Clinical Coding Flashcards
6 cards from real CCDS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Clinical Coding flashcards as text
Under ICD-10-PCS, which of the seven characters defines the specific approach used for a procedure?
Answer: Character 5 (Approach)
In ICD-10-PCS, Character 5 specifies the approach used to reach the operative site, such as open, percutaneous, endoscopic, or via natural or artificial opening.
A patient undergoes a laparoscopic cholecystectomy that is converted to an open procedure. How should this be coded in ICD-10-PCS?
Answer: Code only the open approach since it was the completed procedure
Per ICD-10-PCS guidelines, when a procedure is converted from a laparoscopic to an open approach, only the open approach procedure code is assigned. The laparoscopic portion that did not complete the intended procedure is not separately coded.
Which ICD-10-CM code category is used to report sepsis due to a gram-positive organism when the specific organism is identified?
Answer: A41 - Other sepsis
Category A41 (Other sepsis) covers sepsis due to specific organisms including Staphylococcus aureus. The specific organism code from A40-A41 is sequenced first, followed by R65.2x if severe sepsis criteria are met.
What is the ICD-10-CM convention for coding a condition that is integral to a disease process?
Answer: It is not coded separately, as it is inherent to the condition
ICD-10-CM Guideline Section I.B.5 states that signs and symptoms that are integral to a disease process should not be assigned as additional codes unless otherwise instructed by the classification.
A patient is admitted with acute respiratory failure due to pneumonia. Which is the correct sequencing under ICD-10-CM inpatient guidelines?
Answer: Either condition may be sequenced as principal diagnosis per coding guideline discretion
ICD-10-CM guideline I.C.10.b states that when both respiratory failure and another condition such as pneumonia are equally responsible for the admission, either may be sequenced as the principal diagnosis.
Which ICD-10-PCS root operation is used when a surgeon removes a kidney stone using an endoscope introduced through the urethra?
Answer: Extirpation
Extirpation is the root operation for taking or cutting out solid matter such as a calculus from a body part. For a kidney stone removed via endoscopic approach through the urethra, Extirpation with a via natural or artificial opening endoscopic approach would be coded.