AAPC ICD-10-CM Proficiency Assessment — Questions and Answers

Question 1: Under UHDDS, how is the principal diagnosis defined?

The first diagnosis the admitting physician lists
The most serious condition treated during the stay
The condition that used the most resources
The condition established after study to be chiefly responsible for the admission (Correct answer)

Correct answer: The condition established after study to be chiefly responsible for the admission

UHDDS defines the principal diagnosis as 'that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.'

Question 2: How is diabetes coded in ICD-10-CM?

With codes from E08-E13 specifying the type of diabetes and complications using 4th-6th characters (Correct answer)
Only as E10
With a single code
Only by body system affected

Correct answer: With codes from E08-E13 specifying the type of diabetes and complications using 4th-6th characters

Diabetes codes differentiate by type (Type 1=E10, Type 2=E11, drug-induced=E09, etc.) and complications (kidney, eye, neurological) through additional characters.

Question 3: A pregnant patient is seen for a urinary tract infection and the provider does not state the pregnancy is incidental. Which codes are sequenced first?

Z3A codes
Z33.1
N39.0
Chapter 15 (O) codes (Correct answer)

Correct answer: Chapter 15 (O) codes

Chapter 15 codes have sequencing priority over other chapters unless the provider documents the pregnancy is incidental.

Question 4: A patient is admitted with sepsis due to Escherichia coli, present on admission. Which code is sequenced first?

R65.20
A41.51 (Correct answer)
A41.9
B96.20

Correct answer: A41.51

A41.51 (sepsis due to E. coli) identifies both sepsis and organism and is sequenced first.

Question 5: A patient had breast cancer excised two years ago, has no evidence of disease, and receives no treatment. How is this reported?

Z08
D05.10
Z85.3 (Correct answer)
C50.911

Correct answer: Z85.3

When the primary malignancy has been excised or eradicated with no further treatment and no evidence of disease, a personal history Z85 code is used.

Question 6: What is the difference between an electronic health record (EHR) and an electronic medical record (EMR)?

There is no difference between EHRs and EMRs. It's just a terminology difference
EHRs contain images, while EMRs only contained electronic "paper" chart formats.
EHRs are able to communicate with other systems, but EMRs are not. (Correct answer)
EHRs contain financial information while EMRs only contain clinical information.

Correct answer: EHRs are able to communicate with other systems, but EMRs are not.

The primary difference between an Electronic Medical Record (EMR) and an Electronic Health Record (EHR) lies in their scope and interoperability. An EMR is typically a digital version of a patient's chart within a single practice, while an EHR is designed to be a more comprehensive, interoperable system that can share information across different healthcare settings and organizations. EHRs facilitate communication between various healthcare providers.

Question 7: What is the Excludes1 note in ICD-10-CM?

A list of included conditions
A list of related codes
An obsolete notation
A note indicating two conditions cannot occur together, so the codes should never be reported together (Correct answer)

Correct answer: A note indicating two conditions cannot occur together, so the codes should never be reported together

Excludes1 means 'not coded here.' The excluded condition and the code cannot be used together because the two conditions cannot coexist.

Question 8: For a patient seen for an injury caused by a fall, which type of code captures how the injury happened?

An external cause code (V–Y) (Correct answer)
An R code
A C code
A Z code

Correct answer: An external cause code (V–Y)

External cause codes (V00–Y99) describe the circumstances, like a fall, that led to the injury.

Question 9: Which ICD-10-CM chapter is identified by codes beginning with the letter 'I'?

Mental disorders
Diseases of the respiratory system
Diseases of the circulatory system (Correct answer)
Neoplasms

Correct answer: Diseases of the circulatory system

Codes I00–I99 cover diseases of the circulatory system, including hypertension and heart disease.

Question 10: What is the value of reviewing your answers before submitting an exam?

