Ch. 3 Q & A Flashcards
Which Z code can only be reported as a first listed code?
A. Z37.9
B. Z79.890
C. Z87.710
D. Z00.129
D. Z00.129
RATIONALE: In the ICD-10-CM guidelines I.C.21.c.16, there is a list of Z codes that can only be reported as first-listed diagnosis codes.
When coding for a patient who has had a primary malignancy of the thyroid gland that was completely excised a year ago, and there is no current treatment directed at that site, which of the following statements is TRUE?
A. When no further treatment is provided and there is no evidence of any existing primary malignancy, code Z85.850.
B. When further treatment is provided and there is evidence of an existing metastasis, code first Z85.850 and then C32.3.
C. Any mention of extension, invasion, or metastasis to another site is coded as D49.1.
D. When further treatment is provided and there is evidence of an existing metastasis, code first C78.39.
A. When no further treatment is provided and there is no evidence of any existing primary malignancy, code Z85.850.
RATIONALE: According to the ICD-10-CM guidelines I.C.2.d., when the patient has completed treatment for cancer and there is not an existing malignancy, select a personal history of malignancy by site. From the ICD-10-CM Alphabetic Index, look for History/personal (of)/malignant neoplasm (of)/thyroid. Verify code selection in the Tabular List.
The patient has acute, gangrenous tonsillitis. Code his condition.
A. J35.01, I96
B. J35.01
C. J03.90, 196
D. J03.90
D. J03.90
RATIONALE: There is no need for a second code for gangrene. In the ICD-10-CM Alphabetic Index, look for Tonsillitis. Gangrenous and acute appear as nonessential modifiers (eg, in parentheses) with the term Tonsillitis. Because gangrenous and acute are nonessential modifiers, they do not alter code selection. Tonsillitis directs you to J03.90. Verify code selection in the Tabular List.
The patient has a history of symptomatic HIV. What ICD-10-CM code is reported?
A. Z21
B. B20
C. Z86.39
D. R75
B. B20
RATIONALE: Always pause to consider the meaning of “history” when you see it in a note. Physician documentation does not always dovetail with the language of ICD-10-CM. History is a good example of this. A physician may document that the patient has a history of a disease, and this usually will mean that the disease has been eradicated. It may bean that the disease is not a diagnosis new at this encounter, but something ongoing in the patient’s care. It may also mean that this is a problem that the patient has had and resolved in the past, and that it has recurred. In the case of “history of symptomatic HIV,” this is not a disease that resolves. Once a patient has symptomatic HIV, regardless of whether the patient exhibits symptoms, the diagnosis is coded as B20. According to ICD-10-CM guidelines I.C.1.a.2.f., once a patient with HIV develops symptoms or an opportunistic disease, report code B20. This code can be located by looking in the ICD-10-CM Alphabetic Index for Human/Immunodeficiency virus (HIV) disease (infection) or by looking for HIV. Verify the code in the Tabular List.
Patient presents with sternal chest wall pain, possible angina. Physician rules out angina and documents probable costochondritis. Code the diagnosis.
A. R07.9
B. M94.0
C. R07.89
D. I20.9
C. R07.89
RATIONALE: Codes describing symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis, symptom, complaint, condition, or problem, indicating why the service was performed if a final diagnosis is not available. ICD-10-CM guideline IV.H. states rule out and probable diagnosis are not coded as if they exist in the outpatient setting. In this case, angina was ruled out by the physician, and costochondritis, has not been confirmed. The symptom of sternal chest wall pain is reported. Look in the ICD-10-CM Alphabetic Index for Pain/chest/wall referring you to R07.89. Verify in the Tabular List.
Following a MUGA scan, the physician documents the patient has developed congestive heart failure as an adverse effect of the trastuzumab she received as a treatment for her breast cancer in the right breast. The trastuzumab antineoplastic antibiotic therapy is being discontinued while he attempts to manage the heart failure pharmaceutically. Code the patient’s condition.
A. I50.9, T45.1X1A
B. I50.9, T45.1X5A, C50.911
C. 150.9, C50.911
D. 150.9, C50.919
B. I50.9, T45.1X5A, C50.911
RATIONALE: Congestive heart failure has many codes, but without more information, I50.9 (ICD-10-CM Alphabetic Index path: Failure/hear/congestive) is reported. The heart failure is an adverse effect of the drug trastuzumab, an antineoplastic antibiotic agent. According to ICD-10-CM guidelines, I.C.18.e.5.a., when coding for an adverse effect, code the nature of the adverse effect, followed by the T code for the adverse effect of the drug (Table of Drugs and Chemicals, Adverse effect column). The nature is the congestive heart failure so I50.9 is reported first. Look in the Table of Drugs and Chemicals for Antibiotic NEC/antineoplastic, or for Antineoplastic NEC/antibiotics and use the code from the Adverse Effect column (T45.1X5). In the Tabular List, a 7th character is required for this code. A is chosen for active treatment. Report the breast cancer, as suspension of therapy for the breast cancer will need to be addressed at some point in this patient’s plan of care. Look in the Table of Neoplasms for Neoplasm, neoplastic/breast (connective tissue) (glandular tissue) (soft parts) and select the code from the Malignant Primary column C50.9-. The dash indicates an additional character is required. In the Tabular List, 5th character 1 is reported to indicate the patient is female and 6th character 1 is reported to indicate the right breast. C50.911 is the complete code. Because the patient is still being treated with trastuzumab and the physician notes that treatment is being discontinued for contraindications, she is still considered to have active cancer making a history code inappropriate. Note that separate codes exist for antineoplastic drugs versus antineoplastic antibiotics.
