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CCS Sample Multiple Choice
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- A patient was discharged from the hospital with a diagnosis of bronchial asthma. Upon reviewing the record, the coder notes the patient was described as having prolonged and intractable wheezing, airway obstruction not relieved by bronchodilators, and a decreased PAO2 lab value. The physician should be queried to determine whether the code for ___________is appropriate as the principal diagnosis: A. Acute viral Bronchitis B. COPD C. Respiratory failure D. Status asthmaticus - D. Status asthmaticus
- A patient was admitted to the hospital with severe dehydration and malnutrition. His blood sugar was elevated. The patient is a known alcohol abuser. Intravenous fluid replacement was given to hydrate the patient, who signed out against medical advice after two days. Final diagnoses were: severe dehydration with malnutrition and adult- onset diabetes vs. early cirrhosis associated with alcoholism. The principal diagnosis is: A. Adult-onset diabetes B. Alcohol abuse C. Cirrhosis of liver due to alcoholism D. Severe dehydration - D. Severe dehydration
- A patient is admitted to the hospital to undergo a radical mastectomy for recurrent carcinoma of the breast (Previously, she had elected to have a lumpectomy). The attending physician lists hx of atrial fibrillation as a secondary diagnosis. The patient is currently not on any medication. For medical clearance prior to surgery, the patient is seen by a consultant, who says that the patient was satisfactory for the procedure. The coder should:
A. Report atrial fibrillation as a current condition, because it was documented by the physician in the history. B. Code atrial fibrillation as a current condition, because the patient was seen by a consultant for surgical clearance. C. Add the code for observation for suspected cardiovascular condition D. Omit reporting the code for atrial fibrillation, because it was not treated and did not affect the course of treatment. - D. Omit reporting the code for atrial fibrillation, because it was not treated and did not affect the course of treatment.
- A patient has liver metastasis due to adenocarcinoma of the rectum which was resected two years ago. The patient has been receiving radiotherapy to the liver with some relief of pain. The patient is being admitted at this time for management of severe anemia due to the malignancy. The principal diagnosis listed on this admission is: A. Liver metastasis B. Adenocarcinoma of the rectum C. Anemia D. Admission for radiotherapy - A. Liver metastasis
- The first character of an ICD- 10 - CM code is: A. Always a number B. Always a letter C. Can be either a number or letter D. None of the above - B. Always a letter
- A patient undergoing hemodialysis for renal disease in the outpatient unit of a hospital develops what is believed to be heartburn. After a few hours of observation, he is admitted to the hospital for further care. The consulting cardiologist diagnoses this patient's condition as unstable angina. What is the principal diagnosis for the hospital stay? A. Complication of dialysis B. Heartburn C. Renal disease D. Unstable angina - D. Unstable angina
- A patient was being treated for gastric ulcer with hemorrhage, cirrhosis of liver and esophageal varices. Of the following medications, which would indicate a possible complication or comorbid condition that would impact DRG reimbursement? A. Bactrim®, 1 tablet q.i.d. B. Darvocet-N®, 100 mg prn C. HydroDIURIL®, 50 mg PO daily D. Tagamet®, 300 mg IM q 6 hrs - A. Bactrim®, 1 tablet q.i.d.
A. Acute on Chronic Systolic Congestive heart failure. B. Pneumonia C. Pick the one that pays the most D. Either Pneumonia or CHF could be sequenced first. - D. Either Pneumonia or CHF could be sequenced first.
- A patient has six actinic keratoses destroyed cryosurgically. What should be referenced under the CPT index? A. Excision, lesion, skin (malignant) B. Excision, lesion, skin (benign) C. Lesion, skin, excision D. Lesion, skin, destruction - D. Lesion, skin, destruction
- The following CPT codes appear: 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple, or areolar lesion (except 19140), male or female, one or more lesions 19125 Excision of breast lesion identified by preoperative placement of radiological marker; single lesion 19290 Preoperative placement of needle localization wire, breastThe patient underwent a needle localization with excision of a right breast lesion. Pathology revealed diffuse fibrocystic disease. Which of the following is the appropriate coding for this procedure? A. 19125; 19290 B. 19125 C. 19120; 19125 D. 19120; 19290 - B. 19125
- A 66 year old male patient admitted with atherosclerotic coronary artery disease presents with an acute anterior wall AMI. During the stay the patient develops post infarction angina. How is this coded? a) I21.09, I b) I21.09, I23.7, I25. c) I21.09, I23.7, I25. d) I21.09, I23.7, I25.119 - b) I21.09, I23.7, I25.
- A 32-year-old female was diagnosed with right upper-outer quadrant breast cancer during pregnancy and underwent treatment. Now three weeks post-delivery, she is coming for her third encounter of chemotherapy. a) O9A.13, C50. b) Z51.11, C50. c) Z51.11, O9A13, C50. d) Z51.11, Z85.3 - c) Z51.11, O9A13, C50.
- The patient is in the 29th week of pregnancy and has deep venous thrombosis of the left tibial vein. a) O22.33, I82.442, Z3A. b) O22. c) I82.442, Z3A. d) O22.33, Z3A.29 - a) O22.33, I82.442, Z3A.
