Chapter 1 Review Questions - Ahima Press



Additional Coding Exercises—Instructor’s ManualBasic ICD-10-CM/PCS Coding textbook2013 EditionAnswers for the coding exercises were taken from the 2013 Draft ICD-10-CM and ICD-10-PCScode books. Instructor would remove answers before assigning additional exercises and review questions before giving to students or posting to online learning sites. Please inform AHIMA Press or the author of any discrepancies noted. Thank you. (louann.schraffenberger@)Table of ContentsAdditional Coding Exercises to Apply ICD-10-CM/PCS Codes and to Provide Short Answer QuestionsChapter 1 Introduction to ICD-10-CM Chapter 2 Introduction to ICD-10-PCSChapter 3 Introduction to UHDDS and Official Guidelines Chapter 4 Certain Infectious and Parasitic Diseases (A00–B99) Chapter 5 Neoplasms (C00–D49) Chapter 6 Diseases of the Blood and Blood–Forming Organs and Certain Disorders Immune Mechanism (D50–D89) Chapter 7 Endocrine, Nutritional and Metabolic (E00–E89)Chapter 8 Mental, Behavioral and Neurodevelopment (F01–F99) Chapter 9 Diseases of the Nervous System (G00–G99)Chapter 10 Diseases of the Eye and Adnexa (H00–H59)Chapter 11 Diseases of the Ear and Mastoid Process (H60–H95)Chapter 12 Diseases of the Circulatory System (I00–I99)Chapter 13 Diseases of the Respiratory System (J00–J99)Chapter 14 Diseases of the Digestive System (K00–K95)Chapter 15 Diseases of the Skin and Subcutaneous Tissue (L00–L99)Chapter 16 Diseases of the Musculoskeletal System (M00–M99)Chapter 17 Diseases of the Genitourinary System (N00–N99)Chapter 18 Pregnancy, Childbirth, Puerperium (O00–O9A)Chapter 19 Certain Conditions Originating in Perinatal (P00–P96)Chapter 20 Congenital Malformations, Deformities & Chromosomal Abnormalities (Q00–Q99)Chapter 21 Symptoms, Signs & Abnormal Findings, NEC (R00–R99)Chapter 22A Injury (S00–T34)Chapter 22B Poisoning & Certain Other Consequences of External Causes (T36–T88)Chapter 23 External Causes of Morbidity (V00–Y99)Chapter 24 Factors Influencing Health Status & Contact with Health Services (Z00–Z99)Additional ICD-10-CM Diagnosis Coding Review Questions Additional ICD-10-PCSProcedure Coding Review Questions Review Questions for ChaptersChapter 1 Introduction to ICD-10-CM Chapter 2 Introduction to ICD-10-PCSChapter 3 Introduction to UHDDS and Official Guidelines Chapter 4 Certain Infectious and Parasitic DiseasesChapter 5 Neoplasms Chapter 6 Diseases of the Blood and Blood-Forming Organs Chapter 7 Endocrine, Nutritional and Metabolic Diseases Chapter 8 Mental, Behavioral and Neurodevelopment Disorders Chapter 9 Diseases of the Nervous System Chapter 10 Diseases of the Eye and Adnexa Chapter 11 Diseases of the Ear and Mastoid Process Chapter 12 Diseases of the Circulatory System Chapter 13 Diseases of the Respiratory System Chapter 14 Diseases of the Digestive System Chapter 15 Diseases of the Skin and Subcutaneous Tissue Chapter 16 Diseases of the Musculoskeletal System Chapter 17 Diseases of the Genitourinary SystemChapter 18 Pregnancy, Childbirth, Puerperium Chapter 19 Certain Conditions Originating in Perinatal Period Chapter 20 Congenital Malformations, Deformities and Chromosomal AbnormalitiesChapter 21 Symptoms, Signs and Abnormal Clinical and Lab FindingChapter 22A Injury Chapter 22B Poisoning and Certain Other Consequences of External Causes Chapter 23 External Causes of Morbidity Chapter 24 Factors Influencing Health Status and Contact with Health Services Chapter 25 Coding and ReimbursementChapter 1 Introduction to ICD-10-CM Review Questions1.What is the complete description of the abbreviation ICD-10-CM? International Classification of Diseases, Tenth Revision, Clinical Modification2.What is the complete description of the abbreviation ICD-10-PCS?International Classification of Diseases, Tenth Revision, Procedure Coding System3.What organizations have representatives that serve as members of the Cooperating Parties for ICD-10-CMAmerican Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS) and National Center for Health Statistics (NCHS)4.What organizations’ representatives chair the ICD-10-CM Coordination and Maintenance Committee?NCHS and CMS5. What are the two parts of the Alphabetic Index?Index to Diseases and Injury and Index to External Causes of Injury6.Underline the main term for each diagnosis and procedure and identify if it appears in the Disease Index or the Procedure Index. This is an exercise to examine how the Index uses the disease terms or the procedure titles to refer the coder to the appropriate Index entry.minuted fracture of radiusDisease Index: Fractureb.Carotid artery occlusionDisease Index: Occlusionc.Double right uretersDisease Index: Doubled.Acute myocardial infarctionDisease Index: Infarctione.Alcoholic cardiomyopathyDisease Index: Cardiomyopathy or Alcoholicf.Enlargement of liverDisease Index: Enlargement see Hypertrophyg.Admission for chemotherapyDisease Index: Chemotherapy or Encounterh.Benign prostatic hypertrophyDisease Index: Hypertrophy—see Enlargement, enlarged, prostatei.Endometrial ablationProcedure Index: Ablation see Destructionj.Extracorporeal shockwave lithotripsyProcedure Index: Lithotripsy, with removal of fragments, see Extirpation; Lithotripsy see Fragmentationk.Carpal tunnel neurolysisProcedure Index: Neurolysis see Release, central nervous system or Release, peripheral nervous systeml.Ventriculo-abdominal shuntProcedure Index: Shunt creation see Bypassm.Aortocoronary bypass graftProcedure Index: Bypass n.CholecystectomyProcedure Index: See Excision, Gallbladder; See Resection, Gallbladdero.Inguinal herniorrhaphyProcedure Index: See Supplement, See RepairChapter 2 Introduction to ICD-10-PCS Review QuestionsInstructions: Choose the best answer for each of the following questions.1.ICD-10-PCSprocedure codes are required to be used to code patients in which of the following settings? Check all that apply.__X___Hospital inpatient settings______Physician offices______Hospital outpatient departments______Hospital emergency departments2.What is the maximum number of digits in a valid ICD-10-PCSprocedure code?______Five______Six___X__Seven______Eight3.Identify the main term in Index for each procedure:a.Percutaneous biopsy of prostateProcedure Index: Biopsy see Drainage with qualifier Diagnostic or Excision with qualifier Diagnosticb.Laparoscopic appendectomyProcedure Index: Appendectomy—see Excision, Appendix or Resection, Appendixc.Exploratory laparotomy of abdomenProcedure Index: Laparotomy—Exploratory see Inspection, Peritoneal cavityd.Suture repair of laceration of foot Procedure Index: Suture , Laceration repair—see Repaire.Closed reduction of fracture of left radiusProcedure Index: Reduction, fracture—see Reposition4.What is the main term in the Index and the first three characters and the root operation to be used for the following procedure titles?a.Bunionectomy Index: Bunionectomy, see Excision, lower bones, 0QB Root Operation: Excisionb.Esophagogastroduodenoscopy Index: Esophagogastroduodenoscopy (EGD) 0DJ Root Operation: Inspectionc.Femoral herniorrhaphy without synthetic substituteIndex: Herniorrhaphy—see Repair, Anatomical Regions, Lower Extremities, 0YQRoot operation: Repaird.Excisional biopsy of breast, leftIndex: Biopsy—see Excision with qualifier Diagnostic—see Excision, breast, left. 0HBRoot operation: Excisione.Transfusion of packed red cells via peripheral veinIndex: Transfusion, vein, peripheral, blood, red cells 302Root operation: Transfusionf.Laparoscopic total cholecystectomy Index: Cholecystectomy—see Resection, gallbladder (total meaning entire gallbladder removed) 0FTRoot operation: Resectiong.Amputation of right fifth toeIndex: Amputation—see Detachment, toe, fifth, right 0Y6Root operation: Detachment h.Low cervical Cesarean delivery Index: Delivery, cesarean—see Extraction, Products of Conception 10DRoot operation: Extractioni.Right hip replacementIndex: Replacement, joint, hip, right 0SRRoot operation: Replacementj. Resection of lower lobe, left lungIndex: Resection, lung, lower lobe, left 0BT Root operation: Resectionk.Open reduction, hip fracture, rightIndex: Reduction, fracture see Reposition, joint, hip, right 0SSRoot operation: Repositionl.Artificial rupture of membranes (AROM)Index: AROM 109Root operation: Drainagem.Permanent colostomy of left descending colonIndex: Colostomy, bypass, gastrointestinal 0D1Chapter 3 Introduction to UHDDS and Official Guidelines Review Questions 1. What is name of the electronic equivalent of the UB–04 paper claim?Electronic (HIPAA) 837 transaction standard2. What is the purpose of the POA indicator?To differentiate between conditions that are present on admission and conditions that develop during the hospital stay3. What is the definition of most significant diagnosis?The condition having the most impact on the patient’s health, length of stay, resource consumption and the like.4. In determining the principal diagnosis, what rule(s) take precedence over all guidelines?The coding directives in ICD-10-CM, the Tabular List and the Alphabetic Index take precedence over all the other guidelines.5. If a principal diagnosis is stated as “possible” pneumonia, how is it coded?The pneumonia is coded as it is existed or was established as are other conditions that are documented at the time of discharge as qualified or probable, suspected, likely, questionable, possible or still to be ruled out.6. If the original treatment plan is not carried out after a patient is admitted to the hospital, how is the principal diagnosis determined?The principal diagnosis is still the condition which after study occasioned the admission to the hospital even though the treatment was not carried out due to unforeseen circumstances.7. What is the meaning of “clinical evaluation” used in the definition of “other diagnoses?”Clinical evaluation usually means the physician has taken the condition into consideration when examining the patient. An evaluation can mean the physician is considering testing the condition or closely observing the condition to determine if new treatment is necessary or if the current treatment is sufficient.8. According to the Official Coding Guidelines, what are examples of previous conditions that may be used as secondary diagnoses?History codes (Z80–Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.Chapter 4 Certain Infectious and Parasitic Diseases (A00–B99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Gram negative septicemiaA41.502.Enteritis due to rotavirusA08.03. Postmeasles pneumoniaB05.24. Candidiasis of mouthB37.05. Head liceB85.06. Gonoccocal cervicitisA54.03 7. Chickenpox, uncomplicatedB01.98. Condyloma acuminatumA63.09. Pulmonary toxoplasmosisB58.310. Salmonella gastroenteritisA02.0Chapter 5 Neoplasms (C00–D49) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Carcinoma in situ of breast, leftD05.922.Malignant melanoma, skin of lower leg, rightC43.713.Acute lymphoblastic leukemia C91.004.Metastatic carcinoma of the liver; carcinoma of descending colonC78.7, C18.65.Oat cell carcinoma, right lungC34.916.Admission for chemotherapy; left ovarian carcinomaZ51.11, C56.92 7.Non–Hodgkin lymphoma found in lymph nodes of head, face, and neckC85.918. Malignant neoplasm of head and neckC76.09. Squamous cell carcinoma, skin of backC44.52910. Islet cell carcinomaC25.4 Chapter 6 Diseases of the Blood and Blood–Forming Organs and Certain Disorders Involving the Immune Mechanism (D50–D89) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1. Iron deficiency anemia due to inadequate dietary intake D50.82.Secondary thrombocytopenia due to hypersplenismD69.59, D73.1 3.Sickle-cell traitD57.34.Sickle–cell anemia diseaseD57.15.Allergic vasculitisD69.06.Pernicious anemiaD51.07.Idiopathic eosinophiliaD72.18.Anemia due to acute blood lossD629.Coagulation deficiency due to vitamin k deficiencyD68.4 10.Autoimmune hemolytic diseaseD59.1Chapter 