Learning ICD-10-CM

Transcription

1 Review Questions for Chapter 4 1. There are three major types of diabetes mellitus: type 1; type 2 and secondary, such as due to an underlying condition or drug or chemical induced. Let s identify the correct category for each: E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus 2. If the medical record documentation is not clear with regard to the type of diabetes, the default is category. E11, Type 2 diabetes mellitus. 3. When the type of diabetes is not documented but the record does indicate that the patient uses insulin, the default category is. E11, Type 2 diabetes mellitus Note: The fact that a patient is receiving insulin does not indicate that the diabetes is type Code is not required for type 1 diabetes because these patients require insulin. However, this code may be assigned, if desired, to provide additional information. Z79.4, Long-term (current) use of insulin 5. When a type 2 diabetic patient routinely uses insulin, assign code. Z79.4, Long-term (current) use of insulin Note: Code Z79.4 should not be used if insulin is given temporarily to bring the patient s blood sugar under control during the encounter. Assign the correct code(s): 6. Steroid-induced diabetes mellitus due to the prolonged use of prednisone for an unrelated condition E09.9, Drug or chemical induced diabetes mellitus without complications, followed by code T38.0x5, Adverse effect of glucocorticoids and synthetic analogues. Note: The sequencing of the secondary diabetes codes is based on the Tabular List instructions for categories E08 and E Progressive type 1 diabetic nephropathy with hypertensive renal disease and chronic kidney disease stage 5 E I N18.5

2 8. Type 2 diabetes mellitus with diabetic cataract E Secondary diabetes mellitus due to chronic pancreatitis with mature senile cataract K E H Diabetic third (cranial) nerve palsy, right eye E H Mononeuropathy of the lower limb due to type 2 diabetes E Duodenal ulcer with hemorrhage due to Coumadin therapy, initial encounter K T45.515A 13. Acute gastritis with hemorrhage due to anticoagulant therapy, subsequent encounter K T45.515D 14. Failure or malfunction of the insulin pump may result in underdosing or overdosing of insulin. Both of these situations are considered mechanical complications and are assigned a code from subcategory T85.6, as the first-listed code. The appropriate T85.6- code is selected depending on the type of malfunction. Let s identify the proper T85.6- codes for each of the following: T Breakdown (mechanical) of insulin pump T Displacement of insulin pump T Leakage of insulin pump From the condition listed below, what is the key term to reference in the alphabetical index? What is the correct code(s) assigned? 15. Diabetes mellitus, type 1 and Diabetic nephrosis E10.21 Diabetes mellitus, type 1 and Diabetic nephrosis 16. Chronic kidney disease, Stage IV due to type 1 diabetes E N18.4 Chronic kidney disease, Stage IV due to type 1 diabetes 17. Neonatal hypoglycemia P70.4 Neonatal hypoglycemic 18. Hypoglycemic coma in a patient without diabetes E15 Hypoglycemic coma in a patient without diabetes 19. Hypercholesterolemia and endogenous hyperglyceridemia E78.2 Hypercholesterolemia and endogenous hyperglyceridemia

3 20. Cystic fibrosis with mild mental intellectual disabilities E F70 Cystic fibrosis with mild mental intellectual disabilities 21. Toxic diffuse goiter with thyrotoxic crisis E05.01 Toxic diffuse goiter with thyrotoxic crisis 22. Flushing and sleeplessness due to premature menopause E Flushing and sleeplessness due to premature menopause 23. Anemia, chronic, secondary to blood loss due to adenomyosis D N80.0 Anemia, chronic, secondary to blood loss due to adenomyosis 24. Classical hemophilia D66 Classical hemophilia 25. Sickle-cell Hb-SS disease D57.1 Sickle-cell Hb-SS disease 26. Sickle-cell crisis with acute chest syndrome D57.01 Sickle-cell crisis with acute chest syndrome 27. Hereditary thrombocytopenia D69.42 Hereditary thrombocytopenia 28. Autoerythrocyte sensitization purpura D69.2 Autoerythrocyte sensitization purpura 29. Cell-mediated immune deficiency with thrombocytopenia and eczema D82.0 Cell-mediated immune deficiency with thrombocytopenia and eczema 30. Acute gastritis with hemorrhage, exacerbated by heparin therapy, initial encounter K T45.515A Acute gastritis with hemorrhage, exacerbated by heparin therapy, initial encounter (adverse effect Table of Drugs and Chemicals) 31. Autoimmune lymphoproliferative syndrome D89.82 Autoimmune lymphoproliferative syndrome 32. Hypoglycemic reactions can occur in both diabetic and non-diabetic patients. In a patient who does not have diabetes, code, is assigned for hypoglycemic coma not otherwise specified. E15, Non-diabetic hypoglycemic coma Note: Code E15 also includes drug-induced insulin coma in a non-diabetic patient.

