Chapter 12 — Quiz

Twenty-two questions.


Multiple choice

1. Seventh character A indicates that:

  • A. this is the first visit
  • B. the patient is receiving active treatment
  • C. the condition is acute
  • D. the patient was admitted

2. Seventh character D indicates:

  • A. the second visit
  • B. active treatment is complete and the patient is in routine healing or recovery
  • C. a delayed diagnosis
  • D. discharge

3. A patient's first visit to a new provider, for routine follow-up of a fracture set elsewhere:

  • A. A
  • B. B
  • C. D
  • D. S

4. For a sequela:

  • A. the S code is sequenced first
  • B. the residual condition is sequenced first, then the injury code with S
  • C. the S code is reported alone
  • D. no injury code is used

5. A fracture not documented as open or closed defaults to:

  • A. open
  • B. closed
  • C. unspecified
  • D. requires a query

6. A fracture not documented as displaced or non-displaced defaults to:

  • A. non-displaced
  • B. displaced
  • C. unspecified
  • D. requires a query

7. Routine fracture aftercare is coded with:

  • A. an aftercare Z-code
  • B. the acute fracture code with the appropriate seventh character
  • C. a follow-up code
  • D. a sequela code

8. Burns are sequenced:

  • A. by site, alphabetically
  • B. highest degree first
  • C. lowest degree first
  • D. extent code first

9. A drug taken correctly as prescribed producing a harmful effect is:

  • A. poisoning
  • B. adverse effect
  • C. underdosing
  • D. toxic effect

10. For a poisoning, the sequencing is:

  • A. manifestation first, then the poisoning code
  • B. the poisoning code first, then the manifestation
  • C. external cause first
  • D. either

11. For an adverse effect, the sequencing is:

  • A. the drug code first, then the manifestation
  • B. the manifestation first, then the drug code
  • C. either
  • D. the drug code alone

12. Underdosing requires an additional code identifying:

  • A. the prescriber
  • B. the reason for the underdosing
  • C. the pharmacy
  • D. the drug class

13. External cause codes are:

  • A. always first-listed
  • B. never first-listed
  • C. required nationally
  • D. used only for work injuries

14. Place of occurrence and activity codes are reported:

  • A. on every encounter
  • B. once, at the initial encounter
  • C. never
  • D. only on inpatient claims

15. A test is a screening when:

  • A. it is annual
  • B. the patient has no signs or symptoms of the condition tested for
  • C. the patient asked for it
  • D. it is covered as preventive

Short answer

16. State what the seventh character describes and what it does not. Give the example that breaks the "first visit" intuition.

17. State the sequela sequencing rule and explain why the S code cannot stand alone.

18. Name the four columns of the drug table by what happened, and give the sequencing for each.

19. Which two drug-table sequencings are inverted relative to each other, and what is the reason?

20. Distinguish aftercare from follow-up, and name the situation where neither applies.

21. (Chapter 9) When is a symptom code the correct first-listed diagnosis?

22. (Chapter 7) Account 10-4471's knee pain takes no seventh character. Explain why, and name the clause in the note that settles it.


Answer key **1.** B. **2.** B. **3.** C. **4.** B. **5.** B. **6.** B. **7.** B. **8.** B. **9.** B. **10.** B. **11.** B. **12.** B. **13.** B. **14.** B. **15.** B. **16.** It describes the **kind of care** — active treatment (A), routine healing or recovery (D), or a residual effect (S). It does **not** describe the ordinal position of the encounter. **The example:** a patient's **first** visit to a new provider who is taking over routine follow-up is coded **D** — first visit, subsequent encounter. And a patient seen four times during active treatment has four encounters coded **A**. **17.** **Code the residual condition first, then the injury code with S.** The S code cannot stand alone because it says *"this is a leftover from that"* — it identifies the origin, not the problem. Something has to say what the leftover **is**, and that is the first code's job. **18.** **Poisoning** — the drug was taken incorrectly; **poisoning code first**, then the manifestation. **Adverse effect** — taken correctly as prescribed; **manifestation first**, then the drug code. **Underdosing** — less taken than prescribed; the underdosing code, plus any documented relapse or exacerbation, plus **a code for the reason**. **Toxic effect** — a nonmedicinal substance; toxic effect code first, then the manifestation. **19.** **Poisoning and adverse effect.** Poisoning is drug-first; adverse effect is manifestation-first. **The reason:** in a poisoning the ingestion **is** the clinical event and the manifestation follows from it; in an adverse effect the patient presents with a problem and the drug is the **explanation** for it. **20.** **Aftercare** is care **during** the healing or recovery phase after initial treatment is complete. **Follow-up** is surveillance **after** treatment has concluded and the condition no longer exists. **Neither applies to fracture aftercare**, which uses the acute fracture code with the appropriate subsequent-encounter seventh character. **21.** When **no definitive diagnosis has been established** — endorsed by Section IV and not a fallback; when the symptom is **not routinely associated** with a confirmed disease; and when an **abnormal finding** exists that the provider has documented and not yet explained. **22.** Because **it is not an injury.** M25.561 is in ICD-10-CM chapter 13 (musculoskeletal); seventh characters for episode of care live in chapter 19 (injury). **The clause that settles it: "No known injury."** Without it, six weeks of worsening knee pain could reasonably raise the question of a chronic injury, which would move the code to chapter 19 and require a seventh character. Four words, and they determine which chapter of the classification the encounter lives in.