CPC - Certified Professional Coder ICD-10-CM Diagnosis Coding Questions and Answers — Questions and Answers
Question 1: A patient is seen for painful urination and is diagnosed with an acute cystitis. The patient also has documented chronic cystitis. According to ICD-10-CM guidelines, how should these conditions be coded and sequenced?
- Code both acute and chronic cystitis, and sequence the acute cystitis code first. (Correct answer)
- Code only the acute cystitis as it is the reason for the visit.
- Code both acute and chronic cystitis, and sequence the chronic cystitis code first.
- Code a combination code for acute and chronic cystitis.
Correct answer: Code both acute and chronic cystitis, and sequence the acute cystitis code first.
According to the ICD-10-CM Official Guidelines for Coding and Reporting, if the same condition is described as both acute and chronic, and separate subentries exist in the Alphabetic Index, both codes should be assigned. The acute code is sequenced first, followed by the chronic code.
Question 2: A patient presents to the emergency department with an altered mental status after accidentally taking a double dose of their prescribed oxycodone. How should the ICD-10-CM codes be sequenced?
- Altered mental status code first, followed by the poisoning code for oxycodone.
- Poisoning code for oxycodone first, followed by the altered mental status code. (Correct answer)
- Adverse effect code for oxycodone first, followed by the altered mental status code.
- A single combination code for poisoning by oxycodone with altered mental status.
Correct answer: Poisoning code for oxycodone first, followed by the altered mental status code.
For a poisoning, the ICD-10-CM guidelines state to sequence the poisoning code first (from categories T36-T50), followed by any code(s) for the manifestation(s). Since the patient took an incorrect dose, it is classified as a poisoning, not an adverse effect. The poisoning code (T40.2X1A) would be sequenced first, followed by the code for altered mental status (R41.82).
Question 3: A patient is treated for a keloid scar on their left forearm which is a result of a second-degree burn sustained one year ago. Which of the following is the correct coding and sequencing for this encounter?
- Code for the burn first, followed by the code for the scar.
- Code only the keloid scar, as the burn is healed.
- Code for the keloid scar first, followed by the code for the burn with the 7th character 'S' for sequela. (Correct answer)
- Code for the burn with the 7th character 'D' for subsequent encounter, followed by the code for the scar.
Correct answer: Code for the keloid scar first, followed by the code for the burn with the 7th character 'S' for sequela.
Coding for a sequela (late effect) generally requires two codes. The residual condition (the sequela) is coded first, followed by the code for the cause of the sequela with the 7th character 'S'. In this case, the keloid scar (L91.0) is the sequela and is coded first. The burn (T22.212S) is the cause and is coded second with the 'S' to indicate it is a sequela of the original injury.
Question 4: Which of the following is a key convention when using the placeholder 'X' in an ICD-10-CM code?
- The 'X' is only used for unspecified codes.
- The 'X' is used to allow for future expansion and must be used for the code to be valid if it fills empty character spaces up to the required 7th character. (Correct answer)
- The 'X' indicates the encounter is for a sequela.
- The 'X' is never used as the 5th character.
Correct answer: The 'X' is used to allow for future expansion and must be used for the code to be valid if it fills empty character spaces up to the required 7th character.
The ICD-10-CM uses the placeholder character 'X' for two main reasons: to allow for future expansion and to fill in empty characters when a code requires a 7th character but is not 6 characters long. Where a placeholder exists, the 'X' must be used for the code to be considered a valid code.
Question 5: A patient with Type 2 diabetes mellitus is seen for a routine follow-up. The provider documents 'Type 2 DM with diabetic polyneuropathy'. How should this be coded in ICD-10-CM?
- Code for polyneuropathy first, then the code for Type 2 diabetes.
- Assign two separate codes: E11.9 for Type 2 diabetes and G62.9 for polyneuropathy.
- Use a single combination code, E11.42, which includes both the diabetes and the specific neurological complication. (Correct answer)
- Assign code E11.8 for Type 2 diabetes with unspecified complications.
Correct answer: Use a single combination code, E11.42, which includes both the diabetes and the specific neurological complication.
ICD-10-CM has combination codes for diabetes that include the type of diabetes, the body system affected, and the complication. The 'with' convention in the Alphabetic Index presumes a causal relationship between diabetes and certain other conditions. For Type 2 diabetes with diabetic polyneuropathy, the correct code is E11.42, which is a specific combination code that captures both diagnoses.
Question 6: A patient is prescribed a new medication and develops a rash. The physician confirms the patient took the medication correctly as prescribed and diagnoses the rash as an adverse effect of the drug. What is the correct sequencing of codes?
- Code the drug from the T36-T50 range first, followed by the code for the rash.
- Code only the rash, as it is the manifestation.
- Code the rash first, followed by the appropriate code from T36-T50 with the 5th or 6th character '5' to indicate an adverse effect. (Correct answer)
- Code the Z-code for long-term drug therapy first, then the rash.
Correct answer: Code the rash first, followed by the appropriate code from T36-T50 with the 5th or 6th character '5' to indicate an adverse effect.
The ICD-10-CM guidelines for coding an adverse effect state that the manifestation or nature of the adverse effect (the rash) should be sequenced first, followed by the code for the drug that caused the effect (from categories T36-T50 with the 5th or 6th character of '5').
CPC - Certified Professional Coder ICD-10-CM Diagnosis Coding Questions and Answers
A patient is seen for painful urination and is diagnosed with an acute cystitis.
The patient also has documented chronic cystitis.
According to ICD-10-CM guidelines, how should these conditions be coded and sequenced?