COC ICD-10-CM Coding 4 — Questions and Answers
Question 1: A patient with chronic systolic heart failure is admitted through the ED and ultimately discharged the same day. Which ICD-10-CM guideline applies to sequencing?
- Use inpatient guidelines because the patient was admitted
- Use outpatient guidelines; the confirmed diagnosis I50.22 is coded (Correct answer)
- Code only signs and symptoms since the stay was under 24 hours
- Apply observation guidelines exclusively
Correct answer: Use outpatient guidelines; the confirmed diagnosis I50.22 is coded
Even for same-day admissions, outpatient guidelines apply and the confirmed diagnosis (I50.22, chronic systolic heart failure) is coded.
Question 2: An instructional note 'Excludes1' in ICD-10-CM means:
- The excluded condition can be coded together if both conditions are documented
- The two conditions cannot occur together and cannot be coded simultaneously (Correct answer)
- The excluded code should be assigned as an additional code
- The excluded condition has been incorporated into the current code
Correct answer: The two conditions cannot occur together and cannot be coded simultaneously
Excludes1 indicates a pure exclusion—the conditions are mutually exclusive and cannot be assigned together.
Question 3: When coding adverse effects of correctly prescribed and properly administered medications in ICD-10-CM, what is the sequencing rule?
- Code the drug first, then the adverse effect manifestation
- Code the adverse effect manifestation first, then the drug code with 5th character '5' (Correct answer)
- Code only the drug; manifestations are included
- Code the manifestation with the drug as an external cause
Correct answer: Code the adverse effect manifestation first, then the drug code with 5th character '5'
For adverse effects, the nature of the adverse effect (manifestation) is sequenced first, followed by the drug code from Table of Drugs and Chemicals with the appropriate character for adverse effect.
Question 4: Which ICD-10-CM code is used when a patient is seen specifically because a screening colonoscopy reveals a polyp?
- Z12.11 as the first-listed code only
- Z12.11 plus the polyp finding code, with Z12.11 as first-listed (Correct answer)
- The polyp code as first-listed, with Z12.11 as secondary
- Only the polyp code; screening codes are dropped when a finding exists
Correct answer: Z12.11 plus the polyp finding code, with Z12.11 as first-listed
Per ICD-10-CM guidelines, the screening code Z12.11 remains first-listed even when a finding is discovered; the finding is coded additionally.
Question 5: A patient is treated for cellulitis of the right lower leg caused by Staphylococcus aureus. How many ICD-10-CM codes are required?
- One combination code covers both cellulitis and organism
- Two codes: L03.115 for right lower leg cellulitis and B95.61 for MSSA (Correct answer)
- Two codes: L03.115 and a separate organism code only if MRSA
- Three codes: site, laterality, and organism separately
Correct answer: Two codes: L03.115 for right lower leg cellulitis and B95.61 for MSSA
L03.115 identifies right lower leg cellulitis, and B95.61 identifies Staphylococcus aureus (MSSA) as the causative organism, requiring two codes.
Question 6: In ICD-10-CM, how is alcohol use disorder with alcohol-induced depressive disorder coded?
- Two separate codes: one for AUD and one for depression
- A single combination code from category F10 that captures both (Correct answer)
- Only the depressive disorder code, as it is the more severe condition
- Only the AUD code; mental disorders due to substance use are excluded
Correct answer: A single combination code from category F10 that captures both
ICD-10-CM provides combination codes in category F10 (e.g., F10.14 or F10.24) that capture both the alcohol use disorder and the induced depressive episode.
Question 7: A patient is seen for a follow-up visit for a healed fracture with residual stiffness of the wrist. Which ICD-10-CM character identifies this as a sequela encounter?
- 7th character A
- 7th character D
- 7th character S (Correct answer)
- 7th character G
Correct answer: 7th character S
The 7th character 'S' designates a sequela encounter, used when residual conditions remain after the acute phase of an injury has resolved.
COC ICD-10-CM Coding 4
A patient with chronic systolic heart failure is admitted through the ED and ultimately discharged the same day.
Which ICD-10-CM guideline applies to sequencing?