AAPC IDC 10 Exam (All Exams) Test Bank - American Academy of Professional Coders

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AAPC IDC 10 Exam (All Exams) Test Bank - American Academy of Professional Coders Physician Coding for CPC Preparation (Q-S) Review Test Submission: Chapter 1 Quiz User Course 2019 Physician... Coding for CPC Preparation (Q-S) Test Chapter 1 Quiz Started 6/9/19 9:25 PM Submitted 6/9/19 9:28 PM Status Completed Attempt Score 70 out of 100 points Time Elapsed 2 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year? Selected Answer: c. OIG Work Plan Correct Answer: c. OIG Work Plan Response Feedback: Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny. • Question 2 0 out of 10 points According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with which condition? Selected Answer: d. muscle weakness Correct Answer: b. fibromyalgia Response Feedback: Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia. • Question 3 10 out of 10 points Under HIPAA, what would be a policy requirement for “minimum necessary”? Selected Answer: a. Only individuals whose job requires it may have access to protected health information. Correct Answer: a. Only individuals whose job requires it may have access to protected health information. Response Feedback: Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information. • Question 4 0 out of 10 points Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? Selected Answer: a. HIPAA Correct Answer: b. HITECH Response Feedback: Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information. • Question 5 10 out of 10 points What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? Selected Answer: d. ABN Correct Answer: d. ABN Response Feedback: Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient. • Question 6 0 out of 10 points What document assists provider offices with the development of Compliance Manuals? Selected Answer: c. OIG Suggested Rules and Regulations Correct Answer: a. OIG Compliance Plan Guidance Response Feedback: Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still active compliance guidance today. • Question 7 10 out of 10 points Who would NOT be considered a covered entity under HIPAA? Selected Answer: d. Patients Correct Answer: d. Patients Response Feedback: Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient’s data that is protected. • Question 8 10 out of 10 points Select the TRUE statement regarding ABNs. Selected Answer: a. ABNs may not be recognized by non-Medicare payers. Correct Answer: a. ABNs may not be recognized by non-Medicare payers. Response Feedback: Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered. • Question 9 10 out of 10 points When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost? Selected Answer: c. $100 or 25 percent Correct Answer: c. $100 or 25 percent Response Feedback: Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.” • Question 10 10 out of 10 points Which statement describes a medically necessary service? Selected Answer: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Correct Answer: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Response Feedback: Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient’s complaint or condition. Review Test Submission: Chapter 1 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 1 Quiz Started 6/9/19 9:09 PM Submitted 6/9/19 9:30 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 21 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points Select the TRUE statement regarding ABNs. Selected Answer: a. ABNs may not be recognized by non-Medicare payers. Correct Answer: a. ABNs may not be recognized by non-Medicare payers. Response Feedback: Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered. • Question 2 10 out of 10 points Under HIPAA, what would be a policy requirement for “minimum necessary”? Selected Answer: a. Only individuals whose job requires it may have access to protected health information. Correct Answer: a. Only individuals whose job requires it may have access to protected health information. Response Feedback: Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information. • Question 3 10 out of 10 points According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with which condition? Selected Answer: b. fibromyalgia Correct Answer: b. fibromyalgia Response Feedback: Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia. • Question 4 10 out of 10 points What document assists provider offices with the development of Compliance Manuals? Selected Answer: a. OIG Compliance Plan Guidance Correct Answer: a. OIG Compliance Plan Guidance Response Feedback: Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still active compliance guidance today. • Question 5 10 out of 10 points Who would NOT be considered a covered entity under HIPAA? Selected Answer: d. Patients Correct Answer: d. Patients Response Feedback: Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient’s data that is protected. • Question 6 10 out of 10 points What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? Selected Answer: d. ABN Correct Answer: d. ABN Response Feedback: Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient. • Question 7 10 out of 10 points Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? Selected Answer: b. HITECH Correct Answer: b. HITECH Response Feedback: Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information. • Question 8 10 out of 10 points When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost? Selected Answer: c. $100 or 25 percent Correct Answer: c. $100 or 25 percent Response Feedback: Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.” • Question 9 10 out of 10 points Which statement describes a medically necessary service? Selected Answer: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Correct Answer: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Response Feedback: Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient’s complaint or condition. • Question 10 10 out of 10 points What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year? Selected Answer: c. OIG Work Plan Correct Answer: c. OIG Work Plan Response Feedback: Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny. Review Test Submission: 2019 Chapter 1 Practical Application User Course 2019 Physician Coding for CPC Preparation (Q-S) Test 2019 Chapter 1 Practical Application Started 6/10/19 12:52 PM Submitted 6/10/19 12:58 PM Status Completed Attempt Score 90 out of 100 points Time Elapsed 5 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points What type of profession, other than coding, might skilled coders enter? Selected Answer: c. Consultants, educators, medical auditors Correct Answer: c. Consultants, educators, medical auditors • Question 2 10 out of 10 points What is the difference between outpatient and inpatient coding? Selected Answer: d. Inpatient coders use ICD-10-CM and ICD-10-PCS. Correct Answer: d. Inpatient coders use ICD-10-CM and ICD-10-PCS. • Question 3 10 out of 10 points What is a mid-level provider? Selected Answer: c. Mid-level providers include physician assistants (PA) and nurse practitioners (NP). Correct Answer: c. Mid-level providers include physician assistants (PA) and nurse practitioners (NP). • Question 4 10 out of 10 points What are the different parts of Medicare? Selected Answer: b. Part A, B, C, D Correct Answer: b. Part A, B, C, D • Question 5 10 out of 10 points Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent? Selected Answer: a. Subjective, Objective, Assessment, Plan Correct Answer: a. Subjective, Objective, Assessment, Plan • Question 6 10 out of 10 points What are five tips for coding operative (op) reports? Selected Answer: b. Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body Correct Answer: b. Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body • Question 7 10 out of 10 points What is medical necessity? Selected Answer: d. Relates to whether a procedure or service is considered appropriate in a given circumstance. Correct Answer: d. Relates to whether a procedure or service is considered appropriate in a given circumstance. • Question 8 0 out of 10 points What is not a common reason Medicare may deny a procedure or service? Selected Answer: a. Patient's condition Correct Answer: c. Covered service Response Feedback: Medicare doesn't pay for the procedure/service to treat the patient's condition Medicare doesn't pay for the procedure/service as frequently as proposed Medicare doesn't pay for experimental procedures/services • Question 9 10 out of 10 points Under the Privacy Rule, the minimum necessary standard does NOT apply to to what type of disclosures? Selected Answer: c. Disclosures to the individual who is the subject of the information. Correct Answer: c. Disclosures to the individual who is the subject of the information. • Question 10 10 out of 10 points Which is not one of the seven key components of an internal compliance plan? Selected Answer: b. Conduct training but not perform education on practice standards and procedures. Correct Answer: b. Conduct training but not perform education on practice standards and procedures. Thursday, September 21, 2017 7:48:29 PM MDT Review Test Submission: Chapter 1 Review User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 1 Review Started 6/10/19 1:01 PM Submitted 6/10/19 1:24 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 22 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 4 out of 4 points When are providers responsible for obtaining an ABN for a service NOT considered medically necessary? Selected Answer: a. Prior to providing a service or item to a beneficiary. Correct Answer: a. Prior to providing a service or item to a beneficiary. Response Feedback: Rationale: Providers are responsible for obtaining an ABN prior to providing the service or item to a beneficiary. • Question 2 4 out of 4 points HIPAA stands for Selected Answer: c. Health Insurance Portability and Accountability Act Correct Answer: c. Health Insurance Portability and Accountability Act Response Feedback: Rationale: Health Insurance Portability and Accountability Act (HIPAA) • Question 3 4 out of 4 points The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare. Selected Answer: d. National Coverage Determinations Manual Correct Answer: d. National Coverage Determinations Manual Response Feedback: Rationale: The National Coverage Determinations Manual describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare. • Question 4 4 out of 4 points According to AAPC’s Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings. Selected Answer: b. legal and ethical Correct Answer: b. legal and ethical Response Feedback: Rationale: AAPC members shall use only legal and ethical means in all professional dealings and shall refuse to cooperate with, or condone by silence, the actions of those who engage in fraudulent, deceptive or illegal acts. • Question 5 4 out of 4 points Which provider is NOT a mid-level provider? Selected Answer: d. Anesthesiologist Correct Answer: d. Anesthesiologist Response Feedback: Rationale: Mid-level providers include physician assistants (PA) and nurse practitioners (NP). An anesthesiologist is a physician. Mid-level providers are also known as physician extenders because they extend the work of a physician. • Question 6 4 out of 4 points What is the definition of medical coding? Selected Answer: d. Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. Correct Answer: d. Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. Response Feedback: Rationale: Medical coding is the process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes. • Question 7 4 out of 4 points In what year was the AAPC founded? Selected Answer: a. 1988 Correct Answer: a. 1988 Response Feedback: Rationale: The AAPC was founded in 1988. • Question 8 4 out of 4 points What is the purpose of National Coverage Determinations? Selected Answer: d. To explain CMS policies on when Medicare will pay for items or services. Correct Answer: d. To explain CMS policies on when Medicare will pay for items or services. Response Feedback: Rationale: National Coverage Determinations (NCD) explain CMS policies on when Medicare will pay for items or services. • Question 9 4 out of 4 points HITECH provides a ____ day window during which any violation not due to willful neglect may be corrected without penalty. Selected Answer: c. 30 Correct Answer: c. 30 Response Feedback: Rationale: HITECH also lowers the bar for what constitutes a violation, but provides a 30-day window during which any violation not due to willful neglect may be corrected without penalty. • Question 10 4 out of 4 points How many components are included in an effective compliance plan? Selected Answer: b. 7 Correct Answer: b. 7 Response Feedback: Rationale: The following list of components, as set forth in previous OIG Compliance Program Guidance for Individual and Small Group Physician Practices, can form the basis of a voluntary compliance program for a provider practice: • Conducting internal monitoring and auditing through the performance of periodic audits; • Implementing compliance and practice standards through the development of written standards and procedures; • Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards; • Conducting appropriate training and education on practice standards and procedures; • Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities; • Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct, and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and • Enforcing disciplinary standards through well-publicized guidelines. These seven components provide a solid basis upon which a provider practice can create a compliance program. • Question 11 4 out of 4 points Who is responsible for enforcing the HIPAA security rule? Selected Answer: c. OCR Correct Answer: c. OCR Response Feedback: Rationale: The Office for Civil Rights (OCR) enforces the HIPAA Privacy Rule. • Question 12 4 out of 4 points In what year did HIPAA become law? Selected Answer: b. 1996 Correct Answer: b. 1996 Response Feedback: Rationale: HIPAA was adopted into law in 1996. • Question 13 4 out of 4 points The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer? Selected Answer: c. Part B Correct Answer: c. Part B Response Feedback: Rationale: Medicare Part B helps to cover medically necessary provider services, outpatient care and other medical services (including some preventive services) not covered under Medicare Part A. Medicare Part B is an optional benefit for which the patient pays a monthly premium, an annual deductible, and generally has a 20% co-insurance except for preventive services covered under the healthcare law. • Question 14 4 out of 4 points Which option below is NOT a covered entity under HIPAA? Selected Answer: b. Workers’ Compensation Correct Answer: b. Workers’ Compensation Response Feedback: Rationale: The definition of health plan in the HIPAA regulations excludes any policy, plan or program that provides or pays for the cost of excepted benefits. Excepted benefits include: • Coverage only for accident or disability income insurance, or any combination thereof; • Coverage issued as a supplement to liability insurance; • Liability insurance, including general liability insurance and automobile liability insurance; • Workers’ compensation or similar insurance; • Automobile medical payment insurance; • Credit-only insurance; • Coverage for on-site medical clinics; • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. • Question 15 4 out of 4 points Healthcare providers are responsible for developing ____ ____ and policies and procedures regarding privacy in their practices. Selected Answer: a. Notices of Privacy Practices Correct Answer: a. Notices of Privacy Practices Response Feedback: Rationale: Healthcare providers are responsible for developing Notices of Privacy Practices and policies and procedures regarding privacy in their practices. • Question 16 4 out of 4 points What type of provider goes through approximately 26 ½ months of education and is licensed to practice medicine with the oversight of a physician? Selected Answer: d. Physician Assistant (PA) Correct Answer: d. Physician Assistant (PA) Response Feedback: Rationale: Physician Assistants are licensed to practice medicine with physician supervision. A PA program takes approximately 26 ½ months to complete. • Question 17 4 out of 4 points AAPC credentialed coders have proven mastery of what information? Selected Answer: d. All of the above Correct Answer: d. All of the above Response Feedback: Rationale: AAPC credentialed coders have proven mastery of all code sets, evaluation and management principles, and documentation guidelines. • Question 18 4 out of 4 points What will the scope of a compliance program depend on? Selected Answer: b. The size and resources of the provider’s practice. Correct Answer: b. The size and resources of the provider’s practice. Response Feedback: Rationale: The scope of a compliance program will depend on the size and resources of the provider practice. • Question 19 4 out of 4 points What does MAC stands for? Selected Answer: b. Medicare Administrative Contractor Correct Answer: b. Medicare Administrative Contractor Response Feedback: Rationale: Medicare Administrative Contractor (MAC) • Question 20 4 out of 4 points The minimum necessary rule applies to Selected Answer: c. Covered entities taking reasonable steps to limit use or disclosure of PHI Correct Answer: c. Covered entities taking reasonable steps to limit use or disclosure of PHI Response Feedback: Rationale: The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: · Disclosures to or requests by a health care provider for treatment purposes. · Disclosures to the individual who is the subject of the information. · Uses or disclosures made pursuant to an individual’s authorization. · Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. · Disclosures to the Department of Health & Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. · Uses or disclosures that are required by other law. • Question 21 4 out of 4 points Many coding professionals go on to find work as: Selected Answer: b. Consultants Correct Answer: b. Consultants Response Feedback: Rationale: The coding profession has evolved significantly over the past several decades into a career path with unlimited possibilities. Many professionals who have learned coding have also gone on to roles as consultants, educators or medical auditors. There are endless possibilities in an ever changing field. • Question 22 4 out of 4 points A covered entity does NOT include Selected Answer: c. Patients Correct Answer: c. Patients • Question 23 4 out of 4 points The Medicare program is made up of several parts. Which part is affected by the Centers for Medicare & Medicaid Services - Hierarchical Condition Categories (CMS-HCC)? Selected Answer: d. Part C Correct Answer: d. Part C Response Feedback: Rationale: Accurate and thorough diagnosis coding is important for Medicare Advantage (Part C) claims because reimbursement is impacted by the patient’s health status. The Centers for Medicare & Medicaid Services-hierarchical condition category (CMS-HCC) risk adjustment model provides adjusted payments based on a patient’s diseases and demographic factors. If a coder does not include all pertinent diagnoses and comorbidities, there may be loss of additional reimbursement to which the provider is entitled. • Question 24 4 out of 4 points In what year was HITECH enacted as part of the American Recovery and Reinvestment Act? Selected Answer: d. 2009 Correct Answer: d. 2009 Response Feedback: Rationale: The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. • Question 25 4 out of 4 points The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______. Selected Answer: d. Consistent and appropriate Correct Answer: d. Consistent and appropriate Response Feedback: Rationale: The OIG recommends that a provider practice’s enforcement and disciplinary mechanisms ensure that violations of the practice’s compliance policies will result in consistent and appropriate sanctions, including the possibility of termination, against the offending individual. Thursday, September 21, 2017 7:48:49 PM MDT Review Test Submission: Chapter 2 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 2 Quiz Started 6/11/19 6:16 PM Submitted 6/11/19 6:21 PM Status Completed Attempt Score 80 out of 100 points Time Elapsed 5 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points Which medical term refers to the cheek? Selected Answer: a. Buccal Correct Answer: a. Buccal Response Feedback: RATIONALE: Bucca means cheek. Buccal is relating to the cheek. Buccal swabs can be used for DNA testing. • Question 2 10 out of 10 points What is the root meaning joint? Selected Answer: a. Arthr/o Correct Answer: a. Arthr/o Response Feedback: RATIONALE: The root Arthr/o stands for joint. You will notice in the list of medical terms related to the musculoskeletal system, all of the words beginning with “arthr” are conditions or procedures related to the joint. • Question 3 10 out of 10 points The heart circulates blood through the lungs and is sent back into the left atrium of the heart via which vessel(s)? Selected Answer: b. Left and right pulmonary veins Correct Answer: b. Left and right pulmonary veins Response Feedback: RATIONALE: Blood is circulated through the pulmonary vascular tree in the lungs and sent back into the left atrium through the left and right pulmonary veins. • Question 4 10 out of 10 points Which gland is larger in early life than in puberty? Selected Answer: c. Thymus gland Correct Answer: c. Thymus gland Response Feedback: RATIONALE: The thymus gland does much of its work in early childhood and is largest shortly after birth. By puberty, it is smallest and may be replaced by fat. • Question 5 10 out of 10 points Blepharoplasty is performed on which part of the body? Selected Answer: b. Eyelid Correct Answer: b. Eyelid Response Feedback: RATIONALE: The root Blephar/o means eyelid indicating a blepharoplasty is performed on the eyelid. • Question 6 0 out of 10 points A procedure requiring