual bones. Of
these bones, 24 are
vertebrae that are
separated by cartilage
called intervertebral
discs.
supports the head and
trunk of the body and
protects the spinal cord.
Exhibit 4
25

26. The parts of vertebra
common structure
consisting of a
body, pedicles,
and lamina
that form the
vertebral arch. The
body and arch
come together and
form an opening
called the
vertebral foramen,
through which the
spinal cord passes
26

27. 27

28. -12 pairs of flat bones known as
the ribs articulate with the
thoracic vertebrae .
-The first seven pairs of ribs
meet up with the sternum
directly via costal cartilage.
The cartilage for the next three
pairs of ribs joins with the
costal cartilage of the seventh
rib.
The last two rib pairs do not
join the sternum at all (called
floating ribs)
28
Exhibit 5

29. Function of thoracic cage
• It also supports the shoulders and upper
limbs.
• It protects important internal organs ;as
the heart and the lung
• It gives attachments to muscles of the
upper limb and shoulder
Exhibit 6
29

30. 30

31. The upper limb + shoulder girdle
Exhibit 7
31

32. The wrist
The wrist is
composed of
eight short
bones called
carpals that
meet with the
radius and
ulna.
32

33. The lower limb and pelvic Girdle(hip)
Exhibit 8
Bones of the foot (tarsal , metatarsal , phalanges )
33
Exhibit 9

35. Articulations (joint)
Articulations, or joints, join two bones together and allow for movement
in response to muscle contractions
Fibrous
Cartilaginous
held together by dense
tissue
joined by cartilage
Synovial
have a fluid-filled cavity separating the
bones it joins; called the synovial cavity
fluid is Synovial fluid
The joint cavity is surrounded by a twolayer capsule called the articular capsule.
limited in movement
1-sutures: or seams, bones held
together by connective tissue, such
as those found in the cranium.
2-Gomphosis:found only as a
tooth in its socket
3-syndesmoses:bones joined by a
ligament as articulation between
the tibia and fibula
Do provide for some
free moving and therefore structurally
movement
more complex
The first rib to the
majority of joints in the human body
sternum
It is reinforced by ligaments
35

36. Fibrous joints
Suture joint of the skull
Gomphosis joint
Syndesmoses
36

37. Cartilaginous joint
Joints between the ribs
and the sternum
37

38. 38

39. 2- Condyloid
•These types of
joints move in
all directions.
•An example is
the hip joint ;
•Articulation
between the
head of the
femur and the
acetabulum
•Protrusion of
one bone
meets a
depression of
another to
form this type
of joint.
•Examples are
the wrist
(radius and
carpals) and
Knuckles )
metacarpal
and proximal
phalanges.
• Convex
portion of a
bone meets
with the
concave part of
another to
form a hinge
joint.
•It allows
movement in
one axis
•Example: The
elbow and
knee are large
hinge joints.
Rounded
or
pointed
protrusion
of one
bone
moves
back
and
forth is
a pivot
•Flat
surfaces of
2 flat bones
glide
against one
another
•examples
 The joints
between the
short carpals (
intercarpals )
 The joints
between the
short tarsals (
intertarsals )
•One bone has
a depression
shaped
somewhat like
an equestrian
saddle.
• the joint is
formed by a
second bone
straddling that
depression.
•Allows the
unique
opposition of
the human
thumb.
joint
39
Exhibit 10
Exhibit 11
Exhibit 12
Exhibit 13
Exhibit 14
Exhibit 15

40. 40

41. Functions of the muscular system
41

42. Muscles construction
• Starting from the basic functional and structural unit
of organism which is the cell
Cell (fibers)  tissue  organs  system  organism
42
Exhibit 16

43. Properties of muscle tissue
• Irritability : Ability to electrically respond to
stimuli
• Contractility : Ability to shorten and thicken
when sufficient stimulus is received
• Extensibility : Ability to be stretched when
pulled.
• Elasticity : Ability to return to their original
shape after contraction or extension
43

44. Types of Muscle Tissue
Types and Importance of each :
Skeletal muscles
Attached to the skeleton
(bones)
Responsible for voluntary
movement
Striated,cylindrical,
multinucleated
Cardiac muscles
no
Responsible for heart
contraction (involuntary)
Striated,single nucleus,
branching , intercalated
discs
smooth muscles
no
Responsible for involuntary
movement of the GIT
Non striated,spindle
shap,centrally located
nucleus
44

45. • Skeletal muscles :
1.
They are voluntary muscles .
2.
attached to bone (Skeleton)
3.
Attached to the articulating bones that form joints.
Proximal , more
stationary bone
Distal . More
mobile
45

