Chapter 7 — Exercises
Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.
Every code in these exercises must be verified in the current year's ICD-10-CM before it touches a claim. The code set changes every October 1.
A. Recall and vocabulary
7.1 What is a classification trying to do, and what two design constraints follow from it?
7.2 Name the four purposes ICD-10-CM serves. Which one is not its primary purpose, and what does that explain?
7.3 † Give the letter range for each of these chapters: neoplasms; circulatory; musculoskeletal; genitourinary; symptoms and signs; factors influencing health status.
7.4 Which letter covers two chapters, and which two?
7.5 † Which chapters are organized by something other than body system? What is the consequence for a condition that could plausibly sit in two places?
7.6 State the character rules: minimum length, maximum length, which position is always a letter, which is always a number, and where the decimal sits.
7.7 † A three-character category is a valid code under what condition? What happens if it is reported when that condition is not met?
7.8 What is a block, and name two things that live at the block level.
7.9 † Explain the placeholder X in one sentence. Then state the rule for how many are needed.
7.10 Give the three chapter-19 seventh characters and the definition of each. Then state the definition of "initial" that most people get wrong.
7.11 Why do fractures have an expanded seventh-character set? Name four of the values.
7.12 † State the general laterality pattern, and then state the warning that matters more than the pattern.
7.13 Distinguish a combination code from an etiology/manifestation pair. How do you know which applies?
7.14 Name four costs of an unspecified code, and the one circumstance in which it is correct anyway.
7.15 Who maintains ICD-10-CM? Who are the Cooperating Parties? When does the code set change, and what else changes at the same time?
B. Take a code apart
For each, name the chapter, the category, and what each character after the category contributes.
7.16 † J44.1
7.17 I50.32
7.18 † N18.31
7.19 E11.65
7.20 † S52.501D
7.21 T39.1X1A
7.22 † W19.XXXA
7.23 M25.562
C. Valid or invalid
For each, state whether the code as written could be valid, and if not, what is wrong.
7.24 † M25.5
7.25 I10
7.26 † W19A
7.27 S52.501
7.28 † T39.1XA
7.29 E11.9
7.30 M25.5611
D. Applied reasoning
7.31 † A note documents bilateral knee pain. The category provides codes for right, left, and unspecified, and no bilateral code. What do you report, and what is the plausible wrong answer?
7.32 A coder assumes that in every category, 1 means right. Describe the failure mode, and state why the resulting claim is more dangerous than an invalid code.
7.33 † A patient has type 2 diabetes and stage 3a chronic kidney disease, both on the problem list. The assessment addresses the diabetes and does not mention the kidney disease. State what a combination code would assert, whether you may use it, and what you would need.
7.34 A note's assessment says "knee pain." The examination describes the right knee in detail and says the left is normal. The procedure note documents a right knee injection. Do you code M25.561 or M25.569? Is reaching that answer reading or inference? Defend it.
7.35 † Explain why "code to the highest level of specificity" is a validity rule and not a quality aspiration. Then explain why a coder who always uses unspecified codes to be safe has made a different error.
7.36 A category requires a seventh character. The code you need is four characters long. Build the complete code shape and say how many placeholders are required and where.
E. Certification-style questions
7.37 † The maximum number of characters in an ICD-10-CM code is:
- A. five
- B. six
- C. seven
- D. eight
7.38 The first character of an ICD-10-CM code is always:
- A. a number
- B. a letter
- C. either
- D. a letter except in chapter 22
7.39 † Which code correctly reports an unspecified fall, initial encounter?
- A. W19A
- B. W19.XA
- C. W19.XXA
- D. W19.XXXA
7.40 Codes beginning with the letter N are found in the chapter for:
- A. nervous system
- B. neoplasms
- C. genitourinary system
- D. nutritional disorders
7.41 † In chapter 19, the seventh character D indicates:
- A. the second encounter for the condition
- B. a subsequent encounter during routine healing or recovery
- C. a delayed diagnosis
- D. death
7.42 A single code that classifies a diagnosis together with an associated complication is a:
- A. manifestation code
- B. combination code
- C. placeholder code
- D. sequela code
7.43 † A manifestation code appearing in brackets in the Alphabetic Index:
- A. is sequenced first
- B. is sequenced after the underlying condition
- C. may be reported alone
- D. requires a seventh character
7.44 ICD-10-CM is updated annually effective:
- A. January 1
- B. April 1
- C. July 1
- D. October 1
F. Write it
7.45 † Write the 120-word explanation you would give a new colleague about why "initial encounter" does not mean "the first visit." Include an example.
7.46 Draft the one-page chapter-range reference card you would tape inside your ICD-10-CM book. Twenty-two lines. Then say why §6.2's exam rules matter to your answer.
7.47 Write, in your own words and under 100 words, what an unspecified code costs. Keep it. You will be asked to revise it in Chapter 36.
G. The Encounter
7.48 † Reproduce the drill-down for M25.561 from chapter to code, naming each level. Then do the same for a code you have never used.
7.49 The chapter observes that osteoarthritis (M15–M19) and other joint disorders (M20–M25) are adjacent blocks. State what separates Account 10-4471's code from the osteoarthritis block, quoting the note.
7.50 † Figure 4.2 documents laterality in three independent places. Name them. Then explain why that matters more than the fact that the assessment happened to say "right."
7.51 Account 10-4471's diagnosis B is E11.9. Take it apart character by character. Then state what E11.22 would assert and what the note would need to say to support it. Do not conclude that E11.22 should be assigned.
7.52 Update your Encounter Workbook (Appendix C) with the drill-down for M25.561 and the character-by-character reading of E11.9.