the physician to cut down to the superficial fascia is documented as cutting down into the: Selected Answer: a. Epidermis Correct Answer: c. Hypodermis Response Feedback: RATIONALE: The hypodermis (subcutaneous) serves to protect the underlying structures, prevent loss of body heat and anchor skin to the underlying musculature. Fibrous connective tissue referred to as superficial fascia is included in this layer. • Question 7 10 out of 10 points The prefix sub- means beneath. Based on word parts, what is the definition of subfascial? Selected Answer: b. Beneath the fascia. Correct Answer: b. Beneath the fascia. Response Feedback: RATIONALE: The root fasci- means fascia. Subfascial is beneath the fascia. Fascia is a sheath of fibrous tissue covering individual skeletal muscles or certain organs. • Question 8 0 out of 10 points The heart receives de-oxygenated blood in the right atrium via which vessel(s)? Selected Answer: a. Right pulmonary artery Correct Answer: c. Vena Cavae Response Feedback: RATIONALE: Deoxygenated blood enters the right atrium through the superior vena cava and inferior vena cava. • Question 9 10 out of 10 points The bronchi are found in what body cavity? Selected Answer: c. Thoracic cavity Correct Answer: c. Thoracic cavity Response Feedback: RATIONALE: The thoracic, or chest cavity is the space containing the heart, lungs, esophagus, trachea, bronchi, and thymus. • Question 10 10 out of 10 points What type of cell is housed by the lymphatic system to help the body’s defense system? Selected Answer: b. Phagocytes Correct Answer: b. Phagocytes Response Feedback: RATIONALE: Lymphoid organs scattered throughout the body house phagocytic cells and lymphocytes, which are essential to the body’s defense system. Review Test Submission: Chapter 2 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 2 Quiz Started 6/11/19 6:42 PM Submitted 6/11/19 6:56 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 14 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points What causes cyanosis? Selected Answer: b. Oxygen deficiency Correct Answer: b. Oxygen deficiency Response Feedback: RATIONALE: Cyanosis is bluing of the skin and mucous membranes caused by oxygen deficiency. • Question 2 10 out of 10 points A cystourethroscopy is examination of what structures? Selected Answer: a. Bladder and urethra Correct Answer: a. Bladder and urethra Response Feedback: RATIONALE: The root cyst- means urinary bladder. The root word urethr- means urethra. A cystourethroscopy is examination of the urinary bladder and urethra. • Question 3 10 out of 10 points Which structure is not a true endocrine structure? Selected Answer: b. Carotid body Correct Answer: b. Carotid body Response Feedback: RATIONALE: The carotid body is not a true endocrine structure, but is made of both glandular and nonglandular tissue. • Question 4 10 out of 10 points Which gland has two separate structures called the medulla and the cortex? Selected Answer: a. Adrenal glands Correct Answer: a. Adrenal glands Response Feedback: RATIONALE: The adrenal glands have two separate structural parts; The inner portion is the medulla and the outer portion is the cortex. Each structure performs a separate function. • Question 5 10 out of 10 points The heart receives de-oxygenated blood in the right atrium via which vessel(s)? Selected Answer: c. Vena Cavae Correct Answer: c. Vena Cavae Response Feedback: RATIONALE: Deoxygenated blood enters the right atrium through the superior vena cava and inferior vena cava. • Question 6 10 out of 10 points Which structure is responsible for moistening, warming, and filtering inspired air? Selected Answer: b. Nose Correct Answer: b. Nose Response Feedback: RATIONALE: The nose is responsible for providing an airway to breathe, moistening, warming, and filtering inspired air, serving as a resonating chamber for speech, and housing the smell receptors. • Question 7 10 out of 10 points Which leukocyte does the body use to protect against allergic reactions and parasites? Selected Answer: d. Eosinophils Correct Answer: d. Eosinophils Response Feedback: RATIONALE: The body uses eosinophils to protect against allergic reactions and parasites; elevated levels may indicate an allergic response. • Question 8 10 out of 10 points The prefix sub- means beneath. Based on word parts, what is the definition of subfascial? Selected Answer: b. Beneath the fascia. Correct Answer: b. Beneath the fascia. Response Feedback: RATIONALE: The root fasci- means fascia. Subfascial is beneath the fascia. Fascia is a sheath of fibrous tissue covering individual skeletal muscles or certain organs. • Question 9 10 out of 10 points A procedure requiring the physician to cut down to the superficial fascia is documented as cutting down into the: Selected Answer: c. Hypodermis Correct Answer: c. Hypodermis Response Feedback: RATIONALE: The hypodermis (subcutaneous) serves to protect the underlying structures, prevent loss of body heat and anchor skin to the underlying musculature. Fibrous connective tissue referred to as superficial fascia is included in this layer. • Question 10 10 out of 10 points Which layer of the epidermis is normally found on the palms of the hands and the soles of the feet? Selected Answer: b. Stratum Lucidum Correct Answer: b. Stratum Lucidum Response Feedback: RATIONALE: The stratum lucidum is a clear layer normally found only on the palms of the hands and the soles of the feet. Review Test Submission: 2019 Chapter 2 Practical Application User Course 2019 Physician Coding for CPC Preparation (Q-S) Test 2019 Chapter 2 Practical Application Started 6/16/19 5:49 PM Submitted 6/16/19 6:01 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 11 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points Diagnosis: Calcification left basal ganglia. Where are the basal ganglia located? Selected Answer: b. Cerebral Cortex Correct Answer: b. Cerebral Cortex • Question 2 10 out of 10 points Diagnosis: Vesicoureteral reflux. What is this a reflux of? Selected Answer: d. Urine backflow from bladder into ureters Correct Answer: d. Urine backflow from bladder into ureters • Question 3 10 out of 10 points Documentation: The posterior vaginal fornix and outer cervical os were prepped with a cleansing solution. In this statement, what does “os” stand for? Selected Answer: a. Ostium (opening) Correct Answer: a. Ostium (opening) • Question 4 10 out of 10 points Hysterosalpingogram report: “Right cornual contour abnormality.” Where is the cornua found anatomically for this case? Selected Answer: c. Where the fallopian tubes connect to the fundus. Correct Answer: c. Where the fallopian tubes connect to the fundus. • Question 5 10 out of 10 points Surgical procedure: Myringotomy What anatomic location is being operated on? Selected Answer: a. Ear Correct Answer: a. Ear • Question 6 10 out of 10 points Documentation: There was no cleft of the uvula or submucosal palate by visual and palpable exam. What is being examined? Selected Answer: c. Oral cavity Correct Answer: c. Oral cavity • Question 7 10 out of 10 points Documentation: Recession of left inferior rectus muscle, 5 mm. What anatomic location is being operated on? Selected Answer: b. Eye Correct Answer: b. Eye • Question 8 10 out of 10 points Diagnosis: Kyphosis What anatomic location does this diagnosis most often refer to? Selected Answer: d. Thoracic Spine Correct Answer: d. Thoracic Spine • Question 9 10 out of 10 points Documentation: Suprapatellar recess showed no evidence of loose bodies or joint pathology. What anatomic location does this refer to? Selected Answer: a. Knee (above the patella) Correct Answer: a. Knee (above the patella) • Question 10 10 out of 10 points Colles’ fracture What anatomic location does this refer to? Selected Answer: c. Wrist Correct Answer: c. Wrist Review Test Submission: Chapter 2 Review User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 2 Review Started 6/16/19 6:11 PM Submitted 6/16/19 6:46 PM Status Completed Attempt Score 84 out of 100 points Time Elapsed 35 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 0 out of 4 points The term pneumomediastinum describes what condition? Selected Answer: c. Presence of a cyst or tumor in the mediastinum Correct Answer: a. The presence of air in the mediastinum • Question 2 4 out of 4 points A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: Selected Answer: b. Prostate Correct Answer: b. Prostate • Question 3 4 out of 4 points Which of the following does NOT circulate fluids throughout the body? Selected Answer: d. Endocrine system Correct Answer: d. Endocrine system • Question 4 4 out of 4 points Which part of the brain controls blood pressure, heart rate and respiration? Selected Answer: a. Medulla Correct Answer: a. Medulla • Question 5 4 out of 4 points Which cells produce hormones to regulate blood sugar? Selected Answer: d. Pancreatic islets Correct Answer: d. Pancreatic islets • Question 6 0 out of 4 points Which of the following is true of the stratum germinativum? Selected Answer: d. It is composed of dense fibrous connective tissue. Correct Answer: b. It lies on top of the dermis and has access to a rich supply of blood. • Question 7 4 out of 4 points Which of the following is NOT a function of skin? Selected Answer: b. Acts as a gland by synthesizing vitamin A. Correct Answer: b. Acts as a gland by synthesizing vitamin A. • Question 8 0 out of 4 points Which of the following is significant of an abdominal aortic aneurysm? Selected Answer: b. It is indicative of an underlying heart disorder needing treatment Correct Answer: c. It is a weakness in a large artery and rupture can be deadly • Question 9 4 out of 4 points What is vernix caseosa? Selected Answer: a. A white cheese like substance covering the fetus and newborn. Correct Answer: a. A white cheese like substance covering the fetus and newborn. • Question 10 0 out of 4 points What is affected by myasthenia gravis? Selected Answer: b. Muscle/bone connection Correct Answer: c. Neuromuscular junction • Question 11 4 out of 4 points A patient diagnosed with glaucoma has: Selected Answer: a. Abnormally high intraocular pressure Correct Answer: a. Abnormally high intraocular pressure • Question 12 4 out of 4 points The splenic (left colic) flexure lies in the upper left quadrant, between what two portions of the large intestine? Selected Answer: c. The transverse and descending colon Correct Answer: c. The transverse and descending colon • Question 13 4 out of 4 points What is a myocardial infarction? Selected Answer: b. Lack of oxygen to the heart tissue, resulting in tissue death Correct Answer: b. Lack of oxygen to the heart tissue, resulting in tissue death • Question 14 4 out of 4 points The word describing the presence of blood in the pleural cavity is: Selected Answer: a. Hemothorax Correct Answer: a. Hemothorax • Question 15 4 out of 4 points Inflammation of the membrane lining the abdominal cavity and covering the abdominal organs is called: Selected Answer: c. Peritonitis Correct Answer: c. Peritonitis • Question 16 4 out of 4 points A vesiculotomy is defined as: Selected Answer: c. Surgical cutting into the seminal vesicles Correct Answer: c. Surgical cutting into the seminal vesicles • Question 17 4 out of 4 points A procedure widening a narrowed vessel or obstructed blood vessel is called a(n): Selected Answer: d. Angioplasty Correct Answer: d. Angioplasty • Question 18 4 out of 4 points Where would a subungual hematoma be located? Selected Answer: a. Under the toenail/fingernail Correct Answer: a. Under the toenail/fingernail • Question 19 4 out of 4 points Excessive potassium in the blood is referred to as: Selected Answer: c. Hyperkalemia Correct Answer: c. Hyperkalemia • Question 20 4 out of 4 points What is the Rinne’s test? Selected Answer: d. Test measuring hearing using bone conduction and air conduction Correct Answer: d. Test measuring hearing using bone conduction and air conduction • Question 21 4 out of 4 points Splenorrhaphy is described as: Selected Answer: a. Suture of a wound of the spleen Correct Answer: a. Suture of a wound of the spleen • Question 22 4 out of 4 points The dome-shaped muscle under the lungs flattening during inspiration is the: Selected Answer: b. Diaphragm Correct Answer: b. Diaphragm • Question 23 4 out of 4 points Which of the following characterizes the disorder dystonia? Selected Answer: d. Abnormal muscle tone causing abnormal postures and muscle spasm Correct Answer: d. Abnormal muscle tone causing abnormal postures and muscle spasm • Question 24 4 out of 4 points The radiology term fluoroscopy is described as: Selected Answer: a. An X-ray procedure allowing the visualization of internal organs in motion Correct Answer: a. An X-ray procedure allowing the visualization of internal organs in motion • Question 25 4 out of 4 points A gonioscopy is an examination of what part of the eye: Selected Answer: a. Anterior chamber of the eye Correct Answer: a. Anterior chamber of the eye Review Test Submission: Chapter 2 Review User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 2 Review Started 6/16/19 9:28 PM Submitted 6/16/19 9:53 PM Status Completed Attempt Score 96 out of 100 points Time Elapsed 24 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 4 out of 4 points The term episiotomy best describes a procedure of what type? Selected Answer: a. An incision made in the perineum to enlarge the passage for the fetus during delivery Correct Answer: a. An incision made in the perineum to enlarge the passage for the fetus during delivery • Question 2 4 out of 4 points Which layer is NOT considered part of the skin? Selected Answer: b. Hypodermis Correct Answer: b. Hypodermis • Question 3 4 out of 4 points The term pneumomediastinum describes what condition? Selected Answer: c. The presence of air in the mediastinum Correct Answer: c. The presence of air in the mediastinum • Question 4 4 out of 4 points Which part of the brain controls blood pressure, heart rate and respiration? Selected Answer: a. Medulla Correct Answer: a. Medulla • Question 5 4 out of 4 points Which of the following is true of the stratum germinativum? Selected Answer: d. It lies on top of the dermis and has access to a rich supply of blood. Correct Answer: d. It lies on top of the dermis and has access to a rich supply of blood. • Question 6 4 out of 4 points An ectopic pregnancy is a complication in which the fertilized ovum is implanted in any tissue other than the ____. Selected Answer: d. Uterine wall Correct Answer: d. Uterine wall • Question 7 4 out of 4 points What is vernix caseosa? Selected Answer: d. A white cheese like substance covering the fetus and newborn. Correct Answer: d. A white cheese like substance covering the fetus and newborn. • Question 8 4 out of 4 points Muscle is attached to bone by what method? Selected Answer: d. Tendons, aponeurosis and directly to bone Correct Answer: d. Tendons, aponeurosis and directly to bone • Question 9 0 out of 4 points Upon leaving the last portion of the small intestine, nutrients move through the large intestine in what order? Selected Answer: a. Cecum, ascending colon, transverse colon, sigmoid colon, descending colon, rectum, anus Correct Answer: c. Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus • Question 10 4 out of 4 points What is Bowman’s capsule? Selected Answer: b. C-shaped structure partially surrounding the glomerulus Correct Answer: b. C-shaped structure partially surrounding the glomerulus • Question 11 4 out of 4 points Urine is transported from the kidneys to the urinary bladder by which structure? Selected Answer: d. Ureter Correct Answer: d. Ureter • Question 12 4 out of 4 points Which of the following is significant of an abdominal aortic aneurysm? Selected Answer: c. It is a weakness in a large artery and rupture can be deadly Correct Answer: c. It is a weakness in a large artery and rupture can be deadly • Question 13 4 out of 4 points A patient diagnosed with glaucoma has: Selected Answer: d. Abnormally high intraocular pressure Correct Answer: d. Abnormally high intraocular pressure • Question 14 4 out of 4 points Destruction of lesions of the vulva can be done with cryosurgery. This method uses: Selected Answer: c. Extreme cold Correct Answer: c. Extreme cold • Question 15 4 out of 4 points The term for a shaking or involuntary movement is: Selected Answer: b. Tremor Correct Answer: b. Tremor • Question 16 4 out of 4 points A surgeon performs an escharotomy. This procedure is best described as: Selected Answer: d. Incision into a burn in order to lessen its pull on the surrounding tissue. Correct Answer: d. Incision into a burn in order to lessen its pull on the surrounding tissue. • Question 17 4 out of 4 points Cytopathology is the study of: Selected Answer: a. Cells Correct Answer: a. Cells • Question 18 4 out of 4 points The meaning of the root blephar/o is: Selected Answer: d. Eyelid Correct Answer: d. Eyelid • Question 19 4 out of 4 points The term for pain in the ear is: Selected Answer: a. Otalgia Correct Answer: a. Otalgia • Question 20 4 out of 4 points A diagnostic tool in sleep medicine is: Selected Answer: a. Polysomnography Correct Answer: a. Polysomnography • Question 21 4 out of 4 points A projection is the path of the X-ray beam. If the projection is front to back it would be: Selected Answer: c. Anteroposterior Correct Answer: c. Anteroposterior • Question 22 4 out of 4 points A patient is diagnosed with inflammation of the testis and epididymis. The medical term for this condition is: Selected Answer: b. Orchiepididymitis Correct Answer: b. Orchiepididymitis • Question 23 4 out of 4 points A meningioma is defined as: Selected Answer: a. Tumor of the meninges Correct Answer: a. Tumor of the meninges • Question 24 4 out of 4 points The operative overlapping of tissue to repair a defect in the diaphragm is called: Selected Answer: c. Imbrication Correct Answer: c. Imbrication • Question 25 4 out of 4 points Bone marrow harvesting is a procedure to obtain bone marrow from a donor. Bone marrow collected from a close relative is: Selected Answer: b. Allogenic Correct Answer: b. Allogenic Review Test Submission: Chapter 3 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 3 Quiz Started 6/17/19 9:08 PM Submitted 6/17/19 9:45 PM Status Completed Attempt Score 80 out of 100 points Time Elapsed 37 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points What is a default code? Refer to ICD-10-CM guideline I.A.18. Selected Answer: c. The code that represents the condition most commonly associated with the main term. Correct Answer: c. The code that represents the condition most commonly associated with the main term. Response Feedback: Rationale: The default code represents that condition is the most commonly associated with the main term, or is the unspecified code for the condition. • Question 2 10 out of 10 points Supplementary words enclosed in parentheses in the ICD-10-CM coding manual have what affect on the coding? Refer to ICD-10-CM guideline I.A.7. Selected Answer: d. They do not affect code assignment. Correct Answer: d. They do not affect code assignment. Response Feedback: Rationale: Parentheses are used in both the ICD-10-CM Alphabetic Index and Tabular List to enclose supplementary words that may be present in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. • Question 3 0 out of 10 points What is the ICD-10-CM code for benign prostatic hyperplasia with urinary retention? Selected Answer: c. N40.1 Correct Answer: d. N40.1, R33.8 Response Feedback: Rationale: Look in the Index to Diseases and Injuries look for Hyperplasia/prostate/with lower urinary tract symptoms which refers you to N40.1. In the Tabular List, code N40.1 has instructions to use an additional code for associated symptoms. Code R33.8 is listed as one of those additional codes to report the urinary retention. Correct code choice is N40.1 and R33.8. In ICD-10-CM go to the Tabular List at the beginning of Chapter 14: Diseases of Genitourinary System (N00-N99), there is information on Anatomy of the Male Reproductive System/Common Pathologies/Benign Prostate Hypertrophy (BPH) which gives you a description of this condition. • Question 4 10 out of 10 points Applying the coding concept from ICD-10-CM guideline I.B.1., which of the following is the recommended method for using your ICD-10-CM code book? Selected Answer: d. Always consult the Alphabetic Index first. Refer to the Tabular List to locate the selected code Correct Answer: d. Always consult the Alphabetic Index first. Refer to the Tabular List to locate the selected code Response Feedback: Rationale: Introduction ICD-10-CM - How to Use the ICD-10-CM - Steps to Correct Coding tells us to locate the main term in the Alphabetic Index, then verify the code in the Tabular List. • Question 5 10 out of 10 points What is the ICD-10-CM code for essential hypertension? Selected Answer: d. I10 Correct Answer: d. I10 Response Feedback: Rationale: In the Index to Diseases and Injuries, look for Hypertension. You will see next to the main term Hypertension subterms (or nonessential modifiers) listed in parentheses, and the subterm essential is in parenthesis. Subterms that follow the main term and are enclosed in parentheses are nonessential modifiers in which they can clarify the diagnosis but are not required. Verify in the Tabular List that code I10 is for Essential Hypertension. • Question 6 10 out of 10 points A patient visits the primary care physician for complaints of nausea and vomiting. Which option would be appropriate reporting for a diagnosis of nausea and vomiting? Apply the coding concept from ICD-10-CM guideline I.B.9. Selected Answer: b. R11.2 Correct Answer: b. R11.2 Response Feedback: Rationale: The ICD-10-CM Official Guidelines, Section I.B.9 give instructions to code both conditions together when a combination code applies. Look in the Index to Diseases and Injuries for Nausea/with vomiting. R11.2 combines the nausea and vomiting conditions. • Question 7 10 out of 10 points A patient is brought to the ED with right and left ankle fractures. Applying the coding concept from ICD-10-CM guideline I.B.13., which ICD-10-CM