Chapter 11 — Quiz

Twenty-two questions. Verify all conventions against the current Section I.C.


Multiple choice

1. Hypertension and chronic kidney disease, no stated relationship:

  • A. two separate codes
  • B. a combination code — the relationship is presumed
  • C. query required
  • D. code the CKD only

2. Hypertension and a heart condition, no stated or implied relationship:

  • A. a combination code
  • B. two separate codes
  • C. code the heart condition only
  • D. query required in all cases

3. A combination code for hypertensive chronic kidney disease is reported:

  • A. alone
  • B. with an additional code for the CKD stage
  • C. only for end stage renal disease
  • D. only when the provider states the linkage

4. An acute MI is coded as acute for:

  • A. 7 days
  • B. 14 days
  • C. 28 days (four weeks)
  • D. 90 days

5. A new infarction occurring within the acute period of a previous one is coded from:

  • A. the old MI category
  • B. the subsequent MI category, with both reported
  • C. the acute category only
  • D. the sequelae category

6. Deficits remaining years after a cerebral infarction are coded from:

  • A. the acute infarction category
  • B. the sequelae category
  • C. the personal history category
  • D. the symptoms chapter

7. A patient who had a stroke with no residual deficits is coded with:

  • A. an acute infarction code
  • B. a sequelae code
  • C. a personal history status code
  • D. no code

8. Acute respiratory failure developing after admission is:

  • A. the principal diagnosis
  • B. a secondary diagnosis
  • C. not reportable
  • D. sequenced by severity

9. Respiratory failure sequencing turns on:

  • A. severity
  • B. why the patient was admitted
  • C. whether intubation occurred
  • D. length of stay

10. A pressure ulcer's stage may be taken from:

  • A. only the provider's documentation
  • B. another clinician's documentation, provided the provider documented the ulcer
  • C. the nursing flowsheet alone
  • D. the coder's assessment of the description

11. A patient with a functioning kidney transplant and residual CKD has:

  • A. a transplant complication
  • B. CKD plus a transplant status code — not a complication
  • C. transplant rejection
  • D. end stage renal disease

12. Chapter 15 codes:

  • A. are sequenced after body-system codes
  • B. take sequencing priority over other chapters
  • C. apply only at delivery
  • D. are optional

13. The obstetric trimester is determined by:

  • A. the coder's calculation
  • B. the provider's documented weeks of gestation at the encounter
  • C. the admission date
  • D. the due date

14. In chapter 15, the seventh character identifies:

  • A. episode of care
  • B. trimester
  • C. the fetus
  • D. delivery outcome

15. An outcome-of-delivery code is reported:

  • A. on the newborn's record
  • B. on the maternal record when a delivery occurs
  • C. on every obstetric encounter
  • D. on antepartum encounters

Short answer

16. State the hypertension asymmetry and the reason it exists.

17. Name the four axes of heart failure classification.

18. Name the three coding situations one cerebrovascular event can produce.

19. State the general pattern about what a combination code carries and what it frequently does not.

20. (Chapter 9) A note documents hypertension, and the problem list carries stage 3a CKD whose relationship would be presumed. Why is the code I10?

21. (Chapter 10) Name the three conventions that collide on a patient with diabetes, hypertension, and chronic kidney disease, and say which one decides whether the CKD is reported at all.

22. (Chapter 4) A digestive outcome follows a procedure. Under what circumstances may a coder report it as a complication?


Answer key **1.** B. **2.** B. **3.** B. **4.** C. **5.** B. **6.** B. **7.** C. **8.** B. **9.** B. **10.** B. **11.** B. **12.** B. **13.** B. **14.** C. **15.** B. **16.** **Kidney: the relationship is presumed** — a combination code applies with no stated linkage. **Heart: the relationship must be stated or implied** ("due to hypertension," "hypertensive"); without it, two separate codes. **Why:** the epidemiological relationship between hypertension and kidney disease is close enough that the classification will assume it; many heart conditions have causes other than hypertension, so it will not. **17.** Type (systolic, diastolic, combined) · acuity (acute, chronic, acute on chronic) · cause or association (hypertensive, ischemic) · other specified forms (right, biventricular, high output, end stage). **18.** The **acute event** (acute infarction codes) · **sequelae** (deficits remaining, with a code for each deficit and the dominant/non-dominant side) · **personal history** (no residual deficits). **19.** **A combination code carries the *relationship*; it frequently does not carry the *specificity*, and the Tabular instructs an additional code.** Hypertensive CKD plus the stage code; hypertensive heart disease with heart failure plus the heart failure type; diabetes with CKD plus the stage code. **20.** Because the presumption tells you **how** to code the two conditions **if you are coding both** — and Section IV decides **whether** the CKD belongs on this claim at all. The assessment addresses hypertension, diabetes, and hyperlipidemia and does **not** address the kidney disease, so it is not reported for this encounter. **21.** (1) The **diabetes–CKD "with" convention** (Chapter 10 §10.6) — relationship presumed. (2) The **hypertension–CKD presumption** (§11.1) — relationship presumed. (3) **Section IV's addressed question** (Chapter 9 §9.3). **The third one decides whether the CKD is reported at all**, and it decides first. The other two only tell you how to code it once you have decided to. **22.** **Only when the provider documents it as a complication.** The classification distinguishes an ordinary consequence of a procedure from a complication, and the difference is a **clinical judgment**. A coder may not characterize an outcome as a complication because it seems like one — Chapter 4 §4.7 — and the consequences of doing so extend well beyond the code.