CBCS - Certified Billing and Coding Specialist Coding and Coding Guidelines Questions and Answers 1 — Questions and Answers
Question 1: A patient is seen in the clinic and the provider's final diagnosis is 'acute bronchitis caused by Mycoplasma pneumoniae.' Which is the correct ICD-10-CM code assignment?
- J20.9, B96.0
- J20.0 (Correct answer)
- J40, B96.0
- J20.9
Correct answer: J20.0
The ICD-10-CM Alphabetic Index under 'Bronchitis, acute or subacute, due to, Mycoplasma pneumoniae,' directs the coder to J20.0. This is a combination code that captures both the condition (acute bronchitis) and the causative organism, making it unnecessary and incorrect to code them separately.
Question 2: A surgeon performs a procedure on a patient's left fourth toe. To specify the exact anatomical location, which type of modifier should be appended to the CPT code?
- A CPT Modifier 51
- A CPT informational modifier
- A payment policy modifier
- A HCPCS Level II modifier (Correct answer)
Correct answer: A HCPCS Level II modifier
HCPCS Level II modifiers are used to provide specific details not covered by CPT modifiers, including precise anatomical locations such as individual fingers and toes (e.g., T1-T9). Modifiers like -T3 would be used to specify the left fourth toe.
Question 3: A patient is admitted to the hospital for management of severe dehydration. The dehydration is a direct result of infectious norovirus gastroenteritis. Both conditions are treated. According to the ICD-10-CM Official Guidelines for Coding and Reporting, what is the correct sequencing for the principal diagnosis?
- The principal diagnosis is the infectious norovirus gastroenteritis. (Correct answer)
- The principal diagnosis is the dehydration.
- Either condition can be sequenced first since both were treated.
- A single combination code for gastroenteritis with dehydration should be used.
Correct answer: The principal diagnosis is the infectious norovirus gastroenteritis.
According to the ICD-10-CM Official Guidelines, if a patient is admitted for a condition that is a manifestation or result of an underlying disease, the underlying disease should be sequenced as the principal diagnosis. In this case, the gastroenteritis (A08.1) is the underlying cause of the dehydration (E86.0), so it is sequenced first.
Question 4: When using an external cause code from Chapter 20 of ICD-10-CM (V00-Y99) to describe the circumstances of an injury, which of the following is a primary guideline for its use?
- It must always be sequenced as the principal diagnosis.
- It is only required for claims submitted to Medicare.
- It can never be the principal or first-listed diagnosis. (Correct answer)
- It is only used for inpatient hospital coding.
Correct answer: It can never be the principal or first-listed diagnosis.
The ICD-10-CM Official Guidelines for Coding and Reporting state that external cause codes are supplemental and provide additional information. They can never be sequenced as the principal (inpatient) or first-listed (outpatient) diagnosis.
Question 5: In the ICD-10-CM Tabular List, what does the instructional note 'Excludes1' signify?
- The excluded code should never be used at the same time as the code above the note. (Correct answer)
- The excluded code is a component of the primary code and should not be coded separately.
- The two conditions are unrelated, but a patient may have both, so they can be coded together.
- The excluded condition is another name for the condition listed above the note.
Correct answer: The excluded code should never be used at the same time as the code above the note.
An 'Excludes1' note in ICD-10-CM indicates that the two conditions are mutually exclusive and cannot occur together. The code for the condition mentioned in the Excludes1 note should never be reported with the code it is listed under.
Question 6: A surgeon begins a diagnostic arthroscopy of the shoulder. During the procedure, a significant rotator cuff tear is identified, and the surgeon immediately converts the arthroscopic procedure to a full open rotator cuff repair during the same operative session. How should this encounter be coded?
- Code both the diagnostic arthroscopy and the open repair, with modifier 58 on the repair.
- Code the diagnostic arthroscopy with a modifier indicating it led to a more extensive procedure.
- Code both the surgical arthroscopy and the open repair.
- Code only for the open rotator cuff repair procedure. (Correct answer)
Correct answer: Code only for the open rotator cuff repair procedure.
According to the National Correct Coding Initiative (NCCI) and general coding principles, if an arthroscopic procedure is converted to an open procedure on the same joint during the same session, only the open procedure should be reported. The diagnostic scope is considered an integral part of the more definitive open repair.
CBCS - Certified Billing and Coding Specialist Coding and Coding Guidelines Questions and Answers 1
A patient is seen in the clinic and the provider's final diagnosis is 'acute bronchitis caused by Mycoplasma pneumoniae.' Which is the correct ICD-10-CM code assignment?