code(s) are reported? Selected Answer: c. S82.891A, S82.892A Correct Answer: c. S82.891A, S82.892A Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.B.12 & 13 state to use a diagnosis code only once for an encounter. This applies to bilateral conditions when there are no distinct codes identifying laterality or two different conditions classifies to the same ICD-10-CM diagnosis code. If no bilateral codes is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identifies in the medical record, assign the code for the unspecified side. Look for Fracture, traumatic/ankle, and you are referred to S82.899-. In the questions the ankle fracture does not further indicate a specific location or bone in the ankle that has been fractured, so subcategory S82.89- is correct. Verification in the Tabular List shows that there are specific codes for the right and left ankle and the codes requires additional characters for laterality and initial encounter. Code S82.891A for the right ankle and S82.892A for the left since there is not a code choice for bilateral. • Question 8 10 out of 10 points A patient sees the physician for chest pain, fever, and cough. The physician orders an x-ray to rule out pneumonia. Applying the coding concept from ICD-10-CM guideline IV.H., which ICD-10-CM code(s) are reported? Selected Answer: c. R07.9, R50.9, R05 Correct Answer: c. R07.9, R50.9, R05 Response Feedback: Rationale: ICD-10-CM coding guidelines, Section IV.H. instructs you to code signs and symptoms when the diagnosis is uncertain. Diagnosis stated as “rule out,” “suspected,” or “probably” are not reported. The pneumonia is a “rule out” and is not coded. Instead, code the symptoms. In the Index to Diseases and Injuries, look for Pain(s)/chest (central) (R07.9), Fever (R50.9), and Cough (R05). Verify code selection in the Tabular List. • Question 9 10 out of 10 points A patient visits her family provider for her annual wellness exam. The provider notices a suspicious skin lesion on her arm and refers her to a dermatologist. Applying the coding concept from ICD-10-CM guideline IV.P, which ICD-10-CM code(s) is/are reported? Selected Answer: d. Z00.01, L98.9 Correct Answer: d. Z00.01, L98.9 Response Feedback: Rationale: ICD-10-CM coding guidelines, section IV.P. requires the coder to report first the general medical exam diagnosis and then the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Examination (for) (following) (general) (of) (routine)/annual (adult) (periodic) (physical)/with abnormal findings Z00.01. In the Tabular List, there is a note to also report the code to identify the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Lesion/Skin L98.9. Verify code selection in the Tabular List. • Question 10 0 out of 10 points A patient is in outpatient surgery for a laparoscopic oophorectomy for a right ovarian cyst. After admission, the anesthesiologist discovered the patient had an upper respiratory infection and the surgery was cancelled. Applying the coding concept from ICD-10-CM guideline IV.A.1., which ICD-10-CM code(s) are reported? Selected Answer: b. Z53.09 Correct Answer: d. N83.201, J06.9, Z53.09 Response Feedback: Rationale: ICD-10-CM coding guidelines Section IV.A.1.states to report the reason for surgery as the first listed diagnosis even if the surgery is cancelled due to a contraindication. Look in the Index to Diseases and Injuries for Cyst/ovary, ovarian (twisted) and you are referred N83.201. In the Tabular List, 6th character 1 is reported for the right side. For the respiratory infection, look for Infection/respiratory (tract)/upper (acute) NOS and you are referred to J06.9. Then, look for Canceled procedure/because of/contraindication which refers you to Z53.09. Verify codes in the Tabular List. Review Test Submission: Chapter 3 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 3 Quiz Started 6/18/19 10:16 AM Submitted 6/18/19 10:59 AM Status Completed Attempt Score 90 out of 100 points Time Elapsed 43 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points Which coding convention is used in the description of an ICD-10-CM code when the information in the medical record provides detail, but no specific code exists? Refer to ICD-10-CM guideline I.A.6. Selected Answer: c. NEC Correct Answer: c. NEC Response Feedback: Rationale: NEC "Not elsewhere classifiable" This abbreviation in the index represents "other specified." When a specific code is not available for a condition the index directs the coder to the "other specified" code in the Tabular List. When a specific code is not available for a condition the Tabular List includes an NEC entry under a code to identify the code as the "other specified" code. (see "Other" codes) • Question 2 10 out of 10 points Cyclic neutropenia is coded with D70.4 Cyclic neutropenia.. There are additional coding instructions for this code listed under the category D70 Neutropenia. Using those instructions, how would you report a patient with cyclic neutropenia with an associated fever? Selected Answer: b. D70.4, R50.81 Correct Answer: b. D70.4, R50.81 Response Feedback: Rationale: The instructions under code category D70 state to “use additional code for any associated: fever (R50.81); mucositosis (J34.81, K12.3-, K92.81, N76.81). Cyclic neutropenia with an associated fever is reported with D70.4, R50.81. Additional codes are not reported as primary codes. • Question 3 10 out of 10 points What is the ICD-10-CM code for a bruised left knee, initial encounter? Selected Answer: b. S80.02XA Correct Answer: b. S80.02XA Response Feedback: Rationale: In the Index to Diseases and Injuries, look for the main term Bruise. You are directed to see also Contusion. Look for the main term Contusion, locate the site, subterm, knee and you are referred to S80.0-. Review in Tabular List. There is a fifth character symbol in front of subcategory code S80.0 to indicate the laterality of the contusion. The contusion is on the left knee, reporting so far S80.02. There is a symbol for 7th, X, extension character, indicating you need to report two more characters to complete this code. Because you only have so far five characters, S80.02, you need to report an “X” as a dummy placeholder for your sixth character and then an “A” to indicate initial encounter for your seventh character. There is an instructional note under category code S80 that indicates which letters can only be used as the 7th character. Correct code choice is S80.02XA. • Question 4 10 out of 10 points What is the ICD-10-CM code for benign prostatic hyperplasia with urinary retention? Selected Answer: d. N40.1, R33.8 Correct Answer: d. N40.1, R33.8 Response Feedback: Rationale: Look in the Index to Diseases and Injuries look for Hyperplasia/prostate/with lower urinary tract symptoms which refers you to N40.1. In the Tabular List, code N40.1 has instructions to use an additional code for associated symptoms. Code R33.8 is listed as one of those additional codes to report the urinary retention. Correct code choice is N40.1 and R33.8. In ICD-10-CM go to the Tabular List at the beginning of Chapter 14: Diseases of Genitourinary System (N00-N99), there is information on Anatomy of the Male Reproductive System/Common Pathologies/Benign Prostate Hypertrophy (BPH) which gives you a description of this condition. • Question 5 0 out of 10 points What is the ICD-10-CM code for bilateral hip pain? Selected Answer: a. M25.851, M25.852 Correct Answer: d. M25.551, M25.552 Response Feedback: Rationale: In the Index to Diseases and Injuries, look for Pain(s)/ joint/hip. You are directed to subcategory code M25.55. In the Tabular List, a sixth character is assigned to indicate laterality. Because there is no code choice for bilateral, M25.551 is reported for the right hip pain and M25.552 is reported for the left hip pain. • Question 6 10 out of 10 points Referencing ICD-10-CM guideline I.B.11., what is the appropriate action when a physician documents an impending condition that had not occurred by the time of discharge? Selected Answer: a. Check the ICD-10-CM Alphabetic Index to see if there are listings under “threatened” or “impending” and if not, code the existing underlying condition(s) and not the condition described as impending. Correct Answer: a. Check the ICD-10-CM Alphabetic Index to see if there are listings under “threatened” or “impending” and if not, code the existing underlying condition(s) and not the condition described as impending. Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.B.11 state to check the Index to Diseases and Injuries for listings under the main term threatened or impending. If a subterm does not exist, code the existing underlying condition(s) and not the condition described as impending. • Question 7 10 out of 10 points A patient visits the primary care physician for complaints of nausea and vomiting. Which option would be appropriate reporting for a diagnosis of nausea and vomiting? Apply the coding concept from ICD-10-CM guideline I.B.9. Selected Answer: b. R11.2 Correct Answer: b. R11.2 Response Feedback: Rationale: The ICD-10-CM Official Guidelines, Section I.B.9 give instructions to code both conditions together when a combination code applies. Look in the Index to Diseases and Injuries for Nausea/with vomiting. R11.2 combines the nausea and vomiting conditions. • Question 8 10 out of 10 points A patient is in outpatient surgery for a laparoscopic oophorectomy for a right ovarian cyst. After admission, the anesthesiologist discovered the patient had an upper respiratory infection and the surgery was cancelled. Applying the coding concept from ICD-10-CM guideline IV.A.1., which ICD-10-CM code(s) are reported? Selected Answer: d. N83.201, J06.9, Z53.09 Correct Answer: d. N83.201, J06.9, Z53.09 Response Feedback: Rationale: ICD-10-CM coding guidelines Section IV.A.1.states to report the reason for surgery as the first listed diagnosis even if the surgery is cancelled due to a contraindication. Look in the Index to Diseases and Injuries for Cyst/ovary, ovarian (twisted) and you are referred N83.201. In the Tabular List, 6th character 1 is reported for the right side. For the respiratory infection, look for Infection/respiratory (tract)/upper (acute) NOS and you are referred to J06.9. Then, look for Canceled procedure/because of/contraindication which refers you to Z53.09. Verify codes in the Tabular List. • Question 9 10 out of 10 points A patient visits her family provider for her annual wellness exam. The provider notices a suspicious skin lesion on her arm and refers her to a dermatologist. Applying the coding concept from ICD-10-CM guideline IV.P, which ICD-10-CM code(s) is/are reported? Selected Answer: d. Z00.01, L98.9 Correct Answer: d. Z00.01, L98.9 Response Feedback: Rationale: ICD-10-CM coding guidelines, section IV.P. requires the coder to report first the general medical exam diagnosis and then the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Examination (for) (following) (general) (of) (routine)/annual (adult) (periodic) (physical)/with abnormal findings Z00.01. In the Tabular List, there is a note to also report the code to identify the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Lesion/Skin L98.9. Verify code selection in the Tabular List. • Question 10 10 out of 10 points A patient sees the physician for chest pain, fever, and cough. The physician orders an x-ray to rule out pneumonia. Applying the coding concept from ICD-10-CM guideline IV.H., which ICD-10-CM code(s) are reported? Selected Answer: c. R07.9, R50.9, R05 Correct Answer: c. R07.9, R50.9, R05 Response Feedback: Rationale: ICD-10-CM coding guidelines, Section IV.H. instructs you to code signs and symptoms when the diagnosis is uncertain. Diagnosis stated as “rule out,” “suspected,” or “probably” are not reported. The pneumonia is a “rule out” and is not coded. Instead, code the symptoms. In the Index to Diseases and Injuries, look for Pain(s)/chest (central) (R07.9), Fever (R50.9), and Cough (R05). Verify code selection in the Tabular List. Review Test Submission: Chapter 3 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 3 Quiz Started 6/18/19 3:58 PM Submitted 6/18/19 5:19 PM Status Completed Attempt Score 80 out of 100 points Time Elapsed 1 hour, 21 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points Which coding convention is used in the description of an ICD-10-CM code when the information in the medical record provides detail, but no specific code exists? Refer to ICD-10-CM guideline I.A.6. Selected Answer: c. NEC Correct Answer: c. NEC Response Feedback: Rationale: NEC "Not elsewhere classifiable" This abbreviation in the index represents "other specified." When a specific code is not available for a condition the index directs the coder to the "other specified" code in the Tabular List. When a specific code is not available for a condition the Tabular List includes an NEC entry under a code to identify the code as the "other specified" code. (see "Other" codes) • Question 2 10 out of 10 points What is a default code? Refer to ICD-10-CM guideline I.A.18. Selected Answer: c. The code that represents the condition most commonly associated with the main term. Correct Answer: c. The code that represents the condition most commonly associated with the main term. Response Feedback: Rationale: The default code represents that condition is the most commonly associated with the main term, or is the unspecified code for the condition. • Question 3 10 out of 10 points What is the ICD-10-CM code for bilateral hip pain? Selected Answer: d. M25.551, M25.552 Correct Answer: d. M25.551, M25.552 Response Feedback: Rationale: In the Index to Diseases and Injuries, look for Pain(s)/ joint/hip. You are directed to subcategory code M25.55. In the Tabular List, a sixth character is assigned to indicate laterality. Because there is no code choice for bilateral, M25.551 is reported for the right hip pain and M25.552 is reported for the left hip pain. • Question 4 10 out of 10 points What is the ICD-10-CM code for benign prostatic hyperplasia with urinary retention? Selected Answer: d. N40.1, R33.8 Correct Answer: d. N40.1, R33.8 Response Feedback: Rationale: Look in the Index to Diseases and Injuries look for Hyperplasia/prostate/with lower urinary tract symptoms which refers you to N40.1. In the Tabular List, code N40.1 has instructions to use an additional code for associated symptoms. Code R33.8 is listed as one of those additional codes to report the urinary retention. Correct code choice is N40.1 and R33.8. In ICD-10-CM go to the Tabular List at the beginning of Chapter 14: Diseases of Genitourinary System (N00-N99), there is information on Anatomy of the Male Reproductive System/Common Pathologies/Benign Prostate Hypertrophy (BPH) which gives you a description of this condition. • Question 5 10 out of 10 points What is the ICD-10-CM code for essential hypertension? Selected Answer: d. I10 Correct Answer: d. I10 Response Feedback: Rationale: In the Index to Diseases and Injuries, look for Hypertension. You will see next to the main term Hypertension subterms (or nonessential modifiers) listed in parentheses, and the subterm essential is in parenthesis. Subterms that follow the main term and are enclosed in parentheses are nonessential modifiers in which they can clarify the diagnosis but are not required. Verify in the Tabular List that code I10 is for Essential Hypertension. • Question 6 10 out of 10 points A patient is brought to the ED with right and left ankle fractures. Applying the coding concept from ICD-10-CM guideline I.B.13., which ICD-10-CM code(s) are reported? Selected Answer: c. S82.891A, S82.892A Correct Answer: c. S82.891A, S82.892A Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.B.12 & 13 state to use a diagnosis code only once for an encounter. This applies to bilateral conditions when there are no distinct codes identifying laterality or two different conditions classifies to the same ICD-10-CM diagnosis code. If no bilateral codes is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identifies in the medical record, assign the code for the unspecified side. Look for Fracture, traumatic/ankle, and you are referred to S82.899-. In the questions the ankle fracture does not further indicate a specific location or bone in the ankle that has been fractured, so subcategory S82.89- is correct. Verification in the Tabular List shows that there are specific codes for the right and left ankle and the codes requires additional characters for laterality and initial encounter. Code S82.891A for the right ankle and S82.892A for the left since there is not a code choice for bilateral. • Question 7 10 out of 10 points Referencing ICD-10-CM guideline I.B.11., what is the appropriate action when a physician documents an impending condition that had not occurred by the time of discharge? Selected Answer: a. Check the ICD-10-CM Alphabetic Index to see if there are listings under “threatened” or “impending” and if not, code the existing underlying condition(s) and not the condition described as impending. Correct Answer: a. Check the ICD-10-CM Alphabetic Index to see if there are listings under “threatened” or “impending” and if not, code the existing underlying condition(s) and not the condition described as impending. Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.B.11 state to check the Index to Diseases and Injuries for listings under the main term threatened or impending. If a subterm does not exist, code the existing underlying condition(s) and not the condition described as impending. • Question 8 0 out of 10 points A patient is admitted for an outpatient cholecystectomy for gall stones. During recovery, the patient developed severe postoperative pain. The patient was admitted to observation to monitor the pain. Applying the coding concept from ICD-10-CM guideline IV.A.2., what ICD-10-CM code(s) are reported for the observation? Selected Answer: c. G89.18, K80.20 Correct Answer: a. K80.20, G89.18 Response Feedback: Rationale: According to the ICD-10-CM Guidelines, Section IV.A.2, when a patient presents for outpatient surgery and develops complications requiring admission to observation, code the reason for the surgery as the primary diagnosis, and the complications as secondary diagnosis. Look for main term Gallstone in the Index to Diseases and Injuries and you are referred to see also Calculus, gallbladder. Look for Calculus/gallbladder, which refers you to K80.20. For the postoperative pain, look for Pain(s)/postoperative NOS and you are referred to G89.18. Verify codes in the Tabular List. • Question 9 0 out of 10 points Mr. Smith is scheduled for a splenectomy for hypersplenism. Before his splenectomy, he is required to have clearance from his pulmonologist. The pulmonologist performs a pre-operative screening. Applying the coding concept from ICD-10-CM guideline IV.M., which ICD-10-CM Codes would be reported for the pre-operative clearance? Selected Answer: c. D73.1, Z01.811 Correct Answer: d. Z01.811, D73.1 Response Feedback: Rationale: ICD-10-CM coding guidelines Section IV.M. states to sequence first a code from subcategory Z01.81, Encounter for preprocedural examinations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Look in the Index to Diseases and Inuries for Examination/pre-procedural/respiratory (Z01.811) and for Hypersplenia, hypersplenism (D73.1). Verify the codes in the Tabular List. • Question 10 10 out of 10 points A patient is in outpatient surgery for a laparoscopic oophorectomy for a right ovarian cyst. After admission, the anesthesiologist discovered the patient had an upper respiratory infection and the surgery was cancelled. Applying the coding concept from ICD-10-CM guideline IV.A.1., which ICD-10-CM code(s) are reported? Selected Answer: d. N83.201, J06.9, Z53.09 Correct Answer: d. N83.201, J06.9, Z53.09 Response Feedback: Rationale: ICD-10-CM coding guidelines Section IV.A.1.states to report the reason for surgery as the first listed diagnosis even if the surgery is cancelled due to a contraindication. Look in the Index to Diseases and Injuries for Cyst/ovary, ovarian (twisted) and you are referred N83.201. In the Tabular List, 6th character 1 is reported for the right side. For the respiratory infection, look for Infection/respiratory (tract)/upper (acute) NOS and you are referred to J06.9. Then, look for Canceled procedure/because of/contraindication which refers you to Z53.09. Verify codes in the Tabular List. Review Test Submission: 2019 Chapter 3 Practical Application User Course 2019 Physician Coding for CPC Preparation (Q-S) Test 2019 Chapter 3 Practical Application Started 6/20/19 8:06 PM Submitted 6/20/19 9:06 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 1 hour, 0 minute Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 5 out of 5 points Using the ICD-10-CM codebook locate the diagnosis codes for the following condition: Fever Selected Answer: R50.9 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match R50.9 • Question 2 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Chronic non-intractable common migraine headache with status migrainosus Selected Answer: G43.701 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match G43.701 Response Feedback: Determine the main term which is headache. In the ICD-10-CM Alphabetic Index, look for Headache/migraine (type) (see also Migraine). In the same index, Migraine (idiopathic)/common directs you to see Migraine, without aura. Migraine/without aura/chronic/not intractable/with status migrainosus directs you to code G43.701. Review the code in the Tabular List to verify the code accuracy. • Question 3 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Otitis media left ear Selected Answer: H66.92 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match H66.92 Response Feedback: The main term is otitis. In the ICD-10-CM Alphabetic Index, look for Otitis/media. There is no additional information provided. You are referred to H66.9-. The dash indicates an additional character is required for a complete code. Review the code in the Tabular List for the 5th character. Under subcategory H66.9 you will see Otitis Media NOS