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-219075-5619752018 LTC CODING EXERCISESANSWER KEYAssign code(s) and sequence in correct order1.Acute cystitis due to E. coli infectionN30.00B96.202.Diabetic neuralgia due to type 2 diabetes mellitusE11.42Patient on insulinZ79.43.Acute and chronic pyelonephritisN10N11.94.Stroke two years ago with residual hemiplegia of rightI69.351dominant side-Is this sequale or late effectSequale5.Noncompliance with medication, unintentional due toresident’s advance ageZ91.130 6.Persistent Atrial FibrillationI48.91Long term use of anticoagulantsZ79.017. Sepsis due to MRSAA41.02Under sepsis in Alphabetical – under Staphylococcus8.End of life care Z51.5 (encounter for palliative care)9.Agranulocytosis due to HIV infectionB20D70.3Agranulocytosis in alphabetical – due to infection10.Chronic kidney disease, Stage IV due to type 1E10.22DiabetessN18.411.Type 1 diabetic developed hypoglycemia even though she had E10.649taken only the prescribed dose of insulin and did not alter eatingregimenConfidential and privileged, all rights reserved, “Lutz”2018 LTC CODING EXERCISESPage 212.Aftercare following knee replacement surgery, left knee Z47.1Z96.65213.Chronic neoplasm related pain (look under pain, then chronic) G89.314.Multiple sclerosis G3515.Severe depression, recurrentF33.216.Aplastic anemiaD61.917. Alzheimer’s disease, late onsetG30.118. Lobar pneumonia with influenzaJ11.08J18.1Tabular instruction: under J18 – code first influenza19. Aspiration pneumonia due to aspiration of vomitusJ69.020. Chronic obstructive lung disease with acute exacerbationJ44.1“Confidential and privileged, all rights reserved, Lutz”2018 LTC CODING EXERCISESPage 32018 LTC Coding Scenarios1.This long term care multiple sclerosis patient was admitted for continuing long term antibiotic therapy for a urinary tract infection due to E coliN39.0 (UTI)B96.20 (E coli)G35 (MS)2.This patient sustained a fractured pelvis due to a fall from his moving electric Wheelchair while in the nursing home where he resides due to multiple sclerosis;Patient is readmitted to the nursing home from the hospital. The patient also hasMultiple chronic illnesses to include Hypertension, Hyperlipidemia, Diabetes Mellitus, Atrial Fibrillation, COPD. Patient is on insulin, Coumadin and oxygenG35 (MS)S32.9XXD (Fracture, subsequent tmt)V80.11D (Fall, subsequent tmtI10 (Hypertension)E78.5 (Hyperlipidemia)E11.9 (Diabetes)I48.91 (A-fib)J44.9 (COPD)Z79.4 (Long term use of insulin)Z79.01 (Long term use of Coumadin)Z99.81 (dependence on oxygen)3.This 48 year old male patient was admitted for PT and OT to maintainstrength for Parkinson’s disease. He requires continued monitoring and is not able to live alone.He also has Type 1 Diabetes and COPDG20(Parkinson’s disease)E10.9 (Type 1 diabetes)J44.9 (COPD)Z60.2 (living alone, problems with)4.This patient was hospitalized for a below the knee amputation of the left leg. Following surgery he developed an infection of the amputation stump which wastreated during the hospitalization and the antibiotics were complete at the time of discharge.The patient is now admitted to the nursing facility to monitor for healing, signs of Infection, and to perform dressing changesZ47.81 (Aftercare following surgery, amputation)Z48.01 (after care following surgery,Attention to dressings, surgical)Z89.512 (absence of below the left kneeAcquired)“Confidential and privileged, all rights reserved, Lutz”2018 LTC CODING EXERCISESPage 45.Patient was admitted to the nursing home following hospitalization for acute osteomyelitis and gangrene due to a chronic nonhealing stage 3 decubitus ulcer of the right ankle. Antibiotic therapy is continued. The patient is type 1 diabetic with peripheral vascular disease due to the diabetes. The patient also has stage 4 chronic kidney disease, hypertension and is status post left knee amputation. PMH also includeshypercholesterolemia and chronic alcoholism which is in remissionM86.171 (Osteomyelitis, right foot)I96 (Gangrene)L89.513 (ulcer ankle, stage 3)E10.51 (Diabetes with peripheralVascular disease)I12.9 (Hypertensive kidney disease)N18.4 (Stage 4 kidney disease)Z89.512 (absence of left below knee)E87.0 (hypercholesterolemia)F10.21 Chronic alcoholism (in remission)6.This patient is being treated for a pathological fracture of the right humerus due to severe senile osteoporosis; The fracture was previously diagnosed during andacute care hospital stay. Other diagnoses include: Vitamin D deficiency, Hypothyroidism, Chronic bronchitis with decompensated COPD, Depression, Anxiety, Celiac diseasewith pancreatic insufficiencyM80.021D (OsteoporosisWith pathological fracture, subsequenttreatment)E55.9 (Vitamin D deficiency)E03.9 (Hypothyroidism)J44.1 (Bronchitis with COPD)F32.9 (Depression)F41.9 (Anxiety)K90.0 (Celiac disease)K86.81 pancreatic insufficiency)“Confidential and privileged, all rights reserved, Lutz”2018 LTC CODING EXERCISESPage 57.This 75 year old woman was taken to the emergency room after being found semi-conscious with markedly abnormal vital signs, a fever of over 39 degrees C, a heart rate of 100 and arespiratory rate of 22/min. On admission to the ICU the physician documented her condition as severe sepsis with acute respiratory failure. The final diagnosis provided by the physician was gram-negative sepsis with acute respiratory failure. The patient also had the following diagnosis:Failure to thrive, Senile dementia, Atherosclerotic Heart Disease, Chronic diastolic congestive heart failureA41.50 (Sepsis, gram-)R65.20 (Sepsis with organ dysfunction)J96.00 (acute respiratory failure)R62.7 (Failure to thrive)F09 (senile dementia)I25.10 (ASHD)I50.32 (Diastolic CHF)8.61 year old female patient with small cell carcinoma of the right lower lobe of theLung with metastasis to the intrathoracic lymph nodes, brain and right rib; History ofBreast cancer, anemia in neoplastic diseaseC34.31 (lung cancer)C77.1 (metastasis to lymph node)C79.31 (metastasis to brain)C79.51 (metastasis to bone)Z85.3 (history of breast cancer)D63.0 (anemia in neoplastic disease)“Confidential and privileged, all rights reserved, Lutz”2018 LTC CODING EXERCISESPage 69. This elderly patient was admitted for the treatment of cellulitis of the right lower extremity. The cultures grew streptococcus B and was documented by the physician to be the cause of the cellulitis. Patient also has a stage 1 decubitus ulcer on the left buttock and stage 2 decubitus ulcer of the right gluteal regionL03.115 (cellulitis)B95.1 (streptococcus)L89.312 (Stage 2 ulcer)L89.321 (Stage 1 ulcer)10. 85 year old admitted to the nursing facility following hospitalization for dehydrationdue to pneumonia. Resident is admitted for multiple therapies due to weakness dueto the infiltrates. He will complete the antibiotics in the Nursing home for Pseudomonaspneumonia. Resident also has progressing dementia resulting from Parkinson’s disease and he realized it is getting more difficult to stay in his home and agreed to the admission. His pastmedical history includes: Mitral valve regurgitation, kyphosis, mild asthma and type 2 diabetesJ15.1 (Pneumonia due to pseudomonas)G20 (dementia in Parkinsons)F02.80 (dementia in diseases classifiedelsewhere) code also G20I34.0 (Mitral valve regurgitation)M40.209 (Kyphosis)J45.909 (asthma)E11.9 (Diabetes)“Confidential and privileged, all rights reserved, Lutz” 2018 LTC CODING EXERCISESPage 711.This nursing home resident is admitted following a hospital stay for an acute cerebral infarction. The resident will receive multiple therapies for the resulting left hemiplegia of the nondominant side, dysphasia and facial droop. Other admitting diagnoses include GERD, rheumatoid arthritis and early onset Alzheimer’s disease with Dementia and aggressive behaviorI69.354 Hemiplegia following, cerebrovascular accident (sequale), left nondominant sideI69.321 Dysphasia, following cerebrovascular accident (sequale)I69.392 Sequale of infarction, cerebral, facial droopK21.9 GERDM06.9 Rheumatoid arthritisG30.0 Alzheimer’s disease, early onset withBehavioral disturbanceF02.81 Behavioral disturbance12.Patient admitted after a fall off her porch at her single family home while sweeping. A femoral intertrochanteric fracture was diagnosed on the right side and she was admitted for surgery. She had an open reduction and internal fixation. She was admitted to the Nursing Home for therapyS72.141 Displace intertrochanteric fracture of the right femur, subsequent encounterW13.9XXD, fall from, out of or through building, NOS, subsequent encounter ................
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