It wastes time
No value
It only adds anxiety
It catches careless errors, allows reconsideration of flagged questions, and may improve your score (Correct answer)

Correct answer: It catches careless errors, allows reconsideration of flagged questions, and may improve your score

Review catches mistakes from misreading questions, accidental selections, and provides an opportunity to reconsider difficult questions with a fresh perspective.

Question 11: What are Z codes used for in ICD-10-CM?

Zombie-related conditions
Factors influencing health status and contact with health services, such as screenings, vaccinations, and history of conditions (Correct answer)
Emergency codes
Zero-severity conditions

Correct answer: Factors influencing health status and contact with health services, such as screenings, vaccinations, and history of conditions

Z codes capture encounters not related to illness, including preventive care, screening, personal/family history, and post-procedural states.

Question 12: What is the value of industry certifications?

They validate knowledge, demonstrate commitment to the profession, and may be required by employers or regulations (Correct answer)
They replace experience
They are meaningless
They guarantee employment

Correct answer: They validate knowledge, demonstrate commitment to the profession, and may be required by employers or regulations

Certifications provide third-party validation of your knowledge and skills, showing employers and clients that you meet recognized professional standards.

Question 13: What does 'unspecified' mean in an ICD-10-CM code?

The documentation does not provide enough detail to assign a more specific code (Correct answer)
The code is invalid
The disease is unknown
The patient refused diagnosis

Correct answer: The documentation does not provide enough detail to assign a more specific code

Unspecified codes are used when clinical documentation lacks the detail needed for a more specific code. They should be avoided when more specific information is available.

Question 14: Why is understanding concepts better than memorizing facts for exams?

Memorization is always sufficient
Understanding enables you to apply knowledge to new situations, while memorized facts only help with exact recall (Correct answer)
It is not better
Understanding takes too long

Correct answer: Understanding enables you to apply knowledge to new situations, while memorized facts only help with exact recall

Conceptual understanding allows you to reason through unfamiliar questions by applying principles, while memorization only helps when the exact fact is asked.

Question 15: A patient is documented as nicotine dependent on cigarettes with no complications. Which code is correct?

Z72.0
F17.210 (Correct answer)
F17.200
Z87.891

Correct answer: F17.210

F17.210 is nicotine dependence, cigarettes, uncomplicated; Z72.0 is for tobacco use without dependence.

Question 16: What codes are used for pregnancy, childbirth, and the puerperium?

P codes
Z codes
S codes
O codes (Chapter 15) (Correct answer)

Correct answer: O codes (Chapter 15)

Chapter 15 uses O codes (O00-O9A) for conditions related to pregnancy, labor, delivery, and the postpartum period.

Question 17: What is the importance of ethics in professional practice?

Ethics are just about following the law
Ethics only apply to certain professions
Ethics are optional
Ethical practice builds trust, protects clients, maintains professional standards, and ensures long-term career viability (Correct answer)

Correct answer: Ethical practice builds trust, protects clients, maintains professional standards, and ensures long-term career viability

Professional ethics go beyond legal requirements to encompass honesty, integrity, confidentiality, and putting client interests first, which are fundamental to any trusted profession.

Question 18: In the ICD-10-CM coding convention, what does the abbreviation 'NOS' mean?

None of the system
Not otherwise specified (Correct answer)
Number of services
Newly observed symptom

Correct answer: Not otherwise specified

NOS means 'not otherwise specified' and corresponds to an unspecified code.

Question 19: How many characters can an ICD-10-CM code have?

3-7 (Correct answer)
3-5
Exactly 5
5-10

Correct answer: 3-7

ICD-10-CM codes range from 3 to 7 characters, with the first three being the category and additional characters providing greater specificity.

Question 20: Which Z code is assigned for a patient presenting for a routine general adult medical examination with no abnormal findings?

Z01.00
Z00.01
Z13.89
Z00.00 (Correct answer)

Correct answer: Z00.00

Z00.00 is 'Encounter for general adult medical examination without abnormal findings,' used for routine annual physicals with no issues discovered.

Question 21: How is it coded if a patient gets severe sepsis during a hospital stay that was not present on admission?

