CMC Coding Guidelines & Conventions 2 — Questions and Answers
Question 1: In ICD-10-CM, what does the instruction 'Code first' indicate?
- Code the condition listed as secondary
- The listed code must be sequenced first when a causal condition exists (Correct answer)
- The code is optional and may be omitted
- The condition should be reported only on inpatient claims
Correct answer: The listed code must be sequenced first when a causal condition exists
'Code first' directs the coder to sequence the underlying cause or manifestation code before the current condition code.
Question 2: What is the purpose of the 'Excludes2' note in ICD-10-CM?
- The excluded condition can never be coded with the code
- The two conditions are mutually exclusive
- The excluded condition may be coded together with the code when both conditions are present (Correct answer)
- The excluded condition replaces the current code
Correct answer: The excluded condition may be coded together with the code when both conditions are present
Excludes2 means the excluded condition is not part of the indexed condition but both may be reported simultaneously if documented.
Question 3: When coding an encounter for a condition that is both acute and chronic, which form should generally be sequenced first?
- Chronic form
- Acute form (Correct answer)
- Either form, based on coder preference
- Alphabetical order determines sequencing
Correct answer: Acute form
ICD-10-CM guidelines direct coders to sequence the acute condition first when separate codes exist for both acute and chronic forms.
Question 4: In CPT, what is a 'separate procedure' designation?
- A procedure always billed independently
- A procedure integral to a larger service and not separately reported when performed as part of that service (Correct answer)
- A procedure requiring a modifier
- A procedure coded only on outpatient claims
Correct answer: A procedure integral to a larger service and not separately reported when performed as part of that service
Procedures labeled 'separate procedure' in CPT are commonly bundled into larger services and should not be reported separately unless performed independently.
Question 5: What does the abbreviation 'NEC' mean in the ICD-10-CM index?
- Not Elsewhere Classified (Correct answer)
- Not Entirely Coded
- Not Evaluated Clinically
- Non-Essential Condition
Correct answer: Not Elsewhere Classified
NEC (Not Elsewhere Classified) directs the coder to use this code when a specific code for the condition does not exist.
Question 6: Which CPT modifier indicates a distinct procedural service performed on the same day as another procedure?
- -51
- -59 (Correct answer)
- -25
- -79
Correct answer: -59
Modifier -59 identifies a procedure or service that is distinct or independent from other services performed on the same day.
Question 7: In ICD-10-CM, how should a condition described as 'probable' be coded in the outpatient setting?
- Code the probable condition as confirmed
- Code the signs and symptoms, not the unconfirmed diagnosis (Correct answer)
- Leave the diagnosis field blank
- Use a 'suspected' qualifier code
Correct answer: Code the signs and symptoms, not the unconfirmed diagnosis
Outpatient coding guidelines prohibit coding unconfirmed diagnoses; signs, symptoms, or test findings should be reported instead.
CMC Coding Guidelines & Conventions 2
In ICD-10-CM, what does the instruction 'Code first' indicate?