listed. The 5th character is 2 indicating the infection is in the left ear. This is an infection of the middle ear (media). • Question 4 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Epigastric pain Selected Answer: R10.13 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match R10.13 Response Feedback: The main term is pain. In the ICD-10-CM Alphabetic Index, look for Pain/epigastric, epigastrium. You are referred to R10.13. Review the code in the Tabular List to verify the code accuracy. • Question 5 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Acute asthma exacerbation Selected Answer: J45.901 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match J45.901 Response Feedback: The main term is asthma. In the ICD-10-CM Alphabetic Index, look for Asthma, asthmatic/with/exacerbation (acute) J45.901. Review the code in the Tabular List to verify the code accuracy. Note: There is a category note for J45 to use additional code to identify exposure to, use of, or dependence of tobacco. This is coded if known. • Question 6 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Acute myocardial infarction Selected Answer: I21.3 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match I21.3 Response Feedback: The main term is infarction. In the ICD-10-CM Alphabetic Index, look for Infarct, infarction/myocardium, myocardial (acute) (with stated duration of 4 weeks or less) I21.3. Refer to the Tabular List. This is the correct code, even though there is no stated duration in the question, because code I21.3 lists Myocardial infarction (acute) NOS under the code. Note: There is a category note for I21 to use additional code, if applicable, to identify exposure to, use of, dependence of tobacco, or status post tPA in another facility. This is coded if known. • Question 7 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Hypertensive heart disease Selected Answer: I11.9 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match I11.9 Response Feedback: The main term is disease. In the ICD-10-CM Alphabetic Index, look for Disease, diseased/heart/hypertensive and you are directed to see Hypertension, heart. Hypertension, hypertensive/heart directs you to I11.9. Review the code in the Tabular List to verify the code accuracy. Note: There is a category note for I10-I15 to use additional code to identify exposure to, use of, or dependence of tobacco. This is coded if known. • Question 8 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Syncope Selected Answer: R55 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match R55 Response Feedback: Look for Syncope in the ICD-10-CM Alphabetic Index. You are referred to R55. Review the code in the Tabular List to verify the code accuracy. • Question 9 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Nausea and vomiting Selected Answer: R11.2 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match R11.2 Response Feedback: Nausea and vomiting are both main terms. In the ICD-10-CM Alphabetic Index, look for Nausea/with vomiting or Vomiting/with nausea. You are referred to R11.2. Review the code in the Tabular List to verify the code accuracy. • Question 10 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: GERD Selected Answer: K21.9 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match K21.9 Response Feedback: GERD is an acronym for gastroesophageal reflux disease. The main term is disease. This diagnosis can be located in the index under the acronym or the main term. In the ICD-10-CM Alphabetic Index, look for GERD (gastroesophageal reflux disease) or look for Disease/gastroesophageal reflux (GERD). You are referred to K21.9. Review the code in the Tabular List to verify the code accuracy. • Question 11 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Chlamydial inflammation of the testes Selected Answer: A56.19 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match A56.19 Response Feedback: Inflammation and chlamydia are both main terms. In the ICD-10-CM Alphabetic Index, look for Inflammation, inflamed, inflammatory/testes, which directs you to see Orchitis. Orchitis is the inflammation of the testes. Look for Orchitis/chlamydial or Chlamydia, chlamydial/orchitis. You are referred to A56.19. Review the code in the Tabular List to verify the code accuracy. Under code A56.19 chlamydial orchitis is listed. • Question 12 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Sickle-cell anemia Selected Answer: D57.1 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match D57.1 Response Feedback: The main term is anemia. In the ICD-10-CM Alphabetic Index, look for Anemia/sickle-cell – see Disease, sickle-cell. Disease, diseased/sickle cell directs you to D57.1. Review the code in the Tabular List to verify the code accuracy. Sickle-cell anemia NOS is listed as an inclusion term under D57.1. Note: There is a category note under D57 to use an additional code for any associated fever. This is coded if known. • Question 13 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Ruptured spleen (not due to an injury) Selected Answer: D73.5 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match D73.5 Response Feedback: The main term is ruptured. From the ICD-10-CM Alphabetic Index look for Rupture, ruptured/spleen/nontraumatic. You are referred to D73.5. Review the code in the Tabular List to verify the code accuracy. The diagnosis documents the rupture of the spleen was not due an injury, also called nontraumatic. Splenic rupture, nontraumatic is listed as an inclusion term under D73.5. • Question 14 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Cellulitis of the arm Selected Answer: L03.119 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match L03.119 Response Feedback: The main term is cellulitis. In the ICD-10-CM Alphabetic Index, look for Cellulitis/arm – see Cellulitis, upper limb. Look for Cellulitis/upper limb and you are referred to L03.11-. The dash indicates another character is required for a complete code. Review the code in the Tabular List to report the 6th character and verify the code accuracy. The diagnosis does not specify if the cellulitis is in the left or right arm, so report L03.119. • Question 15 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Chest mass Selected Answer: R22.2 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match R22.2 Response Feedback: The main term is mass. In the ICD-10-CM Alphabetic Index, look for Mass/chest. You are referred to R22.2. Review the code in the Tabular List to verify the code accuracy. • Question 16 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Novel H1N1 flu Selected Answer: J10.1 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match J10.1 Response Feedback: The main term is flu. In the ICD-10-CM Alphabetic Index, look for Flu there are no subentries for Novel or H1N1. It does instruct you to see also Influenza. Look for Influenza/novel (2009) H1N1 influenza. You are referred to J10.1. Review the code in the Tabular List to verify the code accuracy. Note: The use additional code note for associated pleural effusion or sinusitis, if applicable. • Question 17 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Uncontrolled diabetes with diabetic cataracts Selected Answer: E11.36 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match E11.36 Response Feedback: The main term is diabetes. In the ICD-10-CM Alphabetic Index, look for Diabetes, diabetic/with/cataract. You are referred to E11.36. Review the code in the Tabular List to verify the code accuracy. The term uncontrolled is not a factor in code selection for diabetes under ICD-10-CM. Note: There is a note to use an additional code to identify if the diabetes is controlled with insulin, oral antidiabetic drugs, or oral hypoglycemic drugs if known. • Question 18 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Left outer cheek abrasion, initial encounter Selected Answer: S00.81XA Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match S00.81XA Response Feedback: The main term is abrasion. In the ICD-10-CM Alphabetic Index, look for Abrasion/cheek. You are referred to S00.81-. Review the code in the Tabular List to assign the 7th character and to verify the code accuracy. Because this code needs seven characters, the letter X is used as a placeholder for the 6th character, and the 7th character A is reported because the injury is an initial encounter. • Question 19 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Acute cholecystitis with chronic cholecystitis Selected Answer: K81.2 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match K81.2 Response Feedback: The main term is cholecystitis. In the ICD-10-CM Alphabetic Index, look for Cholecystitis/acute/with/chronic cholecystitis. You are referred to K81.2. Review the code in the Tabular List to verify the code accuracy. Two codes are not reported for the acute and chronic cholecystitis because there is a combination code that fully identifies all the elements documented in the diagnosis. • Question 20 5 out of 5 points Using the ICD-10-CM codebook, locate the diagnosis codes for the following condition: Right eyebrow laceration, subsequent encounter Selected Answer: S01.111D Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match S01.111D Response Feedback: The main term is laceration. In the ICD-10-CM Alphabetic Index, look for Laceration/eyebrow and you are directed to see Laceration, eyelid. Look for Laceration/eyelid, and you are referred to S01.11-. Review the code in the Tabular List to report 6th and 7th characters and to verify the code accuracy. S01.111D is the correct code to report because the laceration is on the right side. The 7th character D is reported to indicate subsequent encounter. Review Test Submission: Chapter 3 Review Exam User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 3 Review Exam Started 6/21/19 4:51 PM Submitted 6/21/19 6:15 PM Status Completed Attempt Score 84 out of 100 points Time Elapsed 1 hour, 24 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 4 out of 4 points What is the meaning of provider in the ICD-10-CM guidelines? Selected Answer: d. The physician Correct Answer: d. The physician Response Feedback: Rationale: Per ICD-10-CM guidelines, the term provider means a physician or any qualified health care practitioner who is legally accountable for establishing the patient’s diagnosis. This is stated in the introduction section of the guidelines. • Question 2 4 out of 4 points The terms malignant, benign, in situ and uncertain behavior are all terms used when coding what? Selected Answer: d. Neoplasms Correct Answer: d. Neoplasms Response Feedback: Rationale: Neoplasm codes in ICD-10-CM are classified as malignant, carcinoma in situ, uncertain, unspecified or benign. • Question 3 4 out of 4 points The instructions and conventions of the classification take precedence over ________. Selected Answer: c. Official Coding Guidelines Correct Answer: c. Official Coding Guidelines Response Feedback: Rationale: ICD-10-CM guidelines state the instructions and conventions of the classification take precedence over guidelines. • Question 4 4 out of 4 points When a patient has a condition that is both acute and chronic and there are separate entries for both, how is it reported? Selected Answer: d. Code both sequencing the acute first Correct Answer: d. Code both sequencing the acute first Response Feedback: Rationale: According to the ICD-10-CM guideline 1.B.8 if the same condition is described as both acute (subacute) and chronic and separate entries exist in the ICD-10-CM Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) first. • Question 5 4 out of 4 points What month does the new ICD-10-CM codebook take effect each year? Selected Answer: b. October Correct Answer: b. October Response Feedback: Rationale: The new ICD-10-CM codebook is effective October 1 of each year. • Question 6 4 out of 4 points What is the ICD-10-CM code for low back pain? Selected Answer: d. M54.5 Correct Answer: d. M54.5 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index Pain/low back and you are directed to M54.5. Verify code selection in the Tabular List. • Question 7 4 out of 4 points What is the ICD-10-CM code for hay fever? Selected Answer: d. J30.1 Correct Answer: d. J30.1 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Fever/hay (allergic) J30.1. Verify code selection in the Tabular List. • Question 8 4 out of 4 points What is the ICD-10-CM code for headache? Selected Answer: a. R51 Correct Answer: a. R51 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Headache. You can also find the code by going to Pain/head. There is no further description making R51 the correct code. Verify code selection in the Tabular List. • Question 9 0 out of 4 points Refer to the Tabular List and identify the code that contains a note indicating not to code a specific diagnosis and that it should be coded elsewhere. Selected Answer: b. K31.84 Correct Answer: a. N94.10 Response Feedback: Rationale: Code N94.10 has an Excludes1 note for psychogenic dyspareunia (F52.6), indicating that the diagnosis psychogenic dyspareunia is not reported with code N94.10 but with code F52.6. • Question 10 4 out of 4 points What diagnosis code(s) should be reported for acute and chronic cystitis? Selected Answer: b. N30.00, N30.20 Correct Answer: b. N30.00, N30.20 Response Feedback: Rationale: ICD-10-CM guideline.I.B.8 states when the same condition is described as both acute and chronic and separate subentries exist, code both and sequence the acute code first. • Question 11 4 out of 4 points According to the Tabular List in the ICD-10-CM codebook, category code H80 Otosclerosis, includes what other disorder? Selected Answer: b. Otospongiosis Correct Answer: b. Otospongiosis Response Feedback: Rationale: Look for code H80 in the Tabular List of the ICD-10-CM codebook. The includes box is a note that appears under the three-character category code to further define or give examples of what is accepted in that category. • Question 12 4 out of 4 points What is the ICD-10-CM code for nausea? Selected Answer: c. R11.0 Correct Answer: c. R11.0 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Nausea. You are directed to R11.0. There is no mention of vomiting. Verify code selection in the Tabular List. • Question 13 4 out of 4 points A 6 year-old patient is seen in the office for acute otitis media, coded as H66.90. This is an example of a ____ code. Selected Answer: b. NOS Correct Answer: b. NOS Response Feedback: Rationale: H66.90 is Not Otherwise Specified. ICD-10-CM guideline I.A.9.b codes titled unspecified are for use when the information in the medical record is insufficient to assign a more specific code. The inclusion terms under H66.9 include NOS in the description. • Question 14 4 out of 4 points What do brackets [] indicate in the ICD-10-CM Alphabetic Index? Selected Answer: d. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. Correct Answer: d. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. Response Feedback: Rationale: ICD-10-CM guideline I.A.7 states brackets that appear in the ICD-10-CM Alphabetic Index indicates manifestation codes. Per ICD-10-CM guideline I.A.13 both codes must be assigned to fully describe the condition and are sequenced in the order listed. • Question 15 4 out of 4 points What is the ICD-10-CM code for keloid scar on the foot? Selected Answer: a. L91.0 Correct Answer: a. L91.0 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Scar/keloid L91.0. The location does not affect code selection. Verify code selection in the Tabular List. • Question 16 4 out of 4 points A 32 year-old male is in a diagnostic center to have an ultrasound of his neck due to difficulty swallowing. The patient’s father had esophageal cancer. What is/are the appropriate code(s) to report for the diagnostic service? Selected Answer: b. R13.10, Z80.0 Correct Answer: b. R13.10, Z80.0 Response Feedback: Rationale: A patient receiving a diagnostic service (for example, ultrasound, MRI, diagnostic colonoscopy) for an encounter or visit, report the condition or problem as a primary code to indicate why the patient is having the test performed. Codes for other diagnosis, such as chronic conditions or history are reported as an additional diagnosis. In this case the family history code is reported as an additional diagnosis since it has an impact on current care or influence treatment. Refer to ICD-10-CM guideline IV.K. In the ICD-10-CM Alphabetic Index look for Difficult, difficulty (in)/swallowing which states to see Dysphagia. Look in the Alphabetic Index for Dysphagia which directs the coder to code R13.10. In the Alphabetic Index look for History/family (of)/malignant neoplasm (of)/gastrointestinal tract referring you to code Z80.0. Verify code selection in the Alphabetic Index. • Question 17 0 out of 4 points A patient sees his primary care provider for chest pain and regurgitation. The provider’s diagnosis for the patient is gastroesophageal reflux. What diagnosis code(s) should be reported? Selected Answer: a. K21.9, R07.9, K21.9 Correct Answer: d. K21.9 Response Feedback: Rationale: ICD-10-CM coding guideline I.B.5 states “Signs and symptoms that are associated with routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.” In the ICD-10-CM Alphabetic Index look for Reflux/gastroesophageal guiding you to code K21.9. Verify code selection in the Tabular List. • Question 18 4 out of 4 points A 32 year-old sees her obstetrician about a lump in the right breast. Her mother and aunt both have a history of breast cancer. What diagnosis code(s) should be reported? Selected Answer: a. N63, Z80.3 Correct Answer: a. N63, Z80.3 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Mass/breast N63. Next look for History/family (of)/malignant neoplasm (of)/breast which directs the coder to Z80.3. According to ICD-10-CM guideline IV.J history codes (Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment. Verify code selection in the Tabular List. • Question 19 0 out of 4 points A 45 year-old female with malignant Mullerian duct cancer is receiving her first treatment of chemotherapy. What diagnosis codes are reported? Selected Answer: b. C57.7, Z51.11 Correct Answer: c. Z51.11, C57.7 Response Feedback: Rationale: ICD-10-CM guideline I.C.2.e.2 states if a patient admission/encounter is solely for administration of chemotherapy, immunotherapy or radiation therapy assign codes Z51.0, Z51.11 or Z51.12 as the first listed or principal diagnosis. The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis. In the ICD-10-CM Alphabetic Index look for Chemotherapy (session) (for)/cancer Z51.11. Next, look in the ICD-10-CM Table of Neoplasms for Mullerian duct/female and select the code from the Malignant Primary column which directs the coder to C57.7. Verify code selection in the Tabular List. • Question 20 4 out of 4 points A 50 year-old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is premenopausal. She is diagnosed with impending menopause. What diagnosis code(s) should be reported? Selected Answer: d. G47.00, K30 Correct Answer: d. G47.00, K30 Response Feedback: Rationale: ICD-10-CM guideline I.B.11 states to reference the ICD-10-CM Alphabetic Index to determine if the condition has a subentry for impending or threatened and also reference main term entries for Impending and Threatened. If the subterms are listed, assign the given code. If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatened. Look in the Alphabetic Index for Impending. There is not a subterm for menopause; therefore, the symptoms are coded. Look for Insomnia (organic) which directs the coder to G47.00. Next, look for Upset/stomach which directs the coder to K30. Verify code selection in the Tabular List. • Question 21 4 out of 4 points A patient was seen in the provider’s office and was diagnosed with influenza with pneumonia. The provider selected J18.9. Refer to the Tabular List to verify code J18.9. Is it correct to report code J18.9? Why? Selected Answer: c. No, there is a combination code J11.00 includes influenza with pneumonia. Correct Answer: c. No, there is a combination code J11.00 includes influenza with pneumonia. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Influenza/with/pneumonia guiding you to code J11.00. ICD-10-CM guideline I.B.9, states “Assign only the combination code when that code fully identifies the diagnostic conditions involved or when the Alphabetical Index so directs.” • Question 22 0 out of 4 points 37 year-old male is diagnosed as having cholelithiasis, choledocholithiasis and acute and chronic cholecystitis. What ICD-10-CM code(s) is/are reported? Selected Answer: c. K80.62, K80.66 Correct Answer: a. K80.66 Response Feedback: Rationale: A combination code is reported for all three diagnoses. ICD-10-CM guideline I.B.9 states you assign only the combination code when that code fully identifies the diagnostic conditions involved. In the Alphabetic Index look for Cholelithiasis and you are directed to see Calculus, gallbladder. Look for Choledocholithiasis and you are directed to see Calculus, bile duct. Look for Calculus/gallbladder and bile duct/with/cholecystitis/acute/with/chronic cholecystitis K80.66. Verify the code in the Tabular List. • Question 23 4 out of 4 points What diagnosis code(s) should be reported for primary osteoarthritis in both knees? Selected Answer: a. M17.0 Correct Answer: a. M17.0 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Osteoarthritis/primary/knee/bilateral which directs the coder to M17.0. Verify code selection in the Tabular List. • Question 24 4 out of 4 points What diagnosis codes should be reported for a patient that has polyneuropathy as a result of vitamin B deficiency? Selected Answer: c. E53.9, G63 Correct Answer: c. E53.9, G63 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Polyneuropathy/in (due to) deficiency (of)/B (-complex) vitamins guiding you to codes E53.9 [G63]. Code G63 is a manifestation code. In the Tabular List the description is Polyneuropathy in other diseases classified elsewhere. There is an instructional note stating to code first underlying disease such as nutritional deficiency (E40-E64). Verify code selection in the Tabular List. • Question 25 4 out of 4 points A 10 month-old comes into the pediatrician’s office for a harsh, bark-like cough. She is diagnosed with croup. The mother also wants the pediatrician to look at a rash that has developed on her leg. The pediatrician prescribes over the counter medication of acetaminophen for the croup and hydrocortisone cream for the rash on the leg. She is to follow up in five days or return earlier if the conditions worsen. What ICD-10-CM code(s) should be reported for this visit? Selected Answer: a. J05.0, R21 Correct Answer: a. J05.0, R21 Response Feedback: Rationale: Signs and symptoms that are associated with a disease process should not be reported, refer to ICD-10-CM guideline I.B.5. For this case the ICD-10-CM code R05 should not be reported because cough is a symptom of the croup. Codes for signs and symptoms that are not routinely associated with a definitive diagnosis should be reported, according to ICD-10-CM guidelines 1.B.4 and I.B.5. For this case the rash is reported because it is not related or associated to the croup. Look for Croup in the ICD-10-CM Alphabetic Index referring you to code J05.0. Look for Rash in the Alphabetic Index referring you to code R21. Verify both codes in the Tabular List. Review Test Submission: Chapter 3 Review Exam User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 3 Review Exam Started 6/22/19 5:55 PM Submitted 6/22/19 7:04 PM Status Completed Attempt Score 92 out of 100 points Time Elapsed 1 hour, 9 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 4 out of 4 points Who are the parties responsible for providing the ICD-10-CM guidelines? Selected Answer: c. NCHS and CMS Correct Answer: c. NCHS and CMS Response Feedback: Rationale: ICD-10-CM guidelines introduction states, Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) provide the guidelines for coding and reporting using ICD-10-CM. • Question 2 4 out of 4 points What does ICD-10-CM stand for? Selected Answer: b. International Classification of Diseases 10th Revision, Clinical Modification Correct Answer: b. International Classification of Diseases 10th Revision, Clinical Modification Response Feedback: Rationale: Per the Introduction page of the ICD-10-CM codebook, the abbreviation stands for International Classification of Diseases 10th Revision, Clinical Modification. • Question 3 4 out of 4 points What section of the ICD-10-CM guidelines contains instructions on how to code for a patient receiving diagnostic services only in an outpatient setting? Selected Answer: d. Section IV Correct Answer: d. Section IV Response Feedback: Rationale: Section IV Diagnostic Coding and Reporting Guidelines for Outpatient Services IV.K is specific to patients receiving diagnostic services only. • Question 4 4 out of 4 points According to ICD-10-CM guideline I.B.1 use both ____ and ____ when locating and assigning a diagnosis code. Selected Answer: b. ICD-10-CM Alphabetic Index and Tabular List Correct Answer: b. ICD-10-CM Alphabetic Index and Tabular List Response Feedback: Rationale: According to the ICD-10-CM guideline 1.B.1 both the Alphabetical Index and Tabular List are used to locate and assign a code. Reliance on only the Alphabetic Index or the Tabular List will lead to errors and less specificity in reporting codes. • Question 5 4 out of 4 points Which of the following statements is TRUE in reference to reporting body mass index (BMI) codes? Selected Answer: d. BMI codes should be reported as a secondary code only. Correct Answer: d. BMI codes should be reported as a secondary code only. Response Feedback: Rationale: ICD-10-CM guideline I.B.14 indicates that BMI codes are reported as secondary diagnoses. In the Tabular List, BMI codes can be reported with any code in subcategory E66.-, not just code E66.3. • Question 6 4 out of 4 points In the ICD-10-CM Alphabetic Index next to Hypertension, what do the terms in parentheses indicate? Selected Answer: a. Supplementary words that can be present or absent with the diagnosis hypertension and does not affect the code to which it is assigned. Correct Answer: a. Supplementary words that can be present or absent with the diagnosis hypertension and does not affect the code to which it is assigned. Response Feedback: Rationale: ICD-10-CM guideline I.A.7 states parentheses are used to enclose supplementary words that may be present or absent in the statement of disease or procedure, without affecting the code number to which it assigned. • Question 7 4 out of 4 points A 6 year-old patient is seen in the office for acute otitis media, coded as H66.90. This is an example of a ____ code. Selected Answer: a. NOS Correct Answer: a. NOS Response Feedback: Rationale: H66.90 is Not Otherwise Specified. ICD-10-CM guideline I.A.9.b codes titled unspecified are for use when the information in the medical record is insufficient to assign a more specific code. The inclusion terms under H66.9 include NOS in the description. • Question 8 4 out of 4 points What is the ICD-10-CM code for classical migraine? Selected Answer: c. G43.109 Correct Answer: c. G43.109 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Migraine/classical and you are directed to see migraine with aura. Migraine/with aura directs you to G43.109. Verify code selection in the Tabular List. • Question 9 4 out of 4 points What is the ICD-10-CM code for hives? Selected Answer: c. L50.9 Correct Answer: c. L50.9 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Hives and you are directed to see Urticaria. Urticaria directs you to L50.9. Verify code selection in the Tabular List. • Question 10 4 out of 4 points What is the ICD-10-CM code for cough? Selected Answer: b. R05 Correct Answer: b. R05 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Cough. Without further description you are directed to R05. Verify code selection in the Tabular List. • Question 11 4 out of 4 points Which diagnosis below would be considered a combination code? Selected Answer: a. K80.00 Correct Answer: a. K80.00 Response Feedback: Rationale: Refer to ICD-10-CM guideline I.B.9 for the definition of a combination code. Code K80.00 reports both gallbladder calculus and acute cholecystitis. Verify code selection in the Tabular List. • Question 12 4 out of 4 points What is the ICD-10-CM code for sore throat? Selected Answer: d. J02.9 Correct Answer: d. J02.9 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Sore/throat (acute) and you are directed to see also Pharyngitis. Look for Pharyngitis J02.9. Looking for Pain/throat, you are directed to R07.0. There is an excludes note under R07.0 excluding sore throat (acute) NOS. Verify code selection in the Tabular List. • Question 13 4 out of 4 points Which diagnosis code(s) should be reported for chronic gonococcal salpingitis? Selected Answer: a. A54.24 Correct Answer: a. A54.24 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Salpingitis/gonococcal (acute) (chronic) A54.24. Look for A54.24 in the Tabular List. You only need to report one code for this diagnosis. Under code N70 there is an Excludes1 instructional note that lists gonococcal infection (A54.24) which indicates that no codes from the N70 category should be reported for this diagnosis. • Question 14 0 out of 4 points Which diagnosis code(s) below reports pain in the left and right ears? Selected Answer: c. H92.01, H92.02 Correct Answer: a. H92.03 Response Feedback: Rationale: ICD-10-CM allows for the reporting of laterality (right, left, bilateral). For bilateral sites, the final character of the code indicates laterality. ICD-10-CM guideline I.B.13 indicates if no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. There is a bilateral code provided for pain in the left and right ears H92.03. You would not report two separate codes. • Question 15 4 out of 4 points What is the ICD-10-CM code for hay fever? Selected Answer: c. J30.1 Correct Answer: c. J30.1 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Fever/hay (allergic) J30.1. Verify code selection in the Tabular List. • Question 16 4 out of 4 points A male patient has started having convulsions. His provider sent him to have a computerized axial tomogram (CT scan) of the brain with contrast. The hospital’s radiologist read the CT scan. What diagnosis code is reported for the CT Scan? Selected Answer: a. R56.9 Correct Answer: a. R56.9 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Convulsions which directs the coder to R56.9. Verification in the Tabular List confirms code selection. • Question 17 4 out of 4 points A 22 year-old is in an outpatient facility for an inguinal hernia repair. Just before surgery, the surgeon discovers the patient is positive for MRSA and the surgery is canceled. Which ICD-10-CM code(s) should be reported for the outpatient service? Selected Answer: c. K40.90, A49.02, Z53.09 Correct Answer: c. K40.90, A49.02, Z53.09 Response Feedback: Rationale: ICD-10-CM guidelines for outpatient services IV.A.1 states to report the reason for surgery as the first listed diagnosis even if the surgery is canceled due to a contraindication. Look in the ICD-10-CM Alphabetic Index for Hernia/inguinal referring you to code K40.90. Next, look for MRSA (Methicillin resistant Staphylococcus aureus)/infection referring you to code A49.02. Lastly, look for Canceled procedure (surgical)/because of/contraindication referring you to code Z53.09. Verify code selection in the Tabular List. • Question 18 4 out of 4 points A patient sees his primary care provider for chest pain and regurgitation. The provider’s diagnosis for the patient is gastroesophageal reflux. What diagnosis code(s) should be reported? Selected Answer: c. K21.9 Correct Answer: c. K21.9 Response Feedback: Rationale: ICD-10-CM coding guideline I.B.5 states “Signs and symptoms that are associated with routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.” In the ICD-10-CM Alphabetic Index look for Reflux/gastroesophageal guiding you to code K21.9. Verify code selection in the Tabular List. • Question 19 4 out of 4 points A patient has a history of bilateral otitis media not responsive to medical therapy. Given the history and physical examination, the provider felt he was a candidate for bilateral myringotomy and tubes. The patient went to the ASC for the procedure. The provider’s findings were bilateral chronic serous otitis media. What diagnosis code is reported? Selected Answer: a. H65.23 Correct Answer: a. H65.23 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Otitis/media/chronic/serous which states see Otitis, media, nonsuppurative, chronic, serous. Look for Otitis/media/nonsuppurative/chronic/serous which directs the coder to H65.2-. In the Tabular List, 5th character 3 is selected for bilateral. • Question 20 0 out of 4 points What is the diagnosis code(s) for a patient with bronchitis and the flu? Selected Answer: c. J40, J11.1 Correct Answer: d. J11.1 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Bronchitis/with/influenza, flu or grippe which states to see Influenza, with, respiratory manifestations NEC. Look for Influenza/with/respiratory manifestations NEC J11.1. Verify code selection in the Tabular List. • Question 21 4 out of 4 points A 45 year-old female with malignant Mullerian duct cancer is receiving her first treatment of chemotherapy. What diagnosis codes are reported? Selected Answer: d. Z51.11, C57.7 Correct Answer: d. Z51.11, C57.7 Response Feedback: Rationale: ICD-10-CM guideline I.C.2.e.2 states if a patient admission/encounter is solely for administration of chemotherapy, immunotherapy or radiation therapy assign codes Z51.0, Z51.11 or Z51.12 as the first listed or principal diagnosis. The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis. In the ICD-10-CM Alphabetic Index look for Chemotherapy (session) (for)/cancer Z51.11. Next, look in the ICD-10-CM Table of Neoplasms for Mullerian duct/female and select the code from the Malignant Primary column which directs the coder to C57.7. Verify code selection in the Tabular List. • Question 22 4 out of 4 points What diagnosis code(s) should be reported for primary osteoarthritis in both knees? Selected Answer: c. M17.0 Correct Answer: c. M17.0 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Osteoarthritis/primary/knee/bilateral which directs the coder to M17.0. Verify code selection in the Tabular List. • Question 23 4 out of 4 points The patient is a 12 month-old with a history of muscle weakness. Unfortunately, his etiology is unknown and to help delineate the diagnosis, Neurology has consulted us to obtain a right bicep muscle biopsy. What diagnosis code is reported? Selected Answer: a. M62.81 Correct Answer: a. M62.81 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Weak, weakening, weakness/muscle and you are directed to M62.81. Verification in the Tabular List confirms code selection. • Question 24 4 out of 4 points A 32 year-old male is in a diagnostic center to have an ultrasound of his neck due to difficulty swallowing. The patient’s father had esophageal cancer. What is/are the appropriate code(s) to report for the diagnostic service? Selected Answer: a. R13.10, Z80.0 Correct Answer: a. R13.10, Z80.0 Response Feedback: Rationale: A patient receiving a diagnostic service (for example, ultrasound, MRI, diagnostic colonoscopy) for an encounter or visit, report the condition or problem as a primary code to indicate why the patient is having the test performed. Codes for other diagnosis, such as chronic conditions or history are reported as an additional diagnosis. In this case the family history code is reported as an additional diagnosis since it has an impact on current care or influence treatment. Refer to ICD-10-CM guideline IV.K. In the ICD-10-CM Alphabetic Index look for Difficult, difficulty (in)/swallowing which states to see Dysphagia. Look in the Alphabetic Index for Dysphagia which directs the coder to code R13.10. In the Alphabetic Index look for History/family (of)/malignant neoplasm (of)/gastrointestinal tract referring you to code Z80.0. Verify code selection in the Alphabetic Index. • Question 25 4 out of 4 points What diagnosis codes should be reported for fragilitas ossium, osteogenesis imperfecta and osteopsathyrosis? Selected Answer: b. Q78.0 Correct Answer: b. Q78.0 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Fragilitas/ossium Q78.0. Next look for Osteogenesis imperfect Q78.0. Look for Osteopsathyrosis Q78.0. The Tabular List includes all the conditions in the code Q78.0. Review Test Submission: Chapter 4 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 4 Quiz Started 6/23/19 5:11 PM Submitted 6/23/19 5:34 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 23 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points A patient is admitted to the hospital for repair of an open fracture, type 1, of the head of the left femur. The patient has been previously diagnosed with symptomatic HIV. Applying the coding concept from ICD-10-CM guideline I.C.1.a.2.b., what ICD-10-CM code(s) is/are reported for the admission? Selected Answer: d. S72.052B, B20 Correct Answer: d. S72.052B, B20 Response Feedback: Rationale: ICD-10-CM guideline I.C.1.a.2.b. states, “If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (e.g., the nature of the injury code) should be the principal diagnosis. Other diagnoses would be B20 followed by additional diagnosis codes for all reported HIV-related conditions.” The open fracture of the head of the femur (S72.052B) is reported first as the reason for the visit because it is unrelated to HIV. To locate the diagnosis, look in the ICD 10-CM Alphabetic Index for Fracture, traumatic/femur, femoral/upper end/head referring you to subcategory code S72.05-. In the Tabular List, 6th character 2 indicates the left femur. 7th character B indicates the initial encounter for a type 1 open fracture. HIV is symptomatic so it is reported secondarily with B20. • Question 2 10 out of 10 points A patient with a Pancoast's tumor in the left lung arrives at the oncologist office for chemotherapy. Applying the coding concept from ICD-10-CM guidelines I.C.2.e.2. What ICD-10-CM code(s) should be reported? Note: Use the ICD-10-CM Alphabetic Index instead of the Table of Neoplasms to locate the code for a Pancoast's tumor. Selected Answer: d. Z51.11, C34.12 Correct Answer: d. Z51.11, C34.12 Response Feedback: Rationale: The ICD-10-CM Official Coding Guidelines, Section 1.C.2.e.2., state that if the reason for the encounter is solely chemotherapy, a diagnosis for chemotherapy administration should be listed first, and a diagnosis for the malignancy requiring the chemotherapy is reported secondarily. Look in the ICD-10-CM Alphabetic for Chemotherapy (session) (for)/neoplasm or Encounter (with health service) (for)/ chemotherapy for neoplasm (Z51.11). A Pancoast's tumor is a rapid growing tumor in the apex of the lung. The apex of the lung is in the upper lobe for Pancoast’s Tumor. Look for Tumor/Pancoast’s - see Pancoast’s syndrome. Look for Pancoast's syndrome or tumor C34.1-. Add 2 as the 4th character for left lung. The correct codes and sequencing are Z51.11 and C34.12. • Question 3 10 out of 10 points Mrs. Fryer visits her nephrologists for an erythropoietin (EPO) injection for her anemia. She has Stage 3 chronic kidney disease, which is the cause of the anemia. Applying the coding concept from ICD-10-CM guideline I.A.13., what ICD-10-CM code(s) should be reported for the EPO injection? Selected Answer: b. N18.3, D63.1 Correct Answer: b. N18.3, D63.1 Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section I.A.13., states codes that fall under the category "in diseases classified elsewhere," are manifestation codes. There will be an instructional note (such as a code first note) with these manifestation codes that will indicate the proper sequencing order of the codes. Look in the ICD 10-CM Alphabetic Index for Anemia/in (due to) (with)/chronic kidney disease D63.1. See the Code first note instructing to report the CKD (N18-) code first. Look in the ICD 10-CM Alphabetic Index for Disease/kidney/chronic/stage 3 (moderate) N18.3. Verification in the Tabular List verifies correct sequencing as N18.3, D63.1. • Question 4 10 out of 10 points A 12-year-old’s diabetes mellitus is well controlled with oral antidiabetic medications. The patient has no complications. Applying the coding concept from ICD-10-CM guidelines I.C.4.a.1., I.C.4.a.2., and I.C.4.a.3, what ICD-10-CM code(s) is/are reported? Selected Answer: a. E11.9, Z79.84 Correct Answer: a. E11.9, Z79.84 Response Feedback: Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a.1., the age of the patient is not the determining factor in what type of diabetes is coded. In addition, Section I.C.4.a.2 says if the type of diabetes mellitus is not documented in the medical record the default type is type 2. To find the code, look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic (mellitus) (sugar). The default code is E11.9. Verification in the Tabular List verifies code selection. ICD-10-CM guideline I.C.4.a.3 directs the coder to report V79.84 to indicate the patient uses oral hypoglycemic or antidiabetic drugs. Look in the Alphabetic Index for Long-term (current) (prophylactic) drug therapy (use of)/oral/antidiabetic Z79.84. • Question 5 10 out of 10 points A patient presents to her physician and tells him she drinks each night when she gets home from work. She asks her physician to recommend an alcohol treatment center because her life has become unmanageable and she wishes to quit drinking. The patient is diagnosed with uncomplicated alcohol dependence. Select the diagnosis code. Selected Answer: b. F10.20 Correct Answer: b. F10.20 Response Feedback: Rationale: The patient’s diagnosis is uncomplicated alcohol dependence. In the ICD 10-CM Alphabetic Index, look for dependence/alcohol F10.20. Verify code selection in the Tabular List. • Question 6 10 out of 10 points Mr. Timmins fell off of a roof and suffered a spinal injury. As a result of the injury he has been suffering from chronic pain in his lower back for several years. Today, he presents for insertion of a neurostimulator for pain control. Applying the coding concept from ICD-10-CM guideline I.C.6.b.1.a. and I.C.6.b.1.b.ii., what ICD-10-CM codes should be reported for the pain? Do not code the external cause codes (discussed later in the curriculum). Selected Answer: c. G89.21, M54.5 Correct Answer: c. G89.21, M54.5 Response Feedback: Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.6.b.1.