46. •
•
Skeletal muscles produce movement by pulling on:
1-Tendons.
2-aponeurosis.
NB: Tendons are strong sheets of connective tissue, and are identical to
ligaments. Tendons attach muscle to bone and ligaments attach bone to
bone
3-Other connective tissue
structures which in turn
pull on bones or other
muscles
The place where a tendon
attaches to the
more stationary
bone is called
the origin
• and the attachment to the more
movable bone is called the
insertion.
Usually the tendon origin is the
more proximal point of attachment
and the insertion is the more distal.
The fleshy part of the muscle
between the two bones is called the
belly or gaster
46

47. There are nearly 700 skeletal muscles in the human body.
These muscles are named based on one or more of the following
criteria:
1- Direction of muscle fibers, such
as rectus, transverse, oblique
2-Location, such as temporalis,
tibialis
3-Size, such as maximus, minimus,
brevis, longus
4-Number of origins, such as
biceps, triceps, quadriceps.
5-Site of origin and insertion,
such as brachioradialis
6-Shape, such as deltoid,
trapezius
7- Action, such as flexor, extensor,
abductor, adductor
47

48. • For coding purpose , it is more important to know the
general location of muscles since
diseases, disorders, and injuries of the muscles are
generally reported using the site of the disorder rather
than the specific muscle.
• For example, a muscle contracture is reported by
laterality (right or left side) and by general region
(shoulder, upper arm, forearm, hand, thigh, lower
leg, ankle, foot).
48

49. Diseases and Injuries of the skeletal system
49

50. Comparison of ICD-9-CM/ICD-10-CM
Musculoskeletal System Coding (Chapter 13)
ICD-9-CM (710-739)
• Site and Laterality
• Bone, joint or muscle
• Multiple sites codes
• Bone versus Joint
e.g. osteoporosis M80, M81
• Acute traumatic versus
chronic or recurrent MS
conditions
• Chapter 13 versus Chapter 19
50

51. Comparison of ICD-9-CM/ICD-10-CM
Musculoskeletal System Coding (Chapter 13)
ICD-9-CM (710-739)
• Pathologic #s
ICD-10-CM (M00-M99)
• Pathologic #s
• Acute vs. aftercare
• 733.1; V54.0, V54.2….
• Coding includes 7th digit
extension for episode of
care
• A= Active care; D=after
active treatment; others
are subsequent
encounters and sequela
(S)
• Open/closed
•
51

52. Comparison of ICD-9-CM/ICD-10-CM
Musculoskeletal System Coding (Chapter 13)
ICD-9-CM (710-739)
ICD-10-CM (M00-M99)
• Osteoporosis
• “Site” applicable if +
pathologic fracture
• a: without pathological #
• Category M81
• b: with current
pathological #
• M80
• Site (of #) is included
• Every patient with
osteoporosis
52

53. Fractures
Pathological
Traumatic
Relating to a
condition that is
caused by or
Involves a disease
process.
Osteoporosis
others
Infection
Neoplastic
53

54. 54
Injuries to the skeletal system are quite common as it is a
rigid structure.
The joints are also fairly susceptible to injury

55. Fracture
• A break or crack in the bone caused when physical force exerted on
the bone is stronger than the bone itself
55

56. Some important definitions:
• Closed fracture: Bone
fracture not
accompanied by a break
in skin.
• open fracture.
Fracture in which the
broken end or ends of
the bone have pierced
the skin.
56

57. Some important definitions:
• Displaced fracture: Bone break in which the two
broken ends are separated.
57

58. Some important definitions:
malunion
58

59. Some important definitions:
nonunion
59

60. Some important definitions:
torus fracture. the bone with little or no displacement at
Buckling or bowing of
the end and no breakage, usually occurring in children due to
softer bone tissue.
60
Torus Fracture of the wrist

61. Apophyseal fracture
• Avulsion fracture in which a bony prominence, such as a process or
tuberosity removed from its bone at a point of strong tendinous
attachment
61

62. 62

63. Greenstick fracture
Incomplete fracture In which the bone Is bent
but fractured only on the outer arc of the bend.
63

64. spiral fracture.
• Bone break in which the disruption of the bone is spiral
to the shaft of the bone.
64

65. Monteggia's fracture.
• Break in the proximal half of the ulna accompanied by A radial
dislocation of the radial head
65

66. Neoplastic lesion
may results in fracture
Relating to any
abnormal growth of
new tissue, benign or
malignant; in this
case, usually a
malignancy.
66

67. Salter-Harris fracture
Fractures through a growth plate.
Salter-Harris
fracture
67

68. To code for a pathological fracture in ICD10-CM, the followings are necessary:
1.
2.
3.
4.
Anatomic site
Laterality
Underlying condition
Episode of care (assigned as the seventh character
extension)
Next : Episode of care (assigned as the seventh character extension)
•
•
•
•
•
•
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 = sequel
68

