AAPC - American Academy of Professional Coders ICD-10-CM Diagnosis Coding Questions and Answers — Questions and Answers
Question 1: A patient presents for a follow-up visit for a displaced fracture of the right radial styloid process. The fracture is healing as expected, and the patient is receiving routine care for the healing fracture, such as a cast check. The initial encounter occurred two weeks ago. How should this encounter be coded?
- S52.511A, Displaced fracture of right radial styloid process, initial encounter
- S52.511S, Displaced fracture of right radial styloid process, sequela
- S52.511D, Displaced fracture of right radial styloid process, subsequent encounter for fracture with routine healing (Correct answer)
- S52.511G, Displaced fracture of right radial styloid process, subsequent encounter for fracture with delayed healing
Correct answer: S52.511D, Displaced fracture of right radial styloid process, subsequent encounter for fracture with routine healing
The ICD-10-CM guidelines for injury coding require a 7th character to indicate the episode of care. The character 'D' is used for a subsequent encounter when the patient has completed active treatment and is in the routine healing or recovery phase. Since the patient is in a follow-up visit for a healing fracture, 'D' is the correct 7th character.
Question 2: In the ICD-10-CM Tabular List, what does an "Excludes1" note signify?
- The excluded code should never be used at the same time as the code above the Excludes1 note, as the two conditions are mutually exclusive. (Correct answer)
- The excluded condition is not part of the condition represented by the code, but the patient may have both conditions at the same time.
- The condition is an associated sign or symptom and should only be coded if it is the primary reason for the encounter.
- The condition is a manifestation of an underlying disease, and an additional code is required for the etiology.
Correct answer: The excluded code should never be used at the same time as the code above the Excludes1 note, as the two conditions are mutually exclusive.
An Excludes1 note means "NOT CODED HERE!" and is used when two conditions cannot occur together. The code mentioned in the Excludes1 note should not be reported with the code under which the note appears, with a rare exception for when the two conditions are completely unrelated.
Question 3: A patient with End-Stage Renal Disease (ESRD) on dialysis is diagnosed with anemia due to their kidney disease. According to ICD-10-CM Official Guidelines, how should this be coded and sequenced?
- D63.1, N18.6
- N18.6, D63.1 (Correct answer)
- D64.9, N18.9
- N18.6, Z99.2
Correct answer: N18.6, D63.1
ICD-10-CM guidelines for anemia associated with chronic kidney disease (CKD) instruct the coder to sequence the code for the underlying CKD first, followed by the code for the anemia. Under code D63.1 (Anemia in chronic kidney disease), there is a "Code first" instructional note for the underlying chronic kidney disease (N18.-). Therefore, N18.6 (End stage renal disease) is sequenced first, followed by D63.1.
Question 4: A patient presents for a routine annual exam. The patient had breast cancer treated with a mastectomy five years ago and there is no evidence of recurrence and no ongoing treatment for the cancer. Which code category best represents the patient's resolved cancer status?
- C50.- (Malignant neoplasm of breast)
- Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm)
- D05.- (Carcinoma in situ of breast)
- Z85.- (Personal history of malignant neoplasm) (Correct answer)
Correct answer: Z85.- (Personal history of malignant neoplasm)
When a primary malignancy has been excised or eradicated and the patient is no longer receiving active treatment for it, a code from category Z85, Personal history of malignant neoplasm, is used to indicate the former site of the cancer. Using a code for active cancer (C50.-) would be incorrect as the condition is resolved.
Question 5: Which of the following best describes the primary purpose of External Cause of Morbidity codes (V00-Y99) in ICD-10-CM?
- To report the nature of the patient's injury or illness.
- To serve as the principal (first-listed) diagnosis for an encounter.
- To indicate that an injury is the direct result of a catastrophic event or terrorism.
- To provide supplemental information about the cause, intent, and place of an injury or health condition. (Correct answer)
Correct answer: To provide supplemental information about the cause, intent, and place of an injury or health condition.
External Cause codes are intended to be used as secondary codes to provide additional information. They describe how an injury or health condition occurred (cause), whether it was intentional or accidental (intent), where it happened (place), and what the patient was doing (activity). They should never be sequenced as the principal diagnosis.
Question 6: A 28-year-old patient, who is pregnant for the first time, presents for a routine prenatal visit at 22 weeks gestation. The examination is normal and there are no complaints or complications. How should this encounter be coded?
- Z34.00, Encounter for supervision of normal first pregnancy, unspecified trimester
- O09.892, Supervision of other high-risk pregnancies, second trimester
- Z34.02, Encounter for supervision of normal first pregnancy, second trimester (Correct answer)
- Z01.419, Encounter for routine gynecological examination
Correct answer: Z34.02, Encounter for supervision of normal first pregnancy, second trimester
For routine outpatient prenatal visits for a normal pregnancy without any complications, a code from category Z34 is used. The 5th character '0' indicates a first pregnancy, and the 6th character '2' specifies the second trimester. Since the patient is at 22 weeks and has a normal exam, Z34.02 is the most accurate code.
AAPC - American Academy of Professional Coders ICD-10-CM Diagnosis Coding Questions and Answers
A patient presents for a follow-up visit for a displaced fracture of the right radial styloid process.
The fracture is healing as expected, and the patient is receiving routine care for the healing fracture, such as a cast check.
The initial encounter occurred two weeks ago.
How should this encounter be coded?