How can we help?

You can also find more resources in our Help Center.

210 terms

Professional review guide for the RHIA and RHIT examination

ICD-9-CM Coding
STUDY
PLAY
A patient is admitted with a left ankle fracture. The patient also has AIDS with Kaposi's sarcoma of the skin. He had a closed reduction with internal fixation of the ankle fracture.
A. 042, 176.0, 824.8, 79.16
B. 824.8, 176.0, V08, 79.16
C. 176.1, 824.8, V08, 79.16
D. 824.8, 042, 176.0, 79.16
D
A patient was admitted with Septicemia due to methicillin-resistant Staphylococcus aureus. The patient also was admitted with septic shock and decubitus ulcer of the sacrum. She had a central line inserted and infusion of drotrecogin alfa.

A. 038.19, 785.59, 707.02, 38.91
B. 038.12, 707.03, 995.92, 785.52, 707.20, 38.93, 00.11
C. 707.00, 038.11, 785.59, 38.93, 00.11
D. 038.11, 785.59, 995.92, 38.93
B
A patient was diagnosed with nephropathy due to tuberculosis (confirmed histologically) of the kidney. He had a right nephrectomy performed.

A. 016.05, 583.81, 55.51
B. 583.81, 016.06, 55.52
C. 016.02, 583.81, 55.51
D. 016.02, 583.81, 55.52
A
A patient is admitted with fever and severe headache. The diagnostic workup revealed viral meningitis. She also has asthma with acute exacerbation and hypertension, both of which are treated.

A. 047.9, 780.60, 784.0, 493.90, 401.9
B. 047.8, 493.92, 401.1
C. 047.9, 493.92, 401.9
D. 780.60, 784.0, 047.9, 493.90, 401.9
C
Nurse Jones suffers a needlestick and presents for HIV testing. She sees her physician for the test results and counseling.

A. V72.60, 795.71
B. 795.71, V65.8
C. V08, V72.60, V65.44
D. V73.89, V65.44, V01.79
D
A patient presents with right arm paralysis due to poliomyelitis that the patient suffered from as a child.

A. 045.11, 342.81
B. 138, 344.41
C. 344.40, 138
D. 138, 344.41
C
A patient is admitted for chemotherapy for treatment of breast cancer with liver metastasis. She had a mastectomy 4 months ago. Chemotherapy is given today.

B. 174.9, 197.7, 99.25
D. V58.11, 174.9, V45.71, 197.7, 99.25
A. 197.7, V10.3, 99.25
C. V58.11, V10.3, 197.7, 99.25
D
A patient with a history of malignant neoplasm of the lung is admitted with seizures. The workup revealed metastasis of the lung cancer to the brain.

A. 780.39, V10.11, 198.3
B. 162.9, V10.11, 198.3, 780.39
C. 198.3, 780.39, V10.11
D. 198.3, 780.39, 162.9
C
A patient is admitted to the hospital for treatment of dehydration following chemotherapy as treatment for ovarian cancer.

A. 276.51, 183.0
B. 183.0, 276.51, 99.25
C. 276.50, 183.0, 99.25
D. 183.0, 276.51
A
A patient has malignant melanoma of the skin of the back. She undergoes a radical excision of the melanoma with full-thickness skin graft.

A. 173.5, 86.4, 86.63
B. 172.5, 86.4, 86.63
C. 173.5, 86.3, 86.63
D. 172.5, 86.3, 86.63
B
A patient is admitted with abdominal pain. The needle biopsy of the liver reveals secondary malignancy of the liver. The patient has an exploratory laparotomy to determine the primary site. The primary site is unknown at the time of discharge.

A. 197.7, 199.1, 54.11, 50.12
B. 197.7, 789.00, 54.11, 50.11
C. 197.7, 199.1, 54.11, 50.11
D. 197.7, 199.1, 789.00, 54.11, 50.12
C
A patient with a history of cancer of the colon and status postcolostomy is admitted for closure of the colostomy. The patient is also being treated for chronic obstructive pulmonary disease and diastolic heart failure. He has a takedown of the colostomy.

A. 153.2, 496, 428.30, 46.52
B. V55.3, 496, V10.05, 428.30, 46.52
C. V55.3, 496, V10.05, 428.0, 46.52, 45.79
D. V10.05, 492.8, 428.30, 46.52
B
A female, 68 years old, was admitted with type II diabetes mellitus with a diabetic ulcer of the left heel. The patient was taken to the operating room for excisional debridement of the ulcer.

A. 250.80, 707.14, 86.22
B. 707.14, 250.80, 86.22
C. 250.81, 707.13, 86.22
D. 250.82, 707.14, 86.28
A
A 67-year-old man is admitted with acute dehydration secondary to nausea and vomiting that is due to acute gastroenteritis. He is treated for dehydration. An esophagogastroduodenoscopy is performed.

A. 558.9, 787.01, 276.51, 45.13
B. 558.9, 787.01, 276.51, 45.16
C. 276.51, 787.01, 558.9, 45.13
D. 276.51, 558.9, 45.13
D
A patient was found at home in a hypoglycemic coma. This patient had never been diagnosed as being diabetic.

A. 250.30
B. 251.0
C. 251.1
D. 251.2
B
A patient is admitted with aplastic anemia secondary to chemotherapy administered for multiple myeloma.

A. 284.89, 203.00, E933.1
B. 203.00, 284.81, E933.1
C. 284.9, 203.00, E933.1
D. 203.01, 284.89, E933.1
A
A male patient is admitted with gastrointestinal hemorrhage resulting in acute blood loss anemia. A colonoscopy and esophagogastroduodenoscopy fail to reveal the source of the bleed.
A. 285.9, 578.1, 45.13, 45.23
C. 578.9, 285.1, 45.13, 45.23
B. 578.1, 285.1, 45.13, 45.23
D. 578.9, 280.0, 45.13, 45.23
C
A patient is admitted with severe malnutrition. The physician performs a percutaneous endoscopic gastrostomy.

