COC ICD-10-CM Coding 2 — Questions and Answers
Question 1: A patient presents to an outpatient clinic with a pathological fracture of the right femur due to metastatic bone disease from breast cancer. Which code is sequenced first?
- The pathological fracture code
- The metastatic bone disease code (Correct answer)
- The primary breast cancer code
- The fracture sequencing depends on the reason for the visit
Correct answer: The metastatic bone disease code
In outpatient coding, metastatic disease is coded first when it is the reason for the encounter, with the fracture as a secondary code.
Question 2: Which ICD-10-CM placeholder character 'X' is used when?
- To indicate an unspecified laterality
- To fill a code position so a 7th character can be added to a code with fewer than 6 characters (Correct answer)
- To denote an excluded condition
- To signify a sequela
Correct answer: To fill a code position so a 7th character can be added to a code with fewer than 6 characters
The placeholder 'X' is inserted at empty positions so the required 7th character extension falls in the correct position.
Question 3: A patient is seen in the ED for acute exacerbation of COPD with acute bronchitis. How should these conditions be coded?
- Code only the COPD exacerbation; bronchitis is included
- Code bronchitis first, then COPD
- Code the combination code J44.0 (COPD with acute lower respiratory infection) (Correct answer)
- Code each separately with COPD exacerbation first
Correct answer: Code the combination code J44.0 (COPD with acute lower respiratory infection)
ICD-10-CM provides combination code J44.0 which captures COPD with acute lower respiratory infection, including acute bronchitis.
Question 4: Under ICD-10-CM, how is hypertensive chronic kidney disease coded?
- Two separate codes: one for hypertension, one for CKD
- A combination code from category I12 linking hypertension and CKD (Correct answer)
- Only the CKD code, with hypertension as an excluded condition
- Only the hypertension code unless CKD is stage 4 or higher
Correct answer: A combination code from category I12 linking hypertension and CKD
ICD-10-CM assumes a causal relationship between hypertension and CKD, requiring a combination code from category I12.
Question 5: A patient is seen for a routine follow-up visit after completing treatment for malignant neoplasm of the colon; no evidence of disease is found. Which code is appropriate?
- The active colon cancer code
- Z08 – Encounter for follow-up examination after completed treatment for malignant neoplasm (Correct answer)
- Z85.038 – Personal history of malignant neoplasm of colon
- Z09 with the colon cancer code
Correct answer: Z08 – Encounter for follow-up examination after completed treatment for malignant neoplasm
Z08 is used when the patient has completed treatment and presents for a follow-up with no current disease evidence.
Question 6: When coding an outpatient encounter for a condition that is documented as 'probable' or 'suspected,' what is the correct ICD-10-CM guideline?
- Code the suspected condition as confirmed
- Code the signs and symptoms, not the unconfirmed diagnosis (Correct answer)
- Use a Z code for suspected conditions
- Code 'probable' conditions only if the provider uses the term 'rule out'
Correct answer: Code the signs and symptoms, not the unconfirmed diagnosis
In outpatient settings, uncertain diagnoses such as 'probable' or 'suspected' should not be coded; instead, code the signs and symptoms.
Question 7: Which 7th character extension is used for the initial encounter for an open fracture of the shaft of the humerus in ICD-10-CM?
- A
- B (Correct answer)
- D
- S
Correct answer: B
The 7th character 'B' designates the initial encounter for an open fracture (type I or II, or type IIIA, IIIB, or IIIC).
COC ICD-10-CM Coding 2
A patient presents to an outpatient clinic with a pathological fracture of the right femur due to metastatic bone disease from breast cancer.
Which code is sequenced first?