CRC ICD-10-CM Diagnosis Coding 3 — Questions and Answers
Question 1: A patient with Hb-SS sickle cell disease presents with acute chest syndrome and pain crisis. What is the correct coding?
- D57.00 for sickle cell with crisis, unspecified
- D57.01 and D57.00 separately
- D57.01 for acute chest syndrome, which encompasses the crisis state (Correct answer)
- D57.01 and D57.02 coded separately
Correct answer: D57.01 for acute chest syndrome, which encompasses the crisis state
D57.01 specifically identifies acute chest syndrome in Hb-SS disease, which inherently indicates a crisis state.
ICD-10-CM sickle cell coding provides crisis-type specificity. D57.01 maps to HCC 46.
Question 2: A provider documents 'paraplegia secondary to old T12 spinal cord injury' from 8 years ago. How should this be coded?
- S34.109S Injury of lumbar spinal cord, sequela
- G82.20 Paraplegia, unspecified
- G82.20 and S34.109S for both current condition and cause (Correct answer)
- T91.3XXS Sequela of injury of spinal cord
Correct answer: G82.20 and S34.109S for both current condition and cause
Both the current functional deficit (G82.20) and the sequela code for the cause should be coded. Paraplegia maps to HCC 70.
G82.20 captures the active neurological condition. The S code with 7th character S identifies the original cause.
Question 3: A patient has atrial fibrillation and sick sinus syndrome with tachycardia-bradycardia. How are these coded?
- I49.5 only, as it includes the atrial fibrillation
- I48.91 and I49.5 separately (Correct answer)
- I48.91 only
- I49.5 and I48.20 together
Correct answer: I48.91 and I49.5 separately
These are distinct arrhythmia conditions without an Excludes1 note between them. Both may coexist independently.
I48.91 maps to HCC 96. The specific AF type should be coded based on documentation.
Question 4: A patient has 'chronic pain syndrome' and 'chronic pain due to left hip osteoarthritis.' How should the coder proceed?
- Code G89.4 as it encompasses all chronic pain
- Code M16.12 only as the underlying cause
- Code G89.4 and M16.12, with the underlying condition first (Correct answer)
- Code G89.29 and M16.12
Correct answer: Code G89.4 and M16.12, with the underlying condition first
Per ICD-10-CM guidelines, when chronic pain syndrome coexists with an identified cause, both should be coded with the underlying condition sequenced first.
Chronic pain syndrome (G89.4) is a distinct clinical entity, separate from the underlying cause.
Question 5: A provider documents 'patient has controlled HIV on antiretroviral therapy with undetectable viral load.' What code is assigned?
- Z21 Asymptomatic HIV infection status
- B20 Human immunodeficiency virus disease (Correct answer)
- Z86.19 Personal history of other infectious diseases
- Z21 since controlled status means the disease is not active
Correct answer: B20 Human immunodeficiency virus disease
B20 is correct. Once diagnosed with HIV disease, B20 is assigned for all subsequent encounters regardless of viral load status.
B20 maps to HCC 1, one of the highest RAF weights. Z21 is only for patients who have never had any HIV-related illness.
Question 6: A patient has rheumatoid arthritis affecting both hands with rheumatoid nodules and rheumatoid lung disease. What codes are needed?
- M05.441 and M05.442 for RA with nodules of both hands
- M05.441, M05.442, and M05.10 for hands with lung involvement (Correct answer)
- M05.441, M05.442, and J99
- M06.09 for RA of multiple sites
Correct answer: M05.441, M05.442, and M05.10 for hands with lung involvement
RA with nodules needs laterality-specific codes for each hand, plus M05.10 for lung involvement as a separate manifestation.
RA maps to HCC 40. Proper specificity ensures audit defensibility and clinical accuracy.
CRC ICD-10-CM Diagnosis Coding 3
A patient with Hb-SS sickle cell disease presents with acute chest syndrome and pain crisis.
What is the correct coding?