A. 263.9, 43.11
B. 261, 43.11
C. 261, 43.19
D. 263.8, 43.11
B
A patient is admitted with thrombocytopenia and purpura. A splenectomy is performed.

A. 287.49, 41.5
D. 287.30, 41.5
B. 287.8, 41.5
C. 287.9, 41.42
D
A patient is admitted with sickle cell anemia with crisis.

A. 282.61
B. 282.62
C. 282.63
D. 282.69
B
A patient is admitted with sickle cell pain crisis.

A. 282.62
B. 282.60
C. 282.5
D. 282.42
A Pain is a symptom that is integral to
the sickle cell crisis and therefore is
not coded.
A patient is admitted with Cooley's anemia. =

A. 282.41
B. 282.0
C. 282.49
D. 282.42
C
A patient is admitted with anemia due to end-stage renal disease. The patient is treated for anemia.

A. 285.8
B. 285.21, 585.6
C. 285.22, 585.6
D. 285.9
B
A patient is admitted with pernicious anemia.

A. 280.9
B. 280.8
C. 281.1
D. 281.0
D
A patient is admitted with mild mental retardation due to an old viral encephalitis.

A. 319, 049.8
B. 317, 326
C. 317, 047.8
D. 317, 139.0
D
A patient is admitted with anxiety with depression.

A. 300.11, 311
B. 300.4
C. 309.28
D. 300.00, 311
B
A patient is admitted with delirium tremens with alcohol dependence.

A. 291.0, 303.90
B. 303.91, 291.0
C. 291.3, 303.90
D. 291.0, 303.00
A
A patient is admitted with latent schizophrenia, chronic with acute exacerbation.

A. 295.52
B. 295.55
C. 295.54
D. 295.53
C
A patient with chronic paranoia due to continuous cocaine dependence is admitted. Drug rehabilitation is provided.

A. 301.0, 305.61, 94.63
B. 297.1, 304.21, 94.64
C. 297.1, 305.61, 94.64
D. 297.1, 304.21, 94.63
B
A patient is diagnosed with psychogenic paroxysmal tachycardia.

A. 427.2, 316
B. 306.2, 427.1
C. 427.1, 306.2
D. 316, 427.2
D
A 5-year-old female is admitted to ambulatory surgery with chronic otitis media. She has bilateral myringotomy with insertion of tubes.

A. 381.20, 20.01
B. 381.3, 20.01
C. 382.9, 20.01, 20.01
D. 381.89, 20.01
C
A patient is a type II diabetic with a diabetic cataract. He has phacoemulsification of the cataract with synchronous insertion of the lens.

A. 250.51, 366.42, 13.59, 13.71
B. 250.50, 366.41, 13.41, 13.71
C. 250.52, 366.41, 13.41, 13.71
D. 366.41, 250.50, 13.41, 13.71
B
A patient has epilepsy and paraplegia as residuals of a head injury he suffered 5 years ago.

A. 345.90, 344.1, 907.0
B. 345.91, 344.1, 907.0
C. 959.01, 345.90, 344.1
D. 345.81, 344.2, 907.0
A
A patient is diagnosed with Alzheimer's disease with dementia.

A. 331.0, 294.8
B. 294.8
C. 331.0, 294.10
D. 331.0
C
A patient is admitted with meningitis sarcoidosis.

A. 321.2, 136.1
C. 136.1, 321.2
B. 135, 321.4
D. 321.4, 135
B
A patient with carpal tunnel syndrome is admitted for arthroscopic release of the carpal tunnel.

A. 354.0, 04.43
B. 354.1, 80.23
C. 354.1, 04.43, 80.23
D. 354.0, 04.43, 80.23
D
A patient is admitted with acute cerebral infarction with left hemiparesis. The hemiparesis resolved by discharge.

A. 342.90
B. 434.91
C. 436, 342.90
D. 434.91, 342.90
D Effective October 1, 2010 the Official
ICD-9-CM Coding Guidelines state,
"Additional codes should be
assigned for any neurologic deficits
associated with the acute CVA,
regardless of whether or not the
neurologic deficit resolves prior to
discharge."
A patient is admitted with multiple problems. He has hypertensive kidney disease, congestive heart failure, and acute systolic heart failure.

A. 593.9, 401.9, 482.0, 428.21
B. 404.11, 428.0, 428.21
C. 403.90, 428.0, 428.21
D. 404.91
C
A patient is admitted with acute inferior wall myocardial infarction with unstable angina. He also has coronary artery disease and atrial fibrillation.

A. 410.41, 411.1, 414.01, 427.31
B. 410.41, 414.00, 411.1, 427.31
C. 410.40, 414.00, 427.31
D. 410.41, 414.00, 427.31
D
A patient with a diagnosis of aortic valve stenosis and mitral valve regurgitation is admitted for aortic valve replacement. The patient is also under treatment for congestive heart failure. He undergoes the placement of an aortic valve prosthesis with cardiopulmonary bypass.

D. 424.1, 424.0, 428.0, 35.21, 39.61
C. 396.2, 428.0, 35.22, 39.61
B. 424.1, 424.0, 428.0, 35.22
A. 396.2, 398.91, 35.22, 39.61
A
A patient with atherosclerotic peripheral vascular disease of the lower leg with claudication is admitted for angioplasty of the lower leg artery.

A. 440.20, 39.50
B. 440.21, 39.50
C. 444.22, 38.08
D. 443.9, 39.50
B
A patient presents to the outpatient department for a chest x-ray. The physician's order lists the following reasons for the chest x-ray: fever and cough, rule out pneumonia. The radiologist reports that the chest x-ray is positive for pneumonia.