C)System infection and appropriate code from R65.2 is assigned as a primary diagnosis
D)Systemic infection is coded with A41.9 with code R65.21
B) Systemic infection and appropriate code from R65.2 is assigned as a secondary diagnosis (Correct answer)
A) A41.2 following by R65.2 as secondary diagnosis

Correct answer: B) Systemic infection and appropriate code from R65.2 is assigned as a secondary diagnosis

According to ICD-10-CM coding guidelines, if severe sepsis develops during a hospital stay and was not present on admission (POA), the underlying systemic infection (e.g., specific bacterial infection) should be coded first. The code for severe sepsis (from category R65.2) is then assigned as a secondary diagnosis to indicate the severity and onset during the hospitalization. This accurately reflects that the sepsis was a complication of the hospital stay, not the initial reason for admission.

Question 22: What is a combination code in ICD-10-CM?

A code for multiple patients
Two codes combined into one
A single code that classifies both the diagnosis and a common symptom, manifestation, or complication together (Correct answer)
A merged billing code

Correct answer: A single code that classifies both the diagnosis and a common symptom, manifestation, or complication together

Combination codes classify two diagnoses or a diagnosis with a complication in a single code, reducing the need for multiple codes.

Question 23: What does an Excludes1 note mean in the ICD-10-CM Tabular List?

The two conditions may be coded together if unrelated
The two conditions can never be coded together (Correct answer)
The code requires a placeholder character
The code is excluded from inpatient use

Correct answer: The two conditions can never be coded together

Excludes1 means 'not coded here'; the two conditions are mutually exclusive, with limited exceptions when they are unrelated.

Question 24: A patient stopped taking an antihypertensive because of cost, resulting in uncontrolled hypertension. Which sixth character in the T46 code identifies underdosing?

4
5
1
6 (Correct answer)

Correct answer: 6

Underdosing codes use the character 6 (for example T46.5X6A), with a Z91.12-/Z91.13- code for the reason.

Question 25: An 'Excludes1' note in ICD-10-CM means what?

The code is obsolete
The two conditions can be coded together
The excluded code should never be used with the code above it (Correct answer)
Only one character is excluded

Correct answer: The excluded code should never be used with the code above it

Excludes1 is a pure exclusion meaning the two conditions cannot be reported together.

Question 26: A patient presents only to receive an influenza vaccination. Which code is first-listed?

Z23 (Correct answer)
Z00.00
J11.1
Z79.899

Correct answer: Z23

Z23 is encounter for immunization, reported with the appropriate procedure code for the vaccine.

Question 27: Why does code T36.0X1A include the letter X in the fifth position?

It indicates an unknown drug
It indicates unspecified laterality
It is a placeholder so the seventh character stays in position seven (Correct answer)
It marks an external cause

Correct answer: It is a placeholder so the seventh character stays in position seven

The X placeholder fills unused character positions so that the 7th character is in the correct place.

Question 28: What is the principal diagnosis?

The condition established after study to be chiefly responsible for the patient's admission to the hospital (Correct answer)
The most severe condition
The first diagnosis listed
The most expensive diagnosis

Correct answer: The condition established after study to be chiefly responsible for the patient's admission to the hospital

The principal diagnosis is determined after evaluation and is the condition that prompted the inpatient admission, which may differ from the admitting diagnosis.

Question 29: Which letters begin the ICD-10-CM chapter for certain infectious and parasitic diseases?

S and T
V and W
A and B (Correct answer)
E and F

Correct answer: A and B

Chapter 1 codes A00–B99 cover infectious and parasitic diseases.

Question 30: What is a placeholder character 'x' used for in ICD-10-CM?

To indicate an uncertain diagnosis
To mark codes as experimental
To mark obsolete codes
To fill positions when a code requires more characters but has no valid value for intermediate positions (Correct answer)

Correct answer: To fill positions when a code requires more characters but has no valid value for intermediate positions

The placeholder 'x' fills empty character positions in codes that need a 7th character extension but do not have valid 4th, 5th, or 6th character options.

