COC Outpatient Coding Guidelines 2 — Questions and Answers
Question 1: Which ICD-10-CM guideline applies to outpatient coding of HIV-related conditions?
- Code B20 as first-listed when the encounter is for an HIV-related condition (Correct answer)
- Code Z21 for all HIV-positive patients regardless of symptoms
- Query the physician before coding any HIV-related diagnosis
- Code only when confirmed by Western blot
Correct answer: Code B20 as first-listed when the encounter is for an HIV-related condition
When an HIV-positive patient is seen for an HIV-related illness, B20 (HIV disease) is sequenced first, followed by the specific HIV-related condition.
Question 2: An outpatient is seen for pain management after a recent fracture. The fracture has not fully healed. How should this be coded?
- Code the fracture with the appropriate 7th character for subsequent encounter (Correct answer)
- Code only the pain, not the fracture
- Code the fracture as healed
- Code the fracture with initial encounter character 'A'
Correct answer: Code the fracture with the appropriate 7th character for subsequent encounter
Subsequent encounters for fracture care use the 7th character 'D' (routine healing), 'G' (delayed healing), or other appropriate subsequent-care characters — not 'A'.
Question 3: When a patient presents with signs and symptoms that are integral to a confirmed diagnosis, how are they coded?
- They are NOT coded separately — they are included in the disease code (Correct answer)
- They are coded first, followed by the confirmed diagnosis
- They may optionally be coded for severity tracking
- They are only coded if listed as complications
Correct answer: They are NOT coded separately — they are included in the disease code
Signs and symptoms that are routinely associated with a confirmed disease process are not coded separately, as they are integral components of the diagnosis.
Question 4: In outpatient coding, how should a patient encounter for screening colonoscopy where a polyp is found and removed be coded?
- Code the screening Z-code first, then the polyp finding (Correct answer)
- Code only the polyp; the screening intent is irrelevant
- Code the procedure with modifier only
- Code only the removal, no diagnosis code needed
Correct answer: Code the screening Z-code first, then the polyp finding
When a screening procedure reveals a finding, first-list the screening Z-code (e.g., Z12.11), then add the code for the finding (e.g., polyp of colon).
Question 5: A patient is seen in outpatient surgery for a knee replacement. The procedure is cancelled due to the patient developing acute respiratory distress preoperatively. What is the correct first-listed diagnosis?
- The reason the procedure was cancelled (acute respiratory distress) (Correct answer)
- The original reason for the surgery (knee condition)
- Cancelled procedure Z-code
- Unspecified surgical complication
Correct answer: The reason the procedure was cancelled (acute respiratory distress)
When a procedure is cancelled after the patient is prepared, the reason for cancellation (the complication or new condition) becomes the first-listed diagnosis.
Question 6: How are 'Z codes' used in outpatient coding?
- To describe encounters for reasons other than illness or injury (health status, screening, etc.) (Correct answer)
- As a placeholder when a more specific code is unavailable
- Only for inpatient discharge coding
- To code conditions with unknown etiology
Correct answer: To describe encounters for reasons other than illness or injury (health status, screening, etc.)
Z codes classify encounters for circumstances other than a disease or injury, including preventive care, screenings, follow-up visits, and personal health history.
COC Outpatient Coding Guidelines 2
Which ICD-10-CM guideline applies to outpatient coding of HIV-related conditions?