ICD-10-CM Coding Guidelines for Medical Conditions, Exams of Nursing

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PROCEDURE CODING 101-009 Week 2

Chapter 4;QUESTIONS WITH VERIFIED

SOLUTIONS BEST UPDATE 2023 / 2024

- Question 1 10 out of 10 points A type 2 diabetic patient with diabetic retinopathy visits his ophthalmologist for blurred vision. After performing a visual acuity test and a dilated eye exam, the provider states the patient has macular edema. Applying the coding concept from ICD-10-CM Coding guideline I.C.4.a., what ICD-10-CM code is reported? Selected Answer: a. E11. Answers: a. E11. b. E11. c.

E08.

d. E10. Response Feedback: Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a the diabetes codes are combination codes that include the type of diabetes, the body system affected, and the complications affecting that body system. To locate the codes in the ICD-10-CM code book, look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/with/retinopathy/with macular edema E11.311. Verify code choice in the Tabular List.

- Question 2 0 out of 10 points A 22-year-old female is admitted to ICU for acute renal (kidney) failure due to sepsis (causal organism unknown). Applying the coding concept from ICD-10-CM guideline I.C.1.d.1.b, what ICD-10-CM codes are reported (in the correct sequencing)?

Selected Answer: b. N17.9, R65.20, A41. Answers: a. A41.9, R65.20, N17. b. N17.9, R65.20, A41. c. R65.21, A41.9, N17. d. N17.9, R65.21, A41. Response Feedback: Rationale: ICD-10-CM guideline I.C.1.d.1.b indicates: The coding of severe sepsis requires a minimum of two codes. First, a code for the underlying systemic infection, followed by a code from subcategory R65.2, Severe sepsis. If the causal organism is not documented, assign code A41.9, Sepsis, unspecified organism, for the infection. Additional codes(s) for the associated acute organ dysfunction are also required (if present). The first code to report is sepsis; look for the main term Sepsis in the ICD 10- CM Alphabetic Index referring you to code A41.9.

Next, look for Sepsis/with organ dysfunction (acute) (multiple) referring you to code R65.20. For the last code, look for Failure/renal/acute referring you to code N17.9. In the Tabular List you will find an instructional note under subcategory R65.2 indicating what codes should be reported first and what codes should be reported as additional codes.

- Question 3 10 out of 10 points A 45 year-old female with ovarian cancer visits her oncologist to receive an injection of Procrit®. The Procrit® has been prescribed to her for treatment of her anemia resulting from antineoplastic chemotherapy treatment. Applying the coding concept from ICD-10-CM guidelines I.C.2.c.2. What ICD-10-CM codes should be reported? Selected Answer: a.

D64.81, C56.9, T45.1X5A

Answers: a. D64.81, C56.9, T45.1X5A b. D64.81, C56. c. C56.9, D64. d. T45.1X5A, D64.81, C56. Response Feedback: Rationale: According to ICD-10-CM guidelines 1.C.2.c.2., because the treatment is directed at the anemia associated with chemotherapy, and the treatment is only for the anemia, the anemia should be sequenced first, followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5). Look in the ICD 10-CM Alphabetic Index for Anemia/due to (in) (with)/antineoplastic chemotherapy (D64.81). According to guideline 1.C.2.c.2. the malignancy is reported secondarily followed by code T45.1X5. Look in the ICD-10-CM Table of Neoplasms for ovary and report the code

from the Malignant Primary column (C56.-). In the Tabular List, C56.9 is reported because the laterality is not stated. Next, to locate T45.1X5 look in the Table of Drugs and Chemicals for Antineoplastic NEC and selecting the code from the Adverse effect column (T45.1X5). In the Tabular List, T45.1X5 requires a 7th character extender. A is selected because this is considered active treatment.

- Question 4 10 out of 10 points A patient presents with right ear pain and fever. The provider diagnoses acute otitis media. What ICD-10-CM code(s) is/are reported? Selected Answer: d. H66.

Answers: a. H92.01, R50. b. H66. c. H92. d. H66. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Otitis (acute)/media/acute, subacute H66.90. In reviewing the Tabular List, H66.90 is unspecified and there are more specific codes that indicate laterality. The 5th character 1 indicates the right ear. Right ear pain (H92.01) and fever (R50.9) are signs/symptoms for the acute otitis media and not separately reported (refer to ICD-10-CM guideline I.B.5).

