ICD-9 Diagnosis Questions Flashcards
What is a poisoning?
Caused when a substance is not used according to the physician’s instructions.
Code first the drug or agent
Then specified code for that effect or manifestation (vomiting)
Last E code
What is an adverse affect?
When a patient experiences an adverse reaction to a properly prescribed and administered medication.
What is a Toxic effect?
When a harmful substance is ingested or comes in contact with a person
Code first the effect (980-989) by selecting the substance (bleach)
Next result of toxic effect (vomiting)
Last e code
How would you code a Late effect of an adverse effect?
Code residual condition first
Then 909.5
E code for drug
How would you code late effects of poisoning or toxic effects?
Code residual first
Then 909.0 or 909.1
E code
When can BMI be coded as a diagnosis?
When the dxs meets the definition of a reportable additional diagnosis,
The physician documents it
There is a dxs of obesity
When should cellulitis be coded as the primary diagnosis?
When the patient is treated primary for the cellulitis
When a patient has been injured and has cellulitis, when would the injury be coded as primary?
When the pt is being treated primary for the injury, not the cellulitis
Pt suffers CVA with neurological defects that have resolved prior to discharge. Would you still code the nuero defects?
Yes
What is a poisoning?
Caused when a substance is not used according to the physician’s instructions.
Code first the drug or agent
Then specified code for that effect or manifestation (vomiting)
Last E code
What is a Toxic effect?
When a harmful substance is ingested or comes in contact with a person
Code first the effect (980-989) by selecting the substance (bleach)
Next result of toxic effect (vomiting)
Last e code
How would you code a Late effect of an adverse effect?
Code residual condition first
Then 909.5
E code for drug
How would you code late effects of poisoning or toxic effects?
Code residual first
Then 909.0 or 909.1
E code
When can BMI be coded as a diagnosis?
When the dxs meets the definition of a reportable additional diagnosis,
The physician documents it
There is a dxs of obesity
When should cellulitis be coded as the primary diagnosis?
When the patient is treated primary for the cellulitis
When a patient has been injured and has cellulitis, when would the injury be coded as primary?
When the pt is being treated primary for the injury, not the cellulitis
Pt suffers CVA with neurological defects that have resolved prior to discharge. Would you still code the nuero defects?
Yes
When do patients with type one diabetes developed a condition
Before reaching puberty
When would the code for long-term current use of insulin be assigned? (V58.67).
When the patient is a type two diabetic and routinely uses insulin
What is the diagnosis code for and under dose of insulin due to an insulin pump failure?
996.57 that should be the primary code followed by a from from category 250
What is the diagnosis code for an overdose of insulin due to a pump malfunction?
962.3 poisoning by insulin and antidiabetic agents also called the appropriate code from 250
From what category would you code diabetes caused by another event or condition?
Category 249 secondary diabetes mellitus followed by the code for the associated conditions
What code would you sign for post pancreatectomy diabetes mellitus?
251.3 assign a code from 249 for secondary diabetes mellitus also assign v88.1 aqui red absence of the pancreas plus any manifestations
When can and E code be assigned as the principal diagnosis?
Never it is not appropriate to use an e code as a primary or principal diagnosis
How should E codes be assigned if there are more than one?
The first listed e code should correspond to the most serious diagnosis
In descending order what is the hierarchy of e codes
First adult and child abuse second terrorism third cataclysmic events fourth transport accidents fifth activity sixth external causes seventh place of occurrence
When would a late effect E code be used?
When the condition for the diagnosis is a late effect
When can you add a diagnosis for high blood pressure or hypertension?
When it is documented by the physician. You cannot and the diagnosis based on reviewing the blood pressure reading.
For what period of time is a traumatic fracture category 800-829 coded ?
For as long as the patient is receiving active treatment
How would you code bilateral glaucoma with the same stage?
Assign one code for the type of glaucoma in one code for the stage.
How would you code bilateral glaucoma with each I being different types and different stages?
Assign one code for the type of glaucoma , and one code for the highest, stage
What is right sided failure secondary to left sided failure classified as?
