Chapter 10 — Exercises
Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.
All scenarios are constructed. Verify every code in the current year's ICD-10-CM.
A. Recall and vocabulary
10.1 State the six-step method for entering an unfamiliar body system. Which step is skipped most often, and why is it the highest-yield?
10.2 Are all infections coded from ICD-10-CM chapter 1? Explain, and say what decides.
10.3 † State the two conditions that must both be satisfied before you add a code identifying an infectious organism.
10.4 Distinguish B20 from Z21. State the rule that surprises people.
10.5 † Define sepsis, severe sepsis, and septic shock, and state the minimum number of codes each requires.
10.6 What is always sequenced first in a sepsis encounter?
10.7 † Name the six columns of the Table of Neoplasms. Distinguish "uncertain behavior" from "unspecified behavior" precisely.
10.8 What step do coders skip when using the Table of Neoplasms, and what does skipping it produce?
10.9 † State the three conditions that must all be met before a malignancy is coded as personal history.
10.10 Name the five diabetes categories and what distinguishes them. What is the default when the type is not documented?
10.11 † State the three boundaries on the "with" convention as they apply to diabetes.
10.12 Name three anemia codes that carry "code first" instructions and state what is sequenced first for each.
10.13 What does the mental and behavioral chapter ask for that clinicians frequently do not document?
10.14 † State the four pain-coding rules from §10.9. Is there a duration rule for chronic pain?
B. Apply the rules
10.15 † For each, state every code you would assign, in order, and the rule for each.
(a) "Sepsis due to MRSA." Nothing else documented. (b) "Sepsis, organism unknown. Acute respiratory failure secondary to sepsis." (c) "Sepsis. Acute encephalopathy." No stated relationship. (d) "Septic shock secondary to pneumonia. Acute kidney injury and acute respiratory failure, both secondary to sepsis."
10.16 "Patient presents solely for radiation therapy for prostate adenocarcinoma." Sequence.
10.17 † "Patient with metastatic breast cancer to bone presents for management of hypercalcemia." What is sequenced first, and what would you need to check?
10.18 "Type 2 diabetes with diabetic retinopathy. Also stage 3b chronic kidney disease, no stated relationship to the diabetes." Code and explain each decision.
10.19 † "Diabetes mellitus, poorly controlled." Type not documented, no complications documented. Code it, and name the two things in that sentence that are not codeable as written.
10.20 "Anemia in stage 4 chronic kidney disease." Sequence, and name the instruction that governs.
10.21 † "Patient with known metastatic colon cancer presents for chemotherapy. Develops nausea during infusion, treated." Is the sole-purpose rule satisfied? What follows?
10.22 "Chronic low back pain. Patient here for evaluation of new left leg weakness." Which pain rule applies, and what do you code?
C. Read the document
10.23 † An assessment reads:
1. Breast carcinoma, right, s/p lumpectomy and radiation 2019.
No evidence of recurrence. Surveillance imaging today.
2. Left breast: new suspicious lesion, biopsy pending.
Code both items and explain why they are coded differently.
10.24 A pathology report reads "specimen consistent with a neoplasm of uncertain malignant potential; recommend excision and further evaluation." The clinician's assessment reads "colon lesion." Which column of the Table of Neoplasms, and why is this not the unspecified column?
10.25 † A note documents "sepsis" in the assessment and, in a separate paragraph of the hospital course, "AKI resolved with fluids." State what you code and what you do, and name the rule.
D. Judgment and process
10.26 A colleague codes a chronic pain code because the patient's pain has lasted eight months. Explain what is wrong with that reasoning.
10.27 † Your practice's coders routinely omit long-term drug therapy status codes because "they don't pay." Give the four-part response.
10.28 A physician documents "diabetes with neuropathy" in one note and "neuropathy, etiology unclear" in another for the same patient. Which governs for the encounter you are coding, and what do you do?
10.29 † Design the pre-coding checklist you would use the first time you code a chart from a specialty you have never seen. Six items, in order, with what each produces.
10.30 A coder tells you they use the uncertain-behavior column when the pathology is ambiguous to them. Explain the error and what they should do instead.
E. Certification-style questions
10.31 † A patient has sepsis with no documented acute organ dysfunction. The correct coding is:
- A. the underlying infection code only
- B. the underlying infection code plus R65.20
- C. R65.20 sequenced first
- D. R65.21
10.32 In a sepsis encounter, what is always sequenced first?
- A. the severe sepsis code
- B. the underlying systemic infection
- C. the acute organ dysfunction
- D. septic shock
10.33 † A patient presents solely for chemotherapy for a known malignancy. Sequenced first is:
- A. the malignancy
- B. the encounter code for antineoplastic chemotherapy
- C. any complication
- D. either, at the coder's discretion
10.34 Once a patient has been assigned B20:
- A. they may revert to Z21 when the condition resolves
- B. B20 is assigned for all subsequent encounters
- C. Z21 is used for asymptomatic periods
- D. the inconclusive serology code applies
10.35 † When the type of diabetes is not documented, the default is:
- A. type 1
- B. type 2
- C. unspecified
- D. drug-induced
10.36 "Uncertain behavior" in the Table of Neoplasms indicates:
- A. the coder cannot determine the behavior
- B. the pathologist could not determine whether the neoplasm is benign or malignant
- C. the documentation does not state the behavior
- D. the neoplasm is malignant but the site is unknown
10.37 † A G89 pain code is sequenced first when:
- A. the pain has lasted more than three months
- B. the encounter is for pain management rather than for the underlying condition
- C. a site-specific pain code is also assigned
- D. the underlying diagnosis is unknown
F. Write it
10.38 † Write the compliant query for a note documenting sepsis and acute kidney injury with no stated relationship.
10.39 Write the 100-word explanation you would give a new coder of the difference between an active malignancy and a personal history code, including why it matters beyond accuracy.
10.40 Draft the six-step method from §10.1 as a card. Then apply it, in writing, to a body system this chapter did not cover.
G. The Encounter
10.41 † State exactly what E11.9 asserts and what it therefore assumes about the March 14 encounter. Then state why nothing here requires a query.
10.42 The chapter notes that "stable" and "uncontrolled" are not codeable axes. Explain what the classification asks about instead, and what a coder does when the record uses only those words.
10.43 † Compare Chart 1 in §10.10 with Account 10-4471. Both have type 2 diabetes and stage 3a chronic kidney disease. Explain, in three sentences, why they are coded differently.
10.44 The chapter raises the long-term drug therapy status code question and does not resolve it, directing the reader to the current Tabular instruction. Explain why the book handles it that way rather than printing a code.
10.45 Update your Encounter Workbook (Appendix C) with the endocrine-chapter analysis of diagnosis B.