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Understanding ICD-10-CM Coding Guidelines, Exams of Advanced Education

An overview of the importance and key aspects of the icd-10-cm coding guidelines. It covers topics such as the purpose of the guidelines, the structure and conventions of icd-10-cm codes, the use of combination codes, excludes notes, and the coding of signs, symptoms, and uncertain diagnoses. The document also discusses the differences in coding practices between inpatient and outpatient settings, the concept of principal diagnosis, and the use of the poa (present on admission) indicator. Additionally, it covers the classification of symptoms and abnormal findings, and provides examples of code assignments for various clinical scenarios. This information is crucial for healthcare professionals involved in medical coding and billing to ensure accurate and compliant coding practices.

Typology: Exams

2023/2024

Available from 10/15/2024

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ICD-10-CM Exam 1 with Complete

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What is the complete description of ICD-10-CM and what is the significance of "CM"? - ANS-International Classification of Diseases, 10th Revision, Clinical Modification National Centers for Health Statistics (NCHS) modified ICD-10 to meed the needs of American Hospitals What is the difference between ICD-10-CM and ICD-10-PCS? - ANS-ICD-10-CM is diagnosisi only, ICD-10-PCS contains procedures Who is responsible for ongoing changes to the ICD-10-CM classification system? - ANS-National Center for Health Statistics (NCHS) What is the importance of the ICD-10-CM Coding Guidelines? - ANS-The guidelines are a set of coding rules that accompany and complement the official conventions and instructions provided within the ICD-10-Cm code set. Who are the four cooperating parties? - ANS-AHA - American Hospital Association AHIMA - American Health Information Management Association CMS - Centers for Medicare and Medicaid Services NHS - National Center for Health Statistics Which organization developed the ICD-10-PCS Classification system? Who requested this system? - ANS-3M Health Information Systems developed the system CMS - Centers for Medicare and Medicaid Services requested it What are the two purposes of a placeholder character? - ANS-Provides for future expansion without disturbing the overall code structure When a code has less than six characters and a seventh character is required, the X is assigned for all characters less that six in order to meet the requirement of coding to the highest level of specificity What does a dash at the end of code mean? - ANS-Additional characters are necessary to complete the code ICD-10-CM codes consist of three to seven characters - ANS-True In ICD-10-CM, all the letters of the alphabet are used as first characters except: - ANS- U The 5th and 6th characters were added to the code format for what purpose? - ANS-To provide greater code specificity

The following two ICD-10-CM resources must be consulted to correctly classify a code.

  • ANS-Alphabetic Index and Tabular List A ______ code is a single codee used to classify two diagnoses, a diagnosis with a manifestation or associated complication - ANS-Combination Code In the ICD-10-CM code book, slanted brackets indicate: - ANS-Codes that should be listed second When assigning ICD-10-CM codes, it is essential to adhere to: - ANS-ICD-10-CM Official Guidelines for Coding and Reporting What do the Excludes1 and Excludes2 notes in ICD-10-CM mean? - ANS-Excludes means "not coded here" and Excludes2 means "not included here" Why did the US implement ICD-10-CM? - ANS-All ICD-9-CM does not accurately reflect current technology, impacting claims payment. In ICD-9-CM, significantly different diagnoses and procedures are assigned a single code. Quality of care cannot be accurately measured using 1CD-9-CM. When a three-character category code has been further subdivided, the three-character code is valid for code assignment - ANS-False The term "and" is used in code titles in the ICD-10-CM Tabular List to mean "and" not "and/or" - ANS-False "and" is synonymous with "and/or" Parentheses are used in both the Alphabetic Indexx and the Tabular List to enclose terms called: - ANS-Nonessential modifiers What does an Excludes1 note mean? - ANS-Not coded here: the codes are never reported together Signs and symptoms that are not commonly associated with a disease process should:
  • ANS-Be coded when present In the Tabular List of Diseases and Injuries, what do the brackets enclose? - ANS-All Alternative wordings Explanatory phrases Synonyms A _____ is a word or phrase used by a physician to identify a disease an individual suffers from - ANS-Diagnosis