- Question 5 10 out of 10 points Applying the coding concept from ICD-10-CM guideline I.C.9.a.5, how do you code hypertensive retinopathy?

Selected Answer: d. Sequencing is based on the reason for the encounter. Answers: a. First code the hypertension, then the retinopathy. b. First code the retinopathy, then the heart disease. c.

First code the heart disease, then the retinopathy. d. Sequencing is based on the reason for the encounter. Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.9.a.5, state Background retinopathy and retinal vascular changes, should be used with a code from category I10-I15 to identify the hypertension. Sequencing is based on the reason for the encounter.

- Question 6 0 out of 10 points A mother brings her son into the doctor because he has been getting in trouble in school for his behavior. He is not paying attention or following the instructions. He is constantly losing his pencil and forgetting to bring in his homework. After evaluating the child, the provider diagnoses him with attention deficit hyperactivity disorder (ADHD), predominately inattentive type, and sends the patient for a consultation with a psychiatrist to see if medication can help. Select the diagnosis code. Selected Answer: b. F90.

Answers: a. F90. b. F90. c. F90. d. F90. Response Rationale: The patient is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), predominately inattentive type. In the

Feedback: ICD^ 10-CM^ Alphabetic^ Index,^ look^ for^ Disorder (of)/attention deficit hyperactivity (adolescent) (adult) (child)/inattentive type F90.0. Verify code selection in the Tabular List.

- Question 7 10 out of 10 points A patient presents for a liver transplant. The provider documents the patient has Laennec’s cirrhosis associated with long term alcohol dependent use. What is the diagnosis code for this encounter? Selected Answer: a. K70.30, F10. Answers: a. K70.30, F10. b. K70.0, F10. c. K76.89, F10. d.

K74.60, F10.

Response Feedback: Rationale: In the ICD 10-CM Alphabetic Index, look for Cirrhosis, cirrhotic (hepatic) (liver)/Laennec’s /alcoholic K 70. 30. In this scenario the patient has a history of alcohol use making K70.30 the correct code. There is an instructional note under category code K70 to use additional code to identify alcohol abuse and dependence. The patient is alcohol dependent. In the Alphabetic Index look for Dependence/alcohol referring you to code F10.20. Verify code selection in the Tabular List.

- Question 8 10 out of 10 points

A patient presents with pigmentary glaucoma bilaterally, moderate stage on the right, mild stage on the left. Reference ICD-10-CM guideline I.C.7.a.3. What ICD-10- CM code(s) is/are reported? Selected Answer: d. H40.1312, H40. Answers: a. H40. b. H40.1312, H40. c. H40.1332, H40. d. H40.1312, H40. Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.7.a.3, state when the glaucoma codes report laterality, and each eye is in a different stage, a code is reported for each eye. Look in the ICD-10- CM Alphabetic Index for Glaucoma/pigmentary and you are directed to see Glaucoma, open angle, primary, pigmentary. This path directs you to code

H40.13-. In the Tabular List, 6th character 1 indicates the right eye, 7th character 2 indicates moderate stage. For the left eye, 6th character 2 indicates the left eye and 7th character 1 indicates mild stage. The moderate stage is reported first because it is more severe.

- Question 9 10 out of 10 points Referencing ICD-10-CM guideline I.C.6.b.1.a., when should a code from category G89 be reported as a first-listed diagnosis? Selected Answer: b. When the pain control or pain management is the purpose of the encounter

Answers: a. Whenever it is documented b. When the pain control or pain management is the purpose of the encounter c. Only within the first 72 hours of continuous pain d. When the pain is chronic Response Feedback: Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.6.a.1.(a), when pain control or pain management is the reason for the admission/encounter, a diagnosis from G89 can be reported as the primary diagnosis.

- Question 10 10 out of 10 points Mr. McFarland visits his oncologist for prostate cancer. He is reporting more fatigue than usual. Lab tests determine the patient has anemia due to the cancer. Applying the coding concept from ICD-10-CM guideline I.C.2.c.1., what ICD-10-CM

codes should be reported for the visit? Selected Answer: a. C61, D63. Answers: a. C61, D63. b. C61, D64. c.

