Chapter 11 — Exercises
Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.
All scenarios are constructed. Verify every code and every convention against the current Section I.C — this chapter's guidance is among the most-revised in the document.
A. Recall and vocabulary
11.1 State the hypertension asymmetry precisely: which organ relationship is presumed, which must be stated or implied, and what happens in each case when the linkage is absent.
11.2 Why does the asymmetry exist? Give the reason that makes it memorable rather than arbitrary.
11.3 † State the myocardial infarction time rule. Name the three states and say when the subsequent-MI category applies.
11.4 Name the four axes of heart failure classification. Which two do clinicians usually document?
11.5 † Name the three distinct coding situations one cerebrovascular event can produce, and state what distinguishes them.
11.6 What is the dominant/non-dominant distinction, and where does it arise?
11.7 † State the respiratory failure sequencing rule. What does it turn on, and what does it explicitly not turn on?
11.8 In the digestive chapter, what may a coder not characterize, and why?
11.9 † State the pressure ulcer documentation rule. Give the general form of it from Chapter 4.
11.10 State the CKD staging rule and what governs when both a stage and end stage renal disease are documented.
11.11 † A patient has a functioning kidney transplant and residual chronic kidney disease. Is this a transplant complication? Explain.
11.12 State the obstetric priority rule and its one exception.
11.13 † How is the trimester determined? What determines it, and what does not?
11.14 What does the seventh character identify in ICD-10-CM chapter 15? How does that differ from chapter 19?
11.15 When is an outcome-of-delivery code reported, and on whose record?
B. Apply the conventions
11.16 † Code each and explain the rule.
(a) "Essential hypertension. Stage 3 chronic kidney disease." (b) "Hypertension. Chronic diastolic heart failure." No relationship stated. (c) "Hypertensive heart disease with chronic systolic heart failure." (d) "Hypertension, chronic kidney disease stage 4, and chronic combined systolic and diastolic heart failure documented as hypertensive."
11.17 A patient had an acute MI 12 days ago and is admitted today with a new infarction. What categories apply and how many codes?
11.18 † "Status post cerebral infarction 3 years ago. Residual expressive aphasia and left-sided hemiparesis. Patient is right-handed." Code it.
11.19 "History of stroke. No residual deficits." Code it, and say what would change your answer.
11.20 † "Admitted in acute respiratory failure secondary to COPD exacerbation." Sequence, and say what changes if the respiratory failure had developed on hospital day 3.
11.21 "Sacral pressure ulcer, stage 3, documented by the provider. Staging documented by the wound care nurse." May you use the nurse's staging? What if the provider had not documented the ulcer at all?
11.22 † "32 weeks gestation, twin pregnancy. Gestational diabetes affecting fetus 2." Identify every code element required and say what the seventh character does.
11.23 "Pregnant patient, 10 weeks, presents with a fractured wrist sustained in a fall. Provider documents the fracture is not affecting the pregnancy." How does the priority rule apply?
C. Read the document
11.24 † An assessment reads:
1. Hypertension - controlled.
2. Chronic kidney disease stage 3b - stable, nephrology following.
3. Type 2 diabetes mellitus - A1c 7.1, continue metformin.
All three are addressed. Code the encounter completely and name every convention you applied.
11.25 An assessment reads:
1. Hypertension - controlled on lisinopril.
2. Diabetes - continue metformin.
The problem list additionally carries "chronic kidney disease stage 3b." Code the encounter and explain, in one sentence, the difference from 11.24.
11.26 † A discharge summary reads: "Admitted with sepsis and acute respiratory failure, both present on admission. Sepsis due to pneumonia." Which is principal? What do you need, and where is the rule?
D. Judgment and process
11.27 A colleague assigns a hypertensive heart disease combination code for a note documenting hypertension and heart failure with no linking language. Explain the error and the consequence in a facility setting.
11.28 † Your practice's coders consistently use unspecified heart failure codes. Design the investigation: how would you determine whether this is a documentation problem or a coding problem, and what would each answer imply?
11.29 A physician objects that coding a stroke patient's deficits from the sequelae category "makes it sound like the stroke is still happening." Respond.
11.30 † Write the compliant query for a note documenting hypertension and heart failure where you suspect but cannot confirm a hypertensive relationship.
E. Certification-style questions
11.31 † Hypertension and chronic kidney disease documented together, with no stated relationship:
- A. two separate codes
- B. a combination code, because the relationship is presumed
- C. requires a query
- D. code only the hypertension
11.32 Hypertension and a heart condition documented together, with no stated or implied relationship:
- A. a combination code
- B. two separate codes
- C. code only the heart condition
- D. requires a query in all cases
11.33 † An acute myocardial infarction is coded as acute for:
- A. one week
- B. two weeks
- C. four weeks (28 days)
- D. eight weeks
11.34 A patient has residual hemiplegia three years after a cerebral infarction. Code from:
- A. the acute infarction category
- B. the sequelae category
- C. the personal history category
- D. the symptoms chapter
11.35 † Acute respiratory failure that develops after admission is:
- A. always the principal diagnosis
- B. a secondary diagnosis
- C. not coded
- D. coded only if it required intubation
11.36 In ICD-10-CM chapter 15, the seventh character identifies:
- A. the episode of care
- B. the trimester
- C. the fetus
- D. the delivery method
11.37 † A patient with a functioning kidney transplant has stage 3 chronic kidney disease. This is:
- A. a transplant complication
- B. chronic kidney disease with a transplant status code, and not a complication
- C. transplant rejection
- D. coded as end stage renal disease
11.38 The trimester for an obstetric code is determined by:
- A. the coder's calculation from the due date
- B. the provider's documented weeks of gestation at the encounter
- C. the date of the last menstrual period
- D. the admission date
F. Write it
11.39 † Write the 100-word explanation of the hypertension asymmetry you would give a new coder, including why it exists.
11.40 Draft the one-page reference card for the three-convention collision in §11.8 (diabetes, hypertension, and CKD), usable at the desk.
11.41 Write the two-sentence explanation you would give a clinician about why obstetric codes are sequenced ahead of the body system a condition would otherwise belong to.
G. The Encounter
11.42 † State precisely why diagnosis C is I10, addressing both organ questions §11.1 forces
and identifying which prior question decides it.
11.43 The chapter says this is the second time the same structure has decided a code on this file, and calls the repetition deliberate. State the general rule the repetition is teaching, in one sentence.
11.44 † The hypertension-CKD presumption is stronger than the diabetes-CKD presumption in one respect. Identify it, and then explain why the stronger presumption still does not change the answer for Account 10-4471.
11.45 Suppose the March 14 assessment had read: "3. Chronic kidney disease, stage 3a — stable, continue current management." Recode diagnoses B, C, and the CKD completely, and state every convention you applied.
11.46 Update your Encounter Workbook (Appendix C) with the circulatory analysis of diagnosis C and the Exercise 11.45 counterfactual.