Question 31: A patient comes in with her face covered in boiling soup after her pressure cooker exploded. Fortunately, she was wearing a sweater that shielded her arms. Her entire face is covered in partial-thickness burns. As the hospital removes chicken, celery, and burnt tissue from her face and places dressings on it, what is the correct CPT code to apply?

97597
D)16020, 97597-59
11011
16025 (Correct answer)

Correct answer: 16025

CPT code 16025 is appropriate for the initial treatment, dressing, and/or debridement of a partial-thickness burn, which includes the removal of foreign material and burnt tissue. The patient's face is covered in partial-thickness burns, and the procedure involves removing chicken, celery, and burnt tissue. Code 11011 is for debridement of full-thickness wounds, which is not applicable here.

Question 32: What does the E code chapter cover in ICD-10-CM?

External causes of injury
Endocrine, nutritional, and metabolic diseases (Correct answer)
Emergency codes
Eye diseases

Correct answer: Endocrine, nutritional, and metabolic diseases

Chapter 4 (E00-E89) covers endocrine, nutritional, and metabolic diseases including diabetes, thyroid disorders, and malnutrition.

Question 33: A dietitian documents a BMI of 38, and the physician documents obesity. Can the BMI code be reported?

No, BMI codes are for inpatient only
No, only physicians can document BMI
Yes, BMI may come from other clinicians but the associated diagnosis must be provider-documented (Correct answer)
Yes, without any associated diagnosis

Correct answer: Yes, BMI may come from other clinicians but the associated diagnosis must be provider-documented

BMI can be taken from clinicians other than the provider, but the associated diagnosis such as obesity must be documented by the provider.

Question 34: A manifestation code has a 'code first underlying condition' note. How can it be reported?

Without the underlying condition
Only as a secondary diagnosis after the etiology code (Correct answer)
Only in outpatient settings
As the principal diagnosis

Correct answer: Only as a secondary diagnosis after the etiology code

Manifestation codes cannot be first-listed; the underlying condition is sequenced first.

Question 35: Which statement about external cause codes (V00–Y99) is correct?

They are never sequenced first (Correct answer)
They may be principal diagnosis for injuries
They replace injury codes
They are required by all payers

Correct answer: They are never sequenced first

External cause codes are secondary codes and are never reported as the first-listed or principal diagnosis.

Question 36: What ICD-10-CM code range covers neoplasms?

A00-B99
G00-G99
C00-D49 (Correct answer)
E00-E89

Correct answer: C00-D49

Neoplasms (tumors/cancers) are classified in Chapter 2 using codes C00-D49, with C codes for malignant and D codes for benign/uncertain behavior.

Question 37: What is the purpose of continuing education in a profession?

It is only for new professionals
To collect certificates
To increase tuition revenue for schools
To maintain and expand knowledge, meet licensing requirements, and stay competitive in the field (Correct answer)

Correct answer: To maintain and expand knowledge, meet licensing requirements, and stay competitive in the field

Continuing education ensures professionals maintain current knowledge, meet regulatory requirements, and develop new skills for career advancement.

Question 38: What is the correct format for an ICD-10-CM code?

Only letters
Numbers then letters
A letter followed by two numbers, then a decimal point, then up to four alphanumeric characters (Correct answer)
All numbers

Correct answer: A letter followed by two numbers, then a decimal point, then up to four alphanumeric characters

ICD-10-CM codes start with a letter, followed by two numbers (the category), a decimal point, then up to four additional alphanumeric characters for specificity.

Question 39: In the Alphabetic Index, what do brackets [ ] around a code or term typically enclose?

Synonyms, alternative wording, or explanatory phrases (Correct answer)
Deleted codes
Billing amounts
Manufacturer notes

Correct answer: Synonyms, alternative wording, or explanatory phrases

Brackets enclose synonyms, alternative terms, or explanatory phrases in the index and tabular list.