D63.0, C

d. D64.81, C Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.2.c.1, states when the admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for the anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia. The patient visited the oncologist for the prostate cancer and the lab tests indicate anemia due to cancer. According to the guidelines, the primary diagnosis reported for the visit, is prostate cancer. Look in the Table of Neoplasms for prostate (gland) and select the code from the Malignant Primary column C61. Then look in the Alphabetic Index for Anemia/in (due to) (with)/ neoplastic disease D63.0. Verify codes in the Tabular List. Tuesday, June 30, 2020 4:46:01 PM EDT

- Question 1

10 out of 10 points Name an example of when a problem caused by diabetes is NOT sequenced after the code for diabetes. Refer to ICD-10- CM guideline I.C.4.a.5.a. Selected Answer: a. When a patient’s insulin pump malfunctions. Answers: a. When a patient’s insulin pump malfunctions. b. When the patient has Type II diabetes. c.

When the patient has Type I diabetes. d. When the patient has end stage renal disease caused by diabetes. Response Feedback: Rationale: The ICD-10-CM Official Coding Guidelines, Section I.C.4.a.5.a states to use a code from category T85.6 as the primary diagnosis for an underdose of insulin, due to insulin pump malfunction. The second code would be T38.3x6-, for the underdosing of insulin, followed by the appropriate diabetes mellitus code based on documentation.

- Question 2 10 out of 10 points A patient presents with pigmentary glaucoma bilaterally, moderate stage on the right, mild stage on the left. Reference ICD-10-CM guideline I.C.7.a.3. What ICD-10- CM code(s) is/are reported? Selected Answer: d. H40.1312, H40. Answers: a.

H40.

b. H40.1312, H40. c. H40.1332, H40. d. H40.1312, H40. Response Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.7.a.3, state when the glaucoma codes report laterality, and each eye is in a

Feedback: different stage, a code is reported for each eye. Look in the ICD-10- CM Alphabetic Index for Glaucoma/pigmentary and you are directed to see Glaucoma, open angle, primary, pigmentary. This path directs you to code H40.13-. In the Tabular List, 6th character 1 indicates the right eye, 7th character 2 indicates moderate stage. For the left eye, 6th character 2 indicates the left eye and 7th character 1 indicates mild stage. The moderate stage is reported first because it is more severe.

- Question 3 10 out of 10 points A patient is admitted to the hospital with pneumonia. Testing indicates the patient's pneumonia is due to Staphylococcus aureaus and is methicillin resistant (MRSA). Applying the coding concept from ICD-10-CM guideline I.C.1.e.1.a, what ICD-10-CM code(s) is/are reported? Selected Answer: b. J15.212 Answers: a. J18.9 b. J15.212

c. J15.212, A41.02 d. J18.9, A41.02 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Pneumonia/in (due to)/staphylococcus/aureus/methicillin resistant (MRSA) J15.212. According to ICD-10-CM guideline 1.C.1.e.1.(a), when a combination code exists for MRSA and the infection, only the combination code should be reported. Pneumonia due to Methicillin- resistant Staphylococcus aureus is reported with J15.212.

- Question 4

10 out of 10 points Referencing ICD-10-CM guideline I.C.6.b.1.a., when should a code from category G89 be reported as a first-listed diagnosis? Selected Answer: b. When the pain control or pain management is the purpose of the encounter Answers: a. Whenever it is documented b. When the pain control or pain management is the purpose of the encounter c. Only within the first 72 hours of continuous pain d. When the pain is chronic Response Feedback: Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.6.a.1.(a), when pain control or pain management is the reason for the admission/encounter, a diagnosis from G89 can be reported as the primary diagnosis.

- Question 5 10 out of 10 points Referencing ICD-10-CM guideline I.A.13, when using a code from category D63 it is also necessary to code first: Selected Answer: c. The chronic condition causing the anemia Answers: a.

The hematocrit level of the patient b. A primary (first-listed) diagnosis c. The chronic condition causing the anemia d. The acute condition presented in the patient encounter Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.A.13., state when using a code from a category that indicates "in diseases classified elsewhere", such as in category D63, it is necessary to code first, the chronic condition (underlying condition) causing the anemia. The codes from category D63 are manifestation codes that must be reported as the additional code following the underlying condition.

- Question 6 10 out of 10 points A patient presents with right ear pain and fever. The provider