Chapter 12 — Exercises
Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item. All scenarios are constructed; verify every code currently.
A. Recall and vocabulary
12.1 What question does each of the four special chapters answer? Name the three structural consequences that follow.
12.2 State the injury coding rules: how many codes, what is sequenced first, and what is not coded separately.
12.3 † Define A, D, and S precisely. Then state, in one sentence, what the character describes and what it does not.
12.4 Can a patient's first visit to a provider be coded D? Explain.
12.5 † State the sequela sequencing rule. Why can the S code never stand alone?
12.6 Name the seven fracture seventh characters and what each indicates.
12.7 † State the two fracture defaults — open/closed and displaced/non-displaced — and say which one runs against intuition.
12.8 Why is fracture aftercare not coded with an aftercare Z-code?
12.9 † Name the three axes on which burns are coded and state the sequencing rule.
12.10 Distinguish poisoning, adverse effect, underdosing, and toxic effect by what happened.
12.11 † State the sequencing for each of the four. Which two are inverted relative to each other, and why?
12.12 What additional code does underdosing require that the others do not, and why does it matter?
12.13 † State three rules about external cause codes: position, frequency of reporting, and whether they are required.
12.14 When is a symptom code correct? Give three circumstances. Is chapter 18 the home of all symptoms?
12.15 † Name six categories of Z-code. Which can be first-listed and which are secondary?
12.16 State the screening-versus-diagnostic rule in one sentence. What decides it?
12.17 Distinguish aftercare from follow-up.
B. Seventh characters
For each, state the seventh character and the reasoning.
12.18 † Emergency department, fracture reduced and casted today. 12.19 Orthopedic office, two weeks later, cast check, healing normally. 12.20 † Same patient's first visit to a physiatrist who is managing routine rehabilitation. 12.21 Return to the operating room on day 3 for revision of the fixation. 12.22 † Two years later, chronic pain at the fracture site attributed to the old injury. 12.23 Six months later, imaging shows the fracture has not united. 12.24 Twelve weeks later, the fracture has healed in a poor position.
C. The drug table
12.25 † "Rash after starting a prescribed antibiotic, taken as directed." Column, codes, sequence.
12.26 "Patient took three of his wife's blood pressure pills by mistake. Hypotensive." Column, codes, sequence.
12.27 † "Patient has been taking half her prescribed insulin for four months due to cost. A1c 11.2, presenting with hyperglycemia." Every code required, and the one people omit.
12.28 "Toddler drank from a bottle of drain cleaner." Column and sequence.
12.29 † "Patient stopped taking her antihypertensive because she felt fine. Presents with a hypertensive emergency." Column, codes, and the reason code.
12.30 Change one fact in 12.25 to make it a poisoning, and state what changes about the sequencing.
D. Z-codes and symptoms
12.31 † "Asymptomatic 55-year-old presents for a screening colonoscopy." Code the reason for the encounter.
12.32 Same patient, but the note documents "rectal bleeding for two weeks." Recode and explain what changed.
12.33 † "Patient with a functioning kidney transplant presents for an unrelated respiratory infection." What Z-code applies and in what position?
12.34 "Encounter for surgical wound care following abdominal surgery, healing normally." Aftercare or follow-up? Explain.
12.35 † "Patient completed treatment for colon cancer two years ago. Presents for surveillance colonoscopy. No evidence of disease." Every code, and the reason each is there.
12.36 "Family history of colorectal cancer in a first-degree relative. Patient asymptomatic, presenting for earlier-than-routine screening." Code it, and say what the family history code is doing.
E. Certification-style questions
12.37 † Seventh character A indicates:
- A. the first visit for the condition
- B. the patient is receiving active treatment
- C. an acute condition
- D. an admission
12.38 A patient's first visit to a new provider for routine fracture follow-up is coded:
- A. A
- B. B
- C. D
- D. S
12.39 † For a sequela, the correct sequencing is:
- A. the injury code with S, then the residual condition
- B. the residual condition, then the injury code with S
- C. the S code alone
- D. the external cause code first
12.40 A drug taken correctly as prescribed that produces a harmful effect is:
- A. a poisoning
- B. an adverse effect
- C. underdosing
- D. a toxic effect
12.41 † For an adverse effect, the correct sequencing is:
- A. drug code first, then the manifestation
- B. manifestation first, then the drug code
- C. either
- D. the external cause code first
12.42 External cause codes are:
- A. always first-listed
- B. never first-listed
- C. first-listed for injuries only
- D. optional in all circumstances
12.43 † Place of occurrence and activity codes are reported:
- A. on every encounter for the injury
- B. once, at the initial encounter
- C. only for work injuries
- D. only when the payer requires them
12.44 A test is a screening when:
- A. the patient requested it
- B. the patient has no signs or symptoms of the condition tested for
- C. it is performed annually
- D. it is covered as preventive
12.45 † Fracture aftercare during routine healing is coded with:
- A. an aftercare Z-code
- B. the acute fracture code with the appropriate seventh character
- C. a follow-up Z-code
- D. a sequela code
F. Write it
12.46 † Write the 120-word explanation of the A/D/S distinction you would give a new coder, including the example that breaks the "first visit" intuition.
12.47 Write the two-sentence explanation you would give a patient who was told their colonoscopy was free and received a bill.
12.48 Draft the desk card for the four drug-table columns and their sequencing.
G. The Encounter
12.49 † State every code that is not on Account 10-4471's claim and the reason for each absence.
12.50 The chapter identifies a four-word clause in the note that determines which chapter of the classification the encounter lives in. Quote it and explain both consequences.
12.51 † Construct a variant of the March 14 note in which the knee pain would take a seventh character. Change as little as possible, then state every code that changes and every code that is added.
12.52 The chapter calls "No known injury" a "well-documented negative" and says such statements are rare. Explain why a negative finding is valuable, and name one other negative in Figure 4.2.
12.53 Update your Encounter Workbook (Appendix C). Part II's work on this file is complete — record all four diagnosis codes with their reasoning and the four documented absences.