CCDS Clinical Coding 5 — Questions and Answers
Question 1: In ICD-10-CM, which guideline governs how to code two conditions when a patient has both Type 2 diabetes mellitus and chronic kidney disease stage 3?
- Code only the more severe condition
- Use combination code E11.22 for diabetic CKD (Correct answer)
- Assign separate codes for each condition independently
- Query the physician to determine causal relationship
Correct answer: Use combination code E11.22 for diabetic CKD
ICD-10-CM provides combination code E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease stage 3) that captures both conditions in a single code.
Question 2: Which Present on Admission (POA) indicator is assigned when documentation is insufficient to determine if a condition was present at the time of inpatient admission?
- Y
- N
- U (Correct answer)
- W
Correct answer: U
POA indicator 'U' is assigned when documentation is insufficient to determine if the condition was present on admission.
Question 3: A patient is admitted after a fall from a ladder at a construction site. The injury is a closed fracture of the femoral shaft. Which ICD-10-CM code captures the external cause of the initial encounter?
- W11.XXXA (Correct answer)
- W19.XXXA
- Y93.H9XA
- X58.XXXA
Correct answer: W11.XXXA
W11.XXXA represents a fall on and from a ladder, initial encounter, which correctly captures the external cause mechanism.
Question 4: Under the Uniform Hospital Discharge Data Set (UHDDS), the principal diagnosis is defined as the condition established after study to be chiefly responsible for what?
- The patient's longest length of stay
- Occasioning the admission to the hospital (Correct answer)
- The highest-cost procedure performed
- Generating the highest MS-DRG weight
Correct answer: Occasioning the admission to the hospital
UHDDS defines the principal diagnosis as the condition established after study to be chiefly responsible for occasioning the patient's admission.
Question 5: A physician documents 'acute respiratory failure due to COPD exacerbation.' Which sequencing approach is correct for an inpatient admission?
- Always sequence COPD exacerbation as principal diagnosis
- Always sequence acute respiratory failure as principal diagnosis
- Either condition may be sequenced first per coding guidelines (Correct answer)
- Sequence the condition requiring the most resources first
Correct answer: Either condition may be sequenced first per coding guidelines
ICD-10-CM guidelines allow either acute respiratory failure or the underlying condition to be sequenced as the principal diagnosis when both are present at admission.
Question 6: Which ICD-10-PCS approach value represents an endoscopic procedure performed entirely through an orifice without incision?
- 0 – Open
- 3 – Percutaneous
- 7 – Via Natural or Artificial Opening
- 8 – Via Natural or Artificial Opening Endoscopic (Correct answer)
Correct answer: 8 – Via Natural or Artificial Opening Endoscopic
Approach value '8' in ICD-10-PCS represents procedures performed via natural or artificial opening using endoscopic visualization.
Question 7: A patient with end-stage renal disease (ESRD) on hemodialysis develops hyperkalemia. The CDIS should query whether which additional condition may be clinically supported?
- Acute kidney injury superimposed on CKD
- Hypertensive CKD with heart failure
- Electrolyte and fluid balance disorder due to ESRD (Correct answer)
- Fluid overload with associated pulmonary edema
Correct answer: Electrolyte and fluid balance disorder due to ESRD
Hyperkalemia in ESRD patients is a common complication of impaired renal electrolyte regulation and may support documentation of an electrolyte/fluid disorder for complete code capture.
CCDS Clinical Coding 5
In ICD-10-CM, which guideline governs how to code two conditions when a patient has both Type 2 diabetes mellitus and chronic kidney disease stage 3?