7 Endocrine, Nutritional and Metabolic Diseases (E00–E89) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Uncontrolled Type I diabetes(hyperglycemia)E10.652.Type II diabetes with retinopathyE11.3193.Diabetes mellitus, Type 2, with polyneuropathyE11.424.HyperkalemiaE87.55.Electrolyte imbalanceE87.86.Vitamin B12 deficiencyE53.87. Malnutrition, moderate degreeE44.08. Reactive hypoglycemiaE16.19. Hypertrophy of thymusE32.010. Group A hyperlipidemiaE78.011.Type 1 diabetes mellitus with ketoacidosisE10.1012.Type 2 diabetes mellitus with retinopathy and macula edemaE11.311Chapter 8 Mental, Behavioral and Neurodevelopment Disorders (F01–F99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Paranoid schizophreniaF20.02.Moderate intellectual disabilitiesF713.Chronic alcoholismF10.204.Acute alcoholic intoxication with alcohol dependenceF10.2295.Cocaine addiction, in remissionF14.216.Cocaine abuseF14.107.Major recurrent depressionF33.98.Bipolar II disorderF31.819. Chronic paranoid psychosisF2210. Passive-dependent personality disorderF60.7Chapter 9 Diseases of the Nervous System (G00–G99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Hemophilus meningitis G00.02.Reye's syndrome G93.73.Generalized grand mal epilepsy G40.4094.Guillain-Barré syndrome G61.05.Dural tear during an operative procedureG97.416.Cancer or neoplasm related painG89.37.Brachial plexus disorderG54.08.Bell’s palsy (adult)G51.09.Obstructive sleep apneaG47.3310.Amyotrophic lateral sclerosis (ALS)G12.21Chapter 10 Diseases of the Eye and Adnexa (H00–H59) Additional Coding Exercises Code the following with ICD-10-CM diagnosis codes: 1.Right upper lid blepharochalasisH02.312.Central pterygium left eyeH11.0223.Localized traumatic cataract right eyeH26.1114.Sicca (non Sjorgen’s) keratoconjunctivitis, bilateralH16.2235.Progressive, degenerative myopia, bilateral H44.236.Cystoid macular degeneration (CMD) right eyeH35.3517.Primary open–angle glaucoma mild stageH40.11x18.Alternating convergent concomitant strabismusH50.059.Vitreous floaters right eye H43.39110.Sudden transient vision loss left eyeH53.122Chapter 11 Diseases of the Ear and Mastoid Process (H60–H95) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1. Mixed conductive and sensorineural hearing loss, right ear with normal left earH90.712.Cellulitis right external earH60.113. Acute mastoiditis left earH70.0024.Cochlear otosclerosis right earH80.215.Otorrhea left earH92.126.Benign paroxysmal vertigo (unspecified)H81.107. Total perforation tympanic membrane left earH72.8228.Labyrinthitis right earH83.09.Presbycusis bilateralH91.1310.Swimmer’s ear bilateralH60.333Chapter 12 Diseases of the Circulatory System (I00–I99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Second degree heart AV blockI44.12.Acute myocardial infarction, anterior wallI21.093.Cerebral thrombosis of middle cerebral artery with no infarctionI66.094.Sequelae of cerebral infarction with late effect of dysphagiaI69.391, R13.105.Congestive heart failure; hypertensionT50.9; I106.Coronary artery disease in vein bypass graftI25.8107.Pulmonary embolismI26.998.Acute cerebrovascular insufficiencyI67.819.Atherosclerosis of native arteries of legs with intermittent claudication bilateralI70.21310.Deep vein thrombosis of left leg (not specified as acute or chronic)I82.402Chapter 13 Diseases of the Respiratory System (J00–J99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Pneumonia due to group A streptococcusJ15.42.Acute upper respiratory infection (URI)J06.93.COPD with emphysemaJ44.94.Acute bronchitis as exacerbation of COPDJ44.05.Acute bronchitis with bronchospasmJ20.96.Pneumonia due to KlebsiellaJ15.07. Acute exacerbation of chronic asthmaJ45.9018. Tracheostomy infection with cellulitis of head and neckJ95.02, L03.8119. Black lung diseaseJ6010. Influenza with pneumoniaJ11.00Chapter 14 Diseases of the Digestive System (K00–K95) Additional Coding ExercisesCode the following with the applicable ICD-10-CM diagnosis: 1.Acute perforated gastric ulcerK25.1 2.Chronic cholecystitis with cholelithiasis K80.103.Recurrent inguinal hernia left sideK40.914.Acute generalized peritonitisK65.05.Gastroesophageal refluxK21.96.Active chronic hepatitisK73.27.Acute gastritis with bleedingK29.018.Acute appendicitisK35.809.Ischiorectal abscess; I&D ischiorectal abscessK61.310.Calculus of gallbladder and bile ductK80.70 Chapter 15 Diseases of the Skin and Subcutaneous Tissue (L00–L99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1. Dermatitis of hands due to laundry detergentL24.02. Chronic ulcer of right ankle due to atherosclerosis of extremities with skin breakdownI70.233, L97.3113. Cellulitis of both feetL03.115, L03.1164. Paronychia of finger right handL03.0115. Acute dermatitis due to sun exposureL56.86.Acne rosaceaL71.97. Sunburn second degreeL55.18. Actinic keratosis of templeL57.09. Granuloma of skin due to residual foreign, retained glass fragmentL92.3, Z18.8110. Localized sclerodermaL94.0Chapter 16 Diseases of the Musculoskeletal System and Connective Tissue (M00–M99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1. Displacement lumbar intervertebral discM51.262. Spontaneous fracture, right fibula, due to age-related osteoporosis, initial encounterM80.061A3. Internal derangement of knee due to old tear of lateral anterior horn meniscusM23.2424. Osteoarthritis, primary, generalized in multiple sitesM15.05. Ganglion cyst in wrist tendon, rightM67.4316. Hallux valgus of left great toeM20.127. Acquired kyphosis, thoracolumbar regionM40.2058. Complete tear of rotator cuff of right shoulder nontraumatic M75.1219. Prepatellar bursitis in right kneeM70.4110. Polyarthropathy due to dermatological condition, erythema nodosum, multiple sitesL52, M14.89Chapter 17 Diseases of the Genitourinary System (N00–N99) Additional Coding ExercisesCode the following with the applicable ICD-10-CM diagnosis:1.Benign prostatic hypertrophy with urinary retentionN40.1, R33.82.Acute pyelonephritis due to E. coliN10, B96.20 3.Cervical dysplasia, CIN II (moderate is CIN II)N87.14.Torsion of appendix testisN44.03 5. MenometrorrhagiaN92.16. Chronic kidney disease, stage IIIN18.37.Orchitis due to streptococcus N45.2, B95.58.Endometriosis of ovaries and tubesN80.1, N80.29.Corpus luteum cyst with rupture N83.110.Postartificial menopause syndromeN95.1Chapter 18 Pregnancy, Childbirth and the Puerperium (O00–O9A) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1. Pregnancy, delivered, with premature labor, third trimester, single liveborn infantO60.14X0, Z37.02. Pregnancy, delivered, 40 1/7 weeks, liveborn infant, vaginal delivery, normalO48.0, Z37.03. Normal pregnancy, visit to OB clinic for prenatal supervision, 30 weeks gestation, first babyZ34.034.Spontaneous abortion, 12 weeks, incomplete, complicated by sepsisO03.375. Pregnancy, twins, undelivered, 32 weeks (third trimester)O30.0036. Pregnancy, delivered, 35 weeks; single liveborn infant; postpartum fever of unknown origin; patient with known continuous marijuana drug dependenceO86.4, O99.323, F12.20, Z37.07.Elective abortion, 12 weeks; fetus diagnosed with anencephaly (reason for abortion)Z33.2, O35.0XX0, 8. Ruptured ectopic tubal pregnancyO00.19. Pelvic peritonitis following elective abortion completed 5 days ago; patient admitted today with high feverO04.510. Gestational diabetes, undelivered, 30 weeksO24.419 First Trimester=less than 14 weeks; Second Trimester=14 weeks to less than 28 weeks; Third Trimester=28 weeks 0 days until deliveryChapter 19 Certain Conditions Originating in the Perinatal Period (P00–P96) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Primary atelectasis of newbornP28.02.Neonatal tachycardiaP29.113.Anemia of prematurityP61.24. Premature baby, 2000 gm. birth weight, 35 4/7 weeks of gestation, born in Hospital #1 and transferred to Hospital #2 (Code for hospital #2)P07.18, P07.38 5. Premature baby, 990 gm. birth weight, 29 5/7 weeks of gestation, born in Hospital #1 and transferred to Hospital #2 (Code for hospital #2)P07.03, P07.326.Newborn small for gestational age 1600 gramsP05.167. Erb’s palsy due to birth injuryP14.08.Failure to thrive in newbornP92.69. Drug withdrawal in an infant born to a mother who is dependent on drugsP96.110. Five-day-old infant, light-for-dates, 2200 gm. birth weight, 35 6/7 week gestational age at birth P05.08, P07.38Chapter 20 Congenital Malformations, Deformities and Chromosomal Abnormalities (Q00–Q99) Additional Coding ExercisesCode the following with ICD-10-CM diagnosis codes: 1.Microtia right earQ17.22.Persistent truncus arteriosusQ25.03. Laryngeal hypoplasiaQ31.24. Hypoplastic left heart syndromeQ23.45.Simple syndactyly of fingers right handQ70.016.Unicornuate uterusQ51.47. Bilateral renal hypoplasiaQ60.48.Coartation of aortaQ25.19. Congenital atresia of colonQ42.910.Atresia of bile ductsQ44.2Chapter 21 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99) Additional Coding ExercisesConsider the following coding examples as outpatient visits. Assign the correct ICD-10-CM code for each outpatient visit.1. Fever of unknown origin; rule out sepsisR50.92. Abnormal liver function study R94.53. Positive TB (tuberculin) skin test R76.11 4. Abnormal prothrombin timeR79.15. Generalized abdominal pain, suspect pancreatitis R10.846. Microcalcifications found on mammogram; possible neoplasm of breastR92.07. Burning and tingling sensation of toesR20.8, R20.28. Coin lesion of lungR91.19. Abnormal cardiovascular function study, MUGA testR94.39 (A MUGA test is a specific form of a cardiovascular function test)10. Elevated sedimentation rateR70.0Chapter 22A Injury (S00–T34) Additional Coding ExercisesAssign the correct ICD-10-CM code for each patient.1. Fracture, radius, lower end, initial encounterS52.502A2. Dislocation elbow, lateral initial encounterS53.144A3. Open wound, laceration, hand, with foreign body initial encounterS61.421A4. Foreign body in conjunctiva initial encounterT15.12XA5. Burn, second- and third-degree, of lower legs initial encounterT24.301A, T24.302A6. Laceration of scalp with infection present subsequent encounterS01.01XD.7. Burn, first- and second-degree, of chest, subsequent encounterT21.21XD8. Contusions of face, chest, and arms initial encounterS00.83XA, S20.219A, S40.021A, S40.022A 9. Fracture of nasal bones initial encounterS02.2XXA10. Insect bites on lower extremities initial encounterS80.861A, S80.862A Chapter 22B Poisoning and Certain Other Consequences of External Causes (T36–T88) Additional Coding ExercisesAssign the correct ICD-10-CM code for each patient.1. Coma due to barbiturate overdose; attempted suicide, initial encounterT42.3X2A, R40.20 2. Two-year-old child ingested mother’s birth control pills by accident; no symptoms or illness in child initial encounterT38.4X1A 3. Ataxia due to prescription Valium consumed with alcohol initial encounterT42.4X1A, T51.91XA, R27.0 4. Generalized convulsions due to accidental Darvon overdose initial encounterT39.8X1A, R56.9 5. Hypotension due to Methadone poisoning, undetermined cause initial encounterT40.3X4A, I95.2 6. Premature atrial beats due to correctly prescribed and taken digitalis initial encounterI49.1, T46.0X5A [Premature atrial beats are the “adverse effect” of digitalis.]7. Infant with a high fever after correct administration of diphtheria toxoid vaccine initial encounterR50.2, T50.A95A [Fever is the adverse effect.]8. Hematuria due to an accumulative effect of anticoagulant therapy initial encounterR31.9, T45.515A[Hematuria is the adverse effect.]9. Blurred vision due to allergic reaction to antihistamine initial encounterH53.8, T45.0X5A[Blurred vision is the adverse effect.]10. Parkinson's disease secondary to correct use of haloperidol initial encounterG21.19, T43.4X5A [Secondary Parkinson’s disease is the adverse effect.]11. Infection due to the presence of a right knee joint prosthesis subsequent encounterT84.53XD12. Transfusion reaction initial encounterT80.89XA13. Urinary tract infection due to the presence of an indwelling urinary catheter initial encounterT83.51XA, N39.0Chapter 23 External Causes of Morbidity (V00–Y99) Additional Coding ExercisesAssign the correct External Cause codes only for each patient. 