A. 486
B. 486, 780.61, 786.2, V72.5
C. 780.61, 786.2
D. V72.5, 780.60, 786.2
A
A patient has aspiration pneumonia with pneumonia due to Staphylococcus aureus. The patient also has emphysema.

A. 507.0, 482.9, 496
B. 507.0, 482.41, 496
C. 507.0, 491.21
D. 507.0, 482.41, 492.8
D
A patient is admitted with acute respiratory failure due to congestive heart failure. The patient is placed on the ventilator for 3 days following insertion of the endotracheal tube.

A. 518.81, 428.0, 96.71, 96.04
B. 518.81, 428.0, 96.72, 96.04
C. 428.0, 518.81, 96.71, 96.04
D. 428.0, 518.83, 96.72, 96.04
A
A child has hypertrophic tonsillitis and is admitted for bilateral tonsillectomy and adenoidectomy.

A. 463, 28.3, 28.3
B. 474.00, 28.3
C. 474.02, 28.3, 28.3
D. 463, 28.3
B
A patient is admitted with chronic obstructive pulmonary disease with an exacerbation of acute bronchitis.

A. 491.22
B. 496, 466.0
C. 466.0, 496
D. 491.22, 466.0
A
A patient is admitted with extrinsic asthma with status asthmaticus.

A. 493.11
B. 493.90
C. 493.01
D. 493.81
C
A patient is experiencing exacerbation of myasthenia gravis resulting in acute respiratory failure. The patient required mechanical ventilation for 10 hours, following endotracheal intubation.

A. 358.00, 518.81, 96.71, 96.04
B. 518.81, 358.01, 96.71, 96.04
C. 358.00, 581.89, 96.71, 96.05
D. 518.82, 358.00, 96.72, 96.04
B
A patient is admitted to the hospital for repair of a ventral hernia. The surgery is canceled after the chest x-ray revealed lower lobe pneumonia. The patient is placed on antibiotics to treat the pneumonia.

A. 553.20, 486, V64.1
B. 486, 553.20, V64.3
C. 486, 553.20
D. 553.20, 486
A
A patient is admitted with gastric ulcer with hemorrhage resulting in acute blood-loss anemia. An esophagogastroduodenoscopy is performed.

A. 531.20, 285.1, 45.13
B. 285.1, 531.20, 45.13
C. 531.40, 280.0, 45.14
D. 531.40, 285.1, 45.13
D
A patient has diverticulitis of the large bowel with abscess. The physician performs a right hemicolectomy with colostomy.

A. 562.10, 45.74, 46.03
B. 562.11, 45.73, 46.10
C. 562.11, 569.5, 45.73, 46.10
D. 562.11, 569.5, 45.74, 46.11
C
A patient is admitted with acute and chronic cholecystitis with cholelithiasis. A laparoscopic cholecystectomy was attempted, and then it was converted to an open procedure.

A. 574.00, 574.10, V64.41, 51.22
B. 574.00, 574.10, 51.22, 51.23
C. 574.00, 51.22, 51.23
D. 574.00, V64.41, 51.22
A
A patient is admitted with bleeding esophageal varices with alcoholic liver cirrhosis and portal hypertension. The patient is alcohol dependent. An esophagogastroduodenoscopy is performed for control of the hemorrhage.

A. 456.20, 571.2, 303.90, 42.33
B. 571.2, 456.20, 303.90, 280.0, 42.33
C. 572.3, 571.2, 303.90, 456.20, 42.33
D. 303.90, 456.20, 303.90, 42.33
C
A patient is admitted for workup for melena. The laboratory results reveal chronic blood loss anemia. The colonoscopy with biopsy reveals Crohn's disease of the descending colon.

A. 578.1, 555.1, 45.25, 45.43
B. 555.1, 45.25
C. 555.1, 578.1, 45.25
D. 555.1, 578.1, 45.25, 45.23
B The physician should be asked if the
blood loss should be added as a
discharge diagnosis.
A patient is admitted with acute urinary tract infection due to E. coli.

A. 599.0, 041.4
B. 599.0
C. 041.4, 599.0
D. 590.2, 041.4
A
A patient presents with complaints of gross hematuria. The diagnosis is benign prostatic hypertrophy and the patient undergoes a transurethral prostatectomy.

A. 600.01, 60.21
B. 600.00, 60.29
C. 600.00, 599.71, 60.29
D. 600.00, 599.71, 60.21
C
A male patient presents to the ED with acute renal failure. He is also being treated for hypertension.

A. 410.00, 586
B. 401.9, 584.9
C. 585.9, 401.1
D. 584.9, 401.9
D
A patient is admitted with hemorrhagic cystitis. A cystoscopy with biopsy of the bladder is performed.

A. 595.9, 57.33
B. 595.9, 041.4, 57.32
C. 595.82, 57.33
D. 596.7, 57.33
A
A patient is admitted with chronic kidney disease due to hypertension and type I diabetes mellitus.

A. 250.41, 403.90, 585.9
B. 250.40, 403.10, 585.1
C. 403.90, 250.41, 585.9, V58.67
D. 403.10, 250.41, 585.2
C
A patient has end-stage kidney disease, which resulted from malignant hypertension.

A. 403.01, 585.6
B. 585.9, 401.0
C. 403.00
D. 401.0, 585.9
A
A woman has a vaginal delivery of a full-term liveborn infant. She undergoes an episiotomy with repair and post delivery elective tubal ligation.

A. 650, V25.2, V27.0, 73.6, 66.32
B. 648.91, V27.0, 73.6, 66.32
C. 650, V27.0, 66.32
D. 650, V27.0
A
A woman has an incomplete spontaneous abortion complicated by excessive hemorrhage. The physician performs a dilation and curettage.

A. 634.12, 69.09
B. 634.12, 285.1, 69.09
C. 634.11, 69.02
D. 634.91, 69.02
C
A patient has obstructed labor due to breech presentation. A single liveborn infant was delivered via Cesarean section.

