CRC ICD-10-CM Coding Guidelines 2

Question 1

When a provider documents 'suspected' or 'probable' condition in an outpatient encounter, how should the coder handle this for risk adjustment?

Accepted Answer

Code only signs, symptoms, or findings — never code suspected conditions in outpatient settings

Answer

Section IV.H states uncertain diagnoses should NOT be coded in outpatient settings. Code to the highest degree of certainty.

Question 2

How is the causal relationship between diabetes and a complication established under ICD-10-CM guidelines?

Accepted Answer

ICD-10-CM assumes a causal relationship for certain conditions unless provider documents otherwise

Answer

Section I.C.4.a.6 presumes a causal link between diabetes and certain listed conditions unless the provider documents a different cause.

Question 3

A provider documents 'bilateral knee osteoarthritis.' What is the correct coding approach?

Accepted Answer

Code M17.0 for bilateral primary osteoarthritis

Answer

ICD-10-CM provides a specific bilateral code (M17.0) for knee osteoarthritis. When available, use the bilateral code.

Question 4

When should Z-codes be used as the principal or first-listed diagnosis?

Accepted Answer

When the encounter is specifically for the purpose described by the Z-code, such as screening or aftercare

Answer

Certain Z-codes can be principal when the encounter is specifically for that purpose: immunization, screening, aftercare, etc.

Question 5

When coding acute and chronic conditions for the same condition, what does Section I.B.8 require?

Accepted Answer

Code both with the acute code sequenced first, unless a combination code exists

Answer

If separate codes exist, code both with acute first. If a combination code exists (like acute-on-chronic heart failure), use that instead.

(CRC) Certified Risk Adjustment Coder Practice Test