1. Patient slipped on icy sidewalk initial encounterW00.0XXA2. Driver of auto in collision with another car on interstate highway initial encounterV43.52XA3. Passenger injured in accidental train derailment initial encounterV81.7XXA4. Patient's clothes caught ignited and caught fire in kitchen accident at single family home initial encounterX06.2XXA, Y92.0105. Patient fell down stairs initial encounterW10.9XXA6. Motorcyclist fell off her motorcycle on a city street without having a collision with another vehicle initial encounterV28.0XXA, Y92.4107. Parachutist killed upon landing while skydiving initial encounterV97.22XA8. Child bitten by neighbor's dog at the neighborhood park initial encounterW54.0XXA, Y92.830 9. Accidental drowning in swimming pool at private single family home initial encounterW67.XXXA, Y92.01610. Fireman burned in an uncontrolled apartment building fire initial encounterX00.0XXA, Y92,039Chapter 24 Factors Influencing Health Status and Contact with Health Services (Z00–Z99) Additional Coding ExercisesAssign the correct ICD-10-CM V code(s) for each patient. 1. History of carcinoma of large intestineZ85.0382. Patient on longterm anticoagulant therapyZ79.013. Status post aortocoronary bypass graftZ95.14. Examination following treatment of fractureZ09, Z87.815. Admission for chemotherapyZ51.116. Admission for removal of internal fixation deviceZ47.27. Observation for suspected mental condition not foundZ03.898. Routine postpartum follow-up visitZ39.29. Encounter for pregnancy test, negative resultZ32.0110. Preoperative cardiovascular examinationZ01.810Chapter 25 Coding and Reimbursement Questions appear at the end of this document**********************************************Additional ICD-10-CM Diagnosis Coding Review Questions from Multiple ChaptersAssign the correct ICD-10-CM code(s) for each patient. Answers in Yellow 1. Acute appendicitis with perforationMain term: Appendicitis, with, perforation or ruptureK35.22. Streptococcal pneumoniaMain term: Pneumonia, streptococcalJ15.43. Chest pain, originating in chest wallMain term: Pain, chest, wallR07.894. Acute cor pulmonaleMain term: Cor, pulmonale, acuteI26.095. Osteoarthrosis, primary, of ankle, leftMain term: Osteoarthrosis—see also OsteoarthritisOsteoarthritis, primary, ankleM19.0726. Toxic nodular goiter with crisis (storm)Main term: Goiter, nodular, toxic, with thyroid stormMain term: Goiter, toxic see Hyperthyroidism with goiterMain term: Hyperthyroidism with goiter, nodular, with thyroid stormE05.217. Extra thyroid glandMain term: Extra see AccessoryMain term: Accessory, thyroid glandQ89.28. Angiodysplasia of the colon with hemorrhageMain term: Angiodysplasis (colon) with hemorrhageK55.219. Acute tracheobronchitis with bronchospasm (patient age 16)Main term: Tracheobronchitis (15 years of age and above)—see also BronchitisMain term: Bronchitis, acute (with bronchospasm)J20.910. Arteriosclerotic heart disease of native coronary artery with stable anginaMain term: Arteriosclerosis, heart—see Arteriosclerosis, coronaryMain term: Arteriosclerosis, coronary, native vessel, with angina (pectoris) [Stable is not a specified type of angina, it means it is not unstable]I25.11911. Nephrotic syndrome secondary to systemic lupus erythematosusMain term: Syndrome, Nephrotic—see also NephrosisMain term: Nephrosis—no entry for due to LupusMain term: Lupus, erythematosus, systemic, with organ or system involvement, renalM32.1412. Prenatal care, normal first pregnancy, second trimesterMain term: Prenatal, care, normal pregnancy—see Pregnancy, normalMain term: Pregnancy, normal, firstZ34.0213. Comminuted traumatic fracture of right femur involving the subtrochanteric section, initial encounterMain term: Fracture, traumatic, femur, subtrochanteric (displaced)S72.21XA 14. Prostatitis due to trichomonasMain term: Prostatitis, trichomonalA59.0215. Carotid artery occlusion with cerebral infarction; essential hypertensionMain term: Occlusion, artery, carotid, with infarction (unspecified side)Main term: Hypertension (essential)Note—The I63 category code would change the carotid artery was stated as right or left side. I63.239; I1016. Traumatic nonunion fracture, neck of femur, left (subsequent encounter)Main term: Fracture, traumatic, nonunion—see Nonunion, fractureMain term: Nonunion, fracture—see Fracture by siteMain term: Fracture, traumatic, femur, neck—see Fracture, femur, upper end, neck. Main term: Fracture, femur, upper end, neckS72.002K17. Post-traumatic scars of face skin due to old accidental laceration of face subsequent encounterL90.5, S01.81XSMain term: Scar (see also Cicatrix)Main term: Cicatrix, skinMain term: Laceration, face NEC—see Laceration, head, specified site NECMain term: Laceration, head, specified site NEC18. Anoxic brain damage due to previous diffuse intracranial injury three years ago subsequent visitG93.1, S06.2X9SMain term: Damage, brain, anoxicMain term: Injury, intracranial, diffuse (no loss of consciousness stated)19. Right–sided hemiplegia (dominant side) due to old cerebral infarction (CVA)I69.351Main term: Hemiplegia, following, cerebrovascular disease, cerebral infarction20. Shortening of lower leg (right) due to (sequelae) poliomyelitis at age 12 (patient now age 60)M21.961, B91Main term: Shortening, left, lower—see also Deformity, limb, unequal lengthMain term: Deformity, limb, lowerMain term: Sequelae, poliomyelitis21. Aphasia following past intracerebral hemorrhageI69.12022. Quadriplegia due to spinal cord injury subsequent visitG82.50, S14.109S23. Sensory hearing loss due to previous adverse effect of antibiotic medicationH91.09, T36.95XS24. Late effects of viral encephalitisB94.125. Left wrist contracture due to old fracture of left radius lower end, subsequent visitM24.532, S52.502S Additional ICD-10-PCS Procedure Coding Review Questions from Multiple ChaptersAssign the correct ICD-10-PCS code for each patient. Answers in Yellow 1. Bilateral open direct inguinal herniorrhaphy0YQA0ZZMain Term:Herniorrhaphy, see Repair, Anatomical Regions, Lower Extremities 0YQReference the 0YQ Table for the remaining characters of the code2. Coronary artery bypass graft of the left anterior descending artery using the left internal mammary artery.02100A9Main Term:Bypass, Artery, Coronary, one site, 0210Reference the 021 Table for the remaining characters of the code3. Right thyroid lobectomy using an open approach to excise the entire right thyroid lobe0GTH0ZZMain Term:Lobectomy, see Resection, Thyroid Gland, right lobe, 0GTHReference the 0GT Table for the remaining characters of the code4. Open reduction with internal fixation, left fibula0QSK04ZMain Term:Reduction, fracture—see RepositionReposition, fibula, left, 0QSKReference the 0QS Table for the remaining characters of the code5. Right total hip replacement using an uncemented ceramic–on–ceramic device through open approach0SR903AMain Term:Replacement, joint, hip, right 0SR9Reference the 0SR Table for the remaining characters of the code6. Laparoscopic assisted total vaginal hysterectomy0UT9FZZMain Term:Hysterectomy, see Resection, uterus, 0UT9Reference the 0UT Table for the remaining characters of the code7. Left below knee amputation of proximal tibia and fibula0Y6J0Z1Main Term:Amputation, see Detachment, leg, left lower, 0Y6J0ZProximal part of the tibia and fibula would be a high amputationReference the 0Y6 Table for the remaining characters of the code8. Right kidney transplant with organ donor match0TY00Z0Main Term:Transplantation, kidney, right 0TY00ZDonor match is allogeneicReference the 0TY Table for the remaining characters of the code9. Mitral valve replacement using porcine tissue by open approach02RG08ZMain Term:Replacement, valve, mitral , 02RGPorcine tissue is zooplasticReference the 02R Table for the remaining characters of the code10. Thrombectomy of dialysis arteriovenous graft, right upper arm, right cephalic vein obstructed with thrombus, by incisional approach05CD0ZZMain Term:Thrombectomy, see ExtirpationExtirpation is the root operation for taking or cutting solid material from a body partExtirpation, vein, cephalic, right 05CDReference the 05C Table for the remaining characters of the codeChapter 1—ICD-10-CM Review QuestionsBy examining the actual codes what can the student conclude that the characters of a seven character ICD-10-CM diagnosis represent?First three characters are the three-character category code that identifies the disease or condition. Characters four, five and six are used to identify the etiology, anatomic site or severity of the disease. The seventh character describes more specific information about a particular code.What is the purpose of the placeholder character “X” used in ICD-10-CM?The placeholder X has two purposes:The X provides for future expansion without disturbing the overall code structure.When a code has less than six characters and a seventh character extension is required, the X is assigned for all characters less than six in order to meet the requirements of coding to the highest level of specificity.What are the abbreviations used in ICD-10-CM?ICD-10-CM uses the same abbreviations and the definition of each:NEC: not elsewhere classified: NEC code usually directs the coder to an “other specified” code in the Tabular ListNOS: not otherwise specified: NOS code is available when the documentation of the condition does not provide enough information to assign a more specific codeWhat punctuation marks are used in ICD-10-CM?The punctuations used in ICD-10-CM area. Brackets [ ]Square brackets are used in the Tabular List to enclose synonyms, alternative wording, or explanatory phrases. Slanted brackets are used in the Alphabetic Index to identify manifestation codes.b. Parentheses ( )Used in both Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code numbers to which they are assigned. The terms within the parentheses are referred to as “nonessential modifiers.”c. Colon :Used in the Tabular List after an incomplete term that needs one or more modifiers following the colon to make it assignable to a given categoryWhat are the Instructional Notes contained in ICD-10-CM?Inclusion terms are lists of medical diagnoses under some codes in the Tabular List that are conditions for which that code is to be usedIncludes Notes appear immediately under a three-character titles to further define, or give examples of, the content of the category. There are two types of excludes notesExcludes1 note is a pure excludes notes and mean “not coded here”. It indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.Excludes2 note means “note included here” and means the condition excluded is not part of the condition represented by the code, but a patient with both conditions at the same time may have both codes assigned.What does “And/With” and “With” mean in ICD-10-CM?The word “And” should be interpreted to mean “and/or” when it appears in a code title in ICD-10-CM Tabular List.The word “With” should be interpreted to mean “associated with” or “due to” when it appears in the code title, the Alphabetic Index or in an instructional note in the Tabular List. The term “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetic order.How is the Alphabetic Index organized in ICD-10-CM?The Alphabetic Index is divided into two parts: The Index to Diseases and Injury and the Index to External Causes of Injury. Within the Index to Diseases and Injury, there is a Neoplasm Table and a Table of Drugs and Chemicals. The Alphabetic Index is formatted with main terms set in boldface are listed in alphabetic order. Indented beneath the