(a)., when a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the first listed diagnosis. According to ICD-10-CM guideline 1.C.6.b.1.b.ii., a code to report the site of pain may be sequenced as a secondary diagnosis. In the ICD 10-CM Alphabetic Index, look for Pain/Chronic/due to trauma G89.21 (because the pain is due to the falling off a roof). To report the location of the pain, look in the ICD 10-CM Alphabetic Index for Pain/low back M54.5. • Question 7 10 out of 10 points A mother takes her child to the pediatrician because her right eye is red, itchy, with a mucus discharge coming from the eye. The provider documents the child has pink eye. What ICD-10-CM code is reported? Selected Answer: b. H10.021 Correct Answer: b. H10.021 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Pink/eye and you are directed to see conjunctivitis, acute, mucopurulent. Mucopurulent is a secretion of mucus or pus from the eye. This path directs you to H10.02-. In the Tabular List, 6th character 1 indicates the right eye. • Question 8 10 out of 10 points A patient sees his family practitioner for a muted feeling in his ears. The provider determines there is impacted cerumen in both ears. What ICD-10-CM code(s) is/are reported? Selected Answer: a. H61.23 Correct Answer: a. H61.23 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Impaction, impacted/cerumen (ear) (external) H61.2-. In the Tabular List, a 5th character 3 indicates bilateral. Because there is a bilateral code for this condition only one code is reported for both ears (refer to ICD-10-CM guideline I.B.13). • Question 9 10 out of 10 points Which of the following does NOT require documentation for a cause-and-effect relationship to be coded? Reference guideline I.C.9.a.2. and I.C.9.a.3. Selected Answer: b. Hypertension and chronic kidney disease Correct Answer: b. Hypertension and chronic kidney disease Response Feedback: Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.9.a.2 - Section I.C.9.a.3., state that hypertension has a presumed cause-and-effect relationship with CKD. • Question 10 10 out of 10 points A patient presents for a liver transplant. The provider documents the patient has Laennec’s cirrhosis associated with long term alcohol dependent use. What is the diagnosis code for this encounter? Selected Answer: b. K70.30, F10.20 Correct Answer: b. K70.30, F10.20 Response Feedback: Rationale: In the ICD 10-CM Alphabetic Index, look for Cirrhosis, cirrhotic (hepatic) (liver)/Laennec’s /alcoholic K70.30. In this scenario the patient has a history of alcohol use making K70.30 the correct code. There is an instructional note under category code K70 to use additional code to identify alcohol abuse and dependence. The patient is alcohol dependent. In the Alphabetic Index look for Dependence/alcohol referring you to code F10.20. Verify code selection in the Tabular List. Review Test Submission: 2019 Chapter 4 Practical Application User Course 2019 Physician Coding for CPC Preparation (Q-S) Test 2019 Chapter 4 Practical Application Started 6/25/19 9:15 PM Submitted 6/25/19 10:26 PM Status Completed Attempt Score 77.33333 out of 100 points Time Elapsed 1 hour, 10 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 7.5 out of 10 points Operative Report PREOPERATIVE DIAGNOSES: Splenic abscesses and multiple intra-abdominal abscesses, related to HIV, AIDS, and hepatitis C. POSTOPERATIVE DIAGNOSES: Splenic abscesses and multiple intra-abdominal abscesses, related to HIV, AIDS, and hepatitis C. (Postoperative diagnoses are reported.) OPERATIVE PROCEDURE: 1. Exploratory laparotomy with drainage of multiple intra-abdominal abscesses. 2. Splenectomy. 3. Vac Pak closure. FINDINGS: This is a 42-year-old man who was recently admitted to the medical service with a splenic defect and found to a splenic vein thrombosis. He was treated with antibiotics and anticoagulation. He returned and was admitted with a CT scan showing mass of left upper quadrant with abscesses surrounding both sides of the spleen(The location of the abscesses are on both sides of the spleen.), as well as, multiple other intra-abdominal abscesses below the left lobe of the liver in both lower quadrants and in the pelvis. The patient has a psychiatric illness and was difficult to consent and had been anticoagulated with an INR of 3. Once those issues were resolved by psychiatry consultation and phone consent from the patient's father, he was brought to the operating room. OPERATIVE PROCEDURE: The patient was brought to operating room, a time-out procedure was performed. He was already receiving parenteral antibiotics. He was placed in the supine position and then given a general endotracheal anesthetic. Anesthesia started multiple IVs and an arterial line. A Foley catheter was sterilely inserted with some difficulty requiring a Coude catheter. After the abdomen was prepped and draped in the sterile fashion, a long midline incision was made through the skin. This was carried through the subcutaneous tissues and down through the midline fascia using the Bovie. The fascia was opened in the midline. The entire left upper quadrant was replaced with an abscess peel separate from the free peritoneal cavity. This was opened, and at least 3 to 4 L of foul smelling crankcase colored fluid were removed. Once the abscess cavity was completely opened, it was evident that the spleen was floating within this pus(Confirms the location of the abscess.) as had been predicted by the CT. This was irrigated copiously and the left lower quadrant subhepatic and pelvic abscesses (Location of abscesses.) were likewise discovered containing the same foul smelling dark bloody fluid. All of these areas were sucked out, irrigated, and the procedure repeated multiple times. We thought it reasonable to go ahead with the splenectomy. The anatomic planes were obviously terribly distorted. There was no clear margin between stomach spleen, colon spleen, etc., but most of the dense attachments were to the abscess cavity peel. Using this as a guide, the spleen was eventually rotated up and out to the point where the upper attachments presumably where the short gastric used to reside were taken via Harmonic scalpel. The single fire of a 45 mm stapler with vascular load was taken across the lower pole followed by two firings of the echelon stapler across the hilum. This controlled most of the ongoing bleeding. Single bleeding site below the splenic artery was controlled with two stitches, one of 3-0 Prolene and the other of 4-0 Prolene. Because of diffuse ooze in the area and the fact that the patient would be scheduled for a return visit to the operating room tomorrow to reinspect the abscess cavities, it was elected to leave two laparotomy pads in the left upper quadrant and Vac Pak the abdomen. The Vac Pak was created using blue towels and Ioban dressings in the usual fashion with 10 mm fully perforated flat Jackson-Pratt drains brought out at the appropriate level. The patient was critical throughout the procedure and will be taken directly to the intensive care unit, intubated, with a plan for reexploration and removal of the packs tomorrow. The patient received four units of packed cells during the procedure, as well as albumin and a large volume of crystalloid. There were no intraoperative complications noted and the specimen sent included the spleen. Cultures from the abscess cavity were also taken. What diagnosis(es) code(s) are reported? [a] [b] [c] [d] Specified Answer for: a B20 Specified Answer for: b D73.3 Specified Answer for: c K65.1 Specified Answer for: d Z86.59 Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match B20 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match D73.3 Exact Match K65.1 Exact Match B19.20 Correct Answers for: c Evaluation Method Correct Answer Case Sensitivity Exact Match K65.1 Exact Match B19.20 Exact Match D73.3 Correct Answers for: d Evaluation Method Correct Answer Case Sensitivity Exact Match B19.20 Exact Match D73.3 Exact Match K65.1 Response Feedback: The patient is diagnosed with abscesses on the spleen and intra-abdominal cavity (related to his HIV), AIDS and hepatitis C. According to ICD-10-CM guideline I.C.1.a.2, if a patient is admitted for an HIV-related condition, the principal diagnosis is B20, followed by additional diagnosis codes for all reported HIV-related conditions. In the ICD-10-CM Alphabetic Index, look for AIDS which directs you to B20. In the Tabular List, category B20 instructions say to use additional code(s) to identify all manifestations of HIV infection. The spleen and abdominal abscesses are HIV-related conditions. In the Alphabetic Index, look for Abscess/spleen which directs you to D73.3. Next look in the Alphabetic Index for Abscess/intra-abdominal (see also Abscess, peritoneum) which directs you to K65.1. The diagnosis for hepatitis C is relevant and is reported because hepatitis C may have an impact on the patient’s recovery. In the Alphabetic Index, look for Hepatitis/C (vi-ral). There is no additional information regarding the hepatitis which makes B19.20 the only option. Verify all codes in the Tabular List. • Question 2 4 out of 10 points Dear Dr. Smith, Mr. Martin was seen in the office for continued management of his breast cancer.(This indicates the patient's main reason for the office visit.) He’s having someincreasing pain in his breast which is due to the cancer.(Pain related to the neoplasm.) He is also complaining of neck pain. It does not seem to be worse at night; it seems to be worse with activity. He has no other symptoms. Otherwise his review of systems is unremarkable. He’s had no constitutional symptoms. On physical exam, he is alert and oriented. Eyes: EOMI, PERLA, no icterus. The heart had a regular rate and rhythm; S1, S2 within normal limits. The lungs are clear to auscultation and percussion. The abdomen was soft, without masses or organomegaly. He was tender to palpation over the left anterior iliac crest. Otherwise he had no point tenderness over his musculoskeletal system. Neck: Supple. No tenderness, no enlarged lymph nodes in the neck. ASSESSMENT: Adenocarcinoma of the left breast, stage IV, positive estrogen receptor status. Neck pain. (This is the definitive diagnosis that is reported.) PLAN: The plan is to continue the Tamoxifen at this time. His laboratory studies were reviewed and were essentially unremarkable; however we’ll obtain a bone scan to ascertain the extent of his disease.(This is a male patient.) Sincerely, John Smith, M.D. What diagnosis(es) code(s) are reported? [a] [b] [c] [d] [e] Specified Answer for: a C50.929 Specified Answer for: b G89.3 Specified Answer for: c M54.2 Specified Answer for: d V17.0 Specified Answer for: e [None Given] Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match C50.922 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match G89.3 Exact Match M54.2 Exact Match Z17.0 Exact Match Z79.810 Correct Answers for: c Evaluation Method Correct Answer Case Sensitivity Exact Match M54.2 Exact Match Z17.0 Exact Match Z79.810 Exact Match G89.3 Correct Answers for: d Evaluation Method Correct Answer Case Sensitivity Exact Match Z17.0 Exact Match Z79.810 Exact Match G89.3 Exact Match M54.2 Correct Answers for: e Evaluation Method Correct Answer Case Sensitivity Exact Match Z79.810 Exact Match G89.3 Exact Match M54.2 Exact Match Z17.0 Response Feedback: The patient is being seen for the management of adenocarcinoma of the left breast. In the ICD-10-CM Alphabetic Index, look for Adenocarcinoma which refers you to see also Neoplasm, malignant, by site. Go to the Table of Neoplasms and look for breast and locate the code in the Malignant Primary column which directs you to C50.9-. Refer to the Tabular List for the 5th and 6th characters. This is a male patient and the cancer is in the left breast, which makes C50.922 the correct code to report. The provider documents that the pain is due to cancer. In the Alphabetic Index, look for Pain(s)/acute or chronic/neoplasm related which directs you to G89.3. Verify the code in the Tabular List. Both acute and chronic are in parentheses, which indicate these are supplementary words that may be present or absent in the diagnosis without affecting the code number to which it is assigned. ICD-10-CM guideline I.C.6.b.5 indicates that this code is assigned regardless of whether the pain is acute or chronic. The same guideline also states that when the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional code. In the Alphabetic Index, look for Pain(s)/neck NEC and you are directed to code M54.2. There is an instructional note under category code C50 to use an additional code to identify the estrogen receptor status. Look for Status/estrogen receptor/positive which directs you to Z17.0. The patient is continuing with tamoxifen; look for Long-term (current) (prophylactic) drug therapy (use of)/tamoxifen (Nalvadex)which directs you to Z79.810. • Question 3 10 out of 10 points SUBJECTIVE: Low-grade fever at home. She has had some lumps in the abdominal wall and when she injects her insulin; it does seem to hurt there. She stopped four of her medications including Neurontin, Depakote, Lasix, and Premarin, and overall she feels quite well. Unfortunately, she has put on 20 pounds since our last visit. OBJECTIVE: HEENT: Tympanic membranes are retracted but otherwise clear. The nose shows significant green rhinorrhea present. Throat is mildly inflamed with moderate postnasal drainage. Neck: No significant adenopathy. Lungs: Clear. Heart: Regular rate and rhythm. Abdomen: Soft, obese, and nontender. Multiple lipomas are palpated. ASSESSMENT 1. Diabetes mellitus, type 1. 2. Diabetic neuropathy. 3. Acute sinusitis. (The definitive diagnoses are reported.) PLAN: At this time, I have recommended the addition of some Keflex for her acute sinusitis.(Provider treated the acute sinusitis.) I have given her a chair for the shower. They will not cover her Glucerna anymore so a note for that will be required. What diagnosis(es) code(s) are reported? [a] [b] Specified Answer for: a E10.40 Specified Answer for: b J01.90 Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match E10.40 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match J01.90 • Question 4 5 out of 10 points S: The patient presents today for reevaluation and titration of carvedilol for his coronary artery disease and hyperlipidemia.(Patient returns for treatment of CAD and hyperlipidemia.) His weight is up 7 pounds. He has quit smoking. He has no further cough and he states he is feeling well except for the weight gain. He states he doesn’t feel he’s eating more, but his wife says he’s eating more. We’ve been attempting to titrate up his carvedilol to 25mg twice a day from initially 6.25mg. He has tolerated the titration quite well. He gets cephalgias on occasion. He states he has a weak spell but this is before he takes his morning medicine. I updated his medical list here today. I gave him samples of Lipitor. O: Weight is 217, pulse rate 68, respirations 16, and blood pressure 138/82. HEENT examination is unchanged. His heart is a regular rate. His lungs are clear. A: 1. CAD 2. Hyperlipidemia (Select the codes for the definitive diagnoses.) P: 1.The plan is samples of Lipitor using the two months’ supply that I have given him. 2. We’ve increased his Coreg to 25mg bid. He’ll recheck with us in six months. What diagnosis(es) code(s) are reported? [a] [b] [c] [d] Specified Answer for: a I25.10 Specified Answer for: b E78.5 Specified Answer for: c [None Given] Specified Answer for: d [None Given] Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match I25.10 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match E78.5 Correct Answers for: c Evaluation Method Correct Answer Case Sensitivity Exact Match Z87.891 Exact Match Z79.899 Correct Answers for: d Evaluation Method Correct Answer Case Sensitivity Exact Match Z79.899 Exact Match Z87.891 Response Feedback: In the ICD-10-CM Alphabetic Index, look for Disease, diseased/artery/coronary which directs you to I25.10. The patient also has hyperlipidemia. In the Alphabetic Index, look for Hyperlipemia, hyperlipidemia which directs you to E78.5. There is an instructional note under category code I25 which states to use an additional code to identify exposure to/history of/use of/or dependence of tobacco. The documentation indicates that the patient quit smoking. He has a history of tobacco use, reported with Z87.891. This is found in the ICD-10-CM codebook by looking in the Alphabetic Index for History/personal (of) nicotine dependence. Because there is reevaluation of medication the patient is taking for CAD and hyperlipidemia, code Z79.899 is reported. Look in the Alphabetic Index for Long-term (current) (prophylactic) drug therapy (use of)/drug, specified NEC Z79.899. Verify the codes in the Tabular List. • Question 5 10 out of 10 points PREOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing loss. POSTOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing loss.(Report the postoperative diagnosis.) PROCEDURES PERFORMED: 1. Placement of left Nucleus cochlear implant. 2. Facial nerve monitoring for an hour. 3. Microscope use. ANESTHESIA: General. INDICATIONS: This is a 69-year-old woman who has had progressive hearing loss (The diagnosis is documented as the indication for the surgery.) over the last 10-15 years. Hearing aids are not useful for her. She is a candidate for cochlear implant by FDA standards. The risks, benefits, and alternatives of procedure were described to the patient, who voiced understanding and wished to proceed. PROCEDURE: After properly identifying the patient, she was taken to the main operating room, where general anesthetic was induced. The table was turned to 180 degrees and a standard left-sided post auricular shave and injection of 1% lidocaine plus 1:100,000 epinephrine was performed. The patient was then prepped and draped in a sterile fashion after placing facial nerve monitoring probes, which were tested and found to work well. At this time, the previously outlined incision line was incised and flaps were elevated. A subtemporal pocket was designed in the usual fashion for placement of the device. A standard cortical mastoidectomy was then performed and the fascial recess was opened exposing the area of the round window niche. The lip of the round window was drilled down exposing the round window membrane. At this time, the wound was copiously irrigated with bacitracin containing solution, and the device was then placed into the pocket. A 1-mm cochleostomy was made, and the device was inserted into the cochleostomy with an advance-off stylet technique. A small piece of temporalis muscle was packed around the cochleostomy, and the wound was closed in layers using 3-0 and 4–0 Monocryl and Steri-Strips. A standard mastoid dressing was applied. The patient was returned to anesthesia, where she was awakened, extubated, and taken to the recovery room in stable condition. What diagnosis(es) code(s) are reported? Selected Answer: H90.3 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match H90.3 • Question 6 10 out of 10 points PREOPERATIVE DIAGNOSIS: Cataract, left eye POSTOPERATIVE DIAGNOSIS: Cataract eye Presbyopia PROCEDURE: 1 Cataract extraction with IOL implant 2 Correction of presbyopia with lens implantation PROCEDURE DETAIL: The patient was brought to the operating room under neuroleptic anesthesia monitoring. A topical anesthetic was placed within the operative eye and the patient was prepped and draped in usual manner for sterile ophthalmic surgery. A lid speculum was inserted into the right infrapalpebral space. A 6-0 silk suture was placed through the episclera at 12 o'clock. A subconjunctival injection of non-preserved lidocaine was given. A peritomy was fashioned from 11 o'clock to 1 o'clock with Westcott scissors. Hemostasis was achieved with the wet-field cautery. A 3-mm incision was made in the cornea and dissected anteriorly with a crescent blade The anterior chamber was entered at12 o'clock and 2 o'clock with a Supersharp blade. Non-preserved lidocaine was instilled into the anterior chamber. Viscoelastic was instilled in the anterior chamber and using a bent 25-guage needle, a 360-degree anterior capsulotomy was performed using Utrata forceps. The capsulotomy was measured and found to be 5.5 mm in diameter. Using an irrigating cannula, the lens nucleus was hydrodissected and loosened. Using the phacoemulsification unit, the lens nucleus was divided and emulsified. The irrigating/aspirating tip was used to remove the cortical fragments from the capsular bag, and the posterior capsule was polished. Using a curette to polish the anterior capsule, cortical fragments were removed from the anterior lens capsule for 270 degrees. The irrigating/aspirating tip was used to remove the capsular fragments. The anterior chamber and capsule bag were inflated with viscoelastic and using a lens inserter, a Cystalens was then placed within the capsular bag and rotated to the horizontal position. The viscoelastic was removed with the irrigating/aspirating tip and the lens was found to be in excellent position with a slight posterior vault. The wound was hydrated with balanced salt solution and tested and found to be watertight at a pressure of 20 mmHg. Topical Vigamox was applied The conjunctiva was repositioned over the wound with a wet field cautery. The traction suture and lid speculum were removed. A patch was applied. The patient tolerated the procedure well and left the operating room in good condition. What diagnosis(es) code(s) are reported? [a] [b] Specified Answer for: a h26.9 Specified Answer for: b h52.4 Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match H26.9 Exact Match H52.4 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match H52.4 Exact Match H26.9 • Question 7 10 out of 10 points PROGRESS NOTE This patient is a 50-year-old female who began developing bleeding, bright red blood per rectum, approximately two weeks ago. She is referred by her family physician. She states that after a bowel movement she noticed blood in the toilet. She denied any prior history of bleeding or pain with defecation. She states that she has had an external hemorrhoid that did bleed at times but that is not where this bleeding is coming from. She is presently concerned because a close friend of hers was recently diagnosed with rectal carcinoma requiring chemotherapy that was missed by her primary doctor. She is here today for evaluation for a colonoscopy. Physical examination, she appears to be a well appearing 50-year-old, white female. Abdomen is soft, non-tender, non-distended. ASSESSMENT: 50-year-old female with rectal bleeding PLAN: We’ll schedule the patient for an outpatient colonoscopy. The patient was made aware of all the risks involved with the procedure and was willing to proceed. What diagnosis(es) code(s) are reported? Selected Answer: k62.5 Correct Answer: Evaluation Method Correct Answer Case Sensitivity Exact Match K62.5 • Question 8 3.33333 out of 10 points Subjective: Here to follow up on her atrial fibrillation. No new problems. Feeling well. Medications are per medication sheet. These were reconstituted with the medications that she was discharged home on. 0bjective: Blood pressure is 110/64. Pulse is regular at 72. Neck is supple. Chest is clear. Cardiac normal sinus rhythm. Assessment: Atrial fibrillation, currently stable Plan: 1. Prothrombin time to monitor long term use of anticoagulant. 