Question 40: What ICD-10-CM category covers symptoms and signs not classified elsewhere?

F codes
Z codes
S codes
R codes (Chapter 18) (Correct answer)

Correct answer: R codes (Chapter 18)

Chapter 18 (R00-R99) covers symptoms, signs, and abnormal clinical and lab findings not elsewhere classified, used when a definitive diagnosis has not been established.

Question 41: Codes in the range C00–C96 in ICD-10-CM represent what type of condition?

Endocrine disorders
Infectious diseases
Skin conditions
Malignant neoplasms (Correct answer)

Correct answer: Malignant neoplasms

The C codes are used for malignant neoplasms, which are cancers.

Question 42: Which of the following is an example of a long-term (current) drug therapy status Z code?

Z87.891 – Personal history of nicotine dependence
Z79.01 – Long-term (current) use of anticoagulants (Correct answer)
Z20.822 – Contact with COVID-19
Z00.00 – General health examination

Correct answer: Z79.01 – Long-term (current) use of anticoagulants

Z79 codes indicate the patient is currently receiving ongoing medication therapy, which may affect treatment decisions and drug interactions.

Question 43: The seventh-character 'A' in an injury code most commonly indicates which encounter type?

Subsequent encounter
Routine healing
Initial encounter (Correct answer)
Sequela

Correct answer: Initial encounter

The letter 'A' designates the initial encounter while the patient receives active treatment.

Question 44: In the outpatient setting, a physician documents 'probable pneumonia.' How should the coder report the visit?

Code the signs and symptoms documented (Correct answer)
Code pneumonia, unspecified organism
Query for a surgical procedure
Code Z03.89 only

Correct answer: Code the signs and symptoms documented

Outpatient guidelines prohibit coding uncertain diagnoses (probable, suspected), so signs and symptoms are coded instead.

Question 45: The instructional note 'Code first' in ICD-10-CM directs the coder to do what?

Always use the first code in the chapter
Bill the first provider
Sequence the underlying condition before the manifestation (Correct answer)
Code only the first encounter

Correct answer: Sequence the underlying condition before the manifestation

'Code first' indicates an underlying etiology must be sequenced before the manifestation code.

Question 46: What does 'code also' mean in ICD-10-CM?

An optional instruction
Code again in another system
An error message
An instruction that two codes may be needed together to fully describe a condition, with either code potentially sequenced first (Correct answer)

Correct answer: An instruction that two codes may be needed together to fully describe a condition, with either code potentially sequenced first

'Code also' indicates that both codes should be reported. Unlike 'code first,' sequencing depends on the circumstances of the encounter.

Question 47: What role does rest play in exam preparation?

Rest reduces motivation
Adequate sleep consolidates learning, improves memory, and enhances cognitive function on exam day (Correct answer)
Rest is unnecessary
Sleep only matters the night before

Correct answer: Adequate sleep consolidates learning, improves memory, and enhances cognitive function on exam day

Sleep is essential for memory consolidation — the process of transferring information from short-term to long-term memory. Sleep deprivation impairs cognitive function.

Question 48: Which of the following is NOT a part of personal health information?

License plate number
C)Zip Code
URL
All of the above are PHI elements (Correct answer)

Correct answer: All of the above are PHI elements

Protected Health Information (PHI) under HIPAA includes any information that can be used to identify an individual and relates to their health status, the provision of healthcare, or payment for healthcare. A license plate number, URL, and zip code are all considered direct or indirect identifiers among the 18 elements specified by HIPAA that constitute PHI. Therefore, all the listed items are PHI elements.

Question 49: What ICD-10-CM chapter covers diseases of the musculoskeletal system?

Chapter 5
Chapter 10
Chapter 19
Chapter 13 (M codes) (Correct answer)

Correct answer: Chapter 13 (M codes)

Chapter 13 covers diseases of the musculoskeletal system and connective tissue using M codes (M00-M99), including arthritis, back pain, and osteoporosis.

