Transcript ICD 10 Quiz

Massachusetts Chapter ACDIS
December 2, 2015
Brigham and Women’s Hospital
Boston, MA

Under dosing of anticoagulants, initial encounter

Poisoning by anticoagulants, initial encounter

Atrial Fibrillation
Answer:
Atrial Fibrillation.
Per coding guidelines, under dosing can never be the PDX.
Coding GUIDELINE: DRUG UNDERDOSING
The coding examples will demonstrate the new clinical concept of drug under dosing conveyed in
ICD-10.
Drug under dosing is a new clinical terminology in ICD-10. ICD-10 contains codes for under
dosing, whereas ICD-9 does not. This term identifies situations in which a patient has taken
less of a medication than prescribed by their physician or less than instructed by the
manufacturer, whether inadvertently or deliberately.
For under dosing, assign the code from categories T36 – T50 found in Chapter 19. These codes
require a 7th character extension to describe an initial encounter (A), subsequent encounter
(D), or sequela encounter (S).
Under dosing codes must be identified in the following order:
1. The medical condition is sequenced first. The first-listed code would be the event that is
triggered or prolonged due to this circumstance.
2. The under dosing code is listed as the secondary code assignment. Codes for under dosing
should never be assigned as principal or first-listed codes.
3. The additional code explains why the patient is not taking the medication(s). Financial
hardships and age-related debilities are some examples of under dosing.
Fusion procedures are performed only on:




Long bones
Spine
Vertebrae
Joints
Answer:
Joints
Does a lumbar drain trial result in a surgical DRG?
Answer:
No, it no longer impacts the DRG (does not move to
a surgical DRG)
In ICD-10-PCS, the root operation is coded
according to the objective of the procedure
actually performed.


False
True
Answer:
True
Define a Subsequent MI
Answer:
An MI is considered ‘acute’ in the 4 weeks
following the incident. This is revised from
the 8 week timeframe in ICD-9.
In ICD-10, a subsequent MI is defined as a new
MI that occurs within the 4 week “acute”
period of the original AMI.
Answer:
CAD as the PDX w/the acute MI as an MCC
What would the PDX be if a patient had an
NSTEMI 2 weeks ago, was re-admitted with
chest pain, found to have a new NSTEMI,
and had a coronary angioplasty w/stent
insertion?
Answer:
The subsequent MI is the PDX. The previous, but still acute,
MI and CAD are both secondary diagnoses - but the MI is not an MCC.
Sequencing of I22 and I21 codes depends on circumstances of
admission.
I21 (initial) is sequenced first when a patient is in the hospital due
to AMI and suffers a secondary MI while still in hospital.
I22 (subsequent) is sequenced first when an MI occurred after
discharge
for care of initial AMI (within the 4 week time frame).
This root operation is used for gender
reassignment surgery:
Resection
 Creation
 Extraction
 Excision