2. Follow up with me in one month or sooner as needed if she has any other problems in the meantime. Will also check a creatinine and potassium today. What diagnosis(es) code(s) are reported? [a] [b] [c] Specified Answer for: a I48.91 Specified Answer for: b V79.01 Specified Answer for: c [None Given] Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match I48.91 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match Z79.01 Correct Answers for: c Evaluation Method Correct Answer Case Sensitivity Exact Match Z51.81 Response Feedback: From the ICD-10-CM Alphabetic, look for Fibrillation/atrial or auricular which directs you to I48.91. Next, look in the Alphabetic Index for Long-term (current) (prophylactic) drug therapy (use of)/anticoagulants which directs you to Z79.01. Verify both codes in the Tabular List. Under category code Z79 there is an instructional note to report code Z51.81 for therapeutic drug level monitoring. • Question 9 7.5 out of 10 points Follow-up Visit: The patient has some memory problems. She is hard of hearing. She is legally blind. Her pharmacist and her family are very worried about her memory issues. She lives at home, family takes care of laying out her medi¬cations and helping with the chores, but she does take care of her own home to best of her ability. Exam: Pleasant elderly woman in no acute distress. She has postop changes of her eyes. TMs are dull. Pharynx is clear. Neck is supple without adenopathy. Lungs are clear. Good air movement. Heart is regular. She had a slight murmur. Abdomen is soft. Moderately obese. Non-tender. Extremities; no clubbing or edema. Foot exam shows some bunion deformity but otherwise healthy. Light touch is preserved. There is no ankle edema or stasis change. Examination of the upper arms reveal good range of motion. There is significant pain in her shoulder with rotational movements. It is localized mostly over the deltoid. There is no other deformity. There is a very slight left shoulder discomfort and slight right hip discomfort. Impression: 1. Dementia 2. Right shoulder pain. 3. Benign hypertensive cardiovascular disease. 4. Type 2 diabetes good control. Most recent AlC done today 5.9%. Liver test normal. Cholesterol 199, LDL a little high at 115. Plans: 1. I offered her and her family neuropsychological evaluation to evaluate for dementia. Her system complex is consistent with dementia, whether it be from small vascular disease or Alzheimer’s is unknown. At this point, they would much rather initiate treatment than go through an exhaustive neuropsychological test. 2. For the shoulder we decided on right deltoid bursa aspiration injection. She has had injection for bursitis in the past and prefers to go this route. She will ice and rest the shoulder after injection. 3. Follow up in 3 months. Procedure: Aspiration injection right deltoid bursa. The point of maximal tenderness was identified, skin was prepped with alcohol. A 25-gauge, 1 ½-inch needle was advanced to the humerus and then aspired. 1 cc of 0.25% Marcaine mixed with 80 mg Depo Medrol was deposited. Needle was withdrawn. Band-aid was applied. Post injection she had marked improvement; increased range of motion consistent with good placement of the medication. She was started on Cerefolin, plus NAC and Aricept starter pack was given with email away script. Follow-up in 3 months and we will reassess her dementia at that time. What diagnosis(es) code(s) are reported? [a] [b] [c] [d] Specified Answer for: a E11.9 Specified Answer for: b M25.519 Specified Answer for: c I11.9 Specified Answer for: d F03.90 Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match E11.9 Exact Match M25.511 Exact Match I11.9 Exact Match F03.90 Correct Answers for: b Evaluation Method Correct Answer Case Sensitivity Exact Match M25.511 Exact Match I11.9 Exact Match F03.90 Exact Match E11.9 Correct Answers for: c Evaluation Method Correct Answer Case Sensitivity Exact Match I11.9 Exact Match F03.90 Exact Match E11.9 Exact Match M25.511 Correct Answers for: d Evaluation Method Correct Answer Case Sensitivity Exact Match F03.90 Exact Match E11.9 Exact Match M25.511 Exact Match I11.9 Response Feedback: The patient has multiple diagnoses. It's important to report the diagnoses that the provider treated during the encounter and any chronic conditions that affect the care of the patient. The provider documents that the patient has dementia. The provider is not sure of the cause. Look in the ICD-10-CM Alphabetic Index for Dementia which directs you to F03.90 . The provider performs a joint injection to treat the patient’s right shoulder pain. In the Alphabetic Index, look for Pain(s)/joint/shoulder which directs you to M25.51-. Turn to the Tabular List for the 6th character to indicate the right shoulder, M25.511. The patient is also diagnosed with benign hypertensive cardiovascular disease. The provider reviewed the labs (cholesterol and LDL) to monitor this condition. In the Alphabetic Index, look for Hypertension, hypertensive (benign)/cardiovascular/ disease (arteriosclerotic) (sclerotic) – see Hypertension, heart. Look for Hypertension, hypertensive (benign)/heart which directs you to I11.9. The last diagnosis listed is controlled type 2 diabetes. In the ICD-10-CM Alpha-betic Index, look for Diabetes, diabetic/type 2 which directs you to code E11.9. Verify codes in the Tabular List. • Question 10 10 out of 10 points CC: HTN INTERVAL HISTORY: No new complaints. EXAM: NAD. 130/80, 84, 22. Lungs are clear. Heart RRR, no MRGs. Abdomen is soft, non-tender. No peripheral edema. IMPRESSION: Stable HTN on current meds. PLAN: No changes needed. RTC in six months with labs. What diagnosis(es) code(s) are reported? [a] Specified Answer for: a I10 Correct Answers for: a Evaluation Method Correct Answer Case Sensitivity Exact Match I10 Review Test Submission: Chapter 4 Review Exam User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 4 Review Exam Started 6/26/19 9:00 PM Submitted 6/26/19 9:54 PM Status Completed Attempt Score 96 out of 100 points Time Elapsed 53 minutes out of 2 hours Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 4 out of 4 points What does MRSA stand for? Selected Answer: d. Methicillin Resistant Staphylococcus Aureus Correct Answer: d. Methicillin Resistant Staphylococcus Aureus Response Feedback: Rationale: Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of staph bacteria that becomes resistant to the antibiotics commonly used to treat ordinary staph infections. In the ICD-10-CM Alphabetic Index look for Infection/staphylococcal, unspecified site/aureus/methicillin resistant (MRSA). • Question 2 0 out of 4 points When a patient has a blood test for HIV that is inconclusive, what ICD-10-CM code is assigned? Selected Answer: b. Z11.4 Correct Answer: a. R75 Response Feedback: Rationale: ICD-10-CM guideline I.C.1.a.2.e instructs us to use R75 for patients with inconclusive HIV serology without no definitive diagnosis or manifestations of the illness. To locate the code in the ICD-10-CM Alphabetic Index look for Human/immunodeficiency virus (HIV) disease (infection)/laboratory evidence R75. Verify code selection in the Tabular List. • Question 3 4 out of 4 points According to ICD-10-CM guidelines, what is the maximum length of time for a myocardial infarction to be considered acute? Selected Answer: a. Four weeks (28 days) Correct Answer: a. Four weeks (28 days) Response Feedback: Rationale: In ICD-10-CM guideline I.C.9.e.1, myocardial infarctions are classified as acute if the duration is four weeks (28 days) or less from onset. In the Tabular List the Includes note also lists this under category code I21. • Question 4 4 out of 4 points According to the ICD-10-CM guidelines, how is bilateral glaucoma of the same type and stage reported? Selected Answer: d. A bilateral code can be used to report the type of glaucoma and the stage of glaucoma. Correct Answer: d. A bilateral code can be used to report the type of glaucoma and the stage of glaucoma. Response Feedback: Rationale: In ICD-10-CM guideline I.C.7.a.2 states when a patient has bilateral glaucoma and both eyes are documented as the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the 7th character for the stage. • Question 5 4 out of 4 points What does the 4th character in diabetes mellitus diabetes codes indicate? Selected Answer: c. Any complication associated with diabetes. Correct Answer: c. Any complication associated with diabetes. Response Feedback: Rationale: The 4th character in diabetes mellitus codes indicates the complication associated with diabetes. For example, subcategory code E10.2 indicates a person that has renal (kidney) complications due to diabetes. • Question 6 4 out of 4 points What diagnosis code is reported for secondary neoplasm of the descending colon? Selected Answer: d. C78.5 Correct Answer: d. C78.5 Response Feedback: Rationale: In the ICD-10-CM Table of Neoplasms look for Neoplasm/colon referring you to see also Neoplasm, intestine, large. Look for Neoplasm/intestine/large/colon/descending and use the code from the Malignant Secondary column guiding you to code C78.5. Verify code selection in the Tabular List. • Question 7 4 out of 4 points A 32 year-old patient with an ophthalmoplegic migraine is not responding to medication and is admitted to the observation unit. What ICD-10-CM code is reported? Selected Answer: c. G43.B1 Correct Answer: c. G43.B1 Response Feedback: Rationale: When a migraine does not respond to medication it is considered intractable. In the ICD-10-CM Alphabetic Index, look for Migraine/ophthalmoplegic/intractable referring you to G43.B1. Verify code selection in the Tabular List. The note under category code G43 Migraine confirms that pharmacoresistant is considered intractable. • Question 8 4 out of 4 points What is the time frame defining when pain becomes chronic? Selected Answer: a. No time frame Correct Answer: a. No time frame Response Feedback: Rationale: Per ICD-10-CM guidelines Section I.C.6.b.4, there is no time frame defining when pain becomes chronic pain. The provider’s documentation is used to guide when the pain is acute and when it is chronic. • Question 9 4 out of 4 points A 9 year-old with a history of reactive airway disease (RAD) was admitted into overnight observation with complaints of a two-day history of increased wheezing. Parents stated that nebulizer treatments were not helping. After monitoring and additional treatments given while in observation, breathing was stabilized. Documented diagnosis is RAD exacerbation. What ICD-10-CM code(s) is/are reported? Selected Answer: b. J45.901 Correct Answer: b. J45.901 Response Feedback: Rationale: RAD is an acronym for Reactive Airway Disease. Look in the ICD-10-CM Alphabetic Index for Disease, diseased/reactive airway and you are directed to see Asthma. Look for Asthma, asthmatic/with/exacerbation (acute) J45.901. Verify code selection in the Tabular List. According to the ICD-10-CM guidelines, when a definitive diagnosis is known, the related symptoms are not coded. • Question 10 4 out of 4 points A patient is having surgery to repair a recurrent left inguinal hernia without obstruction. What ICD-10-CM code is reported? Selected Answer: b. K40.91 Correct Answer: b. K40.91 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Hernia/inguinal/unilateral/recurrent referring you to K40.91. Verify code selection in the Tabular List. • Question 11 4 out of 4 points Patient with coronary arteriosclerosis disease (CAD) sees his cardiologist to discuss a coronary artery bypass graft (CABG). This will be the patient’s first CABG. What ICD-10-CM code is reported? Selected Answer: d. I25.10 Correct Answer: d. I25.10 Response Feedback: Rationale: A patient with CAD and no history of a previous CABG indicates it would be the patient’s native coronary artery (it has not been replaced or bypassed). In the ICD-10-CM Alphabetic Index look for Disease/coronary (artery) and you are directed to see Disease, heart, ischemic, atherosclerotic. Disease/heart/ischemic/atherosclerotic (of) which directs you to code I25.10. Verify code selection in the Tabular List. • Question 12 4 out of 4 points A 54 year-old male goes to his primary care provider with dizziness. On physical exam his blood pressure is 200/130. After a complete work-up, including laboratory tests, the provider makes a diagnosis of end stage renal disease and hypertension. What are the appropriate diagnosis codes for this encounter? Selected Answer: b. I12.0, N18.6 Correct Answer: b. I12.0, N18.6 Response Feedback: Rationale: ICD-10-CM guideline I.C.9.a.2 indicate to assign codes from category I12 when conditions classified to category N18 are present with hypertension. A causal relationship is assumed between hypertension and chronic kidney disease. Guideline I.C.14.a.1 tells us to code N18.6 when the provider has documented end stage renal disease. In the ICD-10-CM Alphabetic Index look for Hypertension, hypertensive/with kidney involvement and you are directed to see Hypertension, kidney. Hypertension/kidney/with/stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) referring you to I12.0. In the Tabular List there is an instructional note to use an additional code to identify the stage of the chronic kidney disease (N18.5, N18.6). In this case the patient has end stage renal disease, reporting code N18.6. This is found in the Alphabetic Index by looking for Diseases, diseased/renal/with/end stage (failure) referring you to N18.6. Verify code selection in the Tabular List. • Question 13 4 out of 4 points A male patient is seen by his primary care provider for rectal bleeding and persistent intestinal cramps. After a colonoscopy with biopsy, the results come back and the provider documents that the patient has malignant neoplasm in his sigmoid colon. What ICD-10-CM code(s) is/are reported? Selected Answer: b. C18.7 Correct Answer: b. C18.7 Response Feedback: Rationale: According to the ICD-10-CM guideline when a definitive diagnosis is known, the related symptoms are not coded. In this case, only the malignant neoplasm of the sigmoid colon is reported. Look in the ICD-10-CM Table of Neoplasm for Colon and you are directed to see also Neoplasm, intestine, large. Look for intestine, intestinal/large/colon/sigmoid (flexure), and use the code from the Malignant Primary column C18.7. Verify code selection in the Tabular List. • Question 14 4 out of 4 points A patient has a history of MRSA. She has just been diagnosed with pneumonia due to possible staphylococcus aureus. What ICD-10-CM code(s) is/are reported? Selected Answer: b. J18.9, Z86.14 Correct Answer: b. J18.9, Z86.14 Response Feedback: Rationale: The verbiage possible staphylococcus aureus is an uncertain diagnosis and per ICD-10-CM guidelines should not be coded. The definitive diagnosis is pneumonia reported with code J18.9 which is found in the ICD-10-CM Alphabetic Index by looking for Pneumonia. The patient also has a history of MRSA. Look in the Alphabetic Index for History/personal (of)/Methicillin resistant Staphylococcus aureus (MRSA) referring you to Z86.14. Verify code selection in the Tabular List. • Question 15 4 out of 4 points Patient is admitted to the hospital with streptococcal group B severe sepsis which has caused pneumonia. What codes are assigned? Selected Answer: b. A40.1, J15.3, R65.20 Correct Answer: b. A40.1, J15.3, R65.20 Response Feedback: Rationale: Per ICD-10-CM guideline I.C.1.d.4 if the reason for admission is both sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code for the systemic infection is assigned first, followed by the code for the localized infection. To find the codes in the ICD-10-CM Alphabetic Index, look for Sepsis/Streptococcus, streptococcal/group/ B which directs the coder to A40.1 for the Systemic infection. To locate the code for sepsis, look for Sepsis/severe which directs the coder to R65.20. Pneumonia can be found in the Alphabetic Index by looking for Pneumonia/in (due to)/Streptococcus/group B which directs the coder to J15.3. Verify all codes in the Tabular List. Pay careful attention to the instructional notes in the Tabular List to help with sequencing. • Question 16 4 out of 4 points A patient with amyloidosis being treated for glomerulonephritis. What ICD-10-CM codes are reported? Selected Answer: a. E85.4, N08 Correct Answer: a. E85.4, N08 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Glomerulonephritis/in (due to)/amyloidosis guiding you to codes E85.4 [N08]. In the Alphabetic Index the brackets identify manifestation codes. In the Tabular List code N08 has a code first instructional note to first code amyloidosis (E85.4). Your primary code is E85.4 for Amyloidosis followed by N08 for the manifested Glomerulonephritis. Verify code selection in the Tabular List. • Question 17 4 out of 4 points A young male, was brought to the clinic by his mom. He has had periods of major depression for many years and is on Lithium. His provider also manages his migraine headaches and epilepsy. During the past week, he became psychotic, hearing voices to kill himself and intense feelings of worthlessness. On the day of the clinic visit, he had an epileptic seizure that could not be controlled by medication. He was admitted for Lithium adjustment. Final diagnoses are: Severe depression with psychotic behavior and epileptic seizure poorly controlled with medication. What ICD-10-CM codes should be reported? Selected Answer: c. F33.3, G40.919 Correct Answer: c. F33.3, G40.919 Response Feedback: Rationale: Only two final diagnoses are documented the depression and epilepsy. The migraine headache is not coded because it was not treated or listed as a final diagnosis. In the ICD-10-CM Alphabetic Index look for Depression/major recurrent – see Disorder, depressive, recurrent. Look for Disorder/depressive/major recurrent referring you to code F33.9. The patient has severe depression and became psychotic. Look for Disorder/depressive/recurrent/current episode/severe/with psychotic symptoms referring you to code F33.3. Next, in the Alphabetic Index look for Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) seizure)/intractable G40.919. The mention of poorly controlled with medication makes the epilepsy intractable. • Question 18 4 out of 4 points A patient is seen for his hypertension with stage 5 CKD and myocardial disease. The conditions are stable and he is told to continue with his medications. The myocardial disease is unrelated to the hypertension. What ICD-10-CM codes are reported? Selected Answer: d. I12.0, N18.5, I51.5 Correct Answer: d. I12.0, N18.5, I51.5 Response Feedback: Rationale: ICD-10-CM guideline I.C.9.a.2 indicates that ICD-10-CM presumes a causal relationship between chronic kidney disease (CKD) and hypertension. Look in the ICD-10-CM Alphabetic Index for Hypertension/kidney/stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) referring you to I12.0. Instructional note under I12.0 indicates to use additional code to identify the stage of the CKD. Code N18.5 is reported for stage 5 CKD. ICD-10-CM guideline, I.C.9.a.1 indicates if the documentation does not have a causal relationship between the hypertension and heart disease the conditions are coded separately. Look in the Alphabetic Index for Disease/myocardium, myocardial referring you to I51.5. Verify code selection in the Tabular List. • Question 19 4 out of 4 points After referral from the ED, patient is seeing the ophthalmologist to examine an old injury with retained magnetic iron metal foreign body in his posterior wall within the right eye with the possibility of infection. What ICD-10-CM codes are reported? Selected Answer: a. H44.641, Z18.11 Correct Answer: a. H44.641, Z18.11 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Foreign body/intraocular/old, retained/magnetic/posterior wall guiding you to code H44.64-. In the Tabular List, 6th character 1 is assigned for the right eye. Subcategory code H44.6 has instructions to use an additional code to identify the foreign body (Z18.11). Z18.11 identifies a retained magnetic fragment. Verify code selection in the Tabular List. • Question 20 4 out of 4 points Mrs. Johnson is here today to receive an intercostal nerve block to mitigate the debilitating pain of her malignancy. Her cancer has metastasized to her bones in her thoracic spine. What ICD-10-CM codes are reported? Selected Answer: c. G89.3, C79.51 Correct Answer: c. G89.3, C79.51 Response Feedback: Rationale: The reason for this encounter is pain management. According to ICD-10-CM guideline I.C.6.b.5, pain in neoplastic disease (G89.3) is the first listed diagnosis when the reason for the encounter is documented as pain control or pain management. The patient has metastatic cancer (secondary malignancy) of the thoracic spine. Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/spine, spinal (column)/and use the code from the Malignant Secondary column directing you to code C79.51. Verify code selection in the Tabular List. • Question 21 4 out of 4 points A provider performed an aspiration via thoracentesis on a patient in observation status in the hospital. The patient has advanced right lung cancer that has metastasized to the pleura with malignant pleural effusion. Later the same day, due to continued accumulation of fluid, the patient was returned to the procedure room and the same provider performed a repeat thoracentesis. What ICD-10-CM codes are reported? Selected Answer: c. C78.2, C34.91, J91.0 Correct Answer: c. C78.2, C34.91, J91.0 Response Feedback: Rationale: The patient has malignant pleural effusion. Look in the ICD-10-CM Alphabetic Index for Effusion/pleura, pleurisy, pleuritic, pleuropericardial/malignant directing you to code J91.0. In the Tabular List there is a note under J91.0 to code the malignant neoplasm first, if known. In this case, it is known. According to ICD-10-CM guideline I.C.2.b. when treatment is directed to the secondary cancer, the secondary cancer is reported first. The primary cancer is reported second. Treatment is due to the accumulation of fluid due to metastasis to the pleura. Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/pleura, pleural (cavity) and use the code from the Malignant Secondary column which directs the coder to C78.2. The primary malignancy should also be reported. Look in the Table of Neoplasms for Neoplasm, neoplastic/lung and use the code from the Malignant Primary column which directs the coder to C34.9-. In the Tabular List, 5th character 1 is selected for the right lung. Verify code selection in the Tabular List. • Question 22 4 out of 4 points The patient has a history of unstable angina, hypertension, and chronic systolic heart failure. He is seen in the ED after prolonged chest pain that was not relieved by medication. Cardiac enzymes are elevated, and EKG shows anterior infarct. A decision was made to perform a cardiac catheterization and coronary angiography. Left heart catheterization was performed in order to perform a left ventriculogram. He tolerated the procedure well and will be discharged. His final diagnosis is chronic systolic heart failure and hypertension. The two conditions are unrelated. What ICD-10-CM code(s) is/are reported? Selected Answer: c. I50.22, I10 Correct Answer: c. I50.22, I10 Response Feedback: Rationale: ICD-10-CM guideline I.C.9.a.1. indicates when the documentation specifically states the two conditions are unrelated between hypertension and heart disease, they are coded separately. In this case, there is no causal relationship coded. Look in the ICD-10-CM Alphabetic Index for Failure/heart/systolic (congestive)/chronic (congestive) directing you to I50.22. Then, look for Hypertension which directs you to I10. Verify code selection in the Tabular List. • Question 23 4 out of 4 points A 65 year-old female patient returns to her primary care provider for follow up of an upper respiratory infection diagnosed the previous week. Her condition has not improved and her cough has increased. She has a long history of smoking. She currently smokes one pack a day and is dependent on the cigarettes. She uses a bronchodilator for her COPD. The provider changes her antibiotics to treat her acute bronchitis with COPD. What ICD-10-CM codes are reported for this visit? Selected Answer: d. J44.0, J20.9, F17.210 Correct Answer: d. J44.0, J20.9, F17.210 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Disease, diseased/pulmonary/chronic obstructive/with/acute bronchitis J44.0. In the Tabular List, there is an instructional note to use an additional code to identify the infection. For this example, the infection is reported with a code from category code J20 Acute Bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used. Look for Bronchitis/acute or subacute (with bronchospasm or obstruction) J20.9. In the Tabular List category J44 has a note to code also the type of asthma which is not applicable to this case so it is not coded. J44 also has a note to report an additional code for use of or exposure to smoke. The patient is currently still smoking and is dependent on cigarettes. Look for Dependence (on)/nicotine/cigarettes F17.210. Verify code selection in the Tabular List. • Question 24 4 out of 4 points An elderly male patient presents to the ED complaining of a high fever the day prior to the encounter and of extreme lethargy. He has a history of benign hypertension which has been elevated. On arrival he was examined and admitted, with possible septic urinary tract infection and concern for his elevated blood pressure. He was noted to have hematuria. Positive UTI and pseudomonas showed in the urine culture and IV antibiotics were administered. During the course of the day, his fever decreased and his lethargy improved. He was noted to have hematuria. As the IV fluids were decreased, he resumed a benign hypertensive state. On the next hospital day, the urine was clear and he was discharged on oral antibiotics, with septicemia ruled out. What ICD-10-CM codes should be reported? Selected Answer: b. N39.0, B96.5, I10 Correct Answer: b. N39.0, B96.5, I10 Response Feedback: Rationale: Per ICD-10-CM guideline IV.H Uncertain Diagnosis, we would not code diagnoses documented as probable, suspected, questionable, rule out or working diagnosis or other similar terms indicating uncertainty. During the course of the patient’s stay septicemia was ruled out and would not be coded. The reason for the visit was to treat the urinary tract infection, making that code primary. Look in the ICD-10-CM Alphabetic Index for Infection/urinary (tract) NEC directing you to code N39.0. Look in the Tabular List for code N39.0. There is an instructional note stating, “Use additional code to identify infectious agent.” This note must always be followed when the organism is known. The note states “Pseudomonas showed in the urine culture.” Look in the Alphabetic Index for Infection/Pseudomonas NEC/as cause of disease classified elsewhere which directs you to B96.5. Hematuria (R31.9) is integral to a urinary tract infection and is not reported separately. Hypertension is coded because it is a coexisting condition that was being affected by having the UTI. Look in the Alphabetic Index for Hypertension which directs you to I10. Verify code selection in the Tabular List. • Question 25 4 out of 4 points The provider sees a 70 year-old patient with documented history of being combative and aggressive in the nursing home. The provider diagnoses the patient with dementia and refers the patient to a neurologist for further evaluation. What ICD-10-CM code(s) is/are reported? Selected Answer: b. F03.91 Correct Answer: b. F03.91 Response Feedback: Rationale: In ICD-10-CM Alphabetic Index look for Dementia/with/aggressive behavior directing you to F03.91. Next, look for Dementia/with/combative behavior directing you to F03.91. Verify the codes in the Tabular List. Both manifestations are reported with the same code, so it is only reported once according to ICD-10-CM guideline I.B.12. Review Test Submission: Chapter 5 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 5 Quiz Started 7/1/19 12:58 PM Submitted 7/1/19 3:24 PM Status Completed Attempt Score 70 out of 100 points Time Elapsed 2 hours, 26 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points A patient complains of a rash that is extremely itchy. It began when she started using a new laundry detergent. She is examined and the provider diagnoses her with dermatitis, due to exposure to the laundry detergent. What is the diagnosis code? Selected Answer: d. L24.0 Correct Answer: d. L24.0 Response Feedback: Rationale: The patient is diagnosed with dermatitis due to detergent. In the ICD-10-CM Alphabetic Index, look for Dermatitis/due to/detergents (contact) (irritant). You are referred to L24.0. Verify the code selection in the Tabular List. • Question 2 0 out of 10 points An MRI confirmed the patient has sciatica caused by a herniated disc between L5 and S1. She is scheduled for an injection in this office, after which she will be referred to a physical therapist in an effort to avoid surgery. Select the diagnosis code(s). Selected Answer: b. M51.17, M54.40 Correct Answer: a. M51.17 Response Feedback: Rationale: L5 and S1 refer to the fifth lumbar disc and the first sacral disc in the vertebra. Look in the ICD-10-CM Alphabetic Index for Hernia, hernial/intervertebral cartilage or disc, you are referred to see Displacement, intervertebral disc. Look for Displacement, displaced/intervertebral disc NEC/ lumbosacral region/with neuritis, radiculitis, radiculopathy or sciatica M51.17. Verify code selection in the Tabular List. • Question 3 10 out of 10 points A 55-year-old female with right hydronephrosis presents for a cystourethroscopy with a retrograde pyelogram. What is the correct diagnosis code? Selected Answer: c. N13.30 Correct Answer: c. N13.30 Response Feedback: Rationale: The indication for the surgery is hydronephrosis. In the ICD-10-CM Alphabetic Index, look for the main term Hydronephrosis. There is no indication of causal organism, or that it is a congenital condition. The default code is N13.30. A review of this code in the Tabular List confirms this is the correct diagnosis. • Question 4 0 out of 10 points A pregnant female, at 21 weeks, is diagnosed with iron-deficiency anemia and is sent to the clinic for a transfusion. Select the diagnosis code(s). Selected Answer: a. O99.012 Correct Answer: c. O99.012, D50.9, Z3A.21 Response Feedback: Rationale: Codes 099.012, Z3A.21 are both assigned. ICD-10-CM guideline 1.C.15.b.3. indicates, “in episodes where no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy which necessitated the encounter”. Look in the Alphabetic Index for Pregnancy/complicated by/anemia O99.01-.Verification in the Tabular List indicates the code is completed with a 6th character based on trimester. Choose O99.012 for second trimester. There is an instructional note under category code 099 that indicates to use an additional code to identify the specific condition. Code D50.9 is reported for iron deficiency anemia. Use additional code for number of weeks. Look for Pregnancy/weeks of gestation/21 weeks Z3A.21. • Question 5 10 out of 10 points Assign the code for feeding problems in newborn. Selected Answer: b. P92.9 Correct Answer: b. P92.9 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Feeding/problem/newborn. You are referred to P92.9. Verify the code in the Tabular List. • Question 6 10 out of 10 points A 4-year-old male is brought to the hospital by his mother. Today he is going to have surgery to repair his Cheiloschisis. Assign the correct code for his condition. Selected Answer: c. Q36.9 Correct Answer: c. Q36.9 Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Cheiloschisis referring you to see Cleft, lip. Look for Cleft/lip, you are directed to Q36.9. Verification in the Tabular List lists Cleft lip NOS under code Q36.9. • Question 7 10 out of 10 points Mrs. Bixby, 83, is being admitted for dehydration and anorexia. The probable cause is 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. The gerontology unit will evaluate her mental condition tomorrow after she is stabilized. How would you code the diagnoses? Selected Answer: b. R63.0, E86.0 Correct Answer: b. R63.0, E86.0 Response Feedback: Rationale: ICD-10-CM guidelines tell us not to report an unsubstantiated probable or rule out diagnosis; therefore, a diagnosis of dementia is not appropriate at this time. The symptoms are dehydration and anorexia. Each of these terms requires a simple look-up in the ICD-10-CM Alphabetic Index. Although anorexia often is a short way of describing anorexia nervosa, in this case, there is no documentation of an eating disorder as a psychological disorder; look for the main term anorexia, R63.0, which is the correct diagnosis. Look for the main term Dehydration, E86.0. Verify all codes in the Tabular List. • Question 8 0 out of 10 points The provider performs an open reduction and internal fixation for left fibula and tibia fractures. Select the codes. Selected Answer: b. S82.402B, S82.202B Correct Answer: a. S82.402A, S82.202A Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/ fibula (shaft) (styloid) S82.40-. Next look for Fracture, traumatic/tibia (shaft) S82.20-. Verification in the Tabular List indicates the 6th character 2 for left side. 7th character A for initial encounter is also reported. S82.402A, S82.202A. According to the ICD-10-CM guidelines, when a fracture is not specified as open or closed, the default is to code it as closed. Even though an open repair is performed, the diagnosis is not determined by the type of treatment. • Question 9 10 out of 10 points The patient was hit in the nose by the ball playing basketball on the varsity team last evening at the gym and woke up with severe epistaxis. The family physician controlled the nasal hemorrhage with cauterization and afterwards packed the nose with nasal packs. What are the correct diagnosis codes? Selected Answer: b. R04.0, W21.05XA, Y92.39, Y93.67, Y99.8 Correct Answer: b. R04.0, W21.05XA, Y92.39, Y93.67, Y99.8 Response Feedback: Rationale: The epistaxis is caused from an injury; it is not hereditary. This is found by looking in the ICD-10-CM Alphabetic Index for Epistaxis (multiple) and using the default code R04.0. Four external cause codes are required in this case. The first code indicates how the injury occurred (hit with a ball). Look in the External Cause of Injuries Index for Struck (accidentally) by/ball (hit) (thrown)/basketball W21.05-. Add a placeholder X for the 6th character and an A for the 7th character to indicate initial encounter, W21.05XA. The next code reports where the accident occurred. Look for Place of occurrence/Gymnasium, Y92.39. Next, code the activity he was involved in at the time. Look for Activity/basketball Y93.67. The last external cause code is a status code. Look for Status of external cause/student activity, Y99.8. • Question 10 10 out of 10 points The patient’s dense breast tissue made the screening mammogram unreadable, and she is here today for a breast ultrasound. Her mother and sister both have history of breast cancer. What are the correct diagnosis codes? Selected Answer: d. Z12.39, R92.2, Z80.3 Correct Answer: d. Z12.39, R92.2, Z80.3 Response Feedback: Rationale: Code the special screening as a reason for the encounter, along with a code to report the patient’s breast density, which provides medical necessity for a more extensive test. Dense breast tissue occurs in many premenopausal women, and can interfere with reading a mammogram and may mask abnormalities in the image. Look in the ICD-10-CM Alphabetic Index for Screening/neoplasm (malignant) (of)/breast Z12.39. For the breast density, look in the Alphabetic Index for Dense/breasts R92.2. This code provides medical necessity of an ultrasound. To report the family history of breast cancer, look in the Alphabetic Index for History/family (of)/malignant neoplasm (of)/breast Z80.3, which may provide medical necessity information for the screening exam in a young patient. Verify all codes in the Tabular List. Review Test Submission: Chapter 5 Quiz User Course 2019 Physician Coding for CPC Preparation (Q-S) Test Chapter 5 Quiz Started 9/18/19 8:12 PM Submitted 9/18/19 9:04 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 52 minutes Results Displayed Submitted Answers, Correct Answers, Feedback • Question 1 10 out of 10 points A patient is diagnosed with pressure ulcers on each heel. Select the diagnosis code(s). Selected Answer: d. L89.619, L89.629 Correct Answer: d. L89.619, L89.629 Response Feedback: Rationale: Codes for pressure ulcers are determined by site, stage, and laterality. In this case, the patient has pressure ulcers on each heel. Look in the ICD-10-CM Alphabetic Index for Ulcer/pressure/heel L89.6-. In the Tabular List, a 5th character is required for laterality and 6th character is required for the stage. Report L89.619 for the right and L89.629 for the left. The stage is not documented; it is coded as unspecified stage. Unstageable can only be coded based on clinical documentation, which is not documented in this case. • Question 2 10 out of 10 points An MRI confirmed the patient has sciatica caused by a herniated disc between L5 and S1. She is scheduled for an injection in this office, after which she will be referred to a physical therapist in an effort to avoid surgery. Select the diagnosis code(s). Selected Answer: a. M51.17 Correct Answer: a. M51.17 Response Feedback: Rationale: L5 and S1 refer to the fifth lumbar disc and the first sacral disc in the vertebra. Look in the ICD-10-CM Alphabetic Index for Hernia, hernial/intervertebral cartilage or disc, you are referred to see Displacement, intervertebral disc. Look for Displacement, displaced/intervertebral disc NEC/ lumbosacral region/with neuritis, radiculitis, radiculopathy or sciatica M51.17. Verify code selection in the Tabular List. • Question 3 10 out of 10 points A patient returns to her gynecologist’s office to review the results of her ultrasound. She has been experiencing heavy bleeding and painful menstruation. The results of the ultrasound reveal the patient has a uterine fibroid measuring 4.0 cm. Select the diagnosis code(s). Selected Answer: d. D25.9 Correct Answer: d. D25.9 Response Feedback: Rationale: The patient is diagnosed with a uterine fibroid. The symptoms, heavy bleeding and painful menstruation, she is experiencing are integral to the definitive diagnosis and should not be coded. In the ICD-10-CM Alphabetic Index, look for main term Fibroid and then uterus. You are referred to D25.9.There is no location given of where the fibroid (leiomyoma) is located. Review of the code in the Tabular List confirms this is the correct code. • Question 4 10 out of 10 points A patient presented to the emergency department with second degree burns to both forearms, which makes up 9 percent TBSA (Total Body Surface Area). She is three months pregnant, 12 weeks. The burns are not affecting the pregnancy. Select the diagnosis codes. Selected Answer: d. T22.212A, T22.211A, T31.0, Z33.1 Correct Answer: d. T22.212A, T22.211A, T31.0, Z33.1 Response Feedback: Rationale: The pregnancy is incidental to the problem for which the patient is treated, so complication pregnancy code O09.90 is not reported. The first listed code is for the burns. The patient has a second degree burn to both forearms. In the ICD-10-CM Alphabetic Index, look for Burn/forearm/right/second degree T22.211 and Burn/forearm/left/second degree T22.212. The 7th character, A, completes the code to indicate initial encounter. A code from category T31 is coded to indicate the TBSA burned, as well as the percentage of the burn that is third degree. The TBSA is 9 percent and there are no third degree burns. Look for Burn/extent (percentage of body surface)/less than 10% percent T31.0. The last code is for the pregnancy. Look for State (of)/pregnant, incidental or Status (post)/pregnancy, incidental referring you to Z33.1. A code from category Z34 is not reported because that is if the patient was being seen for routine care or check-up of the pregnancy. • Question 5 10 out of 10 points A male newborn, delivered vaginally in the hospital, is born with jaundice. Select the diagnosis code(s) for the newborn's record. Selected Answer: d. Z38.00, P59.9 Correct Answer: d. Z38.00, P59.9 Response Feedback: Rationale: The question is asking for the codes for the newborn's record. According to the ICD-10-CM guidelines I.C.16.a.1 codes from the obstetric chapter (Chapter 15) are never permitted on the newborn record, do not report codes O80 and Z37.0. ICD-10-CM guideline I.C.16.a.2 indicates, the first listed diagnosis code, Z38.00, is used to report the birth episode, followed by additional codes for perinatal conditions. Look in the ICD-10-CM Alphabetic Index for Newborn/born in hospital. You are referred to Z38.00. In the Alphabetic Index, look for Newborn/jaundice and you are referred to P59.8. Look in the Alphabetic Index for Jaundice/newborn and you are referred to P59.9. In the Tabular List, P59.9 is unspecified which is correct for this case. Verify all codes in the Tabular List. • Question 6 10 out of 10 points The hospital documentation states “normal vaginal delivery, live birth, female, with Down Syndrome.” Select the correct code(s) for the infant’s record. Selected Answer: c. Z38.00, Q90.9 Correct Answer: c. Z38.00, Q90.9 Response Feedback: Rationale: According to ICD-10-CM guideline I.C.17. for birth admission, the appropriate code from category Z38- Liveborn infants, according to the type of birth should be sequenced as the principal diagnosis, followed by any congenital anomaly codes Q00-Q99. To find the type of birth, look in the ICD-10-CM Alphabetic Index for Newborn/born in hospital Z38.00. Down Syndrome is reported secondarily and is found in the ICD-10-CM Alphabetic Index by looking for the main term Down Syndrome, Q90.9. Although category Q90 has a use additional note to also report associated physician condition and degree of intellectual disabilities, this is a newborn and this information is not known so it is not reported. • Question 7 10 out of 10 points When should a code for signs and symptoms be reported? Refer to ICD-10-CM guidelines I.C.18.a. and I.C.18.b. Selected Answer: c. When it is not integral to the definitive diagnosis Correct Answer: c. When it is not integral to the definitive diagnosis Response Feedback: Rationale: Signs and symptoms are reported when a definitive diagnosis has not been established. If the sign or symptom is not integral to the definitive diagnosis, the sign(s) and symptom(s) should be reported. • Question 8 10 out of 10 points A patient was sent home with a PICC line for Vancomycin treatment at home. He returns to his physician with an infection due to the PICC Line. The infection is determined to be MRSA. Select the diagnosis code(s) in the correct sequence. Selected Answer: c. T80.218A, A49.02 Correct Answer: c. T80.218A, A49.02 Response Feedback: Rationale: When complications are reported, a code for the complication is reported first. If the cause of the complication is known, it is reported as the additional code(s). Look in the ICD-10-CM Alphabetic Index for Infection/due to or resulting from/central venous catheter/specified NEC T80.218-. Verification in the Tabular List indicates this code needs a 7th character. 7th character extension A is reported for the initial encounter. T80.218A is correct because we do know that this is an MRSA infection, however, we do not know whether it is a local infection or bloodstream infection. Next look for MRSA (Methicillin resistant Staphylococcus aureus)/infection A49.02. Verify code in the Tabular List. • Question 9 10 out of 10 points Which statement is TRUE regarding external cause codes? Refer to ICD-10-CM guideline I.C.20.a.6. Selected Answer: a. External cause codes are never sequenced first. Correct Answer: a. External cause codes are never sequenced first. Response Feedback: Rationale: According to the ICD-10-CM guideline I.C.20.a.6, An external cause code can never be a principal/first-listed diagnosis. • Question 10 10 out of 10 points The provider orders serum blood tests as part of a pre-employment physical exam. What is the diagnosis? Selected Answer: c. Z02.1 Correct Answer: c. Z02.1 Response Feedback: Rationale: The patient has no complaints. The diagnosis codes for employment exams are found under the main term Examination in the ICD-10-CM Alphabetic Index. Look for Examination/ medical (adult) (for) (of)/ pre-employment you are referred to Z02.1. Verification in the Tabular List confirms this is the correct code. [Show More]

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