RHIT Medical Coding Principles 2 — Questions and Answers
Question 1: Which coding guideline applies when a patient is admitted with a condition that develops into a more specific diagnosis during the stay?
- Code the admitting diagnosis only
- Code the final confirmed diagnosis as the principal diagnosis (Correct answer)
- Code both the initial and final diagnoses
- Use a Z code for uncertain diagnosis
Correct answer: Code the final confirmed diagnosis as the principal diagnosis
The UHDDS guideline requires coding the condition established after study as the principal diagnosis, not the admitting diagnosis.
Question 2: In ICD-10-CM, what does an 'X' placeholder in a code indicate?
- The code requires a 7th character extension
- A dummy placeholder used to allow for future expansion or to reach a required character position (Correct answer)
- The diagnosis is excludes note type 1
- The code is a manifestation code
Correct answer: A dummy placeholder used to allow for future expansion or to reach a required character position
The 'X' placeholder fills a character position so a required character (often 7th) can be assigned correctly.
Question 3: When coding a patient with type 2 diabetes mellitus and diabetic chronic kidney disease stage 3, what is the correct coding approach?
- Code only the diabetes
- Code only the CKD
- Code the diabetes with CKD combination code, then add the CKD stage code (Correct answer)
- Code CKD first, then diabetes as secondary
Correct answer: Code the diabetes with CKD combination code, then add the CKD stage code
ICD-10-CM provides combination codes for diabetes with complications; the CKD stage is coded additionally per guidelines.
Question 4: In CPT coding, what distinguishes a 'new patient' from an 'established patient' for E/M services?
- A new patient has not been seen by the physician in over 1 year
- A new patient has not received professional services from the physician or same group practice within the past 3 years (Correct answer)
- A new patient is one who has never visited the facility
- A new patient has a new insurance plan
Correct answer: A new patient has not received professional services from the physician or same group practice within the past 3 years
CPT defines a new patient as one who has not received professional services from the physician/group within the past 3 years.
Question 5: What is the purpose of the 'Table of Neoplasms' in the ICD-10-CM index?
- To list all cancers by body system only
- To guide coders to the correct code based on site and behavior (malignant, benign, uncertain, etc.) (Correct answer)
- To provide staging information for tumors
- To cross-reference CPT oncology codes
Correct answer: To guide coders to the correct code based on site and behavior (malignant, benign, uncertain, etc.)
The Table of Neoplasms organizes codes by anatomic site and neoplasm behavior, directing coders to the appropriate code.
Question 6: A patient undergoes a laparoscopic appendectomy that is converted to an open procedure. How should this be coded in CPT?
- Code only the open appendectomy (Correct answer)
- Code only the laparoscopic approach with a modifier
- Code both the laparoscopic and open procedures
- Code the open appendectomy and add modifier -52
Correct answer: Code only the open appendectomy
When a laparoscopic procedure is converted to open, only the open procedure code is reported per CPT guidelines.
Question 7: Which ICD-10-CM guideline governs the sequencing of a complication code versus the underlying condition?
- Complication codes are always sequenced first
- The underlying condition is sequenced first unless the complication is the reason for the encounter (Correct answer)
- Manifestation codes are sequenced before etiology codes
- Complication codes are never used as principal diagnosis
Correct answer: The underlying condition is sequenced first unless the complication is the reason for the encounter
Sequencing depends on the reason for the encounter; if the complication prompted the visit, it may be principal.
RHIT Medical Coding Principles 2
Which coding guideline applies when a patient is admitted with a condition that develops into a more specific diagnosis during the stay?