Certified Medical Coding Specialist Case Studies & Practical Application 5

Question 1

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?

Accepted Answer

The femur fracture since it was the most serious and required surgical intervention

Answer

The condition chiefly responsible for the admission — the femur fracture requiring ORIF — is selected as the principal diagnosis.

Question 2

A physician documents 'urinary tract infection due to E. coli.' Which ICD-10-CM codes should be assigned?

Accepted Answer

N39.0 and B96.20 — UTI with E. coli as the causative organism

Answer

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.

Question 3

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?

Accepted Answer

Bill both the AWV and E/M with modifier -25 on the E/M

Answer

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.

Question 4

A patient is treated for acute osteomyelitis of the right femur caused by Staphylococcus aureus. Which code set correctly captures this?

Accepted Answer

M86.011 and B95.61

Answer

M86.011 covers acute hematogenous osteomyelitis of the right femur, and B95.61 identifies Staphylococcus aureus as the causative organism.

Question 5

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?

Accepted Answer

E10.9 — type 1 diabetes without complications, as a comorbidity

Answer

Without documentation of a link between the diabetes and the cellulitis, diabetes is coded as E10.9 (unrelated comorbidity) separately from the cellulitis.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Case Studies & Practical Application 5