Answer:
Creation
The assignment of a cardiac arrest code in
ICD-10-CM ____ dependent on whether or
not the patient is resuscitated.
A is
B is not
Answer:
Is Not
Cardiac Arrest, 427.5 Coding Guidelines Coding Clinic, Second Quarter 1988
Code 427.5, Cardiac arrest (excludes that with pregnancy, anesthesia overdose or wrong substance given,
and postoperative complications), may be assigned as principal diagnosis in the following instances:
◦
If the patient arrives in the hospital's emergency service unit in a state of cardiac arrest, cannot be
resuscitated or only briefly resuscitated, and is pronounced dead with the underlying cause of the
cardiac arrest not established (cause unknown), code 427.5 is assigned as the diagnosis.
◦
If the patient arrives at the hospital in a state of cardiac arrest, is resuscitated, and is admitted as an
inpatient but dies before the underlying cause of the cardiac arrest is established (cause unknown),
code 427.5 is assigned as the principal diagnosis.
Code 427.5, Cardiac arrest, may be used as a secondary code in the following instances:
◦
The patient arrives in the hospital's emergency service unit in a state of cardiac arrest and is
resuscitated (and admitted) with the condition prompting the cardiac arrest known, such as
ventricular tachycardia or trauma. The condition causing the cardiac arrest is sequenced first
followed by code 427.5, Cardiac arrest.
◦
When cardiac arrest occurs during the course of hospitalization and the patient is resuscitated, code
427.5 may be used as a secondary code except as outlined in the exclusion note under category
427.
When the physician records cardiac arrest to indicate an inpatient death, do not assign code 427.5
when the underlying cause or contributing cause of death is known since the Uniform Hospital
Discharge Data Set (UHDDS) has a separate item for reporting deaths occurring during an inpatient
stay.
An appendix that ruptures during an appendectomy:
A
should not be classified as a complication of surgery.
B
should be classified as a complication of surgery.
Answer:
Should not be classified as a complication of
surgery
In ICD-10-PCS, a bilateral
replacement of a joint is usually
indicated by:
A coding the procedure code only once
B coding the procedure code twice
Answer:
Coding the procedure twice
This is a quarterly report that includes statistical claims
data for MS-DRGs which are at risk for incorrect
payment due to problems with billing and coding:
A RAC
B OIG Work plan
C PEPPER
D Dashboard
Answer:
C.
PEPPER
When an encounter is for management of a
complication associated with a neoplasm,
such as dehydration, and the treatment is
only for the complication, then the
complication is coded first, followed by the
appropriate code for the neoplasm.
What is the exception with anemia?
Answer:
When the admission is for the management of
the anemia associated with the malignancy,
the treatment is only for the anemia, the
appropriate code for the malignancy is
sequenced as the principal or first-listed
diagnosis followed by the code for, anemia in
neoplastic disease.
Identified by the Association for Healthcare Research
and Quality (AHRQ), these are conditions that are
considered potentially preventable adverse events for
hospital inpatients.
A POA
B HCC
C PSI
D HAC
Answer:
C.
PSI (Patient Safety Indicator)



If both use and abuse are documented,
assign code for _____________.
If both abuse and dependence are
documented, assign only the code ______ .
If use, abuse and dependence are
documented, assign only the code _________.
Answer:



If use and abuse are
documented
If abuse and
dependence are
documented
If use, abuse, and
dependence are
documented

Code:
Abuse

Code:
Dependence

Code:
Dependence
This is a medical classification system which approximates
the likelihood of an inpatient hospital death.
The categories within the system are: minor, moderate,
major and extreme.
A SOI
B POA
C ROM
D HAC
Answer:
C.
ROM (Risk of Mortality)
Hemorrhagic shock can be captured when
documented secondary to spontaneous GI
bleed.


True
False
Answer:
False
The CDI professional needs to clarify if
hypovolemic shock
Uncontrolled DM can still be coded


True
False
Answer:
True. DM with Hyperglycemia will be coded.
NB: DM with Hyperglycemia increases the SOI
but if not POA will be considered a HAC
This is an undesirable medical condition that negatively
impacts a patient, which was not present on admission.
This terminology is used by Medicare and Medicaid for
determining hospital reimbursement.
A HAC
B POA
C DRG
D HCC
Answer:
HAC
This is a value that reflects the diversity and
complexity of patients treated at a facility.
The value is often used in determining the
allocation of resources to care for patients in
the group.
A
CMI
B
ROM
C
HAC
D
POA
Answer:
A.
CMI
What are the 7 Characters for PCS coding?
Answer:
 Section (medical Surgical, OB Osteopathic)
 Body system (upper veins, endocrine, GI)
 Root Operation (alteration, bypass, creation)
 Body Part
 Approach
 Device
 Qualifier
http://www.cdc.gov/nchs/data/icd10cm_guidelines_2014.pdf
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
Special Thank you to Kelley Sears, RN, CCDS and Cindy
Labins, RN, CCDS for developing and presenting this
quiz at the
Massachusetts Chapter of ACDIS Meeting,
December 2, 2015
Brigham and Women’s Hospital
Boston, MA