Case Studies & Practical Application Flashcards
7 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Case Studies & Practical Application flashcards as text
A patient is admitted after a motor vehicle accident and sustains a closed femur fracture and a closed tibia fracture on the same leg. The femur fracture required ORIF. Which diagnosis is sequenced first?
Answer: The femur fracture since it was the most serious and required surgical intervention
The condition chiefly responsible for the admission — the femur fracture requiring ORIF — is selected as the principal diagnosis.
A physician documents 'urinary tract infection due to E. coli.' Which ICD-10-CM codes should be assigned?
Answer: N39.0 and B96.20 — UTI with E. coli as the causative organism
N39.0 codes the urinary tract infection, and B96.20 (E. coli as the cause of diseases classified elsewhere) is added to identify the organism.
A Medicare patient receives an annual wellness visit (AWV) and also has an E/M service for a new complaint addressed during the same encounter. How is this billed?
Answer: Bill both the AWV and E/M with modifier -25 on the E/M
Both can be billed on the same day with modifier -25 appended to the E/M service to indicate it was a significant, separately identifiable service.
A patient is treated for acute osteomyelitis of the right femur caused by Staphylococcus aureus. Which code set correctly captures this?
Answer: M86.011 and B95.61
M86.011 covers acute hematogenous osteomyelitis of the right femur, and B95.61 identifies Staphylococcus aureus as the causative organism.
A coder is reviewing a record where the patient was admitted for cellulitis of the left leg and also has type 1 diabetes mellitus. The physician does not document a link between the two. How should the diabetes be coded?
Answer: E10.9 — type 1 diabetes without complications, as a comorbidity
Without documentation of a link between the diabetes and the cellulitis, diabetes is coded as E10.9 (unrelated comorbidity) separately from the cellulitis.
A physician performs an initial hospital care visit for a new patient requiring high-complexity medical decision-making. The note meets the criteria for 99223. A resident also participates and documents independently. How is teaching physician involvement handled for billing?
Answer: The teaching physician must be present for key portions and document their participation for the professional fee to be billed
CMS teaching physician rules require the attending to be present for the key portion of the service and document their participation in order to bill the professional fee.
A patient is seen for low back pain and the physician orders an MRI. The MRI reveals a herniated disc at L4-L5. What diagnosis is coded for the encounter?
Answer: The herniated disc at L4-L5 since it is the confirmed etiology of the low back pain
Once a definitive diagnosis is established and documented, the confirmed diagnosis (herniated disc M51.16) replaces the symptom code (low back pain) per outpatient coding guidelines.