Chapter 8 — Exercises

Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.

Do these with a current ICD-10-CM open. That is not a suggestion; the chapter is about navigation and it cannot be practiced from a page.

A. Recall and vocabulary

8.1 State the two-step rule. For each step, name two things it protects against.

8.2 Name five things that live in the Tabular List and not in the Alphabetic Index.

8.3 † What kind of word is a main term? Give four categories of main term besides the disease name itself.

8.4 What does Knee — see condition mean, and what error is it catching?

8.5 † Distinguish essential from nonessential modifiers: how each appears, whether it changes the code, and whether it must be documented.

8.6 What does a trailing dash on an index entry mean?

8.7 † State the difference between Excludes1 and Excludes2 in one sentence each, then give the memory aid.

8.8 State the narrow exception to Excludes1 and what the guidance directs you to do when you are unsure.

8.9 † Distinguish "code first," "use additional code," and "code also" by where each appears and what each says about sequencing.

8.10 Distinguish NEC from NOS. Which one can a query fix, and why not the other?

8.11 What do brackets mean in the Tabular? What do they mean in the Index?

8.12 † What do the conventions "and" and "with" mean in ICD-10-CM? Which one gets its own section in Chapter 9, and why?

8.13 Name the six columns of the Table of Neoplasms and the six columns of the Table of Drugs and Chemicals.

8.14 For each of the three specialty tables, state the clinical question you must answer before you can use it.

B. Index navigation

For each, name the main term you would look up. Do not code yet.

8.15 † "Acute appendicitis" 8.16 "Left hip fracture" 8.17 † "Encounter for annual physical" 8.18 "Family history of colon cancer" 8.19 † "Diabetic neuropathy" 8.20 "Cellulitis of the right lower leg" 8.21 † "Patient here for chemotherapy" 8.22 "Streptococcal pharyngitis" 8.23 "Sprained ankle, initial visit, actively being treated"

C. Modifiers and conventions

8.24 † The index reads: Hypertension (accelerated) (benign) (essential) (malignant) (primary) (systemic) I10. Documentation says "benign hypertension." What do you code, and why does "benign" not change it?

8.25 The index reads:

   Pain(s)  R52
     joint  M25.50
       knee  M25.56-

Documentation says only "pain." May you assign M25.50? Why or why not?

8.26 † A category title reads "Tuberculosis of bones and joints." A patient has tuberculosis of a joint only. Does the category apply? State the convention.

8.27 A Tabular entry carries Excludes2: congenital form (Q__.__). Your patient has both the acquired and the congenital form. How many codes?

8.28 † A Tabular entry carries Excludes1: acquired form (M__.__). Your patient's record documents both, and they appear to be unrelated conditions in this patient. What do you do?

8.29 A code carries Code first the underlying disease. The record does not identify one. Is this a coding problem or a documentation problem? What is the tool?

8.30 † Explain why "code also" is the instruction people misread, and what it actually requires.

D. Full lookups

Perform each lookup completely — main term, subterms, index result, Tabular verification — and record the path. Name at least one plausible wrong turn for each.

8.31 † "Pain in the left knee"

8.32 "Acute exacerbation of COPD"

8.33 † "Screening mammogram, no symptoms"

8.34 "Essential hypertension"

8.35 † "Type 2 diabetes mellitus without complications"

8.36 "Shortness of breath"

8.37 † "Rash following amoxicillin taken as prescribed"

8.38 "Fall at home, initial encounter" — code both the injury circumstance and the place of occurrence.

E. Certification-style questions

8.39 † An Excludes1 note indicates that:

• A. both conditions may be reported together
• B. the two conditions cannot occur together and must not both be reported
• C. an additional code is required
• D. the code is invalid

8.40 A word in parentheses following a main term in the Alphabetic Index is:

• A. an essential modifier that must be documented
• B. a nonessential modifier that need not be documented
• C. a manifestation code
• D. an instructional note

8.41 † The abbreviation NEC indicates that:

• A. the documentation is insufficient
• B. the documentation is specific but the classification has no code for the condition
• C. an additional code is needed
• D. the code is unspecified

8.42 A code appearing in brackets in the Alphabetic Index:

• A. is a nonessential modifier
• B. is a manifestation code, sequenced second
• C. may be reported alone
• D. indicates an Excludes1 relationship

8.43 † In the Alphabetic Index, main terms are:

• A. anatomical sites
• B. conditions
• C. procedures
• D. providers

8.44 The instruction "see" in the Alphabetic Index is:

• A. advisory
• B. mandatory
• C. applicable only in the Tabular
• D. a cross-reference to a procedure code

8.45 † A patient took a prescribed medication exactly as directed and developed a reaction. In the Table of Drugs and Chemicals, the appropriate column is:

• A. poisoning, accidental
• B. poisoning, undetermined
• C. adverse effect
• D. underdosing

8.46 Before using the Table of Neoplasms you must know:

• A. the patient's age
• B. the behavior of the neoplasm
• C. the treatment given
• D. the payer

F. Write it

8.47 † Write the 120-word answer you would give a manager who asks why a lookup you have done four hundred times still takes four minutes. It must not be defensive and must contain a concrete example.

8.48 Write the note-to-self you would put in the front of your code book summarizing the Excludes1/Excludes2 distinction. Maximum 30 words.

8.49 Document the full path for one lookup from Section D, in the form you would want to read two years later if someone questioned the code.

G. The Encounter

8.50 † Reproduce the full lookup for M25.561, including both wrong turns. Then state exactly what step two produced that step one did not.

8.51 The chapter observes that three of step two's four findings for this code were negative — no seventh character, no Excludes, nothing changed. Argue that this makes the step more important rather than less.

8.52 † Write the path documentation for diagnosis A in the form described in Exercise 8.49. Then do the same for diagnosis C (I10), and note what is different about the second one.

8.53 Diagnosis B is E11.9. Perform the lookup. What main term? What subterm? What does the Tabular tell you at the category level that the index did not — and what does that instruction have to do with the problem list entry for chronic kidney disease? (Do not resolve it. Chapter 9 §9.7.)

8.54 Update your Encounter Workbook (Appendix C) with the documented lookup path for all four diagnoses.