CBCS ICD-10-CM Diagnosis Coding 2 — Questions and Answers
Question 1: Which chapter in ICD-10-CM contains codes for external causes of morbidity?
- Chapter 19
- Chapter 20 (Correct answer)
- Chapter 21
- Chapter 18
Correct answer: Chapter 20
Chapter 20 (V00–Y99) contains codes for external causes of morbidity.
ICD-10-CM Chapter 20 (codes V00–Y99) contains codes for external causes of morbidity, including transport accidents, falls, burns, poisonings, and other causes of injury. These codes are used in addition to the injury or condition code to provide information about how an injury occurred and are especially important for trauma and injury cases.
Question 2: A patient has essential hypertension and heart failure. In ICD-10-CM, these conditions are reported using:
- Two separate codes: I10 and I50.9
- A combination code from category I11 (Correct answer)
- A combination code from category I13
- Code I10 only, as heart failure is integral
Correct answer: A combination code from category I11
ICD-10-CM presumes a causal relationship between hypertension and heart failure, coded with a combination code from category I11.
Per ICD-10-CM guidelines, a causal relationship is assumed between hypertension and heart failure (unlike CKD, which requires physician documentation). Category I11 (Hypertensive heart disease) includes combination codes that capture both hypertension and the associated heart failure. The specific code depends on the type of heart failure documented (systolic, diastolic, etc.).
Question 3: What does 'code first' mean in ICD-10-CM?
- The code must be the patient's primary condition
- Certain underlying conditions must be sequenced before the manifestation (Correct answer)
- The code is always the principal diagnosis in inpatient settings
- The code is assigned before determining medical necessity
Correct answer: Certain underlying conditions must be sequenced before the manifestation
'Code first' instructs the coder to sequence the underlying condition before the manifestation code.
The 'code first' instruction in ICD-10-CM is an etiology/manifestation note that requires the underlying condition to be sequenced before the manifestation code. For example, diabetic retinopathy requires coding the diabetes first (e.g., E11.311) followed by the retinopathy manifestation code. This convention ensures that the root cause is identified before the resulting condition.
Question 4: In ICD-10-CM, which code category is used for a patient who is a carrier of an infectious disease but has no symptoms?
- Z codes (Correct answer)
- V codes
- E codes
- S codes
Correct answer: Z codes
Z codes are used for factors influencing health status, including disease carriers without active illness.
Z codes (Chapter 21: Factors influencing health status and contact with health services) are used to describe circumstances when a person who may or may not be sick encounters health services for a specific purpose, or when some circumstance or problem influences the person's health status but is not an illness or injury. Carriers of infectious diseases without symptoms are coded with Z codes such as Z22 (carrier of infectious disease).
Question 5: Which ICD-10-CM code set is used for neoplasm coding?
- Codes from Chapter 2 (C00–D49) (Correct answer)
- Codes from Chapter 19 only
- Codes from the V-code section
- Codes from Chapter 18 only
Correct answer: Codes from Chapter 2 (C00–D49)
Neoplasm codes are found in Chapter 2 of ICD-10-CM, ranging from C00 to D49.
Chapter 2 of ICD-10-CM (codes C00–D49) covers neoplasms. Malignant neoplasms begin with C, while D codes cover benign, in situ, and uncertain behavior neoplasms. Coders must reference the ICD-10-CM Neoplasm Table and verify the behavior (malignant, benign, in situ, uncertain) before assigning the appropriate code.
Question 6: What does 'sequela' mean in the context of ICD-10-CM coding?
- A current acute injury
- A late effect resulting from a previous condition or injury (Correct answer)
- A pre-existing chronic condition
- A condition present on admission
Correct answer: A late effect resulting from a previous condition or injury
A sequela is a condition that is the late effect or residual of an injury or illness that has already healed.
In ICD-10-CM, a sequela (coded with 7th character 'S') is a residual condition or late effect that remains after the acute phase of an illness or injury has ended. For example, a patient who suffered a stroke six months ago may now have hemiplegia as a sequela. The sequela code is sequenced first, followed by the code for the cause of the sequela.
Question 7: When multiple burns are coded, how should they be sequenced?
- Sequence by body site in anatomical order
- Sequence the most severe (highest degree) burn first (Correct answer)
- Sequence the largest surface area burn first
- Sequence burns in the order they were treated
Correct answer: Sequence the most severe (highest degree) burn first
ICD-10-CM guidelines require the highest degree burn to be sequenced first when multiple burns are present.
Per ICD-10-CM guidelines, when a patient has multiple burns, the code for the most severe burn (the highest degree) is sequenced first. If burns of equal degrees are on multiple sites, the sequence may follow the body site conventions. Additional codes for each burn site and a code for total body surface area (TBSA) burned should also be assigned when documented.
Question 8: Which of the following best describes an 'unspecified' code in ICD-10-CM?
- A code used when the condition is unknown or not documented (Correct answer)
- A code that cannot be billed to Medicare
- A code used only for outpatient encounters
- A code reserved for uncertain diagnoses
Correct answer: A code used when the condition is unknown or not documented
Unspecified codes are used when documentation does not provide enough detail to assign a more specific code.
Unspecified codes in ICD-10-CM are used when documentation in the medical record does not contain sufficient detail to assign a more specific code, and querying the physician has not resulted in additional specificity. While unspecified codes are valid, coders should always attempt to code to the highest level of specificity, and payers may require more specific codes for reimbursement.
CBCS ICD-10-CM Diagnosis Coding 2
Which chapter in ICD-10-CM contains codes for external causes of morbidity?