69. ICD 10 approach to Pathological
fractures
• There are three subcategories for pathological fractures in ICD-10-CM
M 8 4.
Pathological fracture,
not elsewhere classified
Pathological fracture in
neoplastic disease
Pathological fracture in
other disease
69

70. By determining the location & laterality of the pathological
fracture 2 more characters are added
M
M
M
M
M
M
M
M
M
8
8
8
8
8
8
8
8
8
4.
4.
4.
4.
4.
4.
4.
4.
4.
4
4
4
4
4
4
4
4
4
7
7
7
7
7
7
7
7
7
1
2
3
4
5
6
7
8
9
70
-

71. By determining the episode of care :
7th digit is added.
• 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 = sequel
71

72. example :
M 8 4. 4 7 5 A
72

73. NB:
• Sometimes when there is not enough digits
seventh charter, require placeholders so that the seventh digit
extension falls to the seventh character.
Example:
Code M84.48—Pathological fracture, other site, requires a seventh
character to make it a complete code; however there are only five
characters currently. The appropriate code for the initial episode of
care would be
M 8 4. 4 8 X A
The “X” must be added as a placeholder in order to have the “A” fall
into the seventh character field. The seventh character extender must
always remain at the 7th character.
73

74. 74

75. Disorder characterized by bone degeneration.
Osteoporosis Is caused by the breakdown of
the bony matrix without equivalent
regeneration, resulting in a
weak, porous, fragile bone structure.
It is the most common type of bone disease as
studies indicate that about one in five American
women over the age of 50 is affected by
A bone
Has bony matrix
made of protein
Minerals calcium
and phosphates
compounds
osteoporosis.
half of these women will have a fracture of the
hip, wrist, or vertebra
75

76. Causes of osteoporosis:
The leading causes of osteoporosis are
• a drop in estrogen in women at the
time of menopause and a drop in
testosterone in men.
Other causes include:
• Confinement to a bed.
• Chronic rheumatoid arthritis
• Chronic kidney disease.
• Eating disorders
• Certain corticosteroids.
76

77. 77

78. To code osteoporosis in ICD-10-CM the
following is necessary:
• Type of osteoporosis
• With or without pathological fracture
• With pathological fracture
- Site of fracture must be identified
• Without pathological fracture
• Episode of care (assigned as a seventh digit extension)
•
•
•
•
•
•
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 (late effect)
78

79. The ICD-10-CM code range for Disorders of bone
density and structure is M80–M85.
Osteoporosis
with current
pathological
fracture
Osteoporosis
without current
pathological
fracture
Adult
osteomalacia
Disorder of
continuity of
bone
Other disorders
of bone density
and structure
79

80. The documentation in the clinical record will be the guide for
the selection of the most appropriate character.
According to the official ICD-10-CM
guidelines,
osteoporosis is a systemic
condition, meaning that all bones of the musculoskeletal
system are affected.
Site is not a component of the codes under category M81,
osteoporosis without current pathological fracture.
The site codes under category M80, osteoporosis with
current pathological fracture, identify the site of the
fracture, not the osteoporosis
80

81. Age-related osteoporosis with
current pathological fracture
right shoulder
M 8 0. 0 1 1 A
initial episode of care
Age-related osteoporosis with
current pathological fracture
left shoulder
Subsequent encounter for
fracture with malunion
Age-related osteoporosis with
current pathological fracture
Unspecified shoulder
Sequela
M 8 0. 0 1 2 K
M 8 0. 0 1 9 S
81

82. Other osteoporosis with current
pathological fracture
right shoulder
M 8 0. 8 1 1 A
initial episode of care
Other osteoporosis with current
pathological fracture
left shoulder
Subsequent encounter for
fracture with malunion
Other osteoporosis with current
pathological fracture
Unspecified shoulder
Sequela
M 8 0. 8 1 2 K
M 8 0. 8 1 9 S
82

83. osteoporosis without current pathological fracture
M81
83

84. 84

85. • It is the point of articulation
between 2 bones as
mentioned before .
Joint between the sternum
and the clavicle.
85
Exhibit 17

86. 
86

87. • Dislocations can occur in
,
,
,
in the
joints.
, and
as well as
When a dislocation occurs, the joint can’t be moved.
Dislocated joints often are swollen, very painful, and
visibly out of place.
•
•
•
manipulations to reposition the bones.
medicine.
a splint or sling, and rehabilitation.
87