A. 660.81, 74.1
B. 660.01, 652.21, V27.0, 74.99
C. 660.01, V27.0, 74.1
D. 660.81, 652.21, 74.99
B
A woman was admitted for delivery of a single newborn at 43 weeks' gestation. It was a manually assisted delivery.

A. 650, V27.0, 73.59
B. 645.20, V27.0, 73.59
C. 644.21, V27.0, 73.59
D. 645.21, V27.0, 73.59
D
A female who is 26 weeks' pregnant is treated for a fractured distal radius and ulna. A closed reduction of the fracture is performed.

A. 813.44, 79.02
B. 648.93, 813.44, 79.02
C. 813.44, V22.2, 79.02
D. V22.2, 813.44, 79.02
B
A patient is diagnosed with a tubal pregnancy. She undergoes a unilateral salpingectomy for removal of the tubal pregnancy.

A. 633.20, 66.63
B. 633.11, 66.62
C. 633.00, 66.61
D. 633.10, 66.62
D
A patient is admitted with an abscess with cellulitis of the abdominal wall. The culture is positive for Staphylococcus aureus.

A. 682.8, 041.11
B. 682.2, 041.11
C. 682.2, 707.8
D. 682.2
B
A patient had a cholecystectomy six days ago and is now coming back with evidence of staphylococcal cellulitis at the site of operative incision.

A. 958.3, 682.2, 041.19
B. 998.51, 682.8, 041.11
C. 958.3, 682.8, 041.11
D. 998.59, 682.2, 041.10
D
A patient has chronic ulcers of the calf and the back. Both ulcers are excisionally debrided and the ulcer on the back has a split-thickness skin graft.

A. 707.12, 707.8, 86.22, 86.22, 86.69
B. 707.12, 707.8, 86.22
C. 707.8, 86.22, 86.69
D. 707.8, 86.22, 86.22, 86.69
A
A patient presents with dermatitis due to prescription topical antibiotic cream used as directed by physician.

A. 692.4
B. 692.3, E930.9
C. 692.3
D. 692.3, E930.1
B
A patient developed a boil on the left side of the face. An incision and drainage was performed.

A. 680.0, 86.04
B. 680.0, 86.09
C. 680.8, 86.11
D. 680.0, 86.04, 86.11
A
A patient has an abscessed pilonidal cyst. An excision of the cyst was performed.

A. 685.1, 86.04
B. 686.09, 86.04
C. 685.0, 86.21
D. 686.01, 86.22
C
A patient has a pathological fracture of the femur due to metastatic bone cancer. He has a history of lung cancer.

A. 198.5, 733.14, V10.11
B. 733.14, 198.5, V10.11
C. 733.19, 198.5, V10.11
D. 821.00, 162.9
B
A 69-year-old man has a herniated lumbar intervertebral disc with paresthesia. A lumbar laminectomy with diskectomy is performed.

A. 722.11, 80.51, 03.09
B. 839.20, 80.51
C. 722.10, 80.59, 03.09
D. 722.10, 80.51
D
A patient developed pyogenic arthritis of the hip due to Group A Streptococcus. An arthrocentesis was done.

A. 716.95, 041.01, 81.91
B. 715.95, 041.01, 81.92
C. 711.05, 041.01, 81.91
D. 711.05, 81.91
C
A patient is admitted with a bunion of the left foot and a hammertoe of the right foot. Keller procedure and hammer toe repair was performed.

A. 727.1, 735.4, 77.59, 77.56
B. 727.1, 735.8, 77.52, 77.59
C. 727.2, 735.4, 77.52, 77.58
D. 727.1, 735.3, 77.56, 77.59
A
A patient developed a malunion of the humeral fracture. The original injury occurred 1 year ago. Open reduction with internal fixation was performed.

A. 812.20, 79.39
B. 733.82, 905.2, 79.31
C. 733.81, 905.2, 79.31
D. 733.94, 905.2, 79.32
C
A patient has recurrent internal derangement of the left knee. A diagnostic arthroscopy of the knee is performed.

A. 715.96, 80.26
B. 718.36, 80.26
C. 836.2, 80.26
D. 718.36, 80.6
B
A liveborn infant is born in hospital with a cleft palate and cleft lip.

A. 749.00, 749.10
B. 749.20
C. V30.00, 749.20
D. V30.00, 749.00, 749.10
C
A newborn is born in the hospital with tetralogy of Fallot.

A. 745.8
B. V30.01, 746.09
C. 745.2
D. V30.00, 745.2
D
A newborn infant is transferred to Manasota Hospital for treatment of an esophageal atresia.
What is the code for Manasota Hospital?

A. V30.00
B. 750.3
C. V30.00, 750.3
D. 750.3, V30.00
. B Newborn V-code is not assigned by the
receiving facility when a newborn is
transferred.
A patient presents with cervical spina bifida with hydrocephalus.

A. 741.02
B. 741.93
C. 741.01
D. 741.91
C
An infant is seen with clubfoot, which is corrected by the Evans operation.

A. 754.70, 83.84
B. 754.71, 83.84
C. 736.71, 83.84
D. 736.79, 83.84
A
A full-term infant, born in hospital is diagnosed with polycystic kidneys.

A. 753.12
B. V30.00, 753.12
C. V30.00
D. 753.12, V30.00
B
A full-term newborn is born in hospital to a mother who is addicted to cocaine; however, the infant tested negative.

A. V30.00, 760.75
B. 779.5 V29.8
C. V30.00, 779.5
D. V30.00, V29.8
D
A preterm infant is born via Cesarean section and has severe birth asphyxia.

A. V30.01, 765.10, 768.5
B. 765.10, 768.5, V30.01
C. 768.5, 765.10
D. 768.5
C
A preterm infant born in the hospital has neonatal jaundice. Phototherapy is done to treat the jaundice.

