CBCS ICD-10-CM Diagnosis Coding 1 — Questions and Answers
Question 1: What is the maximum number of characters in a valid ICD-10-CM code?
- 5
- 6
- 7 (Correct answer)
- 8
Correct answer: 7
ICD-10-CM codes can be up to 7 characters in length.
ICD-10-CM codes range from 3 to 7 characters. The first character is always a letter, the second and third are numeric, and characters 4 through 7 provide additional specificity such as laterality, encounter type, and sequelae. A decimal point is placed after the third character but is not counted as a character.
Question 2: In ICD-10-CM, what does the 7th character 'A' typically indicate?
- Subsequent encounter
- Initial encounter (Correct answer)
- Sequela
- Not applicable
Correct answer: Initial encounter
'A' as the 7th character designates the initial encounter for active treatment.
In ICD-10-CM, the 7th character 'A' indicates the initial encounter — meaning the patient is receiving active treatment for the condition. 'D' indicates a subsequent encounter (routine care after active treatment), and 'S' indicates sequela (a condition that is the late effect of an injury or illness).
Question 3: Which ICD-10-CM guideline governs the sequencing of diagnoses for outpatient visits?
- UHDDS principal diagnosis definition
- First-listed diagnosis rule (Correct answer)
- Present on admission rule
- CC/MCC assignment rule
Correct answer: First-listed diagnosis rule
For outpatient coding, the first-listed diagnosis is the condition established after study to be chiefly responsible for the visit.
For outpatient coding, the term 'first-listed diagnosis' is used instead of 'principal diagnosis.' The first-listed diagnosis is the condition established after study to be chiefly responsible for occasioning the visit. This differs from inpatient coding, where the principal diagnosis is determined after all workup and testing.
Question 4: What does an 'Excludes1' note in ICD-10-CM mean?
- The excluded code may be used together with the code
- The two codes cannot be used together on the same claim (Correct answer)
- The excluded code is a manifestation code
- The code is exempt from POA reporting
Correct answer: The two codes cannot be used together on the same claim
Excludes1 means the two conditions cannot occur together and therefore cannot both be coded.
An Excludes1 note indicates that the excluded code and the code with the note represent mutually exclusive conditions — they cannot exist simultaneously in the same patient. Therefore, both codes cannot be reported on the same claim. This differs from Excludes2, which means the excluded condition is not included in the code but may coexist and be coded separately.
Question 5: A patient is seen for type 2 diabetes with diabetic chronic kidney disease, stage 3. What combination code would be used?
- E11.65
- E11.22 (Correct answer)
- E11.9
- N18.3
Correct answer: E11.22
E11.22 is the combination code for type 2 diabetes mellitus with diabetic chronic kidney disease, stage 3.
ICD-10-CM uses combination codes to capture a condition and its associated complication or manifestation in a single code. E11.22 represents type 2 diabetes mellitus with diabetic chronic kidney disease, stage 3 (or unspecified). Using this combination code eliminates the need for a separate CKD code in most guidelines.
Question 6: Which of the following correctly describes 'laterality' in ICD-10-CM?
- The severity level of a diagnosis
- A code specifying right, left, or bilateral (Correct answer)
- The encounter type for traumatic injuries
- The sequencing of secondary diagnoses
Correct answer: A code specifying right, left, or bilateral
Laterality refers to identifying whether a condition affects the right side, left side, or both sides of the body.
Laterality in ICD-10-CM refers to a code component that specifies whether a condition affects the right, left, or bilateral (both) sides of the body. This level of specificity was not available in ICD-9-CM and represents a major improvement. Coders should always code to the highest level of specificity, including laterality when documented by the provider.
Question 7: When coding signs and symptoms, which guideline applies in the inpatient setting?
- Signs and symptoms are always coded as additional diagnoses
- Signs and symptoms integral to the principal diagnosis are not coded separately (Correct answer)
- Signs and symptoms are never coded in inpatient settings
- Signs and symptoms replace the definitive diagnosis code
Correct answer: Signs and symptoms integral to the principal diagnosis are not coded separately
Signs and symptoms that are routinely associated with (integral to) the principal diagnosis should not be coded separately.
ICD-10-CM guidelines state that signs and symptoms that are integral to (routinely associated with) the principal diagnosis should not be coded as additional diagnoses. For example, if a patient is admitted for pneumonia, the accompanying fever and cough should not be coded separately because they are integral to the principal diagnosis of pneumonia.
Question 8: What is a 'placeholder' character in ICD-10-CM, and what letter is used?
- The letter O, used to fill the 6th character position
- The letter X, used to fill a required character position (Correct answer)
- The number 0, used when laterality is unspecified
- The letter Z, used for encounter type
Correct answer: The letter X, used to fill a required character position
The letter X is used as a placeholder to fill a required character position when no specific code exists for that position.
In ICD-10-CM, the letter 'X' is used as a placeholder character. It is required when a code needs a 7th character but does not have applicable values for intermediate positions. For example, T46.1X1A uses 'X' in the 6th character position so the 7th character 'A' (initial encounter) appears in the correct location.
CBCS ICD-10-CM Diagnosis Coding 1
What is the maximum number of characters in a valid ICD-10-CM code?