ICD Flashcards

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

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.

Secondary glaucoma due to ocular inflammation was discovered in a patient with recurrent acute iridocyclitis in both eyes. The left eye is in a severe condition, while the right eye is at a moderate level. Which ICD-10-CM code (s) would you use to report this encounter?

Answer: H40.41X2, H40.42X3, H20.023

The correct codes are H40.41X2 for secondary glaucoma due to ocular inflammation, severe, in the left eye, and H40.42X3 for secondary glaucoma due to ocular inflammation, moderate, in the right eye. The 'X' is a placeholder for the seventh character, which is not applicable here. H20.023 is used for recurrent acute iridocyclitis in both eyes. These codes accurately reflect the specific type of glaucoma, its cause, laterality, severity, and the underlying inflammatory condition in both eyes.

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?

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.

A ten-year-old patient comes in with nausea, vomiting, a runny nose, and a sore throat. He's been unwell for a few days, but nausea and vomiting only started today. The mother claims that there are a lot of kids at school who have the same symptoms. The doctor diagnosed the patient with a viral infection after an examination. A streptococcal test was performed and found to be negative. What ICD-10-CM code (s) applies to this encounter?

Answer: B34.9

When a definitive diagnosis of a viral infection (B34.9, Viral infection, unspecified) is made, the individual symptoms (nausea, vomiting, runny nose, sore throat) are not coded separately. The negative streptococcal test further supports the viral diagnosis. Coding only the confirmed diagnosis avoids unnecessary and potentially misleading symptom codes.

A patient has CKD stage III, edema, and hypertension. For this chart, the proper ICD-10 CM codes are:

Answer: N18.3, I12.9

N18.3 correctly identifies Chronic Kidney Disease (CKD) Stage III. When hypertension and CKD are both present and documented as related, the appropriate code for hypertensive chronic kidney disease is I12.9. This code implicitly links the hypertension to the kidney disease, making a separate code for essential hypertension (I10) redundant. Edema (R60.9) is a symptom and is not coded separately when it's a known manifestation of the primary conditions and not further specified.

A cyst is found at the base of a patient's tailbone. The patient became swelled and uncomfortable to sit on. The clinician drapes the patient as normal, gives lidocaine, and excises the 2cm cyst and a subcutaneous extension. He then rinses the wound with sterile saline and does an intermediate wound repair with layered closure. For this procedure, the appropriate CPT code is:

Answer: 11771

CPT code 11771 is specifically for the excision of a pilonidal cyst or sinus with extensive excision, which includes subcutaneous extension as described in the scenario. The intermediate wound repair is considered an integral part of this complex excision and is bundled into the primary procedure code. Codes like 10080/10081 are for incision and drainage, and 11770 is for simple excision without extensive involvement.

The following ICD-10 codes are used:

Answer: All of the above

ICD-10 codes are primarily used as diagnosis codes to describe diseases, injuries, and other health conditions. These diagnosis codes are then utilized in Diagnosis-Related Groups (DRGs) for inpatient reimbursement, which are crucial for facility payments. Therefore, ICD-10 codes serve multiple critical functions in healthcare billing and data analysis.

A seven-year-old boy comes in for a series of vaccinations. The MMR and DTaP vaccines are given to the patients, as well as vaccination counseling. What is the correct CPT code for this procedure?

Answer: 90460x2, 90461x4

For patients under 18 receiving vaccines with counseling, CPT code 90460 is used for the first component of each vaccine, and 90461 is used for each additional component. The MMR vaccine has 3 components (Measles, Mumps, Rubella), and the DTaP vaccine has 3 components (Diphtheria, Tetanus, acellular Pertussis). This results in two 'first components' (90460x2) and four 'additional components' (90461x4) for the two vaccines.

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?

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.

A pregnant 25-year-old woman is 27 weeks and 6 days along in her pregnancy. The patient has dysuria and has blood in her urine. Acute cystitis has been diagnosed in her. What is the correct coding for this patient's medical record?