Congestive heart failure
When is hematuria coded separately?
When it is excessive and has been documented by the physician as excessive.
Many conditions in the genitourinary system have hematuria as an integral symptom.
When we can use code 791.2 hemoglobinuria?
When blood has been discovered in the urine via urine analysis. This would never be coded as hematuria.
What information is required for coding an HIV infection?
The physicians documentation the positive HIV test is not required
From which v-code category would you code an HIV-infected patients that is asymptomatic?
V08 do not use if aids has been mentioned
If the patient was previously diagnosed with HIV which categories with you never use
795.91 or V08
If a patient is admitted for an HIV related condition from what category would you code the principal diagnosis?
042
True or false: patient is admitted for a condition unrelated to the HIV (trauma) , category 042 is primarily followed by the trauma related codes.
False traumatic injury would be coded as primary, categories 042 would be subsequent
In the case of an obstetrics patient with the HIV infection what the subcategory would you code first?
647.6 X, followed by either 042 symptomatic or V08 asymptomatic as an additional code
If heart disease is stated as occurring with hypertension can you assume a cause-and-effect relationship?
No do not assume code it separately
True or false: Two code influenza H1n1 you must have a positive laboratory testing documented?
False the physicians documentation only need indicate the case is confirmed
When would you choose not to code a superficial injury such as an abrasion or contusion?
When there are more severe injuries of the same site
What is a late effect?
The message will condition that remains after the acute phase of illness or injury has passed
When would you want to omit the code for the acute phase of an illness or injury?
Any time that the late effect is being coded
What are the codes in category 438 used for?
He’s a combined codes the describe remaining deficits in patients who suffered cerebrovascular accident
When the infection does not have a combination code that includes an MRSA how would you code?
Code 1st the infection then code 0 41.12 for MRSA
What is the timeframe for myocardial infarction to be considered acute?
Duration of eight weeks or less or as documented by the physician
When coding a myocardial infarction what does the fourth digit indicate?
The area or wall involved
When coding a myocardial infarction what does the fifth digit indicate?
Whether the encounter is for the initial episode of care one, or the subsequent episode of care two or unspecified zero.
What would you do if a patient has a second infarction the time of an encounter for the original infarction?
Code for both
A patient is admitted solely for the purpose of chemotherapy immunotherapy or radiation therapy from which category would you code as the principal diagnosis?
Category V58,
If a patient has multiple malignant neoplasms how do you determine the principal diagnosis
Which ever site the treatment is directed towards is coded as primary. For example the patient is admitted for treatment of a secondary malignant neoplasm of the secondary neoplasm would be coded as primary.
True or false category v10 cannot be a primary diagnosis?
True
What category would be used when the primary neoplasm has been eradicated the patient is no longer receiving treatment for that site?
Category V10
True or false:If a patient is being treated only for anemia pain management or dehydration code , the condition would be coded as primary with the neoplasm as subsequent ?
True
A patient is admitted for surgical removal of a neoplasm followed by chemotherapy what is coded as primary?
Code 1st in neoplasm, primary or secondary
If the primary reason for admission is to determine the context of the malignancy even though chemotherapy or radiation therapy is administered what is the primary diagnosis?
You would code the neoplasm as primary.
How long can immaturity and prematurity continue to be coded?
There is no time limit because can be used as long as the physician indicates that birth weight is an issue
What type of post birth conditions would be coded?
Code any significant conditions noted after birth. Insignificant or transient conditions that resolve without treatment are not coded.
What chapter take sequencing precedence over other chapter coats?
Chapter 11 obstetrics
What is the peripartum period?
The last month of pregnancy through five months postpartum
For what period of time can codes from Chapter 11 be used?
There is no time limit the codes can be used after the six week period. If the doctor documents that it is pregnancy related
If the mother delivers outside the hospital prior to admission and there are no complications what diagnosis code would be used?
V24.0
If a mother delivers outside the hospital prior to admission and there are complications how would you code?
Code only the complications. You would not code the delivery said she delivered prior to admission.