A groupd of similar diseases and procedures and organizing related information for easy retrieval is known as a: - ANS-Classification system The abbreviation WHO stands for: - ANS-World Health Organization Which of the following is NOT a Cooperating Party for ICD-10-CM? - ANS-AMA Which of the following are boldface type entries in the alphabetic index of the ICD-10- CM Code Book? - ANS-Main Terms What is the main term for this diagnosis: Comminuted fracture of radius - ANS-Fracture fx What is the main term for this diagnosis? Carotid artery occlusion - ANS-Occlusion, occluded What is the main term for this diagnosis? Double right ureters - ANS-Double What is the main term for this diagnosis? Alcoholic cardiomyopathy - ANS-either alcoholic or cardiomyopathy What is the main term for this diagnosis? Enlargement of liver - ANS-Enlargement see (or) hypertrophy What is the main term for this diagnosis? Admission for chemotherapy - ANS-admission encounter chemotherapy What is the main term for this diagnosis? Benign prostatic hypertrophy - ANS-hypertrophy hypertrophy, see enlargement enlargement, enlarge benign { } slanted brackets - ANS-Used in the alpha index to enclose a code that must be used with a code for the underlying/primary disease NOS - ANS-Equals not otherwise specified : Colon - ANS-Incomplete term that needs one or more additional terms to make a code assignable Excludes2 - ANS-Two codes are assigned when both conditions are present

NEC - ANS-Used when a more specific code is not available ( Not Elsewhere Classified) Includes - ANS-Further defines or provides examples of a category or section ( ) Parentheses - ANS-Encloses supplementary words and does not affect the code [ ] square brackets - ANS-Encloses synonyms, alternative words, and explanatory phrases Excludes1 - ANS-Indicates conditions listed after it can be used in with the code above the note Chapter 3 - ANS- What was the purpose of developing the UHDDS? - ANS-To improve the uniformity and comparability of hospital discharge data Define principal diagnosis - ANS-The condition established AFTER STUDY to be chiefly responsible for occasioning the admission of the patient to the hospital for care What is the difference between a complication and comorbidity? - ANS-Complication is an additional diagnosis that describes a condition arising after the beginning of the hospital observation and treatment and modifies the course of the patient's illness of medical care Comorbidity is a pre-existing condition, it may increase length of stay or require increased care What is the difference between a significant procedure and a principal procedure? - ANS-Principal procedure is the procedure performed for definitive treatment rather than diagnosis purposes Significant Procedure is a procedure that is surgical in nature, carries a procedural risk, carries an anesthetic risk, and requires specialized training When determining what "other diagnoses" should be coded and reported for an inpatient encounter, the condition must affect the patient's care in terms of requiring one of the following: - ANS-Clinical Evaluation Therapeutic Treatment Diagnostic Procedures Extended length of stay or Increased nursing care or monitoring The UB-04 billing form allows for how many diagnosis and procedure codes to be reported on an inpatient claim? On an outpatient claim? - ANS-Inpatient allows 28 total (22 ICD-10-CM, 6 ICD-10-PCS codes) Outpatient allows 24 ICD-10-CM (no ICD-10-PCS)

Differentiate the coding of uncertain diagnoses for inpatient and outpatient services. - ANS-Uncertain diagnoses are only coded for inpatient services For outpatient services codes the condition to the highest degree of certainty for that visit, such as signs, systems, or abnormal findings The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. What does "after study" mean? - ANS-The condition determined after evaluation of findings What guidelines are used by all non-outpatient settings to report patient data elements in a standardized manner? - ANS-UHDDS definitions and guidelines In the case of a final inpatient discharge diagnosis documented as "rule out", the guidelines direct us to: - ANS-Code the condition as if it existed or was established A patient complains of nausea and abdominal pain and undergoes an EGD for suspected hiatal hernia. The EGD was negative, so the physician instructed the patient to return next week to be tested for reflux. Based on the outpatient guidelines, which of the following would be coded? - ANS-Nausea and abdominal pain For an outpatient visit, when a definitive diagnosis has not been determined by the provider, what should be coded? - ANS-Signs and symptoms In the outpatient setting, when the physician's final diagnosis is documented with the term "probable" based on diagnosis workup, arrangements for further workup and initial therapeutic approach that are consistent with the diagnosis, which of the following two options is correct? - ANS-Code the condition to the highest degree of certainty for that encounter, such as symptoms, signs, abnormal test results, or other reasons for the visit In which of the following can a symptom NOT be utilized as a code? - ANS-When a definitive diagnosis is available If the physician includes a diagnosis in the final diagnostic statement, it should be coded even if there is no supporting documentation in the medical record. - ANS-False The coding guidelines and conventions in ICD-10-CM, along with the circumstances of admission, dictate the selection and reporting of the principal diagnosis and any secondary diagnoses - ANS-True Any physician diagnosis documented in the record for the encounter should be coded regardless of whether it affected patient management - ANS-False Signs and symptoms that are not an integral part of a disease process may be reported in addition to the definitive diagnosis when present - ANS-True