main term are an applicable subterm or essential modifiers in alphabetic order. The Alphabetic Index includes both “See” and “See Also” instructions following the main term to indicate another term should be referenced. A “Code Also” note appears in ICD-10-CM meaning that two codes may be required to fully describe a condition. ICD-10-CM refers to the code listed next to the main term in the Alphabetic Index as the “default code” or the condition that is most commonly associated with the main term or is the unspecified code for the condition.What are the basic steps in ICD-10-CM coding? Identify all main terms included in the diagnostic statementLocate each main term in the Alphabetic IndexRefer to any subterms indented under the main term. The subterms form individual line entries and describe essential differences by site, etiology, or clinical typeFollow the instructions (see, see also) provided in the Alphabetic Index if the needed code is not located under the first main entry consultedVerify the code selected in the Tabular ListRead and be guided by any instructional terms in the Tabular ListAssign codes to their highest level of specificity, up to a total of seven characters if applicableContinue coding the diagnosis statement until all the component elements are fully identified.Chapter 2 ICD-10-PCS Review QuestionsWhat are the seven characters of the ICD-10-PCScodes?Character 1 = SectionCharacter 2 = Body systemCharacter 3 = Root operationsCharacter 4 = Body partCharacter 5 = ApproachCharacter 6 = DeviceCharacter 7 = QualifierWhat is the overall organization of ICD-10-PCS?How many sections are included in ICD-10-PCS?ICD-10-PCS is composed of 16 sections, represented by numbers 0 through 9 and letters B through D and F through H.What are the three main sections?The 16 sections are contained in three main sections: Medical and Surgical section, Medical and Surgical–related section and Ancillary SectionWhat is contained in the first section?The first section, Medical and Surgical section, contains the majority of procedures typically reported in an inpatient setting. All procedure codes in this section begin with the value of “0” (zero)The Medical and Surgical related sections contains section values 1 through 9 for obstetrics, placement, administration, measurement and monitoring, extracorporeal assistance and performance, extracorporeal therapies, osteopathic, other procedures and chiropractic.What is included in the Ancillary Section?The Ancillary section contains section values B through D and F through H for such procedures as imaging, nuclear medicine, radiation oncology, physical rehabilitation and diagnostic audiology, mental health and substance abuse treatment.What are the root operations in ICD-10-PCS?The third character in the Medical and Surgical section is the root operations. There are a total of 31 root operations divided into nine groups that share similar attributes. Appendix B of the ICD-10-PCS code book describes the nine groupsProcedures that take out some/all of a body part(Excision, resection, detachment, destruction and extraction)Procedures that take out solids/fluids/gases from a body part(Drainage, extirpation and fragmentation)Procedures involving cutting or separation only(Division and release)Procedures that put in/put back or move some/all of a body part(Transplantation, reattachment, transfer, and reposition)Procedures that alter the diameter/route of a tubular body part(Restriction, occlusion, dilation and bypass)Procedures that always involve a device(Insertion, replacement, supplement, change, removal and revision)Procedures that involve examination only(Inspection and map)Procedures that include other repairs(Repair and control)Procedures that include other objectives(Fusion, alteration, and creation)How does ICD-10-PCSdefine “approach” and what are the approaches identified?Approach is the technique used to reach the site of the procedure. For the Medical and Surgical section there are seven different approaches:1. Open2. Percutaneous3. Percutaneous endoscopic4. Via natural or artificial opening5. Via natural or artificial opening endoscopic6. Via natural or artificial opening endoscopic with percutaneous endoscopic assistance7. ExternalHow does ICD-10-PCSdefine “device” as the sixth character in the Medical and Surgical section?The device is specified in the sixth character and is only used to specify devices that remain after the procedure is completed. There are four general types of devices1. Grafts and prostheses that takes the place of all or a portion of a body part2. Implants are therapeutic material that is not absorbed, eliminated or incorporated into a body part. 3. Simple or mechanical appliances are biological or synthetic materials that assist or prevent a physiological function. 4. Electronic appliances used to assist, monitor, take the place of or prevent a physiological functionHow is an ICD-10-PCScode assigned?An ICD-10-PCScode is constructed by assigning values for each of the characters. The procedure term is referenced in the Index. The main terms in the Index can be either root operation phrases, such as resection, with a subterm gallbladder, or a common procedure term, such as cholecystectomy.The Index will usually give the coder the first 3 characters of the ICD-10-PCScode.The next step is to access for the 3 character code, such as 0FT, in the PCS book.Using the following, the remaining 4 characters are assigned. The values for each of the characters must be from the same rowFor example, a laparoscopic total cholecystectomy would have the first 3 characters of 0FT, with body part 4 being gallbladder (value 4), approach percutaneous endoscopic (value 4), no device (value Z) and no qualified (value Z) for a complete code of 0FT44ZZ.Chapter 3 UHDDS and Guidelines 1. What are the 11 items contained in the current UHDDS that are collected pertaining to the patient’s episode of care?Personal identification; date of birth; sex; race; ethnicity (Hispanic or non–Hispanic); residence; hospital identification; admission and discharge dates; physician identification; disposition of patient; and expected payer2. What are the medical data elements that are defined in the UHDDS?Diagnoses; Principal diagnosis; other diagnoses; complication; comorbidity; procedures and dates; significant procedure; and principal procedure3. What is the purpose of the National Uniform Billing Committee?The NUBC was established with the goal of developing an acceptable uniform bill that would consolidate the numerous billing forms hospitals were required to use.4. How many diagnoses codes are available for use on inpatient claims and outpatient claims?Inpatient: Admitting diagnosis (1); final diagnoses (18); external cause of injury (3) for a total of 22 ICD-10-CM diagnosis codesOutpatient: Reason for visit (3); final diagnosis (18); external cause of injury (3) for a total of 24 ICD-10-CM diagnosis codes5. What is the definition of principal diagnosis?The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care6. What is the definition of other diagnoses for reporting?Another diagnosis is interpreted as additional conditions that affect patient care in terms of requiring (1) clinical evaluation; (2) therapeutic treatment; (3) diagnostic procedures; (4) extended length of hospital stay; or (5) increased nursing care or monitoring7. What is the difference in reporting uncertain diagnoses depending on whether the patient is an inpatient or an outpatient?For an inpatient, an uncertain condition is coded as it existed or was established. For an outpatient, the condition is not coded but instead the coder assigns codes for the conditions to the highest degree of certainty, such as symptoms, signs, abnormal test results or other reason for the visitChapter 4 Infectious and Parasitic Diseases Review Questions1. What other term may is equivalent to “septicemia” in ICD-10-CM Chapter 1?Sepsis2. How many codes does “severe sepsis” require in ICD-10-CM?Two ICD-10-CM diagnosis codes: (1) code for the underlying systemic infection and (2) code from category R65.2, severe sepsis.3. Can the diagnosis of “possible” HIV infection be coded in ICD-10-CM?No, only confirmed cases of HIV infection or illness are coded. Patients with inconclusive laboratory evidence of HIV are coded with another code, R75.4. How would bacterial infections resistant to current antibiotics be coded in ICD-10-CM?Code Z16, Infection with drug resistant microorganisms is coded following the infection code for a patient with a current infection with an antibiotic resistance.5. What do ICD-10-CM categories B95–B97 represent?Categories B95–B97 are provided for use as an additional code to identify the infectious agent(s) in diseases classified elsewhere, such as;B95: Streptococcus, Staphylococcus and EnterococcusB96: Other bacterial agentsB97: Viral agentsChapter 5 Neoplasm Review Questions1.How is the ICD-10-CM Neoplasm Table organized?The ICD-10-CM Neoplasm Table is organized into seven columns, with the left column listing the anatomic site and the next six columns providing codes for primary malignant, secondary malignant, CA in situ, benign, uncertain and unspecified behavior for each anatomic site. 2. How is laterality identified in ICD-10-CM as it relates to neoplasms?To address the concept of laterality, the codes listed in the ICD-10-CM Neoplasm Table with a “dash” (-) following the code have a required fifth character for laterality. The Tabular List must be reviewed for the complete code. Neoplasm codes are specific as to whether the location is the right or left organ when a tumor is present in an organ that exists bilaterally.3.What is the exception to the Guideline I.C.2.a, Treatment directed at the malignancy?The only exception to this guideline is if a patient admission or encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign the appropriate Z51.- code as the first listed or principal diagnosis and the diagnosis or problem for which the service is being performed as a secondary diagnosis.4. If a patient had a primary malignancy previously excised and there is no treatment to that site and no evidence of existing malignancy at that site, how is this condition coded according to the coding guidelines?A code from category Z85, Personal history of primary and secondary malignant neoplasm should be coded to indicate the former site of the malignancy according to Guideline I.C.2.d.5. What instructional notes appear in ICD-10-CM Chapter 2, Neoplams, for the coder to follow?Instruction notes appear in Chapter 2 to code additional diagnoses such as multiple endocrine neoplasia syndrome, carcinoid syndrome, alcohol abuse and dependence, alcohol dependence in remission, tobacco dependence and history of tobacco use. Also an additional code from Chapter 4 may be used to identify functional activity associated with any neoplasm.Chapter 6 Diseases of Blood Review Questions1. What are examples of additional diagnosis codes uses with codes from chapter 3 of ICD-10-CM as included in the Instructional Notes?There are notes to use additional codes for adverse effects if applicable to identify the drug. Another note states to code first if applicable toxic effects of substances chiefly nonmedicinal as to source. Other codes appear with a code as the type of anemia produced by either a poisoning or adverse effect of a drug. Other instructional notes apply to an entire category of codes to use additional codes for associated conditions. 