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HCS-D Practice

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1. Sepsis is a systemic inflammatory reaction to an infection and may be coded in homecare. a. False, sepsis is an infection. b. False, because sepsis is an acute condition that only occurs in the hospital. c. False, sepsis is a systemic inflammatory reaction to an infection and may not be coded in homecare. d. True, and the inflammatory reaction can continue to cause problems even after the infection is resolved. d. True, and the inflammatory reaction can continue to cause problems even after the infection is resolved.
2. Chapter 13 codes that represent laterality include the site of the: a. Joint b. Bone c. Muscle d. All of the Above

d. All of the Above

3. Patient admitted to HH for observation and assessment of his unstable angina. He had a CABG 2 years ago and cardiac catheterization shows CAD but the bypass grafts are patent. He also has documented atrial fibrillation and HTN. How would you code this? a. I25.110, I20.0, I48.1, I b. I20.0, I48.91, I10, Z95. c. I25.110, I48.91, I10, Z95. d. I25.700, I10, I48. c. I25.110, I48.91, I10, Z95.
4. The physician documented an infected surgical wound in the abdomen after an appendectomy, and coded S31.613A. What is the incorrect statement regarding this coding? a. We do not have to query the physician for the type of wound. b. Trauma wounds or open wounds codes are never to be used for surgical wounds or surgical complications. c. We have to code what the physician codes. d. The coder should use the description in the documentation to code, not the code itself. c. We have to code what the physician codes. **We code according to physician documentation, not the coding.
5. How should pneumonia due to an unspecified organism be coded? a. J18. b. J16. c. J18. d. J18.

**The heart failure is documented as due to HTN, so code from Category I11 is used for hypertensive heart disease. Instructional note states to use additional code for the heart failure, so that code follows the I11.0 code. The type of heart failure is specified as acute on chronic diastolic, the code I50.33 includes the congestive heart failure so the I50.9 code is not needed.

9. The physician documented that the diabetes is uncontrolled. Which of the following is the correct statement regarding uncontrolled diabetes? a. Code Type 2 diabetes with hyperosmolarity b. Add a 6th character for uncontrolled c. Code E11. d. Query whether the patient has hyperglycemia, hypoglycemia or both d. Query whether the patient has hyperglycemia, hypoglycemia or both **There is no special character or digit for uncontrolled. "Uncontrolled" can mean hyperglycemia or hypoglycemia
10. The patient has secondary diabetes and polyneuropathy. What is the correct coding? a. E08. b. G63, E11. c. E13.9, G62. d. E13. d. E13.
11. The physician documented severe obesity but did not document the BMI. What should you do? a. Document and code the BMI to match the physician's statement of severe obesity. b. Leave the code off if the physician didn't document the BMI c. Code BMI based on the clinician's calculations.

c. Code BMI based on the clinician's calculations.

12. Patient is admitted to home health for wound care to her atherosclerotic ulcer of the left ankle. Upon assessment, the nurse documents necrosis of muscle tissue is present. The patient also has left non-dominant hemiplegia from a stroke 4 years ago. How would you code this? a. I70.243, L97.323, I69. b. I70.243, L97.323, I69. c. I70.243, I69. d. I70.233, I97.323, I69. b. I70.243, L97.323, I69. **The atherosclerosis of native arteries of left leg with an ulcer is coded to L70.243 - the L70.233 is incorrect because it is the right leg. The instructional note at L70.24 states to use additional code to identify the severity of the ulcer, which can be coded based on the clinician's documentation. The correct code for the stroke deficit is I69.354 - the I69.9 should not be used per the Excludes 1 note under I69.9 category.
13. To find the code for use of supplemental oxygen, look under ________ in the alphabetical index. a. use of, oxygen, supplemental b. oxygen, dependence on c. dependence, supplemental oxygen d. status, supplemental oxygen c. dependence, supplemental oxygen
14. Patient with fractured right hip and osteoporosis. Hip replacement was performed. History states that the patient fell when getting up from his chair. Admitted to home health for therapy.

a. I50.9, T50.1x6D, Z91.120, Z99. **This scenario follows the coding sequencing for underdosing. Z99.3 is found under dependence, on, wheelchair.

17. A combative patient with Alzheimer's Dementia is admitted. On SOC assessment, it is noted that the patient has urinary and fecal incontinence related to dementia, and wears adult diapers. The patient has a diaper rash in the genital and anal area, and the daughter admits, she can only get her dad to let her change his diaper a couple of times a day due to the combativeness. The nurse calls and discusses options with the physician, which includes providing a zinc based ointment to put on the area at each diaper change. How would the coder assign codes to this patient? a. G30.9, F02.81, L22, R39.81, R15. b. F03.91, L22, R39.81, R15. c. G30.8, F03.91, R21, R39.81, R15. d. G30.9, F02.80, L23.7, R32, R15. a. G30.9, F02.81, L22, R39.81, R15.
18. Which of the following is the correct statement regarding use of 7th character D in home health and hospice? a. 7th character D is used for a healing/resolving injury or complication. b. The 7th character D is always the correct 7th character for home health patients. c. 7th character D should never be used for injuries/complications in M1011. d. 7th character D doesn't show medical necessity well; 7th character A works better. a. 7th character D is used for a healing/resolving injury or complication.
19. A diagnosis from the R chapter (Signs and Symptoms) has been placed before the code for cancer. What should you, as the coder, do?

a. Code the cancer before the sign/symptom if allowed by the clinician. b. Query whether the sign/symptom is associated with or caused by the cancer. c. Reference the alphabetical index to determine the correct sign/symptom code. d. Code the sign/symptom only if routinely associated with the cancer. b. Query whether the sign/symptom is associated with or caused by the cancer.