A. V30.00, 774.2, 99.83
B. 774.2, 99.83
C. V30.00, 99.83
D. V30.00, 774.2
A
A one-week-old infant is admitted to the hospital with a diagnosis of urinary tract infection contracted prior to birth. The urine culture is positive for E. coli.

A. V30.00, 599.0
B. 599.0, 041.4
C. V30.00, 599.0, 041.4
D. 771.82, 041.4
D
An infant has hypoglycemia with diabetic mother.

A. 251.2
B. 775.1
C. 775.0
D. 251.1
C
A full-term infant is born in the hospital. The birth is complicated by cord compression, which affected the newborn.

A. V30.00, 762.5
B. V30.00
C. 762.5
D. 762.6, V30.00
A
A patient is admitted with abdominal pain. The discharge diagnosis is listed as abdominal pain due to gastroenteritis or diverticulosis.

A. 789.00
B. 562.10, 558.9
C. 789.00, 558.9, 562.10
D. 558.9, 562.10, 789.00
C
A patient has a lung mass. A diagnostic bronchoscopy is performed.

A. 518.89, 33.23
C. 793.1, 33.27
B. 786.6, 33.23
D. 786.6, 33.27
B
A woman has a pap smear that detected cervical high-risk human papillomavirus (HPV). The DNA test was positive.

A. 795.05
B. 795.09
C. 795.04
D. 795.02
A
A patient presents to the emergency department with ascites. A paracentesis was done.

A. 789.30, 54.91
B. 789.51, 54.91
C. 789.59, 54.91
D. 782.3, 54.91
C
A patient is admitted with fever due to bacteremia.

A. 780.61, 790.7
B. 038.9
C. 780.61
D. 790.7, 780.61
D
A patient has urinary retention requiring the insertion of a Foley catheter.

D. 788.29, 57.93
C. 788.20, 57.94
B. 788.20, 57.93
A. 788.21, 57.94
C
A patient has a fracture of the medial malleolus due to a fall down some steps. The fracture was treated with a closed reduction procedure.

A. 824.1, E880.9, 79.05
B. 824.0, E880.9, 79.06
C. 824.0, 79.09
D. 824.1, E880.1, 79.05
B
A patient experienced a closed head injury. He was a passenger in a motor vehicle involved in a head-on collision with another motor vehicle.

A. 959.01, E812.1
B. 959.09, E812.2
C. 959.01, E813.1
D. 959.09, E813.1
A
A man appears with a gunshot wound to the abdomen. There is a moderate laceration of the liver. The patient stated that he was assaulted with a pistol.

A. 864.00, E965.1
B. 864.10, E965.0
C. 864.13, E965.1
D. 864.13, E965.0
D
A patient was admitted with third-degree burns to his upper back, which involved 20% of his body surface. There was an explosion and fire at his home.

A. 942.25, 948.22, E890.2
B. 942.44, 948.21, E895
C. 942.34, 948.22, E890.3
D. 942.24, 949.3, E897
C
A woman experienced third-degree burns to her thigh and second-degree burns to her foot. She stated that the burns were from hot liquid.

A. 945.36, 945.22, E924.0
B. 945.22, 945.36, E924.0
C. 945.22, E924.0
D. 945.29, 945.39, E924.0
A
A patient presents with a laceration of left wrist with injury to the radial nerve as a result of an accident, with embedded glass. The wrist laceration was repaired with sutures.

A. 881.02, 86.59
B. 881.12, E920.8, 86.59
C. 955.3, E920.8, 86.59
D. 881.12, 955.3, E920.8, 86.59
D
A 76-year-old female is admitted with tachycardia due to theophylline toxicity.

A. 785.0, E942.1
B. 995.20, E942.1
C. 785.0, E944.1
D. 995.20, E944.1
C
A patient suffered dizziness as a result of taking prescribed Phenobarbital. The patient took his medication with beer.

A. 780.4, 980.0, E860.0
B. 967.0, 980.0, 780.4, E851, E860.0
C. 967.0, 708.4, E851
D. 780.4, E851, E860.0
B
A patient is experiencing pain in the hip due to a displaced hip prosthesis. The patient is admitted and undergoes a revision of the hip prosthesis.

A. 996.49, 81.53
B. 996.77, 81.53
C. 719.45, 81.53
D. 996.49, 719.45, 81.53
A
A patient has postoperative hemorrhage resulting in acute blood-loss anemia.

A. 997.72, 285.1
B. 999.1, 285.1
C. 998.11, 285.1
D. 998.11
C
A patient is admitted for colostomy takedown. The takedown procedure is performed.

A. V44.3, 46.52
B. 569.60, 46.52
C. 997.4, 46.52
D. V55.3, 46.52
D
The patent is being admitted for a preoperative EKG on an outpatient basis. He is scheduled to have an elective cholecystectomy tomorrow for chronic cholecystitis and cholelithiasis. The EKG reveals atrial flutter.

A. 574.10
B. V72.81, 51.23
C. V72.81, 574.10, 427.32
D. 427.32
C
The patient presents for a screening examination for lung cancer.

A. V72.82
B. 162.9
C. V72.5
D. V76.0
D
A patient is admitted for observation for a head injury following a fall. The patient also suffered a minor laceration to the forehead. Head injury was ruled out.

A. V71.4, 873.42, E888.9
B. 873.42, E888.9
C. 959.01, 873.42, E888.9
D. V71.4, E888.9
A
An elderly man was admitted through the emergency department for severe urinary retention. Upon study, it was determined that his hypertension was uncontrolled (215/108). Prior medical records show admission 8 weeks ago for the same problem. As per conditions on previous admission, his BPH is complicated by acute cystitis. He is noncompliant with medications. Medication for the hypertension was immediately started and his hypertension was quickly brought under control. Urinary retention was relieved by placement of a Foley catheter.
Transurethral resection of the prostate was done.