2. What is the guideline changed for sequencing of codes to describe anemia associated with malignancy?The ICD-10-CM guideline states when the admission or encounter is for management of anemia associated with the malignancy, and the treatment is only for the anemia, the appropriate code for the malignancy is sequenced first with an additional code for the anemia, for example, D63.0, anemia in neoplastic disease.3. If the patient is treated for management of anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, how does the coding guideline direct the codes to be assigned?The type of anemia treated is coded and sequenced first. Additional codes are assigned for the neoplasm being treated with chemotherapy or immunotherapy and the code for adverse effect of antineoplastic and immunosuppressive drugs.4. If the patient is being treated for management of anemia associated with an adverse effect of radiation, how does the coding guideline direct the codes to be assigned?The type of anemia is coded and sequenced first. Additional codes are assigned for the neoplasm being treated with radiation therapy. Another code, Y84.2, radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure5. What are the types of diseases included in Chapter 3 of ICD-10-CM?Diseases of blood include anemias, coagulation defects, purpura and other hemorrhagic disorders. Other conditions are disorders of blood and blood forming organs such as neutropenia, bandemia, or heparin-induced thrombocytopeniaChapter 7 Endocrine, Nutritional, Metabolic Diseases Review Questions1. What are the five categories for coding diabetes mellitus in ICD-10-CM?E08, Diabetes mellitus due to underlying conditionsE09, Drug or chemical induced diabetes mellitusE10, Type 1 diabetes mellitusE11, Type 2 diabetes mellitusE13, Other specified diabetes mellitus2. Explain what conditions are included in the diabetes combination codes in ICD-10-CM?Diabetes codes are combination codes that include the type of diabetes (type 1, type 2, due to underlying condition or due to drug or chemical), the body system affected, and the complications affecting that body system.3.What other conditions may be required to be coded in addition to the ICD-10-CM diabetes codes to fully describe diabetes and the related conditions?Diabetes due to underlying condition requires the underlying condition to be coded first. Diabetes or chemical induced diabetes requires a T36–T65 code to be coded first to identify the drug or chemical involved. Some diabetes codes require an additioal code to identify the stage of a complication, such as the stage of chronic kidney disease involved. Also an additional code is available to indicate the use of insulin.4. If the diabetes is unspecified by the physician as to what type of diabetes the patient has, what code is used in ICD-10-CM to describe it according to the Alphabetic Index?Diabetes of an unspecified type defaults to Type 2.5. What other forms of diabetes are coded in ICD-10-CM chapters other than chapter 4?Other forms of diabetes coded elsewhere are gestational diabetes (O24.44) and neonatal diabetes mellitus (P70.2)Chapter 8 Mental Disorders Review Questions1. According to the coding guidelines for mental disorders, when the provider documentation refers to use, abuse, and dependence of the same substance, such as alcohol or cannabis, how many codes should be assigned for that encounter?Only one code should be assigned to identify the pattern of use based on the following hierarchy:If both use and abuse are documented, assign only the code for abuse.If both abuse and dependence are documented, assign only the code for dependence.If use, abuse and dependence are all documented, assign only the code for dependenceIf both use and dependence are documented, assign only the code for dependence2. In the DSM-IV-TR multiaxial system, what axes identify diagnostic information?Axis I—Clinical disorders and other conditionsAxis II—Personality disorders and mental retardationAxis III—Presence of general medical conditions3. According to the coding guidelines, how is “history of drug or alcohol dependence” coded in ICD-10-CM?History of drug or alcohol dependence is coded as “in remission” but the diagnosis of history of or in remission requires the provider’s clinical judgment and must be specifically documented in the patient’s record.4. What additional codes are used with codes for mental and related disorders?Instructional notes appear to assign an additional code to identify any associated behavioral disorder. Other instructional notes state to code first the underlying physiological condition or code first the associated physical disorder. An additional code note also state to use additional code to identify other conditions for associated medical conditions or intellectual disabilities5. What are examples of inclusion and exclusion notes in Chapter 5 of ICD-10-CM?Includes notes identify the types of drugs included under a drug class such as hallucinogens. Other includes notes identify other terminology for the same disease, such as dissociative and conversion disorders. Excludes1 notes identify when codes cannot be used together, such as alcohol dependence and alcohol use. Excludes2 notes identify when two conditions are present the two conditions are coded separately. Chapter 9 Nervous System Review Questions1.How is Alzheimer’s disease classified in ICD-10-CM?Four digit codes are available to classify Alzheimer’s disease with early onset and Alzheimer’s disease with late onset as well as other and unspecified Alzheimer’s disease. There are use additional code notes to identify delirium, dementia with and without behavioral disturbance2. What does the coding guideline for ICD-10-CM category G81, hemiplegia and hemiparesis specify whether a code for dominant or nondominant side should be used?If the affected side of the body that has the hemiplegia or hemiparesis is documented, but not specified as dominant or nondominant, and the ICD-10-CM classification does not indicate a default, code selection is as follows:For ambidextrous patients, the default should be dominantIf the left side is affected, the default is nondominantIf the right side is affected, the default is dominant3. What is the coding guideline that addresses the coding of neoplasm related pain?Code G89.3 is used when pain is documented as being related, associate or due to cancer, primary or secondary malignancy or tumor. This code is assigned regardless of whether the pain is acute or chronic. The code may be a principal, first listed or additional diagnosis code.4. With ICD-10-CM category G40, epilepsy and recurrent seizures and G43, migraine, what terms are considered equivalent to “intractable?”The terms pharmacoresistant, pharmacologically resistant, treatment resistant, refractory, medically refractory and poorly controlled are considered equivalent to the coding term of “intractable.”5. When can category G89 codes be used with site specific pain codes?G89 category codes may be used with codes that identify the site of pain if the G89 code provides additional information, for example, if the site of pain code does not fully describe whether the pain is acute or chronic, then both codes should be assignedChapter 10 Eye and Adnexa Review Questions1. What terminology in ICD-10-CM updated the phrase “senile cataract?” Age-related cataract is the new descriptor in ICD-10-CM.2. How is laterality recognized in the ICD-10-CM codes for diseases of the eye and adnexa?Codes exist for right side, left side and bilateral for specific conditions of the eye and adnexa. There is also a code for unspecified side3. When a patient has bilateral glaucoma with the same type and same stage of glaucoma, how is it coded?When there is a bilateral code for the type of glaucoma the patient has, the code assigned is for the type of glaucoma, bilateral, with the seventh character for the stage.If there is no bilateral code for the type of glaucoma the patient has, the coder should report only one code for the type of glaucoma with the appropriate seventh character for the stage, for example, see subcategories H40.10, H40.11 and H40.204. What is the difference between the glaucoma stage seventh characters of “4” for indeterminate stage and “0” for unspecified?Indeterminate stage should be based on the clinical documentation. It is used when the glaucoma cannot be clinically determined. The unspecified seventh character is used when there is no documentation regarding the stage of the glaucoma5. What are the specific types of age–related cataracts?The most common is a cortical cataract which creates an opacity and swelling of the entire lens in a mature cataract as well as anterior subcapsular or posterior subcapsular types. Subcapsular cataracts develop in the back of the eye. Others are nuclear cataracts with an opacity in the central nucleus. Morgagnian type cataracts have a cortex that has liquefied and the nucleus moves freely in the lens.Chapter 11 Ear and Mastoid Review Questions1. How are the codes for diseases of the ear and mastoid process arranged in the chapter 8 of ICD-10-CM, Diseases of the ear and mastoid process?The diseases are arranged into blocks, such as conditions occurring in the external ear, middle ear, and inner ear. A separate block is used for other conditions of the ear and a fifth block contains codes for intraoperative and postprocedural complications.2. How is the condition of otitis media with perforation of the tympanic membrane coded in ICD-10-CM?In ICD-10-CM, the associated otitis media is coded first with an additional code for perforation of tympanic membrane. There is an instructional note at category H72, perforation of tympanic membrane to code first the associated otitis media. There is also an Excludes1 note with H72 category to identify conditions that are not coded with H72 as the rupture of the tympanic membrane is included in other codes, such as H66.01-3. How is laterality recognized in the ICD-10-CM codes for diseases of the ear and mastoid process?Codes exist for right side, left side and bilateral for specific conditions of the ear and mastoid process. There are also codes for unspecified sides of the body4. What are the three variations of otitis media that can be classified in ICD-10-CM?Acute suppurative (formation of pus) otitis media; acute secretory or serous (produces secretion or serous exudates); and chronic otitis media that has its origin in childhood and usually persists into adulthood.5. What are diseases of the inner ear that can be classified in categories H80–H83 in ICD-10-CM?Otosclerosis, disorders of vestibular function such as Meniere’s disease and different types of vertigo such as benign paroxysmal vertigoChapter 12 Circulatory System Review Questions1. How does ICD-10-CM categorize the type of hypertension to be coded, such as benign, malignant or unspecified?In ICD-10-CM, hypertension codes no longer classify the type of hypertension a patient may have. There is only one code for essential hypertension (I10).2. What is the stated number of weeks a specific category of codes for acute myocardial infarction may be used in ICD-10-CM?In ICD-10-CM the code for acute MI is intended to present a myocardial infarction specified as acute or with a stated duration of four weeks (28 days) or less from onset.3. What assumption is made in ICD-10-CM in terms of coding hypertension and chronic kidney disease?A coder can assume a relationship exists between hypertension and chronic kidney disease whether or not the condition is so stated in the health record.4. What is the sequencing guideline for use of ICD-10-CM category code I22, Subsequent ST elevation (STEMI) or non-ST elevation (NSTEMI) myocardial infarction?If a patient is in the hospital due to an initial acute myocardial infarction (AMI) and has a subsequent AMI while still in the hospital, code I21 for the initial AMI is sequenced first with a code I22, subsequent AMI is sequenced as a secondary code.If a patient has a subsequent AMI after discharge for the care of the initial AMI and the reason for admission is the subsequent AMI, the I22 code for subsequent AMI should be sequenced first followed by the I21 code for the initial AMI. An I21 code must accompany the I22 code to identify the site of the initial AMI and to indicate that the patient is still within the four-week timeframe of healing from the initial AMI.5. How is atherosclerotic heart disease with angina pectoris coded in ICD-10-CM?ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris: I25.11 for Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7 for Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris. It is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris unless the documentation indicates the angina is due to something other than atherosclerosis.6.What is the title of the category of codes in ICD-10-CM that identify the late effects of cerebrovascular disease?The category for late effects of cerebrovascular disease is “Sequelae of cerebrovascular disease” and has been restructured by expanding all subcategory codes. This expansion involves laterality, changing subcategory titles, making terminology changes, adding sixth characters, and providing greater specificity in general. Sequelae of cerebrovascular disease are differentiated by type of stroke, such as, hemorrhage or infarction.7. What are some examples of intraoperative and postprocedural circulatory complications coded in ICD-10-CM?Examples include intraoperative versus postprocedural cardiac arrest, postprocedural hypertension, postprocedural heart failure, intraoperative and postprocedural cerebral infarction, accidental puncture or laceration during circulatory system procedure and accidental puncture or laceration of a circulatory system organ during another body system procedure.Chapter 13 Respiratory System Review Questions1. What instructional note appears at the beginning of ICD-10-CM chapter 10 concerning tobacco?A note instructs the coding professional to use an additional code, where applicable to identify: exposure to environmental tobacco smoke (Z77.22), exposure to tobacco smoke in the perinatal period (P96.81), history of tobacco use (Z87.891), occupational exposure to environmental tobacco smoke (Z57.31), tobacco dependence (F17.-), or tobacco use (Z72.0). Since these instructions appear at the beginning of the chapter, they should be followed when assigning any code from this chapter.2. What is the terminology used to describe asthma in ICD-10-CM that reflects the current clinical classification of asthma? The following terms have been added to describe asthma in the ICD-10-CM codes: mild, intermittent and three degrees of persistent, mild persistent, moderate persistent, and severe persistent. 3. When a respiratory condition is described as occurring in more than one respiratory site and it is not specifically indexed, how is it classified in ICD-10-CM as described in the instructional that at the beginning of Chapter 10?The respiratory condition occurring in more than one site and not specifically indexed in ICD-10-CM should be classified to the lower anatomic site, for example, tracheobronchitis is coded to bronchitis in J40.4. According to the coding guidelines, is acute respiratory failure always listed as a principal diagnosis?Acute respiratory failure may be assigned as principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and the selection is supported by the Alphabetic Index and Tabular List. However, there are chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction that take precedence over the guidelines mentioned above.5. Can influenza due to certain identified influenza viruses (Category J09) and due to other identified influenza virus (Category J10) be assigned to these category codes when the physician describes the influenza as possible or suspected or uses another certain qualifier for the condition?No, the coding guidelines state to code only confirmed cases of influenza to categories J09 and J10. This is an exception to the inpatient guideline for uncertain diagnoses.Chapter 14 Digestive System Review Questions1. Give two examples of how ICD-10-CM uses the terminology of “bleeding” versus “hemorrhage” in chapter 11.The term bleeding is used when classifying gastritis, duodenitis, diverticulosis and diverticulitis. The term hemorrhage is used when referring to ulcers.2. What does the sixth character in ICD-10-CM category K50, Crohn’s disease, represent?The sixth character further classifies the specific complication when present with Crohn’s disease.3. What does the term “obstruction” indicate in ICD-10-CM for the classification of a hernia?A hernia with obstruction indicates that incarceration, irreducibility or strangulation is present with the hernia. An irreducible hernia is also known as an incarcerated hernia that indicates a hernia of the intestine cannot be returned or reduced by manipulation. This condition may or may not be strangulated which means the contents of the hernia sac are so tightly constricted as to restrict the blood supply to the contents of the hernia sac that possibly causes gangrene4. How does ICD-10-CM distinguish between gallstones versus stones in the bile ducts?ICD-10-CM has specific codes for cholelithiasis or the presence of one or more calculi in the gallbladder also known as gallstones. Another set of codes identify choledocholithiasis or the presence of stones in the bile ducts. When stones in the gallbladder or in the bile duct or both locations occur with acute or chronic cholecystitis, combination codes are available such as K80.0–K80.8.5. When are the category K92 codes, gastrointestinal hemorrhage, used from ICD-10-CM?The use of category K92 codes are limited to cases when a GI bleed is documented but no bleeding site or cause is identified. There is an Excludes1 note under the code K92.2 that identifies a number of GI condition that can be coded based on the presence of hemorrhage. The use of the K92.2 code is not appropriate when one of the conditions listed under the Excludes1 note is presentChapter 15 Skin and Subcutaneous Tissue Review Questions1. How are pressure ulcer coded in ICD-10-CM?Category L89, pressure ulcer, contain combination codes that identify the site, the laterality as well as the stage of the pressure ulcer. 2. What term is used synonymously with dermatitis in categories L20–L30?Eczema3. What documentation is required to code the patient’s pressure ulcer stage in ICD-10-CM?According to the coding guidelines for Chapter 12 of ICD-10-CM, the assignment of the pressure ulcer stage code should be guided by clinical documentation of the stage or documentation of the terms found in the Alphabetic Index. As long as the diagnosis of pressure ulcer is documented by the patient’s provider, code assignment of the pressure ulcer stage may be coded based on the documentation of another health care practitioner such as a nurse according to ICD-10-CM coding guideline I.B.14.4. What must be coded first with L97, Nonpressure chronic ulcers if an underlying condition is documented as the cause of the ulcer?The associated underlying condition is coded first.5. What are the underlying conditions that can be assumed as a causal condition when documented with a lower extremity ulcer?Atherosclerosis of the lower extremitiesChronic venous hypertensionDiabetes ulcersPostphlebitic syndromePostthrombotic syndromeVaricose ulcerChapter 16 Musculoskeletal & Connective Tissue Review Questions1. What is the definition of “direct infection of joint” in ICD-10-CM?Direct infection of joint is where organisms invade synovial tissue and microbial antigen is present in the joint.2. What are the type types of indirect infection?Reactive arthropathy where microbial infection of the body is established but neither organisms or antigens can be identified in the joint.Postinfective arthropathy where microbial antigen is present but recovery of an organism is inconstant and evidence of local multiplication is lacking.3.What are the seventh characters used with pathological or stress fracture codes in chapter 13 of ICD-10-CM?A = initial encounter for fracture careD = subsequent encounter for fracture with routine healingG = subsequent encounter for fracture with delayed healingK = subsequent encounter for fracture with nonunionP = subsequent encounter for fracture with malunionS = sequela4. What are examples of subsequent treatment included for encounter for fracture with routine healing (seventh-character D)?Examples of subsequent treatment are cast change or removal, removal of external or internal fixation device, medication adjustment, or other aftercare and follow up visits.5. What are four types of pathologic fractures classified in chapter 13 of ICD-10-CM?M80, Osteoporosis with current pathological fracturesM84.4, Pathological fracture, not elsewhere classifiedM84.5, Pathological fracture in neoplastic diseaseM84.6, Pathological fracture in other diseaseChapter 17 Genitourinary System Review Questions1. How is chronic kidney disease classified in ICD-10-CM?Chronic kidney disease is classified with ICD-10-CM category N18 with specific codes for stage I, II, III, IV, and V.2. What terminology used in ICD-10-CM may also be stated as “benign prostatic hypertrophy or hyperplasia?”Category N40 has the title of “enlarged prostate” which may also be documented as BPH.3.Give examples of lower urinary tract symptoms that are coded in addition to the code for enlarged prostate?Such symptoms include incomplete bladder emptying, nocturia, straining on urinary, urinary frequency, urinary hesitancy, urinary incontinence, urinary obstruction, urinary retention, urinary urgency, and week urinary stream4. Give two examples of combination codes in ICD-10-CM for genitourinary conditions.Two examples of combination codes are N30.00, acute cystitis without hematuria and N30.01, acute cystitis with hematuria5. How is dysplasia of the cervix classified in ICD-10-CM?Mild cervical dysplasia or cervical intraepithelial neoplasia I is CIN I that is coded with N87.1 Moderate cervical dysplasia is CIN II and classified with N87.1 There is an unspecified code N87.9 for an unspecified form of cervical dysplasia. The condition known as severe cervical dysplasia or CIN III is also known as carcinoma in situ of cervix is classified as a neoplasm with code D06.Chapter 18 Pregnancy, Childbirth, Puerperium Review Questions1. What abortion code has been moved to another chapter in ICD-10-CM?Codes for elective (legal or therapeutic) abortion (without complication) have been moved to code Z33.2, Encounter for elective termination of pregnancy, in Chapter 21 of ICD-10-CM.2. What is the ICD-10-CM definition of “trimesters?”Trimesters are counted from the first day of the last menstrual period and are defined as follows:1st trimester = less than 14 weeks, 0 days2nd trimester = 14 weeks 0 days to less than 28 weeks 0 days3rd trimester = 28 weeks 1 days until delivery3. What are the two possible ICD-10-CM category codes for prenatal outpatient visits?For routine prenatal outpatient visits when there is no complication present, a code from category Z34 for the encounter for supervision of normal pregnancy is used as the first-listed code. If the prenatal outpatient visit is to manage a high-risk pregnancy, a code from Chapter 15 category O09, Supervision of high-risk pregnancy, is used as the first-listed code. 4. What ICD-10-CM category code for outcome of delivery?In ICD-10-CM a code from category Z37, Outcome of delivery, is used on every maternal record when a delivery occurs. 