Mr. Jones is here today to receive an intercostal nerve block to mitigate the debilitating pain of his malignancy. His cancer has metastasized to his lungs. Code the patient’s condition.
A. G89.3, C78.01, C78.02
B. G89.12, C34.90
C. G89.3, C34.91, C34.92
D. G89.12, C78.00
A. G89.3, C78.01, C78.02
RATIONALE: In the ICD-10-CM guidelines, I.C.2.h. Admission/encounter for pain control/management refers you to I.C.6. ICD-10-CM guidelines I.C.6.b.5., provide detailed instructions for sequencing and reporting neoplasm related pain. The reason for this encounter is pain management; pain in neoplastic disease (G89.3) is the first listed diagnosis. To locate this code, look in the ICD-10-CM Alphabetic Index for Pain/due to malignancy (primary) *secondary). The patient has metastatic cancer of his lungs (plural - meaning the right and left lung). Look in the Table of Neoplasms for Neoplasm, neoplastic/lung and use the code from the Malignant Secondary column (the cancer is metastasized to his lungs making it secondary) C78.0-. In the Tabular List, there is not a code for bilateral, so both the right and left lung are reported separately (ICD-10-CM guideline I.B.13).
Four years post hepatic transplant, the patient is diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma of the liver. Code the patient’s condition.
A. T86.49, C80.2, C22.0
B. C80.2, C22.0, Z98.85
C. T86.49, C80.2, C22.9
D. T86.49, C80.2, C22.9, Z98.85
A. T86.49, C80.2, C22.0
RATIONALE: According to ICD-10-CM guidelines I.C.2.r., Assign first the transplant complication code (T86.-), followed by code C80.2 Malignant neoplasm associated with transplanted organ, then a code for the malignancy. Look in the ICD-10-CM Alphabetic Index for Complication/transplant/liver/specified type NEC referring you to T86.49. In the Tabular List, at category T86, there is an instructional note to also code the malignancy associated with organ transplant, C80.2. To report the malignancy, look in the Alphabetic Index for Cholangiocarcinoma/with hepatocellular carcinoma, combined referring you to C22.0. Verify in the Tabular List.
Mrs. Bixby, who is 83 years old, is being admitted for dehydration and anorexia, probably cause, dementia. She was brought in by her daughter who is visiting from out of town. Her daughter will take her from our office to St. Mary’s hospital. The gerontology unit will evaluate her mental condition tomorrow after she is stabilized. How would you code the diagnoses?
A. F50.00, E86.0
B. R63.0, E86.0
C. F50.00, E86.0, F06.8
D. R63.0, E86.0, F06.8
B. R63.0, E86.0
RATIONALE: Codes describing symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been confirmed by the physician (ICD-10-CM guidelines I.B.4.). Coders should select an ICD-10-CM code to describe the diagnosis, symptom, complain, condition, or problem, indicating why the service was performed if a final diagnosis is not available. ICD-10-CM Guideline IV.H. states rule out and probable diagnosis are not coded as if they exist in the outpatient setting. In this case, dementia is not reported because it is only listed as probable. Although anorexia is often a short way of describing anorexia nervosa, in this case, there is no documentation of an eating disorder as a psychological disorder, so anorexia, unspecified is reported along with dehydration. Look in the ICD-10-CM Alphabetic Index for Anorexia R63.0 and Dehydration E86.0. Verify code selection in the Tabular List.
A 27 year-old man with a 25-year history of juvenile diabetes is admitted to the ICU with diabetic ketoacidosis brought on by H1N1 influenza virus which includes respiratory symptoms. Which codes best report how his consulting endocrinologist will report his condition?
A. E10.10, J10.1
B. J11.89, E13.10
C. J10.08, E10.10
D. E08.10, J11.89
A. E10.10, J10.1
RATIONALE: The reason for this patient’s hospitalization is the diabetic ketoacidosis (DKA), which is also the main concern of the endocrinologist, so the diabetes is sequenced first. The diabetes is stated as being juvenile, so the patient has type I diabetes. Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/type 1/with/ketoacidosis referring you to E10.10. the patient is also diagnosed with H1N1 flu. In the Alphabetic Index, look for Influenza/novel influenza A/H1N1 directing you to see also Influenza, due to, identified influenza virus NEC. Look for Influenza/due to /identified influenza virus NEC/with/respiratory manifestations referring you to J10.1. Confirm code selections in the Tabular List.
Acute
A condition with a rapid onset with a short course.
Brackets [ ]
Symbols to enclose synonyms, alternate wording, or explanatory phrases in the Tabular List. Brackets are used in the Alphabetic Index to identify manifestation codes in which multiple coding and sequencing rules will apply.
Chronic
A condition that develops slowly and lasts a long period of time.
Closed Fracture
A fractured bone that does not pierce the skin.
Default Code
The code listed next to the main term and represents the condition most commonly associated with the main term.