Question 50: Which ICD-10-CM chapter covers diseases of the respiratory system?

Chapter 10 (J codes) (Correct answer)
Chapter 7 (H codes)
Chapter 14 (N codes)
Chapter 5 (F codes)

Correct answer: Chapter 10 (J codes)

Chapter 10 of ICD-10-CM covers diseases of the respiratory system using codes beginning with the letter J (J00-J99).

Question 51: What is the best way to build credibility in a professional field?

Having a large social media following
Demonstrating expertise through consistent quality work, obtaining certifications, and building a portfolio (Correct answer)
Working for free
Self-promotion only

Correct answer: Demonstrating expertise through consistent quality work, obtaining certifications, and building a portfolio

Professional credibility is built through a track record of quality work, relevant certifications, and a portfolio that demonstrates your capabilities.

Question 52: Which of these is NOT a column in the ICD-10-CM Neoplasm Table?

Uncertain Behavior
Metastatic Recurrence (Correct answer)
Malignant Secondary
Carcinoma in situ

Correct answer: Metastatic Recurrence

The Neoplasm Table columns are Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior and Unspecified Behavior. 'Metastatic Recurrence' is not a column.

Question 53: Where are injury codes found in ICD-10-CM?

A codes
Chapter 19 (S and T codes) (Correct answer)
J codes
N codes

Correct answer: Chapter 19 (S and T codes)

Chapter 19 covers injuries, poisoning, and certain other consequences of external causes, using S codes for body-region injuries and T codes for other trauma.

Question 54: What is sequencing in ICD-10-CM?

A random arrangement
Putting codes in alphabetical order
The order in which diagnosis codes are listed, with the principal/first-listed diagnosis sequenced first (Correct answer)
Numbering codes

Correct answer: The order in which diagnosis codes are listed, with the principal/first-listed diagnosis sequenced first

Sequencing determines which diagnosis is listed first (principal diagnosis for inpatient, first-listed for outpatient) followed by additional diagnoses in order of relevance.

Question 55: What does ICD-10 stand for?

International Classification of Diseases, 10th Revision (Correct answer)
International Code of Diseases version 10
Integrated Classification of Diagnostics 10
Internal Coding Dictionary 10

Correct answer: International Classification of Diseases, 10th Revision

ICD-10 is the 10th revision of the International Classification of Diseases, maintained by the World Health Organization for classifying diseases and health conditions.

Question 56: What should you code first in an outpatient encounter?

The chronic conditions
The most severe condition
Symptoms only
The reason for the encounter or visit (Correct answer)

Correct answer: The reason for the encounter or visit

In outpatient settings, the first-listed diagnosis is the condition chiefly responsible for the services provided during the encounter.

Question 57: A coder for urosepsis must:

Code first localized sepsis
Query the provider (Correct answer)
Use the code for severe sepsis
Use the code for sepsis with organ dysfunction

Correct answer: Query the provider

The term 'urosepsis' is a clinical term that does not have a specific, direct code in ICD-10-CM. It can imply various conditions, such as a urinary tract infection (UTI), sepsis originating from the urinary tract, or even severe sepsis. Therefore, a coder must query the provider for clarification on the definitive diagnosis (e.g., UTI, sepsis, or severe sepsis with organ dysfunction) to ensure accurate and compliant coding.

Question 58: This HIV-positive patient has never had any opportunistic infections and is asymptomatic. His primary care physician is seeing him today for a single episode of moderate major depressive disorder. To report this encounter, what code (s) would you use?

F32.1, B20
F32.1, Z21 (Correct answer)
B20, F32.1
Z21, F32.1

Correct answer: F32.1, Z21

For an asymptomatic HIV-positive patient, code Z21 (Asymptomatic human immunodeficiency virus [HIV] infection status) is used, not B20 (HIV disease). The primary reason for the encounter, moderate major depressive disorder, is coded first as F32.1. Therefore, the correct sequence is F32.1 followed by Z21, prioritizing the condition being treated during the visit.