4 33. Code, is assigned for hypoglycemia not otherwise specified. E16.2, Hypoglycemia, unspecified 34. Several codes are used to identify overweight and obesity. Let s identify these codes: E66.01 Morbid (severe) obesity due to excess calories E66.09 Other obesity due to excess calories E66.1 Drug-induced obesity E66.2 Morbid (severe) obesity with alveolar hypoventilation E66.3 Overweight E66.8 Other obesity E66.9 Obesity, unspecified Note: These codes are assigned only on the basis of the physician s diagnostic statement. Category E66, Overweight and obesity, requires that an additional code (Z68.-) for the body mass index (BMI) be assigned, if known. 35. Code, is also known as Pickwickian syndrome, which involves sleep-disordered breathing that causes a person to stop breathing for short periods of time while sleeping. It may be related to both obesity and neurological conditions. E66.2, Morbid (severe) obesity with alveolar hypoventilation 36. Cystic fibrosis (E84.-), also known as mucoviscidosis or cystic fibrosis of the pancreas, is a disorder of the exocrine glands that cause the accumulation of thick, tenacious mucus. Specific codes identify the site of manifestation involvement such as pulmonary involvement, meconium ileus, or other intestinal manifestations. Code, should be used if the manifestation is not specified. E84.9, Cystic fibrosis, unspecified Note: If an infectious organism is involved with cystic fibrosis with pulmonary involvement, assign an additional code for the organism present. 37. Tumor lysis syndrome (TLS) refers to a group of serious, potentially life-threatening metabolic disturbances that can occur after antineoplastic therapy. Code, is used to report spontaneous tumor lysis syndrome as well as tumor lysis syndrome following antineoplastic drug therapy. E88.3, Tumor lysis syndrome Note: Use an additional code (T45.1x5-) to identify an adverse effect of drug when tumor lysis syndrome is drug induced. 38. Iron-deficiency anemias are classified to category D50. If the cause is unspecified, code, is assigned. code D50.9, Anemia, unspecified 39. However, iron-deficiency anemia specified as secondary to acute blood loss is assigned code, instead of category D50. D62, Acute posthemorrhagic anemia

5 40. When postoperative anemia is documented without specification of acute blood loss, code, is the default. D64.9, Anemia, unspecified 41. Code, should be assigned when postoperative anemia is due to acute blood loss. D62, Acute posthemorrhagic anemia 42. When neither the diagnostic statement nor review of the medical record indicates whether a blood-loss anemia is acute or chronic, code, should be assigned. D50.0, Iron deficiency anemia secondary to blood loss (chronic) 43. Antineoplastic chemotherapy-induced anemia is classified to code,. D64.81, Anemia due to antineoplastic chemotherapy. 44. Anemia due to chemotherapy should not be confused with aplastic anemia due to antineoplastic chemotherapy, which is coded to. D61.1, Drug-induced aplastic anemia. Note: Anemia due to a drug, where the drug is not specified, is coded to the type of anemia (or to code D64.9 if the type of anemia is not specified). 45. Bleeding in a patient who is being treated with Coumadin, heparin, anticoagulants, or other antithrombotics does not indicate that a hemorrhagic disorder due to intrinsic circulating anticoagulant is present. In this situation, assign code or code. T , Adverse effect of anticoagulant or code T45.525, Adverse effect of antithrombotic drugs. 46. Prolonged prothrombin time or other abnormal coagulation profiles should not be coded as a coagulation defect. Code, is assigned for this abnormal laboratory finding. R79.1, Abnormal coagulation profile Note: If the patient is receiving Coumadin therapy, however, a prolonged bleeding time is an expected result, and therefore code R79.1 is not assigned. Also, Coumadin is not a circulating anticoagulant; it induces anticoagulation through other mechanisms The following are case examples demonstrating code assignment. 47. A 50-year old man receiving Coumadin therapy is admitted with hematemesis secondary to acute gastritis. A prolonged prothrombin time is reported, secondary to the anticoagulant effects of the Coumadin therapy. Code, is assigned. K29.01, Acute gastritis with bleeding Note: Code D68.3- is not reported because no hemorrhagic disorder was identified. No code is assigned for the prolonged bleeding time because this is an expected result of Coumadin therapy. Note again that Coumadin is not a circulating anticoagulant; it induces anticoagulation through other mechanisms!

6 48. A patient is admitted following multiple episodes of hematemesis secondary to Coumadin therapy. No significant pathology was discovered. The Coumadin is discontinued, and no recurrence of the bleeding occurs. Code, with code, are assigned to indicate Coumadin as the responsible external agent. K92.0, Hematemesis, with code T45.515A, Adverse effect of anticoagulants, initial encounter