- Which statement is true regarding coding excision debridement in ICD- 10 - PCS? a) Knife dissection means the same as an excisional debridement. b) Minor removal of loose fragments with scissors or using a sharp instrument to scrape away tissue is the same as excisional debridement. c) Excisional debridement is when the provider documents the excisional debridement and/or documentation meets the root operation definition of "excision". Excision of bone, fascia or muscle is always considered excisional - c) Excisional debridement is when the provider documents the excisional debridement and/or documentation meets the root operation definition of "excision". Excision of bone, fascia or muscle is always considered excisional
- A 62-year-old female patient is taken to the cardiac cath lab for percutaneous orbital atherectomy of the plaque in the right coronary artery using the Diamondback ®orbital atherectomy system, followed by balloon angioplasty and insertion of a drug-eluting stent. a) 027034Z b) X2C c) 02C03ZZ, 027034Z d) X2C0361, 027034Z - d) X2C0361, 027034Z History and Physical Findings: This 71-year-old male is a nursing home resident as a result of a cerebrovascular accident two years ago. He has had numerous hospital admissions for pneumonia and other infectious complications. On the day of admission, the patient was noted to be clammy, with tachypnea, to have decreased level of responsiveness, and to show increased fever. He was seen in the ER, where evaluation revealed the presence of probable urinary tract infection and sepsis. The patient was also found to have renal insufficiency with BUN and creatinine elevated. His WBC count
C80.1 Neoplasm Table, by site (unknown site or unspecified), malignant primary G30.1 Disease, diseased, Alzheimer's, late onset F02. S00.83XA Contusion (skin surface intact), head, specified part NEC F32.9 Depression (acute) (mental) J43.9 Emphysema (atrophic) (bullous) (chronic) (interlobular) (lung) (obstructive) (pulmonary) (senile) (vesicular) W05.0XXA Index to External Causes, Fall, falling (accidental) from, off, out of, wheelchair, non-moving Y92.129 Index to External Causes, Place of Occurrence, residence, institutional, nursing home Y99.8 Index to External Causes, External cause status, specified NEC Discharge Diagnoses:
- Carcinoma of the lung, right upper lobe, currently undergoing chemotherapy
- Type 2 diabetes, with neuropathy and nephropathy
- Hyperlipidemia
- Hepatomegaly History: This patient is a 58-year-old male who presented for outpatient chemotherapy. He had surgery for lung cancer three months ago and is now undergoing chemotherapy with Taxol and carboplatin, including dexamethasone as part of his chemotherapy and prophylaxis for nausea. He has done very well with the outpatient chemotherapy. When he presented for treatment on the day of admission, he was found to be hypoglycemic. He is a known type 2 diabetic which is also complicated by neuropathy and nephropathy. Due to his blood glucose levels, it was decided to postpone this chemotherapy session and he was admitted for control of his diabetes. Dr. Johnson consulted with the patient to manage his diabetes regimen. He has been on 70/30 insul - E11.649 Diabetes, diabetic (mellitus) (sugar), type 2, with hypoglycemia C34.11 Neoplasm Table, by site, (lung), upper lobe malignant, primary E11.21 Diabetes, diabetic (mellitus) (sugar), type 2, with nephropathy E11.40 Diabetes, diabetic (mellitus) (sugar), type 2, with neuropathy R16.0 Hepatomegaly, see also Hypertrophy, liver Hypertrophy, hypertrophic, liver E78.5 Hyperlipemia, hyperlipidemia Z79.4 Long-term (current) (prophylactic), drug therapy (use of), insulin Discharge Summary History of Present Illness: The patient is an 87-year-old female who was admitted from a nursing home with congestive heart failure, dehydration as well as urinary tract infection and thrombocytopenia with petechial hemorrhage. On admission she was found
to have a platelet count of 77,000 and a Hematology consult was done. The patient denied any bleeding diathesis in the past. She stated that she had recent bruising of the hands related to needle sticks, but otherwise has not had any past history of any bleeding disorder. No specific history of hematuria, hematemesis, gross rectal bleeding, or black stools. Past Medical History: Significant for congestive heart failure, diabetes Medications: Coreg, isosorbide, Actos, digoxin, glyburide, hydralazine, furosemide, Ditropan, and potassium Family History: No family history of any bleeding disorder Physical Examination: She is an elderly-appearing wh - I50.9 Failure, failed, heart (acute) (senile) (sudden), congestive (compensated) (decompensated) E86.0 Dehydration D69.49 Thrombocytopenia, thrombocytopenic, primary NEC N39.0 Infection, infected, infective (opportunistic), urinary (tract) E11.9 Diabetes, diabetic (mellitus) (sugar), type 2 Z79.84 Use of oral hypoglycemic drug INPATIENT CASE 6 (PCS CODES ONLY) Preoperative Diagnosis: Abnormal bleeding; pelvic pain; uterine retroversion and malposition; uterine descensus; abnormal liver function studies; status-postop ovarian cystectomies; status-postop cesarean section, tubal ligation Postoperative Diagnosis: Same Operation: Total abdominal hysterectomy; bilateral salpingo-oophorectomy; liver biopsy Procedure: With the patient in the supine position under general anesthesia, the abdomen was prepped and draped in the usual sterile fashion. A Pfannenstiel incision was made in the area of the patient's previous Pfannenstiel incision and this was carried down through the subcutaneous fat to the fascia, which was incised transversely. The fascia was dissected off of the underlying rectus muscles. Bleeders were coagulated. The rectus muscles were separated from the fascia above. There was some scarring of the fascia, particularly on the pati - 0UT90ZZ Resection, Uterus (0UT9) Hysterectomy, see Resection, Uterus (0UT9) 0UT20ZZ Resection, Ovary, Bilateral (0UT2) 0UT70ZZ Resection, Fallopian Tubes, Bilateral (0UT7) 0FB20ZX Excision, Liver, Left Lobe (0FB2) Biopsy, see Excision with qualifier Diagnostic