Answer: O23.12, N30.01, Z3A.27

When a pregnant patient has a condition like acute cystitis, the pregnancy-related code takes precedence. O23.12 specifies an infection of the bladder in pregnancy, second trimester, as the patient is 27 weeks and 6 days along. N30.01 further details the acute cystitis with hematuria. Z3A.27 is used to indicate the specific weeks of gestation, providing essential information about the pregnancy stage.

Faye called the coding department to complain about her adult sister's duplicate procedures when she was in an inpatient mental health facility. Faye knows her sister's birthday and name, but not her ID number. She claims that her sister is too depressed to speak up for herself and that all Faye wants is for the charge to be reviewed. What exactly do you do?

Answer: Tell Faye you'll review her sister's chart while she was hospitalized and process a corrected claim if needed.

While HIPAA generally requires patient consent to discuss Protected Health Information (PHI) with family members, the coding department can internally review a patient's chart to investigate a potential billing error. This action does not involve disclosing PHI to Faye but rather addressing a concern about the accuracy of the sister's bill. The department can investigate without violating privacy regulations.

Payments to the facility are based on:

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.

The following are the relative value units:

Answer: All of the above

Relative Value Units (RVUs) are a key component of the Medicare Physician Fee Schedule, representing the resources required to perform a service. They serve as a weight for procedure codes, are multiplied by a conversion factor to calculate payment, and are adjusted for different localities to account for geographic variations in practice costs. Therefore, all the listed statements accurately describe RVUs.

The following are examples of ___________: pressure ulcers, catheter-associated urinary tract infections, falls and head injuries, DVTs, and pulmonary embolisms.

Answer: Hospital-acquired conditions that will not be reimbursed

The listed conditions—pressure ulcers, catheter-associated urinary tract infections, falls and head injuries, DVTs, and pulmonary embolisms—are examples of Hospital-Acquired Conditions (HACs), also known as 'Never Events.' Under Medicare's payment policies, hospitals will not receive additional reimbursement for treating these conditions if they were not present on admission (POA), incentivizing hospitals to prevent them.

A prospective payment system is used by Medicare to pay for skilled nursing facilities. Reimbursement is dependent on the following criteria:

Answer: Per Diem

Medicare pays Skilled Nursing Facilities (SNFs) using a prospective payment system based on a 'Per Diem' rate. This means a fixed payment is made for each day a patient is in the facility, with adjustments based on the patient's Resource Utilization Group (RUG) classification, which reflects the intensity of care needed. This differs from DRGs, which are used for inpatient hospital stays.

Payment status indicator C in Medicare's Outpatient Prospective Payment System (OPPS) indicates that the HCPCS is:

Answer: Only performed in inpatient settings

In Medicare's Outpatient Prospective Payment System (OPPS), Payment Status Indicator 'C' signifies that a HCPCS code describes a service or procedure that is 'inpatient only.' This means Medicare will not pay for this service if it is performed in an outpatient setting, as it is deemed too complex or risky to be performed outside of an inpatient hospital stay.

The final authentication of the patient's health record by the provider, according to CMS, must NOT be done by:

Answer: Rubber stamp

CMS regulations require legitimate and verifiable methods for authenticating patient health records to ensure integrity and accountability. Acceptable methods include ink signatures, electronic signatures verified by biometrics, or electronic signatures verified by passcodes. Rubber stamps are generally not accepted as a valid form of authentication because they lack unique identification and can be easily misused.

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

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.

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

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.

In an electronic health record program, which of the following standards are used to create standardized nomenclature?

Answer: SNOMED CT

SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms) is a comprehensive, multilingual clinical terminology that provides a standardized way to represent clinical information in electronic health records. It is used to create standardized nomenclature within EHR programs, enabling consistent documentation, data exchange, and analysis across different systems and healthcare providers. ICD-10-CM, in contrast, is primarily for diagnosis coding.