88. Strains , Sprains , Tears
sprain
It is an injury to a
ligament
strain
Tear
It is an injury to
either a muscle or a
tendon.
Tearing (part or all) of
the muscle fibers and
the tendons attached to
the muscle.
Depending on the severity
of the injury, a strain may be
a simple overstretch of the
muscle or tendon, or it can
result in a partial or
complete tear.
The tearing of the
muscle can also damage
small blood vessels,
causing local bleeding
(bruising) and pain
Site : The most commonly
injured ligaments are in the
ankle, knee, and wrist.
It involve a stretching or a
tearing of this tissue.
88

89. To code for dislocations in ICD-10-CM
the following is necessary
1-Anatomic site
2-Laterality
3-Type of injury
[Dislocation o Subluxation o Sprain ]
4. Episode of care (assigned as the seventh digit extension)
A = initial encounter
D = subsequent encounter
S = sequel
89

90. ICD 10 approach to Dislocation
S
S
S
S
S
S
S
S
S
S
0
1
2
3
4
5
6
7
8
9
3.
3.
3.
3.
3.
3.
3.
3.
3.
3.
90

91. We will pick up Dislocation and sprain of joints and ligaments of
shoulder girdle S43. category
By determining direction of subluxation 2 more characters are added
S 4 3. 0 0
S 4 3. 0 1
S 4 3. 0 2
S 4 3. 0 3
S 4 3. 0 8
91

92. By determining laterality and distinguishing between subluxation and
dislocation: 1 more character is added
S 4 3. 0 1 1 S 4 3. 0 1 2 S 4 3. 0 1 3 S 4 3. 0 1 4 S 4 3. 0 1 5 -
S 4 3. 0 1 6 -
92

93. S 4 3. 0 1 2 D
93

94. 94
Arthritis is a group of conditions involving
damage to the joints of the body. There are
over 100 different forms of arthritis.
The most common type is osteoarthritis
A common type is rheumatoid arthritis

95. 95

96. • also known as inflammatory degenerative joint disease.
Causes : which can result from trauma to the joint, infection of the
joint, or age (It affects the elderly and cannot be cured.)
Symptoms: The most common symptom of arthritis is constant
pain, The pain it causes can be debilitating and prevent one from doing any
type of activity.
Pathophysiology :
Osteoarthritis can affect both the larger and smaller joints of the
body, including the hands, feet, back, hip, or knee. Osteoarthritis begins in
the cartilage and eventually leads to the two opposing bones eroding into
each other, acquired from daily wear and tear of the joint.
Prevention and treatment: It can be prevented from
worsening through weight loss, and muscle strengthening. In the very
advanced stages, surgery may be required to include joint replacement.
96

97. Types of osteoarthritis
97

98. Exhibit 18
• RA is chronic inflammation and destruction
of the joint tissues due to an autoimmune
disorder.
• RA can also affect other body systems and
organs and is, therefore, sometimes
considered a systemic disease.
• most damage occurs
to the joint lining and cartilage, which
eventually results in erosion of two opposing
bones.
98

99. • Rheumatoid arthritis is an autoimmune disease that affects
joints in the fingers, wrists, knees, and elbows. The disease
can lead to severe deformity within a few years if not treated.
• Rheumatoid arthritis occurs mostly in people aged 20 and
above.
In children, the disorder can present with a skin rash, fever, pain, disability, and
limitations in daily activities
1-Joint pain and swelling
2-Stiffness, especially in the morning or after sitting for long periods
3-Fatigue.
4-Firm bumps of tissue under the skin.
99

100. Neuropathy
inflammation
and
disfigurement
of the
joints, causing
compression
and
entrapment of
nerves
100

101. The ICD-10-CM codes for osteoarthritis
are found in sections M15.– M19.
• To code for arthritis in ICD-10-CM, the following
is necessary:
- Type of osteoarthritis
- primary.
- secondary.
- traumatic
- Laterality
101

102. osteoarthritis of knee Primary--Bilateral
Unilateral primary osteoarthritis.
unspecified knee
Unilateral primary osteoarthritis
Right knee
Unilateral primary osteoarthritis
left knee
Osteoarthritis of knee
Secondary Post-traumatic Bilateral
Unilateral post-traumatic osteoarthritis
unspecified knee
Unilateral post-traumatic osteoarthritis
right knee
Unilateral post-traumatic osteoarthritis
left knee
Osteoarthritis of knee
Secondary Due to other cause Bilateral
unilateral secondary osteoarthritis
Due to other cause
M
M
M
M
M
M
M
M
1
1
1
1
1
1
1
1
7.
7.
7.
7.
0
1 0
1 1
1 2
7.
7.
7.
7.
2
3 0
3 1
3 2
M 1 7. 4
M 1 7. 5
102