20. A patient is admitted to home health for physical therapy related to charcot's joint with documented 'unknown etiology' of the right shoulder, left ankle, and right foot. He also has a comorbidity of diabetes. How would this be coded? a. M14.611, M14.672, M14.671, E11. b. A52. c. E11.610, M14.611, M14.672, M14. d. E11. a. M14.611, M14.672, M14.671, E11. ** If the patient had diabetes and charcot's joint, the charcot's would be assumed related to the diabetes. In this case, the physician documented unknown etiology, so do not code it as a manifestation of diabetes.
21. The patient does not have diabetes. How should hyperglycemia be coded? a. R73. b. R73. c. E11. d. R73. d. R73.
22. The patient had a fracture of the right femur during the insertion of the prosthetic joint. Periprosthetic fracture was the inpatient diagnosis. How would this be coded in M1011?

25. How is prediabetes coded? a. R73. b. E11. c. R73. d. R73. d. R73.
26. Your patient sustained a pathologic fracture of her right femur when rolling over in bed. SN, PT and OT are ordered. She has senile osteoporosis and had a vertebral pathologic fracture one year ago. How would this be coded? a. S72.8x1D, M81.0, Z87. b. M84.35xD, M81. c. M80.051D, Z87. d. M80.08xS, M81.0, S72.8x1D c. M80.051D, Z87. **Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
27. The 8 month old female has an intracranial AV hemangioma. The code is: a. Q82. b. D21. c. D18. c. D18.

28. A 70-year-old female presents to her family physician's office with atypical chest pain and fatigue. She is provided with a prescription for nitroglycerin. The patient is referred for an outpatient testing and expedient consultation with a cardiologist. Home Health to see and monitor cardiac status. How would this be coded? a. I25.119, R53. b. R53.82, I25. c. I20.8, R53. d. R07.89, R53. d. R07.89, R53.
29. 67 year old female admitted to home care following surgery to remove bladder due to CA, now has an ileal conduit, SN will instruct patient and caregiver in care of ileal conduit and appliance management. How would this be coded? a. Z48.816 - Z43.6 - Z90.6 - Z85. b. Z48.3 - Z43.6 - Z90.6 - Z85. c. Z48.816 - C67.9 - Z43.6 - Z90.6 - Z85. d. Z48.3 - C67.9 - Z43.6 - Z90. b. Z48.3 - Z43.6 - Z90.6 - Z85. **Aftercare following neoplasm is used, followed by attention to other artificial opening, absence of bladder and history of bladder cancer.
30. A 78-year-old male who is 15 years status post left total hip arthroplasty presents with increased pain and difficulty walking. He has had an unsteady gait for several years and has fallen on numerous occasions but refused evaluation prior to this visit. X-ray of the left femur reveals periprosthetic osteolysis with resulting major osseous defect. Arrangements will be made for revision of the hip replacement. How would this be coded? a. T84.051D, M89.

a. Query the provider as to type of diabetes. **Guidelines indicate that type II is the correct code for unspecified diabetes, but because ketoacidosis is so rare in type II DM, the physician must be queried for type.

33. A 68 year old female with a history of HTN has decided to have a facelift. The MD refers to home health following surgery for monitoring of incisions. Two days after surgery, she has developed a post auricle skin flap necrosis with underlying hematoma. How would this be coded? a. L76.82, L76.21, R b. L76. c. L76.82, L72. d. L76.82, L76. d. L76.82, L76.
34. The 48 year old male is paralyzed after his car slid off the road in the ice storm and hit a tree. Documentation states incomplete lesion at L3 with paraplegia. How should this patient be coded? a. S34.123S, G82. b. G82.22xD, S34.123S c. G82.22, S34.123S d. G82.20, S34.123D c. G82.22, S34.123S
35. Code basal cell carcinoma on the right eyelid. a. C44. b. C43.

c. C44. d. C44. c. C44.

36. Traumatic injuries are arranged by: a. Type of injury b. Site of injury b. Site of injury
37. Which of the following statements regarding metastasis is false? a. Metastasis means the cancer has migrated to other sites b. Metastasis is the initial location of the cancer c. Metastatic site is the same thing as secondary site d. The metastatic site is the same type of tumor as the primary cancer b. Metastasis is the initial location of the cancer
38. The patient had a subdural intracranial injury 2 months ago, and is returning home from the rehab facility with spastic hemiplegia affecting the left side and dysphasia. How should this be coded? a. S06.5x9S, I69.354, I69. b. G81.12, R47.02, S06.5x9S c. S06.5x9S, G81.12, R47. d. I69.354, I69.321, S06.5x9S b. G81.12, R47.02, S06.5x9S
39. The patient is being admitted to hospice after a head injury resulting in coma. Documentation indicates a subarachnoid hemorrhage. How should this be coded?

a. K85.9, F10. b. K85.30, F10. c. K85.20, F10. d. K86.0, F10. c. K85.20, F10.

