CRC ICD-10-CM Diagnosis Coding 2 — Questions and Answers
Question 1: A patient has Type 2 diabetes with diabetic chronic kidney disease, stage 4. Which code combination is correct?
- E11.22 and N18.4 (Correct answer)
- E11.65 and N18.4
- E11.9 and N18.4
- E11.22 only
Correct answer: E11.22 and N18.4
E11.22 establishes the causal relationship. N18.4 must be coded additionally to specify the CKD stage.
E11.22 maps to HCC 18 while N18.4 maps to HCC 137. Both contribute independently to RAF.
Question 2: A provider documents 'acute exacerbation of chronic systolic heart failure.' What is the correct code?
- I50.21 Acute systolic heart failure
- I50.23 Acute on chronic systolic heart failure (Correct answer)
- I50.22 Chronic systolic heart failure
- I50.9 Heart failure, unspecified
Correct answer: I50.23 Acute on chronic systolic heart failure
I50.23 captures both the chronic nature and the acute episode in a single combination code.
ICD-10-CM has specific combination codes for heart failure. Using I50.21 misses the chronic component; I50.22 misses the acute exacerbation.
Question 3: A coder encounters 'history of breast cancer, currently on tamoxifen for chemoprevention' after mastectomy 3 years ago with no recurrence. Which code applies?
- C50.911 Malignant neoplasm of breast
- Z85.3 Personal history of malignant neoplasm of breast (Correct answer)
- Z86.000 Personal history of in-situ neoplasm
- C50.911 and Z85.3 together
Correct answer: Z85.3 Personal history of malignant neoplasm of breast
Z85.3 is appropriate when cancer has been excised with no recurrence. Tamoxifen for chemoprevention does not indicate active cancer.
Active cancer codes map to HCC 12 while history codes do not. Coding active cancer for a patient in remission is overcoding.
Question 4: A patient presents with sepsis due to MRSA. Which coding sequence is correct?
- A41.02 first, then B95.62 (Correct answer)
- B95.62 first, then A41.02
- A41.02 only
- R65.20 first for severe sepsis, then A41.02
Correct answer: A41.02 first, then B95.62
A41.02 is sequenced first as the systemic infection. B95.62 identifies the infectious agent additionally.
Sepsis coding follows Section I.C.1.d. A41.02 maps to HCC 2, one of the highest RAF weights in the model.
Question 5: A provider documents 'morbid obesity with BMI of 42' and obesity hypoventilation syndrome. What is the complete code set?
- E66.01, Z68.42, E66.2 (Correct answer)
- E66.01, Z68.42
- E66.2, Z68.42, E66.01
- E66.01 and E66.2 only
Correct answer: E66.01, Z68.42, E66.2
E66.01 for morbid obesity, Z68.42 for specific BMI, and E66.2 for obesity hypoventilation syndrome. Each captures distinct clinical information.
E66.01 maps to HCC 22. E66.2 (Pickwickian syndrome) is a separate serious respiratory complication of obesity.
Question 6: When coding alcoholic cirrhosis and hepatitis C together, which convention applies?
- Code only alcoholic cirrhosis as the more severe condition
- Code both K70.30 and B18.2 as independent conditions (Correct answer)
- Use a combination code
- Code hepatitis C first as underlying cause
Correct answer: Code both K70.30 and B18.2 as independent conditions
These are independent conditions with separate etiologies. K70.30 maps to HCC 28 and B18.2 maps to HCC 29.
ICD-10-CM classifies liver diseases by etiology. Alcoholic and viral hepatitis have different etiologies and contribute independently to RAF.
CRC ICD-10-CM Diagnosis Coding 2
A patient has Type 2 diabetes with diabetic chronic kidney disease, stage 4.
Which code combination is correct?