Ch. 4: ICD-10-CM

Question 1

What are the 3 main coding systems and what do each apply to?

Answer 1

ICD-10-CM-international classification fo diseases, clinical modification, is used for medical diagnoses in all health care settings

ICD-10-PCS-procedural coding system, is used to code inpatient procedures

HCPCS-Healthcare Common Procedure Coding System (HCPCS, pronounced “hick-pix)
Level I-CPT-current procedural terminology-applies to physician and other provider services performed in an ambulatory, office, or outpatient setting

Level II-covers services and supplies not listed in Level I

Question 2

Who maintains and updates diagnoses in ICD-10-CM?

Answer 2

NCHS-National Center for Health Statistics

Question 3

Who maintains and updates ICD-10-PCS?

Answer 3

CMS-Centers for Medicare and Medicaid Services

Question 4

Who maintains the ICD-10-CM central office for queries, publishes the coding clinic (quarterly update newsletter) for ICD-10-CM, and the official guidelines for usage?

Answer 4

AHA-American Hospital Association

Question 5

puerperium

Answer 5

the period of time that begins at the end of the third stage of labor and continues for six weeks

Question 6

perinatal period

Answer 6

begins before birth and last until the 28th day of life

Question 7

Laterality

Answer 7

refers to a specific side of the body in coding

if the condition affects both sides, and there is no bilateral option, you have to use both codes for right and left

Question 8

What are the two lists in the ICD-10-CM? Which do you start with?

Answer 8

Alphabetic index
Tabular list

You start by looking it up in the alphabetic index, and use that to find the condition in the tabular list, which is where you get the actual code as it includes more detail

Question 9

What does a code always start with?

Answer 9

a letter

Question 10

how many characters is the max a code can have?

Answer 10

7

Question 11

describe the 7th character extension

Answer 11

provides additional info about the patients condition, letters and numbers are used

Question 12

what is a placeholder x?

Answer 12

used in conjunction with codes that require a 7th character extension and the code has less than six characters, then an “x” it used to make it 6 so you can add the 7th character

Question 13

How do you know what the main term is in the Alphabetic index? What are the terms next to it in parenthesis? What about the terms listed below that are indented?

Answer 13

the main term in bold

The terms in parenthesis are “nonessential modifiers”, which means they don’t affect the code

The terms below are called “essential modifiers” or “subterms” and they do affect the code

Question 14

What does a (-) in the Alphabetic index or a (.-) mean in the tabular list?

Answer 14

incomplete codes that require additional digits

Question 15

What does the ( ) parentheses mean?

Answer 15

nonessential modifiers

codes excluded from a category

range of codes for a chapter or category block of codes

Question 16

What do [ ] square brackets mean?

Answer 16

synonyms, alternative wording, or explanatory phrases

Question 17

What do slanted [ ] square brackets mean?

Answer 17

codes for conditions that are manifestations of underlying conditions

Question 18

What does “Excludes1” mean?

Answer 18

indicates that the excluded code should never be used at the same time as the code above the Excludes1 note.

Question 19

What does “Excludes2” mean?

Answer 19

the excluded condition is not part of the condition represented by the code preceding the note, however, the patient might have both conditions at the same time, therefore both codes may be assigned

Question 20

NOS

Answer 20

not otherwise specified- for when the diagnosis doesn’t specify

Question 21

NES

Answer 21

Not Elsewhere Specified-for when their is not a more specific code to use

Question 22

When can sign and symptoms codes be used?

Answer 22

when a definitive diagnosis has not been established or confirmed by the provider

they should not be used when they are simply associated with a disease or condition as the condition code is being used and the symptoms are expected

Question 23

When a acute and chronic condition is described in the same diagnostic statement, which one is coded first (if two codes exsist)?

Answer 23

the acute comes first

Question 24

What is a combination code? When is it used?

Answer 24

it is a single code used to classify two diagnoses, a diagnosis with an associated secondary condition (manifestation), or a diagnosis with an associated complication.

It is used when the combination code accurately represents the documented record, you only use the combo code.

Question 25

What is a sequela?

Answer 25

a condition or problem that remains after the acute phase of an illness or injury. Example: paralysis from a stroke. Also called “residual effects” and “late effect”.

Usually, require two codes. one for the condition that represents the late effect, and one for the reason for the late effect. the condition code is listed first, followed by the code for the reason.

Question 26

How is the “first-listed diagnosis” used?

Answer 26

in an outpatient setting, it is the main reason for their visit and it is listed first in the coding

If a definitive diagnosis was not determined, a sign or symptom may be used

Question 27

What is a concurrent condition?

Answer 27

a problem that coexists with the first-listed diagnosis and complicates the treatment

Question 28

What is a secondary condition?

Answer 28

a condition that coexists with the first-listed diagnosis but does not directly affect the outcome or treatment of the first-listed diagnosis

Question 29

What is the principal diagnosis?

Answer 29

used in inpatient, diagnosis determined after study to be the reason for patient’s admission to a hospital or other non-outpatient setting. Not necessarily the reason they came in. Example: admitted for rectal bleeding, but cancer is identified as diagnosis. Cancer would be sequenced first on the claim.