401.0 Essential hypertension, malignant
401.9 Essential hypertension, unspecified benign or malignant
595.0 Acute cystitis
595.9 Cystitis, unspecified
600.00 Hypertrophy, (benign) of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS)
600.01 Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)
600.3 Cyst of prostate
788.20 Retention of urine, unspecified
V15.81 Personal history of noncompliance with medical treatment
57.92 Dilation of bladder neck
57.94 Insertion of indwelling urinary catheter
60.29 Other transurethral prostatectomy
60.61 Local excision of lesion of prostate

A. 600.01, 595.0, 788.20, 401.9, V15.81, 57.94, 60.29
B. 600.3, 595.0, 401.0, V15.81, 57.92, 60.61
C. 600.00, 595.9, 788.20, 401.9, V15.81, 57.94, 60.61
D. 600.3, 595.0, 788.20, 401.0, V15.81, 57.94, 60.61
A
A 32-year-old female known to be HIV positive was admitted with lesions of the anterior trunk. Excisional biopsies of the skin lesions were positive for Kaposi's sarcoma. Further examination revealed thrush.
042 Human Immunodeficiency Virus (HIV) Disease
112.0 Candidiasis of mouth
176.0 Kaposi's sarcoma of skin
528.9 Other and unspecified diseases of the oral soft tissues
686.00 Pyoderma, unspecified
795.71 Nonspecific serological evidence of Human Immunodeficiency Virus (HIV)
86.11 Closed biopsy of skin and subcutaneous tissue
86.22 Excisional debridement of wound, infection, or burn

A. 042, 686.00, 112.0, 86.22
B. 042, 176.0, 112.0, 86.11
C. 795.71, 176.0, 528.9, 86.11
D. 795.71, 686.00, 528.9, 86.22
B
A female patient was admitted with uncontrolled type II diabetes. She also had an abscessed diabetic ulcer of the foot that was treated with incision and drainage. The culture and sensitivity of the abscess shows growth of Staphylococcus aureus, methicillin resistant. The patient was started on the appropriate antibiotic. The patient is on oral as well as injectional insulin for control of her diabetes.
041.11 Bacterial infection in conditions classified elsewhere and of unspecified site, methicillin susceptible staphylococcus aureus (MSSA)
041.19 Bacterial infection in conditions classified elsewhere and of unspecified site, other staphylococcus
250.82 Diabetes mellitus with other specified manifestation, type II or unspecified type, uncontrolled
250.83 Diabetes mellitus with other specified manifestation, type I (juvenile type), uncontrolled
682.7 Other cellulitis and abscess of foot, except toes
682.8 Other cellulitis and abscess of other specified sites
707.00 Chronic ulcer of skin, pressure ulcer, unspecified site
707.15 Ulcer of lower limbs, except pressure ulcer, of other part of foot (toes)
707.8 Chronic ulcer of other specified sites
V09.0 Infection with microorganisms resistant to penicillins
86.01 Aspiration of skin and subcutaneous tissue
86.04 Other incision with drainage of skin and subcutaneous tissue

A. 250.83, 682.8, V09.0, 86.04
B. 682.7, 682.8, 707.15, 041.19, 86.01
C. 682.8, 041.19, 250.82, 707.00, 86.04,
D. 250.82, 682.7, 707.15, 041.11, V09.0, 86.04
D
A patient was admitted from the nursing home in acute respiratory failure that was due to congestive heart failure. Chest x-ray also showed pulmonary edema. Patient was intubated and placed on mechanical ventilation and expired the day after admission.
428.0 Congestive heart failure, unspecified
428.1 Left heart failure
428.20 Systolic heart failure, unspecified as to acute, chronic, or acute on chronic
518.4 Acute edema of lung, unspecified
518.81 Acute respiratory failure
518.84 Acute and chronic respiratory failure
96.71 Continuous invasive mechanical ventilation for less than 96 consecutive hours
96.04 Insertion of endotracheal tube
A. 428.1, 518.84, 518.4, 96.71, 96.04
B. 428.20, 428.0, 518.81, 518.4, 96.71, 96.04
C. 518.81, 428.0, 96.71, 96.04
D. 428.0, 518.4, 96.04, 96.71
C
The patient has hypertensive heart disease and nephrosclerosis with end stage renal disease. The patient had placement of arteriovenous fistula in his left wrist to prepare for the hemodialysis.
Dialysis was also performed on this admission.
404.92 Hypertensive heart and chronic kidney disease, unspecified as malignant or benign, without heart failure and with chronic kidney disease Stage V or end stage renal
disease
404.93 Hypertensive heart and chronic kidney disease unspecified as malignant or benign, with heart failure and chronic kidney disease Stage V or end stage renal disease
585.6 End stage renal disease
585.9 Chronic kidney disease, unspecified
V56.0 Encounter for extracorporeal dialysis
39.27 Arteriovenostomy for renal dialysis
38.95 Venous catheterization for renal dialysis
39.95 Hemodialysis
54.98 Peritoneal dialysis

A. 404.93, 585.9, 54.98, 39.27
B. 404.92, 585.6, 39.95, 39.27
C. 404.93, 585.6, 39.95, 39.27
D. 404.92, 585.9, 38.95, 39.27
B
The patient has had abnormal heavy uterine bleeding and abdominal pain. There was bright red blood in the vagina and the right adnexa was enlarged. The woman was admitted. In surgery, a laparoscopy revealed a right follicular ovarian cyst. A laparoscopic ovarian cystectomy was performed. Following surgery, she was transfused two units of packed red blood cells for acute blood-loss anemia.
280.0 Iron deficiency anemia secondary to blood loss (chronic)
285.1 Acute posthemorrhagic anemia
620.0 Follicular cyst of ovary
65.25 Other laparoscopic local excision or destruction of ovary
65.39 Other unilateral oophorectomy

