ICD-10-CM Coding Guidelines Flashcards
6 cards from real CRC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 ICD-10-CM Coding Guidelines flashcards as text
When a provider documents 'suspected' or 'probable' condition in an outpatient encounter, how should the coder handle this for risk adjustment?
Answer: Code only signs, symptoms, or findings — never code suspected conditions in outpatient settings
Section IV.H states uncertain diagnoses should NOT be coded in outpatient settings. Code to the highest degree of certainty.
How is the causal relationship between diabetes and a complication established under ICD-10-CM guidelines?
Answer: ICD-10-CM assumes a causal relationship for certain conditions unless provider documents otherwise
Section I.C.4.a.6 presumes a causal link between diabetes and certain listed conditions unless the provider documents a different cause.
A provider documents 'bilateral knee osteoarthritis.' What is the correct coding approach?
Answer: Code M17.0 for bilateral primary osteoarthritis
ICD-10-CM provides a specific bilateral code (M17.0) for knee osteoarthritis. When available, use the bilateral code.
When should Z-codes be used as the principal or first-listed diagnosis?
Answer: When the encounter is specifically for the purpose described by the Z-code, such as screening or aftercare
Certain Z-codes can be principal when the encounter is specifically for that purpose: immunization, screening, aftercare, etc.
When coding acute and chronic conditions for the same condition, what does Section I.B.8 require?
Answer: Code both with the acute code sequenced first, unless a combination code exists
If separate codes exist, code both with acute first. If a combination code exists (like acute-on-chronic heart failure), use that instead.
A chart documents 'history of DVT, currently on anticoagulation.' How do guidelines distinguish history from active conditions?
Answer: The provider's documentation determines status; 'history of' uses Z-codes unless the condition is documented as active
The provider's documentation drives the decision. History codes generally do not map to HCCs, while active condition codes often do.