5. What is the definition of “normal delivery” or full–term uncomplicated delivery in ICD-10-CM?The definition of normal delivery in ICD-10-CM is a full-term normal delivery occurs when the woman delivers a full-term, single, liveborn infant by a spontaneous cephalic vaginal delivery that requires minimal or no assistance, with or without episiotomy, without fetal manipulation, that is no rotation, version, or no instrumentation such as forceps6. What time frames are used in ICD-10-CM related to maternal and fetal codes?The time frame for differentiating the abortion and fetal death codes has changed from 22 weeks to 20 weeks (category O36.4)The time frame for differentiating early and late vomiting in pregnancy has changed from 22 weeks to 20 weeks (category O21)Preterm labor is defined as before 37 completed weeks of gestation (category O60)7. What codes are included in Chapter 21, Factors influencing health status and contact with health services, are related to obstetrical conditions?The following categories relate to the pregnant female:Z32, Encounter for pregnancy test and childbirth and childcare instructionZ33, Pregnant stateZ34, Encounter for supervision of normal pregnancyZ36, Encounter for antenatal screening of motherZ37, Outcome of deliveryZ39, Encounter for maternal postpartum care and examinationChapter 19 Perinatal Period Review Questions1. What is defined as the perinatal period in ICD-10-CM?Codes in this chapter describe conditions that begin before birth or develop during the first 28 days of life which is known as the perinatal period. These conditions may continue to exist past the first 28 days of life and can be coded regardless of the patient’s age. These are not congenital conditions.2. Are the ICD-10-CM codes in chapter 16 used for only confirmed conditions?No, the phrase “suspected to be” is included in the code title in ICD-10-CM as a nonessential modifier to indicate that the codes are for use when the listed maternal condition is specified as the cause of confirmed or suspected newborn morbidity or potential morbidity.3. When both birth weight and gestational age of the newborn is documented, what is the sequencing of the codes for these conditions?Both conditions, birth weight and gestational age, are coded with birth weight code sequenced before gestational age.4. Are the codes from ICD-10-CM chapter 16 limited to use when the patient is a newborn?No, should a condition originate in the perinatal period continue through the life of the child, the perinatal code should continue to be used regardless of the age of the patient. The condition must have occurred before birth and through the 28th day following birth.5. How are the immaturity and prematurity codes organized in ICD-10-CM chapter 16?In ICD-10-CM, the codes are divided into two subcategories. Subcategory P07.2 is used for extreme immaturity of newborn, defined as less than 28 completed weeks, with specific codes for less than 23 completed weeks as well as codes for 23, 24, 25, 26, and 27 completed weeks. Subcategory P07.3 is used for other preterm newborn, defined as 28 completed weeks or more but less than 37 completed weeks with specific codes for 28, 29, 30, 31, 32, 33, 34, 35, and 36 completed weeks.Chapter 20 Congenital Malformations Review Questions1. According to the coding guidelines, how are congenital anomalies or syndromes coded in ICD-10-CM when no specific code exists for a specific syndrome?If there is no specific code for a specific syndrome or anomaly, a code should be assigned for each manifestation of the syndrome, from any chapter in ICD-10-CM.2. Are the codes for Chapter 17, congenital conditions, restricted for a certain age group in patients?No, a code from chapter 17 is not only coded at birth or when it is first diagnosed. If a congenital condition remains throughout the life of the patient, the condition may be coded with a code from ICD-10-CM chapter 17.3. How does ICD-10-CM classify chromosomal defects? Specific forms of chromosomal abnormalities are classified in ICD-10-CM in nine categories, Q90, Q91, Q92, Q93, Q95, Q96, Q97, Q98, and a category Q99 for chromosomal abnormalities not elsewhere classified. Chromosomal abnormalities are disorders that arise from abnormal number of chromosomes or from defects in specific fragments of the chromosomes.4. According to the coding guidelines, are manifestations of congenital anomaly or chromosomal abnormality coded separately?When the code assignment specifically identifies the malformation, deformation or chromosomal abnormality, manifestations that are an inherent component of the anomaly should not be coded separately. Additional codes should be assigned for manifestations that are not an inherent component.5. According to the coding guidelines, if a congenital anomaly has been corrected, how is the condition coded?If the congenital malformation or deformity has been corrected, a personal history code should be used to identify the history of the malformation or deformity.Chapter 21 Symptoms and Signs Review Questions1. What types of conditions are included in Chapter 18 of ICD-10-CM?According to the note at the beginning of Chapter 18 of ICD-10-CM “this chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.” 2. When are symptom codes used as an additional diagnosis with an associated disease?Conditions that are routinely associated with a disease process, the symptoms or signs should not be assigned as an additional code unless otherwise instructed by the classificationConditions that are not routinely associated with a disease process should be coded when present3. What are examples of the abnormal findings coded in ICD-10-CM?Abnormal findings without a diagnosis are an objective measurements documented in reports according to examination of:bloodurineother body fluids, substances and tissuesdiagnostic imaging and in function studies.In addition, abnormal tumor markers are grouped together4. What are the main terms used in the ICD-10-CM Alphabetic Index to access the symptom and abnormal finding codes?The terminology used in the Alphabetic Index include terms such as “abnormal, abnormality, abnormalities, findings-abnormal-without-diagnosis, decreased, elevation, high, low or positive.” 5. The Glasgow Coma Scale codes are likely to be used with what type of disease codes?The Glasgow Coma Scale codes are used in conjunction with traumatic brain injury or sequelae of cerebrovascular disease codes.Chapter 22A Injury Review Questions1. What is the organization of Chapter 19?Specific types of injuries are arranged by body region beginning with the head and concluding with the ankle and foot. All injuries of the specific site are grouped. This results in the grouping of injury types together under the site where it occurred.2. What two alphabetic characters are used in Chapter 19 codes?The S section provides codes for the various types of injuries related to a single body region. The T section covers injuries to unspecified body regions as well as poisonings and certain other consequences of external causes.3. What additional code(s) are used with chapter 19 codes?A note refers to the entire chapter: Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause as part of the T code do not require an additional external cause code.4. What specificity has been added to the ICD-10-CM fracture codes?Some of the information found in fracture codes includes the type of fracture, specific anatomical site, whether the fracture is displaced or not, laterality, routine versus delayed healing, nonunions and malunions. Identification of type of encounter (initial, subsequent, sequel) are also included in the code expansion.5. What is the ICD-10-CM guideline concerning the use of the terminology of displaced versus nondisplaced and open versus closed for fractures?According to guideline IC.19.c., a fracture not indicated as displaced or nondisplaced should be coded to displaced. A fracture not designated as open or closed should coded to closed.6. What treatment is included in the terminology of “initial encounter?”Initial encounter is used when a patient is receiving active treatment for an injury such as surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.7. What is meant by “subsequent encounter” for the injury codes?Subsequent encounter extension is used for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. For example, cast change or removal, removal of external or internal fixation device, medical adjustment, other aftercare and follow up visits following injury treatment.8. How is the extension S for sequel used?Extension S, sequel, is used for complications or conditions that arise as a direct result of an injury, such as a scar formation after a burn. When using extension S, it is necessary to use both the injury code that precipitated the sequel and the code for the sequela itself. The S extension is only added to the injury code to identify the injury responsible for the sequela. The specific type of sequel is sequenced first, followed by the injury code.9. Are the aftercare Z codes used with the injury codes?No, the aftercare Z codes should not be used for aftercare for injuries. For aftercare of an injury, the acute injury code is assigned with the appropriate seventh character extension for “subsequent encounter.”10. What is the difference between the coding terms “burns” versus “corrosions?”The burn codes identify thermal burns, except for sunburns, that come from a heat source. The burn codes are also for burns resulting from electricity and radiation. Corrosions are burns due to chemicals.Chapter 22B Poisoning and Other Consequences Review Questions1. Are there separate category of codes in ICD-10-CM for poisoning, adverse effect and underdosing of particular drugs?No, in ICD-10-CM a single category for a specific drug exists with codes for poisoning, adverse effects and underdosing of that particular drug as well as the external cause. No additional external cause code is required for poisonings, toxic effects, adverse effects, and underdosing codes.2. What is the definition of underdosing in ICD-10-CM?Underdosing is defined as taking less of a medication than is prescribed by a provider or the manufacturer’s instructions with a resulting negative health consequence.3. What additional code may be used with the T36–T50, Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances?A code from categories T36–T50 is sequenced first, followed by the code(s) that specify the nature of the poisoning, adverse effect, or toxic effect. This instruction does not apply to the underdosing codes.4. According to the coding guidelines, what may be coded with the underdosing codes?Codes for underdosing should never be assigned as principal or first–listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition is coded first with an additional code to identify the underdosing of the particular drug. In addition, noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.61, Y63.8–Y63.9) codes are used with the underdosing code to indicate intent, if known.5. Are external cause of injury and poisoning codes used with the T36–T50 codes?No, the external cause is included within the T36–T50 codes themselves so no additional cause of injury code is required.6. What is the definition of adverse effect and poisoning in ICD-10-CM?Adverse effect is a hypersensitivity or reaction to a substance correctly prescribed and properly administered. In comparison, poisoning is an overdose of a substance or the wrong substance given or taken in error.7. How is the ICD-10-CM Table of Drugs and Chemicals organized?The ICD-10-CM Table of Drugs and Chemicals is organized into seven columns with rows for the substances involved. The first, left-most column contains the name of the drug, chemical, or biological substance. The next six columns contains:Poisoning, accidental (nonintentional)Poisoning, intentional self–harmPoisoning, assaultPoisoning, undeterminedAdverse effectUnderdosingChapter 23 External Causes Review Questions1. What is the first character of the chapter 20, External causes of morbidity codes and when are these codes used?The first character of the chapter 20 codes are either V, W, X, or Y. Most often these codes are used with conditions classifiable to Chapter 19, injury, poisoning and certain other consequences of external causes (S00–T88) Other conditions that may be stated to be due to external causes are classified in chapters 1 to 18. The external cause codes are used to provide additional information as to the cause of the condition. The external cause codes are always used as an additional code, never a principal or first listed code.2. What does the seventh character extension indicate in Chapter 20 of ICD-10-CM?The seventh character extension indicate whether the episode of care was the initial, subsequent or a secondary encounter, or the condition is a result of an event or sequelae.A = initial encounterD = subsequent encounterS = sequela3. How is the ICD-10-CM category Y92, Place of occurrence used??Category codes Y92 are used in conjunction with the activity code, Y93 Category Y93 indicates the activity of the person seeking healthcare for an injury or health condition. Also the place of occurrence should be recorded only at the initial encounter for treatment. Also only one code from category Y92 should be recorded on the medical record. If the place of occurrence is not stated, a code form Y92 is not used.4. When are the ICD-10-CM external cause of injury codes used, other than Y92?The external cause code, with the appropriate seventh character (initial encounter, subsequent encounter or sequela) is assigned for each encounter for which the injury or condition is being treated. This is new to ICD-10-CM because the E codes in ICD-9-CM were only assigned for the initial encounter for an injury, poisoning or adverse effect. 