A. 620.0, 285.1, 65.25
B. 620.0, 280.0, 65.39
C. 620.0, 285.1, 65.39
D. 620.0, 280.0, 65.25
A
Jane Doe is 6 weeks post mastectomy for carcinoma of the breast. She is admitted for chemotherapy. What is the correct sequencing of the codes?
A. V58.11 (chemotherapy), 174.9 (malignant neoplasm of the breast), V45.71 (acquired absence of breast)
B. V58.11 (chemotherapy), V10.3 (personal history of malignant neoplasm of breast), V45.71 (acquired absence of breast)
C. V67.00 (follow-up exam after surgery), V58.11 (chemotherapy)
D. V10.3 (personal history of malignant neoplasm of breast)
A
The patient was admitted due to increasingly severe pain in his right arm, shoulder, and neck for the past 6 weeks. MRI tests showed herniation of the C5-C6 disc. Patient underwent cervical laminotomy and diskectomy C5-C6 disc. The patient is currently being treated for COPD and CAD with a history of a PTCA.
414.00 Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01 Coronary atherosclerosis of native coronary artery
492.8 Other emphysema
496 Chronic airway obstruction, not elsewhere classified
722.0 Displacement of cervical intervertebral disc without myelopathy
722.11 Displacement of thoracic intervertebral disc without myelopathy
V45.82 Percutaneous transluminal coronary angioplasty status
80.51 Excision of intervertebral disc
03.09 Other exploration and decompression of spinal canal

A. 722.0, 492.8, 414.01, V45.82, 80.51
B. 722.11, 496, 414.01, V45.82, 03.09, 80.51
C. 722.11, 492.8, 414.00, 03.09, 80.51
D. 722.0, 496, 414.01, V45.82, 80.51
D
A 75-year-old man is admitted with acute cerebral embolism with infarction. He had hemiplegia and dysphagia. Physical therapy was given for the hemiplegia. The hemiplegia was resolved at the time of discharge.
342.90 Hemiplegia, unspecified, affecting unspecified side
434.11 Cerebral embolism with cerebral infarction
787.20 Dysphagia, unspecified
V57.1 Other physical therapy
A. 434.11, 342.90, V57.1
B. 434.11, 342.90, 787.20
C. 434.11, 342.90
D. 434.11, 342.90, 787.20, V57.1
D Effective October 1, 2010, the Official
ICD-9-CM Coding Guidelines state,
"Additional codes should be assigned
for any neurologic deficits associated
with the acute CVA, regardless of
whether or not the neurologic deficit
resolves prior to discharge."
Patient is admitted to St. Mary's Hospital with hyperthermia, tachycardia, hypoxemia, and
altered mental status. Urinalysis is positive for E. coli and blood cultures are negative. Patient is
immediately started on broad-spectrum IV antibiotics. Physician documents urosepsis as the
final diagnosis. The coder should
A. report 599.0 (UTI) and 041.4 (E. coli).
B. report 038.42 (septicemia due to E. coli) and 995.91 (SIRS-sepsis).
C. report 038.42 (septicemia due to E. coli), 599.0 (UTI) and 995.91 (SIRS-sepsis).
D. confer with physician for reporting 038.9 (unspecified septicemia) based upon the clinical findings with 041.4 (E. coli) and 995.91 (SIRS-sepsis).
D
Six-year-old Alex attended a birthday party where hot dogs and potato salad were served for lunch. Several hours after returning home, Alex began vomiting and having severe diarrhea. Alex was admitted to the hospital for treatment of his vomiting and diarrhea and was diagnosed with Salmonella food poisoning. Alex was given IV fluids for dehydration. Alex also has asthma, so he was given respiratory treatments while in the hospital.
003.9 Salmonella infection, unspecified
005.9 Food poisoning, unspecified
276.51 Dehydration
493.90 Asthma, unspecified, unspecified as to with status asthmaticus or with acute exacerbation
787.03 Vomiting alone
787.91 Diarrhea

A. 003.9, 276.51, 493.90
B. 005.9, 003.9, 276.51, 493.90
C. 005.9, 276.51, 493.90
D. 005.9, 003.9, 267.51, 787.03, 787.91, 493.90
A
A patient is admitted to the hospital with listlessness, fever, and persistent cough. Workup reveals HIV infection with HIV-related pneumonia. The patient is treated for pneumonia.
042 Human Immunodeficiency Virus (HIV) disease
486 Pneumonia, organism unspecified
795.71 Nonspecific serologic evidence of Human Immunodeficiency Virus (HIV)
V08 Asymptomatic Human Immunodeficiency Virus (HIV) infection status

A. 486, 042
B. 042, 486
C. 486, 795.71
D. 486, V08
B
David was experiencing chronic fatigue and was experiencing flulike symptoms. Blood testing indicated that he had hepatitis C. A percutaneous liver biopsy was performed to determine the stage of the disease.
070.41 Acute viral hepatitis C with hepatic coma
070.51 Acute viral hepatitis C without mention of hepatic coma
487.1 Influenza with other respiratory manifestations
780.79 Other malaise and fatigue
50.11 Closed (percutaneous) (needle) biopsy of liver
50.12 Open biopsy of liver

A. 070.51, 487.1, 780.79, 50.12
B. 070.41, 50.11
C. 070.51, 487.1, 50.11
D. 070.51, 50.11
D Fatigue and flulike symptoms/signs
of hepatitis would not be coded.
A 40-year-old female suddenly develops a painful rash. A visit to her physician reveals she has shingles. She is experiencing a great amount of anxiety and stress, so her physician prescribes medication for the shingles and for the anxiety that occurred as a reaction to the stress.
053.8 Herpes zoster with unspecified complication
053.9 Herpes zoster without mention of complication
300.00 Anxiety state, unspecified
308.0 Predominant disturbance of emotions
308.3 Other acute reactions to stress