43. What is the code for Bowen's disease, a carcinoma in situ? a. This code is impossible to find. b. I looked under carcinoma in situ and found the code. c. I looked under carcinoma in situ, Bowen's type and it directed me to Neoplasm, skin, in situ. d. The code is D04. d. The code is D04.
44. The patient injured his pancreas in a biking accident and had part of the lacerated pancreas surgically removed last year resulting in diabetes. How should this be coded? a. E13.9, E89.1, S36.231S b. E13.9, Z90. c. S36.231D, E08.9, Z90. d. E89.1, E13.9, Z90. d. E89.1, E13.9, Z90. **Postsurgical hypoinsulinemia or postpancreatectomy diabetes is coded E89.1, the appropriate E13 code(s) and then the Z90.41- code for absence of the pancreas.
45. Adnexa refers to:

a. Anatomical parts associated with an organ b. Optic nerve c. Abnormal ophthalmic conditions d. None of the Above a. Anatomical parts associated with an organ

46. 72 year old male has a flare of gout in his right foot. He has a history of frequent UTI, diabetic neuropathy, and benign hypertension. He also has frequent kidney stones as the result of the gout, and the MD states these are a chronic problem. How would this be coded? a. M10.071, N22, E11.40, I10, Z87. b. M1A.071, E11.40, I c. M1A.071, E11.40, I10, N22, Z87. d. M10.071, N20.2, E11.40, I10, Z87. a. M10.071, N22, E11.40, I10, Z87.
47. The patient has diabetes related to his cystic fibrosis. What is the correct coding? a. E13.9, E84. b. E84.8, E08. c. E08.9, E84. d. E08. b. E84.8, E08. **When diabetes is due to an underlying condition, choose E08. A convention at E08 states to code the underlying condition first.
48. Code cancer of the large ascending colon with metastasis to the liver. a. C18.0, C78.

51. A 75 year old male presents to the Emergency Department in winter with blisters and a red blotchy rash. Ten days ago he was started on carbamazepine for painful diabetic neuropathy. The patient is sent home with home health for wound care with diagnosis of pemphigoid due to the carbamazepine. How would this be coded? a. L12.31, T42.1x5D, E11. b. L12.31, L27.0, T42.1x5D, E11. c. L12.31, E11.40, L27.0, T42.1x5S d. L12.0, L27.0, E11. a. L12.31, T42.1x5D, E11. **This coding follows the adverse effect sequencing rule. Code the pemphigoid due to drug first, then reference carbamazepine in the Table of Drugs and Chemicals and choose the adverse effect code. Lastly code the diabetes with neuropathy.
52. To code organ failure as a result of sepsis, the coder should use codes for: a. Underlying systemic infection, septic shock, then organ failure b. Underlying systemic infection, organ failure c. Underlying systemic infection, severe sepsis, then organ failure d. Organ failure only because the sepsis was resolved in the hospital c. Underlying systemic infection, severe sepsis, then organ failure
53. PT eval and treat patient with history of degenerative disc disease, radiculopathy with ambulation (lumbosacral region), emphysema, history of prostate cancer. How would this be coded? a. M51.17, J44. b. M51.17, J43.9, Z85. c. M51.07, M54.17, J43.9, Z85. d. M51.17, J44.0, Z85.

b. M51.17, J43.9, Z85.

54. Type I patient with ketoacidosis in the hospital and continuing hyperglycemia at home who was found to have insulin pump failure. How would this be coded in M1011? a. T85.614A, E10.10, T38.3X6A, Z91. b. T85.614D, E10.10, E10.65, T38.3X6D, Y63. c. T85.614A, E10.10, T38.3X6A, Y63. d. T85.614A, E10.10, T38.3X6A d. T85.614A, E10.10, T38.3X6A **An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, that specifies the type of pump malfunction, as the principal or first-listed code, followed by code T38.3X6-, Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned. 7th character A would be used for the inpatient stay while providing active treatment. Sequencing should follow the sequencing indicated by the underdosing guideline. Y codes are not allowed in M1011. Hyperglycemia is not coded with ketoacidosis.
55. The patient was given a tracheostomy for pulmonary hygiene after aspiration pneumonia 5 months ago. The patient then developed an infection of the stoma with cellulitis followed by a TE fistula. Skilled nursing will provide care to the ostomy until the infection is resolved so that the TE fistula can be repaired. How should this be coded? a. Z43.0, Z95.04, J69. b. Z43.0, L03.8, Z95.04, Z87. c. J95.02, L03.8, Z95.04, Z87. d. J95.02, L03.221, J95.04, Z87.