5. What is the definition of a transport accident in ICD-10-CM ?A transport accident is one in which the vehicle involved must be moving or running or in use for transport purposes at the time of the accident. The definitions of transport vehicles are provided in the classification and should be reviewed.6. When are the category Y93 codes used?The activity codes from category Y93 are used to indicate the activity of the person seeking healthcare for an injury or health condition which resulted from the activity or was contributed to by the activity. These codes are appropriate for use for both acute injuries, such as those form Chapter 19 and conditions that are due to the long-term cumulative effects of an activity. The Y93 code are also appropriate for use with external cause codes for cause and intent. These codes should be used in conjunction with codes for external cause status (Y99) and place of occurrence (Y92). The activity code Y93 is used only once, at the initial encounter for treatment. Only one Y93 code should be recorded on the encounter.The activity code are not applicable to poisonings, adverse effects, misadventures, or late effects.Do not assign Y93.9, unspecified activity, if the activity is not stated.7. When are the category Y99 codes used?Category Y99, external cause status codes, should be assigned whenever any other external cause code is assigned for an encounter, including an activity code, except for the events noted in the classification. Category Y99 is used to indicate the work status of the person at the time the event occurred.The external cause status codes are not applicable to poisoning, adverse effects, misadventures, or late effects.Category Y99 is only assigned with other external cause codes. It is not assigned if no other external cause codes are applicable. Code Y99.9 is not assigned if the status is not statedThe external cause status is used only once, at the initial encounter for treatmentOnly one code from Y99 is recorded on a medical record8. How is the seventh character used if the code from category Y99 is less than 6 characters?The seventh character of an external cause code must always be the seventh character in the data field. If a code that requires a seventh character is not six characters, a placeholder X must be used to fill in the empty characters.Chapter 24 Factors Influencing Health Status Review Questions1. What are the Z codes in ICD-10-CM?Z codes are diagnosis codes and represent reasons for the encounter or visit. The codes are used for circumstances other than a disease or injury that are the reason for the health care services.2. What are examples of the blocks of the Z codes in ICD-10-CM?Examples of ICD-10-CM blocks of codes are:Persons encountering health services for examinationPersons encountering health services in circumstances related to reproductionPersons encountering health services in other circumstances3. When are Z codes used?According to a note at the beginning of the chapter, Z codes represent reasons for encounters. Categories Z00–Z99 are provided for occasions when circumstances other than a disease, injury, or external cause classifiable to categories A00–Y89 are recorded as “diagnoses” or “problems.” The codes are used when:A person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to done an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.4. What does guideline I.C.21.a state in terms of sequencing of Z codes?Z codes may be used as either a first-listed (or principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis.5. What are the main terms used in the Alphabetic Index to locate the codes for factors influencing health status?The terms for these codes should describe the reason for the encounter or admission. The coder should ask “why is the patient receiving services?” Examples of main terms are admission or encounter for, attention to, carrier (suspected) of, chemotherapy, examination, follow up, history, newborn, observation, prophylactic, resistance, status, therapy, vaccination among other terms.Chapter 25 Coding and Reimbursement Review Questions 1. What is the goal of the MS-DRG system?The goal was to significantly improve Medicare’s ability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to the sicker patient and decrease payments for treating less severely ill patients.The MS-DRGs represent an inpatient classification system designed to categorize patients who are medically related with respect to diagnoses and treatment and who are statistically similar in their lengths of stay. Each DRG has a present reimbursement amount that the hospital receives whenever the MS-DRG is assigned.2. How is the base payment rate for each DRG determined?First, each MS-DRG is assigned a relative weight. The relative weight represents the average resources required to care for cases in that particular DRG relative to the national average resources used to treat all Medicare cases.The second source that determines MS-DRG payment rate is the individual hospital’s payment rate per case. This payment rate is based on a regional or national adjusted standardized amount that considers the type of hospital; designation of hospital as large urban, other urban or rural; and a wage index for the geographic area in which the hospital is located.The actual amount the hospital is reimbursed for each Medicare inpatient is determined by multiplying the hospital’s individual payment rate by the relative weight of the DRG, less any applicable deductible amount.The formula for computing the hospital payment for each MS-DRG is as follows:DRG Relative Weight × Hospital Base Rate = Hospital Payment3. In addition to the base payment rate, what other payments are made to certain hospitals by Medicare?Medicare provides for an additional payment for other factors related to a particular hospital’s business. If the hospital treats a high percentage of low-income patients, it receives a percentage add-on payment applied to the MS-DRG adjusted base payment rate. This is known as the disproportionate share hospital (DSH) adjustmentIf the hospital is an approved teaching hospital, it receives a percentage add-on payment for each Medicare discharge paid under IPPS, known as the indirect medical education (IME) adjustment.Additional payments may be made for Medicare beneficiaries that involve new technologies or medical services that have been approved for special add-on payments.4. How are certain hospitals paid differently by Medicare?Some categories of hospitals are paid the higher of a hospital-specific rate based on their costs in a base year. Sole community hospitals (SCHs) are the sole source of care in their area and Medicare-dependent, small rural hospitals (MDHs) are a major source of care for Medicare beneficiaries in their areas. Both of these categories of hospitals are afforded this special payment protection in order to maintain access to services for beneficiaries.5. What coded information determines the MS-DRG assignment?The MS-DRG assignment is based on coded information, that is, Diagnoses (principal and secondary)Surgical procedures (principal and secondary)Discharge disposition or statusPresence of major or other complications and comorbidities (MCC or CC) as secondary diagnoses6. What is the focus of the work performed by quality improvement organizations (QIO)?Reviewing beneficiary complaints as well as serving as an advocate for beneficiaries and their families through quality improvement activitiesUsing evidence based performance improvement tools to promote healthcare servicesWorking with nursing homes to reduce the occurrence of pressure ulcersWorking with hospitals to reduce central line catheter bloodstream infectionsPromoting the use of electronic health records for care managementIncreasing preventive services like flue and pneumococcal immunizations as well as colorectal and breast cancer screeningsHelping reduce readmissions to hospitals for Medicare beneficiaries by promoting community based services provide follow up care for the hospitals7. What type of reviews are performed by FIs and MACs?FIs and MACs perform medical review of acute IPPS hospitals and long term care hospital claims to ensure that the payments are for covered, correctly coded, and reasonable and necessary services. The reviews are performed on either a prepayment or post-payment basis. They may conduct claim adjustments as needed. Also FIs and MACs provide feedback to the providers based on their review findings.8. What type of reviews are done by CERT contractors?The CERT contract reviews claims for the purpose of producing a national Medicare fee-for-service payment error rates for acute IPPS hospital and LTCH claims. The reviews are performed on a post-payment basis in order to determine the degree to which the FIs and MACs are paying appropriately in accordance with coverage, coding and medical necessity guidelines.9. What is a major area of focus for the RAC reviews?The examination of the ICD-10-CM coding is a major area of focus for the RACs because the diagnosis and procedure codes create the MS-DRGs that are the basis of payment for acute care hospitals. The ICD-10-CM and CPT coding in other healthcare organizations, such as rehabilitation hospitals and units and physician offices, determines reimbursement to the provider and will be focus of attention during these providers’ reviews10. What three factors define medical necessity of a diagnostic test, procedure or treatment according to Medicare?The likelihood that a proposed healthcare service will have a reasonable beneficial effect on the patient’s physical condition and quality of life at a specific point in his or her illness or lifetime.Healthcare services and supplies that are proven or acknowledged to be effective in the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease, or its symptoms and to be consistent with the community’s accepted standard of care. Under medical necessity, only those services, procedures, and patient care warranted by the patient’s condition are provided. The concept that procedures are only reimbursed as a covered benefit when they are performed for a specific diagnosis or specified frequency. ................
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