Question 59: What are 7th character extensions used for in ICD-10-CM?

Error codes
Providing additional information such as initial encounter, subsequent encounter, or sequela (Correct answer)
Billing amounts
Provider identification

Correct answer: Providing additional information such as initial encounter, subsequent encounter, or sequela

The 7th character often indicates the encounter type: A (initial), D (subsequent), or S (sequela), particularly for injury and fracture codes.

Question 60: What is the 'code first' convention?

Code the first condition diagnosed
Certain codes must be sequenced before others; the underlying condition is coded first followed by the manifestation (Correct answer)
An obsolete rule
Always code alphabetically

Correct answer: Certain codes must be sequenced before others; the underlying condition is coded first followed by the manifestation

The 'code first' note indicates a manifestation code that requires the underlying disease to be coded first, establishing the etiology/manifestation relationship.

Question 61: What is the difference between ICD-10-CM and ICD-10-PCS?

They are the same
CM is older than PCS
CM is for diagnosis coding; PCS is for inpatient procedure coding (Correct answer)
CM is for outpatient; PCS is for outpatient

Correct answer: CM is for diagnosis coding; PCS is for inpatient procedure coding

ICD-10-CM (Clinical Modification) codes diagnoses across all settings. ICD-10-PCS (Procedure Coding System) codes inpatient procedures in hospitals.

Question 62: What ICD-10-CM chapter covers mental and behavioral disorders?

Chapter 15
Chapter 10
Chapter 1
Chapter 5 (F codes) (Correct answer)

Correct answer: Chapter 5 (F codes)

Chapter 5 covers mental, behavioral, and neurodevelopmental disorders using F codes (F01-F99), including depression, anxiety, and substance use disorders.

Question 63: Payments to the facility are based on:

RVUs and conversion factors
IPPS using DRGs (Correct answer)
Fee schedules
ICD-10 PCS codes

Correct answer: IPPS using DRGs

Medicare's Inpatient Prospective Payment System (IPPS) uses Diagnosis-Related Groups (DRGs) to determine a fixed payment amount for inpatient hospital stays. DRGs classify patients based on their diagnoses, procedures, age, and complications, allowing for a standardized reimbursement system. This differs from RVUs (Relative Value Units) which are used for physician services, or fee schedules which are common in outpatient settings.

Question 64: An 'Excludes2' note in ICD-10-CM indicates what?

The condition is not part of the code but may be coded together if present (Correct answer)
Two codes must always be combined
The diagnosis is excluded from billing
The code is deleted

Correct answer: The condition is not part of the code but may be coded together if present

Excludes2 means the excluded condition is separate, and both codes may be assigned if both are present.

Question 65: Can you code a suspected or probable diagnosis in outpatient settings?

Only with physician approval
No, code only confirmed conditions or the signs/symptoms in outpatient settings (Correct answer)
Only for cancer
Yes, always

Correct answer: No, code only confirmed conditions or the signs/symptoms in outpatient settings

In outpatient settings, do not code suspected, probable, or rule-out diagnoses. Instead, code the signs, symptoms, or conditions to the highest degree of certainty.

Question 66: A patient's history is made up of:

Chronic conditions, History of Present Illness, Review of Symptoms, Reason for Visit, Surgical history
Reason for Visit, History of Present Illness, Review of Symptoms, Prior History
Reason for Visit, History of Present Illness, Review of Symptoms, Prior History
Chief Complaint, History of Present Illness, Review of Symptoms, Past Family and Social History (Correct answer)

Correct answer: Chief Complaint, History of Present Illness, Review of Symptoms, Past Family and Social History

A patient's history, as defined in medical documentation guidelines (e.g., for Evaluation and Management services), typically comprises four main components: the Chief Complaint (CC), History of Present Illness (HPI), Review of Systems (ROS), and Past, Family, and Social History (PFSH). These elements collectively provide a comprehensive overview of the patient's health status and relevant background.

Question 67: What is algorithmic trading?

Trading algorithms as assets
Trading alphabetically
A manual trading strategy
Using computer programs to automatically execute trades based on predefined rules and conditions (Correct answer)

Correct answer: Using computer programs to automatically execute trades based on predefined rules and conditions

Algorithmic trading uses software to automatically identify opportunities and execute trades based on predefined criteria like price, volume, timing, or technical indicators.

Question 68: How should you manage test anxiety?

Test anxiety cannot be managed
Take medication only
Ignore it
Use preparation, deep breathing, positive self-talk, and arrive early to feel in control (Correct answer)

Correct answer: Use preparation, deep breathing, positive self-talk, and arrive early to feel in control

A combination of thorough preparation, relaxation techniques, positive visualization, and practical measures like early arrival helps manage test anxiety effectively.

Question 69: What chapter covers diseases of the circulatory system?

Chapter 11
Chapter 7
Chapter 3
Chapter 9 (I codes) (Correct answer)

Correct answer: Chapter 9 (I codes)

Chapter 9 covers diseases of the circulatory system using codes I00-I99, including heart disease, hypertension, and cerebrovascular conditions.

Question 70: How many characters does every valid ICD-10-PCS code contain?

7 (Correct answer)
Up to 8
3 to 7
5

Correct answer: 7

Every ICD-10-PCS code has exactly 7 alphanumeric characters. Each position has a set meaning, such as section, body system and root operation. ICD-10-CM codes can be 3 to 7 characters, but PCS codes are always 7.

Question 71: What does the first character of an ICD-10-CM code represent?

The provider type
A letter (A-Z, except U) indicating the chapter/category of disease (Correct answer)
The body system
The severity

Correct answer: A letter (A-Z, except U) indicating the chapter/category of disease

The first character is always a letter that corresponds to a specific chapter of the ICD-10-CM classification, such as J for respiratory diseases.

Question 72: What does 'laterality' mean in ICD-10-CM coding?

The severity of illness
Specifying which side of the body (right, left, or bilateral) is affected (Correct answer)
The direction of a procedure
The duration of disease

Correct answer: Specifying which side of the body (right, left, or bilateral) is affected

ICD-10-CM includes laterality to identify whether a condition affects the right side, left side, or both sides, adding clinical specificity.

Question 73: When should you use an acute and chronic code together?

Only for respiratory conditions
Never
Only in inpatient settings
When a condition has both an acute exacerbation and an underlying chronic condition, code both with the acute code first (Correct answer)

Correct answer: When a condition has both an acute exacerbation and an underlying chronic condition, code both with the acute code first

When a patient has both acute and chronic forms of a condition, both should be coded, with the acute condition sequenced first.

Question 74: A provider documents 'adenoma of the colon.' What should the coder do first?

Assign an unspecified behavior code
Code the malignant primary column
Look up 'adenoma' in the Alphabetic Index (Correct answer)
Go straight to the Neoplasm Table under 'colon'

Correct answer: Look up 'adenoma' in the Alphabetic Index

The guidelines say to look up the histologic term (for example, adenoma) in the Alphabetic Index first. The index entry then tells you which Neoplasm Table column to use or gives a specific code.

Question 75: What are external cause codes in ICD-10-CM?

Emergency department codes
Insurance codes
Codes (V00-Y99) that describe the cause, intent, place, and activity associated with an injury or health condition (Correct answer)
Hospital identification codes

Correct answer: Codes (V00-Y99) that describe the cause, intent, place, and activity associated with an injury or health condition

External cause codes provide additional information about how, where, and under what circumstances an injury or adverse effect occurred.

AAPC ICD-10-CM Proficiency Assessment

The AAPC ICD-10-CM Proficiency Assessment evaluates a medical coder's knowledge of ICD-10-CM format and structure, code groupings and categories, official coding guidelines, and accurate diagnosis code assignment.

Questions

210 min

Time Limit

80%

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