True or false: any condition that occurs during pregnancy childbirth or the puerperium Is considered to be a complication unless the position specifically documents otherwise?
True
When is A code from category V27 assigned?
To indicate the outcome of delivery on the maternal chart
True or false, V.27 codes are not to be used on subsequent records or on the newborn record?
True codes from this category are specific to the mother
When is code 650 normal delivery assigned?
What a delivery is perfectly normal and results in a single live birth. No abnormalities of labor or delivery or postpartum conditions can be present. No additional coaching Chapter 11
What is the only code that can be assigned along with 650?
V270 Single live born
What V code categories should be used with no obstetric complications present?
With what chapter should these codes not be combined?
V 22, V 23, and V 24
Chapter 11
When would code 677 be used?
When a complication of pregnancy or delivery develops a residual or sequela at a later date. As with all late if the codes the residual is sequenced first followed by code 677
When would you use code 655 or 656?
When the fetal condition is responsible for the modifying the management of the mother for example: diagnostic studies special care termination of pregnancy.
When in utero surgery is performed on the fetus in what category would you code?
- Do not use code from chapter 15 on the mother
What codes would you assigned to a patient with HIV related illness during pregnancy childbirth or Puerperium?
647.6 X and 042
Other viral conditions and HIV
Patient asymptomatic HIV infection status during pregnancy childbirth and puerperium Should have what codes sign?
647.6 X other viral diseases and V08
How would you code a patient with diabetes during pregnancy childbirth or puerperium?
648.0 X diabetes mellitus, had a great 250 or 249. Also code V58.67 long-term current use of insulin if the diabetes is treated with
When is an open wound consider complicated?
When the following conditions are present: delayed healing delay treatment, foreign body in wound, or infection
When would it be appropriate to use a code from category 338 is a principle or first listed diagnosis?
When the reason for admission or encounter is pain control or the patient is admitted for the insertion of a nuerostimulator for pain control
Underlying cause of the pain should be coded as additional diagnoses
When might you code postoperative pain?
When the postoperative pain is not associated with a specific postoperative complication
use category 338
how would you code pain due to a device implant or graft left in the surgical site?
First code from chapter 17 followed by a code from 338
From which chapter would you code postoperative pain associated with a specific postoperative complication?
Chapter 17 followed by a code from 338
When may postoperative pain be listed as a principal diagnosis?
When the reason for admission is pain control
What type of fracture can because by either disease or trauma?
A compression fracture. It is not clear which is the cause quite a physician
When might you come from category 733.1 X?
When cutting a pathological fracture for which the patient is receiving active treatment
Which V code category is used for routine care during the healing phase of a fracture?
V54.x
What is included in the aftercare of the fracture?
Casts change, removal of devices, medication adjustment.
Why is a pleural effusion usually not coded?
Because it is almost always integral to an underlying condition.
When can pleural effusion be coded?
When the effusion is address and treated separately
Pleural effusion has been noted on an x-ray, would it be coded?
No if only mention an x-ray pleural effusion is not coded
True or false: lower pneumonia refers to the lobe of the lung that is affected?
False this is a particular type of pneumonia
We pneumonia is a manifestation of an underlying condition how many codes are needed?
Two. One for the underlying condition and the other for the pneumonia
Worsening of cough, dyspnea, fever, purulent sputum, elevated leukocyte count, and patchy infiltrate on x-ray or signs of what type of pneumonia?
Gram-negative pneumonia
The physician has documented that the patient has a ventilator associated pneumonia, (VAP) what code is required in addition to 997.31?
An additional code to identify the organism
When coding VAP what do you not want to code?
The type of pneumonia from category 480-484
What is required in order to code a postoperative complication?
Physician documentation indicating that the condition is a complication of the procedure
When would you coach them category 996-999
Postoperative complications
When do you expected conditions occur?
During the immediate postop period
When would you use 707.0 and 707.2?
When coding a pressure ulcer
The two codes required for a pressure ulcer indicate what?
