Chapter 7 — Quiz

Twenty-four questions. Verify every code in the current year's book before using it on a claim.


Multiple choice

1. An ICD-10-CM code contains a minimum of ___ and a maximum of ___ characters.

  • A. three, six
  • B. three, seven
  • C. four, seven
  • D. four, eight

2. The second character of an ICD-10-CM code is always:

  • A. a letter
  • B. a number
  • C. either
  • D. a placeholder

3. The decimal point sits after character:

  • A. two
  • B. three
  • C. four
  • D. it varies

4. Neoplasms are classified in the chapter with the range:

  • A. A00–B99
  • B. C00–D49
  • C. D50–D89
  • D. E00–E89

5. The only letter covering two chapters is:

  • A. D
  • B. H
  • C. M
  • D. T

6. A three-character category is a valid code:

  • A. always
  • B. never
  • C. only when it has no further subdivision
  • D. only in chapters 1 through 5

7. A code reported at four characters when its complete form is six characters is:

  • A. less specific but acceptable
  • B. invalid
  • C. a truncation permitted for outpatient claims
  • D. a category code

8. The placeholder X:

  • A. pads the end of short codes
  • B. holds an empty position open so the seventh character sits in the seventh position
  • C. is optional when the meaning is clear
  • D. indicates an unspecified condition

9. Unspecified fall, initial encounter, is correctly reported as:

  • A. W19A
  • B. W19.XXA
  • C. W19.XXXA
  • D. W19.XXXXA

10. In chapter 19, seventh character A indicates:

  • A. the first visit for the condition
  • B. that the patient is receiving active treatment
  • C. an acute condition
  • D. an admission

11. For fractures, seventh character K indicates a subsequent encounter with:

  • A. routine healing
  • B. delayed healing
  • C. nonunion
  • D. malunion

12. In chapter 15, the seventh character identifies:

  • A. the trimester
  • B. which fetus the condition applies to
  • C. the episode of care
  • D. the delivery method

13. Laterality digit assignments:

  • A. are identical in every category
  • B. vary by category and must be verified
  • C. are always in the fifth character
  • D. always include a bilateral option

14. A single code classifying type 2 diabetes with diabetic chronic kidney disease is an example of a:

  • A. manifestation code
  • B. combination code
  • C. sequela code
  • D. placeholder code

15. A manifestation code shown in brackets in the Alphabetic Index is:

  • A. sequenced first
  • B. sequenced after the underlying condition
  • C. always reportable alone
  • D. a category code

16. ICD-10-CM is maintained by:

  • A. the American Medical Association
  • B. the National Center for Health Statistics
  • C. AAPC
  • D. the Medicare Administrative Contractors

17. The Cooperating Parties are:

  • A. CMS, NCHS, AHA, AHIMA
  • B. CMS, AMA, AAPC, AHIMA
  • C. NCHS, CDC, AMA, AHA
  • D. CMS, NCHS, AAPC, AHA

Short answer

18. Name the four purposes ICD-10-CM serves, and say which is not its primary purpose.

19. Take J96.01 apart character by character.

20. Explain the placeholder rule in one sentence, then say how many placeholders W19 needs and why.

21. State the definition of "initial encounter" and the definition people wrongly assume.

22. Name four costs of an unspecified code.

23. (Chapter 4) A note documents "knee pain" in the assessment, describes the right knee in the examination, and documents a right knee injection in the procedure note. What do you code, and is that reading or inference?

24. (Chapter 6) Besides new and deleted codes, what else changes on October 1, and why does it produce errors that never reject?


Answer key **1.** B. **2.** B. **3.** B. **4.** B. **5.** B — eye (H00–H59) and ear (H60–H95). **6.** C. **7.** B — **invalid**, not merely less specific. **8.** B. **9.** C. **10.** B — active treatment, not "the first visit." **11.** C. **12.** B. **13.** B. **14.** B. **15.** B. **16.** B. **17.** A. **18.** Reimbursement; statistics and public health; quality measurement; risk adjustment. **Reimbursement is not the primary purpose** — it is a downstream use of a system built for classification, which explains why the code that best describes an encounter and the code that best supports payment are frequently different, and why the coder's obligation runs to the first. **19.** `J` → chapter 10, respiratory system (J00–J99). `J96` → category, respiratory failure not elsewhere classified. `.0` → fourth character, acute respiratory failure. `.01` → fifth character, with hypoxia. Five characters, complete. **20.** If a code requires a seventh character and has fewer than six characters, X fills every empty position up to the sixth. `W19` is a three-character category, so it needs **three** placeholders — positions 4, 5, and 6 — producing `W19.XXXA`. Without them the `A` would sit in the fourth position, where it means something else or nothing. **21.** **Initial encounter** means the patient is receiving **active treatment** for the condition. The wrong assumption is that it means the first visit. A patient can have several encounters that are all "initial" because active treatment continues, and a first visit to a new provider taking over routine follow-up is "subsequent." **22.** It can fail a medical necessity edit against a coverage policy's diagnosis list; it understates severity in facility payment; it corrupts quality and public health data; and under risk adjustment it describes a population as healthier than it is — the largest cost and the one that never appears on a claim. **23.** **M25.561**, pain in right knee. This is **reading**, not inference. The laterality is documented in the record for this encounter — in the examination and in the procedure note — and reading the whole encounter rather than one section is what a coder is supposed to do. Inference would be supplying laterality the record never states anywhere. **24.** **The Official Guidelines are reissued and some of them change.** That produces silent errors, because a code that still exists with a new instruction attached to it will not reject — the claim is processed normally and the coding is wrong. Chapter 6 §6.7's checklist item is "check whether a guideline changed, not just whether codes changed," and it is the one organizations skip.