For outpatient diagnosis tests that have been interpreted by a physician whose final report is available at the time of coding, abnormal findings are not coded and reported unless the provider responsible for the clinical management of the case indicates their clinical significance. - ANS-False What does the abbreviation UHDDS stand for? - ANS-Uniform Hospital Discharge Data Set Which of the following is the UHDDS definition for principal diagnosis? - ANS-The condition established after study to be chiefly responsible fo occasioning the admission An additional diagnosis that describes a condition arising after the beginning of hospital observation and treatment and then modifying the course of the patient's illness is called a - ANS-Complication A significant procedure has all of the following except - ANS-Requires specialized instrumentation The purpose of the POA indicator is: - ANS-To differentiate between conditions present at admission and conditions that develop during an inpatient admission According to the ICD-10-CM Official Guidelines codes for symptoms, signs and ill- defined conditions are not to be used as the principal diagnosis when: - ANS-A related definitive diagnosis has been established If a diagnosis is documented as probable, suspected, likely, questionable, possible, or still to be ruled out, the condition is coded as if it exists except in which scenario? - ANS-Physicians office (outpatient setting) In an outpatient setting, the term _____ is used in lieu of principal diagnosis - ANS-First- listed diagnosis Which of the following statements is true about coding chronic diseases in an outpatient setting? - ANS-Chronic diseases are coded if the patient receives treatment and care for the condition Chapter 21 - ANS- Identifying situations inn which codes from Chapter 18 can be assigned - ANS--No specific diagnosis can be made, even after work-up -Signs/Symptoms found to be transient (no cause) -Provisional diagnosis only given, pt did not return for f/u -Pt referred elsewhere before diagnosis could be made -Certain symptoms are important and are reported even when a definitive diagnosis is made -more precise diagnosis is not available

Cite one example of symptoms that are an integral part of a disease process: - ANS- nausea and vomitting - gastroenteritis Cite on example of conditions that are NOT an integral part of a disease process: - ANS-Brain tumor - coma, edema of the brain Per ICD-10-CM guidelines for coding nonspecific abnormal findings, when can abnormal findings from lab or x-ray results be coded and reported? As inpatient and as outpatient - ANS-Inpatient: when the physician documents the clinical significance of the finding in the record it can be coded Outpatient: codes can be assigned based upon reports from diagnostic tests, but not based upon a lab result alone What would be some possible main terms for locating specific condtions indicated as abnormal findings? - ANS-Abnormal, findings; decreased; elevated; high; low; positive Code the following diagnoses as inpatient discharge diagnoses and as outpatient reasons for the encounter: (give codes as if patient as an inpatient and as an outpatient) Cough and fever, probably pneumonia - ANS-Inpatient: J18. Outpatient: R05, R50. Code the following diagnoses as inpatient discharge diagnoses and as outpatient reasons for the encounter: (give codes as if patient as an inpatient and as an outpatient) Abnormal pain, rule out gastric ulcer - ANS-Inpatient: K25. Outpatient: R10. ICD-10-CM classifies symptoms in which of the following way(s)? - ANS-Both Signs or symptoms that point to a specific diagnosis are assigned to a category in other chapters of ICD-10-CM Signs or Symptoms of an unexplained etiology are classified to Chapter 18 of ICD-10- CM Which of the following is included in the category for urinary incontinence NOS (R32) - ANS-Enuresis In which of the following circumstances may the code for ill-defined and unknown cause of mortality, (R99), be used? - ANS-When the patient is brought in the Emergency Room or other healthcare facility and is pronounced dead upon arrival Functional quadriplegia (R53.2) can be utilized for cases of neurologic quadriplegia - ANS-False (see Excludes1 note) Choose the correct code assignment for the following scenario: 17-year-old seen in the ER today for right lower quadrant abdominal pain, rule out appendicitis - ANS-R10.

Choose the correct code assignment for the following scenario: 37-year-old seen today for an elevated GTT - ANS-R73. Choose the correct code assignment for the following scenario: 76-year-old brought in from the assisted living center where she lives as she had been having repeated falls - ANS-R29. Choose the correct code assignment for the following scenario: 34-year-old presents to the ER with a 3 day history of vertigo, N&V, and diarrhea - ANS-R42,R11.2, R19, Whoose the correct code assignment for the following scenario: 76-year-old admitted with pleuisy - ANS-R09. Pleuritic-type chest pain - ANS-R07. Nausea and vomiting due to gastroenteritis - ANS-K52. Shortness of breath - ANS-R06. Localized swelling of the neck - ANS-R22. Periumbilical pain - ANS-R10. Gross hematuria - ANS-R31. Coma, unspecified - ANS-R40. Adult failure to thrive - ANS-R62. Abnormal EKG - ANS-R94.