Site 707.0, stage 707.2
true or false the pressure ulcers maybe used as a primary diagnosis?
false secondary only
When can a nurses documentation be used for code assignment for pressure ulcers?
When the physician has documented the diagnosis a pressure ulcer
When the stage of pressure ulcer cannot be clinically documented (due to covered by each at, treated by skin or muscle graft, or deep tissue but not documented as due to trauma) which code what do you use?
707.25
Why can’t category 639 be assigned with any code from 634-638?
Because abortion complications are are classified according to the 4th digit
639 should be used to identify what?
Complications related to 630-633 (complications of pregnancy, childbirth and the Puerperium)
or the complication is the reason for the medical care.
If sepsis or severe sepsis develop during admission where would you code the systemic infection and sepsis?
Secondary diagnoses
In a patient with sepsis or severe sepsis and additional code can be added for what?
Any localized infection if present
When would you not want to code a personal history V-code?
When the condition is still present or still under treatment
From what category would you select a code to identify an infection that is resistant to medication?
V09
From v code category would you select for a patient who is or has an encounter for work up A suspected condition where no signs or symptoms are present?
V71 observation and evaluation for suspected conditions not found
Based on the UH DDS definition what is a principal diagnosis for inpatient account?
The condition determined (after study) to be chiefly responsible for the patient’s admission.
When an encounter results in delivery, what code series must be included in the maternal record?
V27.0-V-27.9
What is elderly primagravida?
Women 1st birth over the age of 35
When adding an E code for an adverse effect from which column in the table of drugs would you select the code?
Therapeutic use
In the table of drugs for selecting E codes which column represents a poisoning?
The accident column
Which column in the table of drugs represents instances in which self-inflicted injuries or poisonings have been involved?
Suicide attempt
In the table of drugs which column represents instances in which injury or poisoning has been inflicted by another person with the intent to injure or kill?
Assault
In the table of drugs what does the undetermined column represent?
E980 through E989 represents when it cannot be determined whether the poisoning or injury was intentional or accidental
When might you use an unknown adverse effect code?
When a reaction to substance has been documented but it is unclear what the reaction is
how is the nonhealing burn coded
As an acute burn
How is necrosis of burned skin coded?
As a non-healed burn, acute cute bird
How would you code late effect burn?
Could the residual condition, sequela, followed by the appropriate late affect code. The code late effects code may also be added
How would you locate an insulin pump failure?
Complication
If a patient is admitted to inpatient from an outpatient surgery due to a complication what is the principal diagnosis?
The complication
If a patient is admitted from outpatient surgery and there is no complication or other condition what is the principal diagnosis?
The reason for surgery
If a patient is admitted from outpatient surgery due to a condition unrelated to the surgery what is the principal diagnosis
The unrelated condition
If at the time of discharge the diagnosis is still documented as probable, suspected, likely, possible, questionable, or still to be ruled out how would you code the principal diagnosis
Code the condition as if it existed or was established
In inpatient coding what qualifies as an additional diagnosis?
Conditions that affect patient care in terms of requiring clinical evaluation therapeutic treatment diagnostic procedures and extended length of hospital stay or increase nursing care or monitoring
If a provider includes conditions are diagnoses previous admission have no bearing on current stay in the discharge summary what should you do?
Exclude the codes. If pertinent history codes maybe use a secondary
In an inpatient setting how do you code abnormal findings, on x-ray laboratory etc.
Omit codes for abnormal findings unless the provider indicates their clinical significance
In an inpatient setting why are and certain diagnoses coded as if they existed or were established
Because the diagnostic workup and arrangements for further workup would be the same if the diagnosis were established
In outpatient setting when are codes for signs and symptoms acceptable?
What a diagnosis has not been established or confirmed by the provider
When would signs and symptoms of a condition be coded in addition to the diagnosis?
When they are not routinely associated with the condition
When coding a late effect, what must always be coded first
The residual condition
To code in impending or threatened condition which Main term would you use to look up in the index
Impending, threatened
True or false, the neoplasm code remains active even if it has been surgically removed
True if the patient is receiving treatment the neoplasm code is still considered active and should be coded
