COBGC Coding Guidelines and Conventions 2 — Questions and Answers
Question 1: An Excludes2 note in ICD-10-CM means:
- The excluded code can never be reported with the code
- The excluded condition is not part of the condition but may occur simultaneously and both codes may be reported (Correct answer)
- The excluded code replaces the code being referenced
- The condition is included in the code and should not be coded separately
Correct answer: The excluded condition is not part of the condition but may occur simultaneously and both codes may be reported
An Excludes2 note means the excluded condition is not part of the condition represented by the code, so both codes may be reported together when both conditions are present.
Question 2: In ICD-10-CM, the placeholder character 'X' is used to:
- Indicate an unspecified code
- Hold a position in a code when a character is not required but a later character is needed (Correct answer)
- Denote an excluded diagnosis
- Mark a code as requiring a 7th character extension
Correct answer: Hold a position in a code when a character is not required but a later character is needed
The placeholder 'X' fills a position in the code structure so that a required character (such as a 7th character) can be placed in its correct position.
Question 3: When a patient presents with a condition that is both an Excludes1 condition and integral to the reported condition, the coder should:
- Report both codes regardless of the Excludes1 instruction
- Report only the integral condition code
- Query the provider to confirm both conditions are distinct and documented, then follow the guideline (Correct answer)
- Report only the Excludes1 code
Correct answer: Query the provider to confirm both conditions are distinct and documented, then follow the guideline
An Excludes1 note means the two conditions cannot occur together; if documentation suggests both are present, the coder should query the provider to clarify before coding.
Question 4: Under CPT coding conventions, a semicolon (;) in a code descriptor indicates:
- The end of the code description
- That the portion before the semicolon is shared by the indented codes that follow (Correct answer)
- An add-on code relationship
- A bundled service that cannot be billed separately
Correct answer: That the portion before the semicolon is shared by the indented codes that follow
In CPT, the text before the semicolon in a parent code is the common descriptor shared by all indented child codes beneath it.
Question 5: A 'Code Also' instruction in ICD-10-CM means:
- The additional code must always be sequenced first
- Two codes may be required to fully describe a condition, but sequencing depends on the reason for the encounter (Correct answer)
- The additional code is optional and rarely used
- The code being referenced is deleted and replaced by the instructed code
Correct answer: Two codes may be required to fully describe a condition, but sequencing depends on the reason for the encounter
A 'Code Also' note alerts the coder that two codes may be required and that sequencing depends on the circumstances of the encounter.
Question 6: Which statement is true regarding ICD-10-CM coding of trimesters in obstetric cases?
- The third trimester ends at 36 weeks and 0 days
- Trimester is counted from the first day of the last menstrual period
- The second trimester begins at 13 weeks 0 days and ends at less than 28 weeks (Correct answer)
- Trimester must always be documented by the coder based on gestational age
Correct answer: The second trimester begins at 13 weeks 0 days and ends at less than 28 weeks
The second trimester is defined in ICD-10-CM as beginning at 13 weeks 0 days and ending before 28 weeks 0 days.
Question 7: In CPT, the term 'separate procedure' in a code description means:
- The procedure must always be billed with a modifier
- The procedure is commonly part of a larger service and should not be reported separately when performed as part of that larger service (Correct answer)
- The procedure requires a separate operative report
- The procedure can only be performed by a specialist
Correct answer: The procedure is commonly part of a larger service and should not be reported separately when performed as part of that larger service
A 'separate procedure' designation means the code is ordinarily part of a larger service; it should only be reported independently when performed as a distinct, standalone procedure.
COBGC Coding Guidelines and Conventions 2
An Excludes2 note in ICD-10-CM means: