3-2-1 Code It - Chapter 3 Flashcards and Exercises

C HAPTER 3 — C HAPTER S PECIFIC C ODING G UIDELINES — ICD-10-CM C HAPTERS 1–10 Exercise 3.2: Neoplasms 1. Carcinoma in situ , cervix uteri: D06.9 Correct Check My Work Feedback For code D06.9 , go to ICD-10-CM index main term Carcinoma-in-situ – see also Neoplasm, in situ , by site. Then, go to ICD-10-CM Table of Neoplasms main term Neoplasm, neoplastic and subterm cervix (cervical) (uteri) (uterus). Locate the code in the Ca in situ column. Verify the code in the tabular list. According to ICD-10-CM Chapter 2 Neoplasms "General Guidelines," ICD-10-CM chapter 2 contains codes for most benign and all malignant neoplasms. To code a neoplasm, it is necessary to determine from the patient record if the neoplasm is benign, in situ , malignant, or of uncertain histologic behavior. (If malignant, any secondary (metastatic) sites should also be determined.) The diagnostic statement includes in situ to describe the carcinoma of the cervix uteri. 2. Adenocarcinoma, left breast (male patient), extending from lower-outer quadrant into adjacent axillary tail: C50.822 Correct Check My Work Feedback For code C50.822 , go to ICD-10-CM index main term Adenocarcinoma – see also Neoplasm, malignant, by site. Then, go to ICD-10-CM Table of Neoplasms main term Neoplasm, neoplastic, subterm breast, and second qualifier overlapping lesion. Verify the code in the tabular list. Add fifth-character 2 for male and sixth-character 2 for left breast. According to Chapter 2 Neoplasms "General Guidelines," a primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. Contiguous sites (or overlapping sites) occur when the origin of the tumor (primary site) involves two adjacent sites. 3. Treatment of secondary liver cancer due to metastatic colorectal cancer: C78.7 , C19 Correct Check My Work Feedback For code C78.7 , go to ICD-10-CM index main term Cancer – see Neoplasm, malignant, by site. Then, go to ICD-10-CM Table of Neoplasms main term Neoplasm, neoplastic, subterm liver, and locate the code in the Malignant Secondary column. Verify the code in the tabular list. Notice the use of "and" in the code description, which means "and/or." For code C19 go to ICD-10-CM index main term Cancer – see Neoplasm, malignant, by site. Then, go to ICD-10-CM Table of Neoplasms main term Neoplasm, neoplastic, subterm colon, second qualifier with rectum, and locate the code in the Malignant Primary column. C19. Verify the code in the tabular list. According to ICD-10-CM Chapter 2 Neoplasms chapter-specific coding guideline "Treatment of secondary site," when a patient is admitted because of a primary neoplasm with metastasis & treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present. 4. Anemia due to primary brain cancer involving the basal ganglia: C71.0 , D63.0 Correct Check My Work Feedback For code C71.0, go to ICD-10-CM index main term Cancer – see Neoplasm, malignant, by site. Then, go to ICD-10-CM Table of Neoplasms main term Neoplasm, neoplastic, subterm brain NEC, second qualifier basal ganglia, & locate the code in the Malignant Primary column. Verify the code in the tabular list. For code D63.0, go to ICD-10-CM index main term Anemia, subterm in, and second qualifier neoplastic disease – see also Neoplasm D63.0. Verify the code in the tabular list. Notice the "Code first neoplasm (C00-D49)" instruction, which provides direction to sequence the primary brain cancer code first.

According to ICD-10-CM Chapter 2 Neoplasms chapter-specific coding guideline "Anemia associated with malignancy," when admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease). 5. Personal history of malignant melanoma: Z85.820 Correct Check My Work Feedback For code Z85.820 , Go to ICD-10-CM index main term History, subterm personal (of), & second qualifier melanoma, & third qualifier malignant (skin). Verify the code in the tabular list. According to ICD-10-CM Chapter 2 Neoplasms chapter-specific coding guideline "Current malignancy versus personal history of malignancy," when a primary malignancy (1) has been previously excised or eradicated from its site, (2) there is no further treatment (of the malignancy) directed to that site, and (3) there is no evidence of any existing primary malignancy at that site, a code from category Z85, Personal history of malignant neoplasm, is assigned to indicate the former site of the malignancy. Codes from subcategories Z85.0–Z85.85 are assigned for the former site of a primary malignancy, not the site of a secondary malignancy . Code Z85.89 may be assigned for the former site(s) of either a primary or a secondary malignancy. Exercise 3.3: Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism 1. Acquired polycythemia: D75.1 Correct Check My Work Feedback For code D75.1, go to ICD-10-CM index main term Polycythemia (secondary) and subterm acquired. Next to the index main term, the word "secondary" is in parentheses, identifying it as a nonessential modifier that may be present or absent from the diagnostic statement. Verify the code in the tabular list. (There is no ICD-10-CM Chapter 3 chapter-specific coding guideline.) 2. Acute posthemorrhagic anemia: D62 Correct Check My Work Feedback For code D62, go to ICD-10-CM index main term Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), subterm posthemorrhagic (chronic), and second qualifier acute. Next to the index main term are many terms in parentheses, which are nonessential modifiers that may be present or absent from the diagnostic statement. Verify the code in the tabular list. (There is no ICD-10-CM Chapter 3 chapter-specific coding guideline.) 3. Secondary agranulocytosis: D70.4 Correct Check My Work Feedback For code D70.4, go to ICD-10-CM index main term Agranulocytosis (chronic) (cyclical) (genetic) (infantile) (periodic) (pernicious) and subterm secondary. Next to the index main term are many terms in parentheses, which are nonessential modifiers that may be present or absent from the diagnostic statement. Verify the code in the tabular list. Notice the "Use additional code for any associated: fever (R50.81), mucositis (J34.81, K12.3-, K92.81, N76.81)" below the category description. The diagnostic statement does not document either condition, so an additional code is not assigned. (There is no ICD-10-CM Chapter 3 chapter-specific coding guideline.) 4. Chronic simple anemia: D53.9 Correct Check My Work Feedback In the ICD-10-CM Index, reference anemia and the subterm simple chronic. You will see the code D53.9. Verify D53.9 in Chapter 3 of the Tabular List. There is no indication that additional

4. Factitious disorder, imposed on self, with predominantly physical signs and symptoms: F68.12 Correct Check My Work Feedback For code F68.12, go to ICD-10-CM index main term Disorder (of), subterm factitious, second qualifier imposed on self, third qualifier with predominantly, and fourth qualifier physical symptoms. According to ICD-10-CM Chapter 5 Mental, Behavioral, and Neurodevelopmental Disorders chapter- specific guideline "Factitious Disorder," factitious disorder imposed on self (or Munchausen's syndrome ) is a disorder in which a person falsely reports or causes his or her own physical or psychological signs or symptoms. For patients with documented factitious disorder on self or Munchausen's syndrome, assign the appropriate code from subcategory F68.1-, Factitious disorder imposed on self. 5. Major depressive disorder, recurrent, with psychotic features: F33.3 Correct Check My Work Feedback For code F33.3, go to ICD-10-CM index main term Disorder (of), subterm depressive, second qualifier major, third qualifier recurrent, and fourth qualifier with psychotic features. Verify the code in the tabular list. Notice that an inclusion term matches diagnostic statement "Major depressive disorder, recurrent, with psychotic features," which means the code is assigned even though "severe" and "symptoms" are included in the code description. (There is no ICD-10-CM Chapter 5 chapter-specific coding guideline for this condition.) Exercise 3.6: Diseases of the Nervous System 1. Flaccid hemiplegia, left dominant side: G81.02 Correct Check My Work Feedback For code G81.02, go to ICD-10-CM index main term Hemiplegia and subterm flaccid. Verify the code in the tabular list. Add fifth-character 2 for left dominant side. According to ICD-10-CM Chapter 6 Diseases of the Nervous System chapter-specific guideline "Dominant/nondominant side," codes from category G81, Hemiplegia and hemiparesis, and subcategories, G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and G83.3, Monoplegia, unspecified, identify whether the dominant or nondominant side is affected. Should the affected side be documented, but not specified as dominant or nondominant, and the classification system does not indicate a default, code selection is as follows:  For ambidextrous patients, the default should be dominant.  If the left side is affected, the default is non-dominant.  If the right side is affected, the default is dominant. 2. Chronic pain syndrome (admission for pain management): G89.4 Correct Check My Work Feedback For code G89.4, go to ICD-10-CM index main term Syndrome and subterm chronic, and second qualifier pain. Verify the code in the tabular list. According to ICD-10-CM Chapter 6 Diseases of the Nervous System chapter-specific guideline "Category G89 codes as principal or first-listed diagnosis," category G89 codes are acceptable as principal diagnosis or the first-listed code when pain control or pain management is the reason for the admission/encounter. The underlying cause of the pain should be reported as an additional diagnosis, if known. (In this case, the underlying cause of the pain is not included in the diagnostic statement.) 3. Acute pain due to trauma; cervicalgia (admission for pain control): G89.11 , M54.2 Correct Check My Work Feedback For code G89.11, go to ICD-10-CM index main term Pain, subterm acute, and second qualifier due to trauma. Verify the code in the tabular list. Notice the "Excludes2: spine pain

(M54.-)" note, which indicates that a second is to be assigned. For code M54.2, go to ICD-10- CM index main term Cervicalgia. Verify the code in the tabular list. According to ICD-10-CM Chapter 6 Diseases of the Nervous System chapter-specific guideline "Use of category G89 codes in conjunction with site-specific pain codes, assigning category G89 codes and site-specific pain codes," codes from category G89 may be used in conjunction with codes that identify the site of pain (including codes from ICD-10-CM Chapter 18) if the category G89 code provides additional information. In addition, chapter- specific guideline "Sequencing of category G89 codes with site-specific pain codes," states that the sequencing of category G89 codes with site-specific pain codes (including Chapter 18 codes), is dependent on the circumstances of the encounter/admission as follows: If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain. 4. Acute transverse myelopathy: G37.3 Correct Check My Work Feedback For code G37.3, go to ICD-10-CM index main term Myelopathy (spinal cord), and subterm transverse, acute. Verify the code in the tabular list. Notice that the diagnostic statement is included in the list of inclusion terms/phrases below the code description. (There is no chapter-specific guideline for this condition.) 5. Obstructive sleep apnea with hypopnea; morbid obesity with 51.4 BMI (adult patient): G47.33 , E66.01 , Z68.43 Correct Check My Work Feedback For code G47.33, go to ICD-10-CM index main term Apnea, apneic (of) (spells), subterm sleep, second qualifier obstructive (adult) (pediatric), and third qualifier hypopnea. Verify the code in the tabular list. Notice the "Code also any associated underlying condition" instruction, such as morbid obesity. (There is no chapter-specific guideline for this condition.) For code E66.01, go to ICD-10-CM index main term Obesity and subterm morbid. Verify the code in the tabular list. Notice the "Use additional code to identify body mass index (BMI), if known (Z68.-)" below the category description. For code Z68.43, go to ICD-10-CM index main term BMI –see Body, mass index. Then, go to ICD-10-CM index main term Body, subterm mass index (BMI), second qualifier adult, and third qualifier 50.0–59.9. Verify the code in the tabular list. 6. Adenocarcinoma of urinary bladder neck as primary site: C67.5 Correct Check My Work Feedback For code C67.5, go to the ICD-10-CM Table of Neoplasms, and locate main term Neoplasm, neoplastic, subterm bladder (urinary), and second qualifier neck. Locate the code in the Malignant Primary column. Coding convention "Tables" applies because the ICD-10-CM Table of Neoplasms is used to locate the code (instead of the alphabetic index). Verify the code in the tabular list.