CRC - Certified Risk Adjustment Coder ICD-10-CM Diagnosis Coding Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old male presents for a follow-up visit for his Type 2 diabetes and hypertension. The physician documents the patient's diabetes is complicated by peripheral vascular disease (PVD). How should this be coded in ICD-10-CM?
- E11.9, I73.9
- I73.9, E11.9
- E11.51 (Correct answer)
- E11.69, I70.90
Correct answer: E11.51
ICD-10-CM provides a combination code, E11.51, for Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene. This single code accurately captures both the diabetes and the specified complication of PVD, reflecting the causal relationship. Using separate codes for the conditions is incorrect when a specific combination code is available.
Question 2: A patient is seen for an acute exacerbation of chronic obstructive pulmonary disease (COPD) with acute bronchitis. Which of the following is the correct ICD-10-CM code sequencing?
- J44.0, J20.9
- J44.1, J20.9 (Correct answer)
- J20.9, J44.1
- J44.9, J20.9
Correct answer: J44.1, J20.9
According to ICD-10-CM Official Guidelines, when coding an acute exacerbation of a chronic condition, the code for the acute exacerbation is sequenced first. J44.1 represents Chronic obstructive pulmonary disease with (acute) exacerbation. The acute bronchitis (J20.9) is sequenced second as it is the specific acute condition causing the exacerbation.
Question 3: Which of the following statements is TRUE regarding the coding of chronic conditions for risk adjustment purposes?
- Chronic conditions should only be coded once when they are first diagnosed.
- A chronic condition can be coded from a problem list without being addressed during the encounter.
- All co-existing chronic conditions that affect patient care can be reported annually. (Correct answer)
- Only chronic conditions that are the primary reason for the visit should be coded.
Correct answer: All co-existing chronic conditions that affect patient care can be reported annually.
For risk adjustment, all current co-existing chronic conditions that affect the care and management of a patient should be documented and reported at least once each calendar year. This ensures an accurate representation of the patient's health status and risk score.
Question 4: A 75-year-old female with known osteoporosis (M81.0) trips and falls at home, sustaining a pathologic fracture of the right hip. This is the initial encounter for the fracture. What is the correct primary diagnosis code?
- S72.001A, M81.0
- M80.051A (Correct answer)
- M81.0, S72.001A
- Z87.81, M80.051A
Correct answer: M80.051A
ICD-10-CM directs coders to use a code from category M80 for pathological fractures in patients with osteoporosis. M80.051A (Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture) is the specific combination code that captures both the fracture and the underlying osteoporosis, and it should be sequenced first.
Question 5: A patient undergoes a routine screening colonoscopy, and a benign polyp is found and removed. What is the appropriate first-listed diagnosis?
- K63.5, Polyp of colon
- D12.6, Benign neoplasm of colon, unspecified
- Z12.11, Encounter for screening for malignant neoplasm of colon (Correct answer)
- Z86.010, Personal history of colonic polyps
Correct answer: Z12.11, Encounter for screening for malignant neoplasm of colon
When the reason for the encounter is a screening, the appropriate screening Z code is the first-listed diagnosis, regardless of the findings. In this case, Z12.11 is used for the screening colonoscopy. The finding of a polyp (K63.5 or a more specific benign neoplasm code like D12.6) would be coded as a secondary diagnosis.
Question 6: In ICD-10-CM, an instructional note states 'Code first underlying condition.' This note is associated with a manifestation code. What does this indicate to the coder?
- The manifestation code can never be the principal diagnosis. (Correct answer)
- The underlying condition is optional and coded only if known.
- The manifestation code should be sequenced before the underlying condition.
- This note only applies to inpatient coding scenarios.
Correct answer: The manifestation code can never be the principal diagnosis.
The 'Code first' note is a sequencing instruction indicating that the underlying etiology must be coded first, before the manifestation code. Therefore, the manifestation code, which has this instructional note, can never be sequenced as the principal or first-listed diagnosis.
CRC - Certified Risk Adjustment Coder ICD-10-CM Diagnosis Coding Questions and Answers 1
A 68-year-old male presents for a follow-up visit for his Type 2 diabetes and hypertension.
The physician documents the patient's diabetes is complicated by peripheral vascular disease (PVD).
How should this be coded in ICD-10-CM?