ICD-10 Practice Test
How is it coded if a patient gets severe sepsis during a hospital stay that was not present on admission?
B is the correct answer. Answer C - The scenario identifies the sepsis was not present on admission therefore it is not assigned as primary diagnosis Answer D - R65.21 is for septic shock and this is not documented Answer A - sepsis due to unspecified staphlococcus is not identified as the systemic infection. View ICD-10-CM guidelines for instructions
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?
B is the correct answer. When a patient has bilateral glaucoma and each eye is documented as having a different type of stage, assign the appropriate code for each eye rather than the code for bilateral glaucoma. Tabular index indicates to "code alo underlying condition" or the recurrent actue iridocyclitis.
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?
A is the correct answer. Per guidelines if the patient is asymptomatic and has not been treated for any HIV illness, the correct code is Z21. The depression is the primary reason for the visit and would be the first listed diagnosis of F32.1.
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?
A is the correct answer. When a definitive diagnosis is made by the provider the signs and symptoms are not reported. See ICD-10-CM guidelines
A patient has CKD stage III, edema, and hypertension. For this chart, the proper ICD-10 CM codes are:
Per ICD-10CM guidelines do not code signs and symptoms. Edema is a symptom of both hypertension and CKD. ICD-10CM guidelines state there is a casual relationship assumed between CKD and hypertension unless the provider specifically states that the hypertension is not related to the CKD, giving this patient hypertensive chronic kidney disease instead of regular hypertension.
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:
The provider performs an excision, not an incision, completely removing the cyst. The excision is intermediate because it involves subcutaneous extensions and the repair is included with the procedure.
The following ICD-10 codes are used:
ICD-10 PCS are used as procedure codes for inpatient visits. DRGs use similar ICD-10CM weights for facility reimbursement and ICD-10CM are used as diagnosis codes for all healthcare settings.
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?
Pediatric vaccines with counseling are coded per component. Each first component of a vaccine (Measles and Diphtheria in this case) are coded as one unit of 90460. Each additional component to the vaccine (mumps, rubella, tetanus and acellular pertussis) receive another 90461 for an additional component code.
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?
16025 covers whole face burns and includes debridement
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?
Cystitis is an infection of the bladder. The provider must specifically state that the infection or condition is not affecting the pregnancy for an incidental code. The patient is experiencing blood in her urine, which gives us the hematuria portion of the diagnosis.
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?
HIPAA Privacy Rule Section 164.510(b)(3) allows providers to discuss PHI with family members if they determine it is in the patient's best interest for coordination of treatment or payment, unless the patient has expressed wishes that their information is not shared with family.
Payments to the facility are based on:
The Inpatient Prospective Payment System drives value-based care by paying inpatient stays based on DRGs (Diagnosis-Related Group(s)) which are groups of diagnoses with similar weights in order to determine "how much" a patient's stay ought to cost. These drivers force hospitals to work to be most efficient in their use of resources to come in under what they will be paid in order to avoid losing money.
The following are the relative value units:
RVUs multiplied by conversion factor gives you the amount payable for a provider's fee schedule.
The following are examples of ___________: pressure ulcers, catheter-associated urinary tract infections, falls and head injuries, DVTs, and pulmonary embolisms.
The HAC-POA (Hospital acquired condition, present on admission) program was created by the Deficit Reduction Act of 2005--any of these conditions which are not present on admission and could have reasonably been prevented by following accepted standards of care will not be reimbursed. Usually, adding the DRG weight would have increased the facility's reimbursement, but this forces hospitals to avoid hospital acquired conditions, rather than profit from them.
A prospective payment system is used by Medicare to pay for skilled nursing facilities. Reimbursement is dependent on the following criteria:
The Balanced Budget Act mandated that SNF-PPS be paid per diem for all costs, which is based on a case-mix of diagnoses.
Payment status indicator C in Medicare's Outpatient Prospective Payment System (OPPS) indicates that the HCPCS is:
Payment status indicator C indicates that the HCPCS is only performed in an in-patient setting.
The final authentication of the patient's health record by the provider, according to CMS, must NOT be done by:
Rubber stamps were prohibited by CMS in 2015 for provider authentication
Which of the following is NOT a part of personal health information?
There are 18 unique identifiers protected by HIPAA. Only the first 3 digits of a patient's zip code is not PHI, as long as there are more than 20,000 people in the group that forms all zip codes. E.g. 123XX+123XY+123XZ have more than 20,000 people. Otherwise the zip code must be changed to 00000.
What is the difference between an electronic health record (EHR) and an electronic medical record (EMR)?
EHRs are defined by NAHIT as being able to communicate and exchange data with multiple systems. EMRs do not have this capacity.
In an electronic health record program, which of the following standards are used to create standardized nomenclature?
Systemized Nomenclature of Medicine--Clinical Terminology (SNOMED CT) is the global standard for clinicians and is used to define terms in EHRs around the world.
A patient's history is made up of:
CC, HPI, ROS, and PFSH are the components of patient history. ROS is performed to make sure the provider did not miss any relevant complaints and can be pulled from the HPI if needed.
The patient's history and physical must be completed and documented in the patient's record, as per CMS.
CMS conditions of participation require that the patient's history and physical be completed and documented within the patient's record within 24 hours of admission, but not greater than 30 days prior to admission.
Which of the following is a good example of a compliant query to a doctor?
Physician queries must be non-leading, not based on reimbursement, for the purpose of improving patient care and open-ended, or Yes/No questions. Providers must not add documentation solely for the purpose of being reimbursed and it must be within a reasonable time frame
Which of the following is a form of deception:
Procedures include a minor evaluation and management service. If the patient complains of an abscess and a I&D is performed, only the procedure should be reported. If the patient comes in complaining of hypertension and an abscess is discovered, then it would be acceptable to report an evaluation and management service.
A coder for urosepsis must:
According to ICD-10CM guidelines, urosepsis is a nonspecific term and has no tabular position. The provider must be queried for clarification.