A. 053.9, 308.0
B. 053.9, 308.3, 300.00
C. 053.8, 300.00
D. 053.8, 308.0
A
James is admitted to the hospital for severe anemia that is a result of the chemotherapy treatments he is receiving for metastatic prostate cancer to bone. James receives blood transfusions and is discharged home.
185 Malignant neoplasm of prostate
198.5 Secondary malignant neoplasm, bone and bone marrow
285.22 Anemia in neoplastic disease
E933.1 Adverse effect of antineoplastic and immunosuppressive drugs

A. 185, 198.5, 285.22, E933.1
B. E933.1, 285.22
C. 285.22, E933.1
D. 285.22, 185, 198.5, E933.1
D
Mary had resection of the large bowel for carcinoma of the colon. She is admitted for further staging of her cancer and receives radiation therapy during this admission.
153.9 Malignant neoplasm of colon, unspecified
V10.05 Personal history of malignant neoplasm of large intestine
V58.0 Encounter for radiotherapy
V67.09 Follow-up examination following other surgery
92.29 Other radiotherapeutic procedure

A. 153.9, 92.29
B. V58.0, V10.05
C. V67.09, V58.0
D. V10.05, V58.0
A
Jackie has developed a lesion on her right shoulder. A biopsy was obtained and was positive for malignant melanoma. She is now admitted for radical excision of the melanoma lesion and full-thickness skin graft.
172.6 Malignant melanoma of skin, upper limb, including shoulder
173.5 Other malignant neoplasm of skin of trunk, except scrotum
173.6 Other malignant neoplasm of skin of upper limb, including shoulder
86.3 Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue
86.4 Radical excision of skin lesion
86.63 Full thickness skin graft to other sites

A. 172.6, 86.4, 86.63
B. 173.5, 86.4, 86.63
C. 173.5, 86.3, 86.63
D. 172.6, 86.3, 86.63
A
Richard is admitted for chemotherapy for leukemia. Chemotherapy is administered. Given this information,
A. the leukemia code and a procedure code for the chemotherapy will be assigned.
B. an admission for chemotherapy code and a chemotherapy procedure code will be assigned.
C. an admission for chemotherapy code, a leukemia code, and a procedure code for the chemotherapy should be assigned and the principal diagnosis will be the admission for chemotherapy V code.
D. an admission for chemotherapy code, a leukemia code, and a procedure code for the chemotherapy should be assigned and the principal diagnosis will be the leukemia code.
C
Sophia has been diagnosed with metastatic carcinoma of lung, primary site breast. Simple mastectomy performed 2 years ago. What is the principal diagnosis?
A. Metastatic carcinoma of lung
B. Carcinoma of breast
C. History of carcinoma of breast
D. Status post mastectomy
A
Given the following diagnosis: "Carcinoma of axillary lymph nodes and lungs, metastatic from breast." What is the primary cancer site(s)?
A. Axillary lymph nodes
B. Lungs
C. Breast
D. Both A and B
C
When is it appropriate to use category V10, history of malignant neoplasm?
A. Primary malignancy recurred at original site and adjunct chemotherapy is directed at the site.
B. Primary malignancy has been eradicated and no adjunct treatment is being given at this time.
C. Primary malignancy eradicated and the patient is admitted for adjunct chemotherapy to primary site.
D. Primary malignancy is eradicated; adjunct treatment is refused by patient even though there is some remaining malignancy.
B
Ralph is a 96-year-old nursing home resident who is admitted for malnutrition. Ralph has suffered a previous stroke that has left him with dysphagia. Ralph is treated for malnutrition with hyperalimentation. Ralph was also found to have hypokalemia that was treated with IV potassium replacement. On the day prior to discharge, Ralph underwent a PEG tube insertion.

263.9 Unspecified protein-calorie malnutrition
276.8 Hypopotassemia (Hypokalemia)
438.82 Dysphagia, late effect of cerebrovascular disease
787.20 Dysphagia, unspecified
43.11 Percutaneous endoscopic gastrostomy (PEG) insertion
A. 438.82, 263.9, 787.20, 43.11
B. 787.20, 276.8, 43.11
C. 263.9, 276.8, 438.82, 43.11
D. 263.9, 787.20, 276.8, 43.11
C
Jessica has been diagnosed with hyperthyroidism due to toxic multinodular goiter with crisis. She also has hypertension and has a history of sick sinus syndrome with pacemaker insertion. Jessica has a partial thyroidectomy on this admission.

240.9 Goiter, unspecified
241.1 Nontoxic multinodular goiter
242.21 Toxic multinodular goiter with mention of thyrotoxic crisis or storm
401.0 Essential hypertension, malignant
401.9 Essential hypertension, unspecified benign or malignant
427.81 Sinoatrial node dysfunction
V45.01 Other postprocedural states, cardiac pacemaker
06.39 Other partial thyroidectomy
06.4 Complete thyroidectomy

A. 240.9, 401.0, 427.81, 06.4
B. 242.21, 401.9, 427.81, V45.01, 06.39
C. 240.9, 242.21, 401.9. V45.01, 06.4
D. 242.21, 401.9. V45.01, 06.39
D SSS would not be reported as a
current condition because the
pacemaker would have taken care
of this condition.
Laura is 7 years old and has acute bronchitis and cystic fibrosis. She is admitted to ambulatory surgery for bronchoscopy.
277.00 Cystic fibrosis without mention of meconium ileus
277.01 Cystic fibrosis with meconium ileus
466.0 Acute bronchitis
33.23 Other bronchoscopy
33.24 Closed (endoscopic) biopsy of bronchus
96.56 Other lavage of bronchus and trachea

A. 466.0, 277.00, 33.23
B. 466.0, 277.01, 33.24
C. 277.00, 96.56, 33.23
D. 277.00, 33.23, 33.24, 96.56
A
Estelle has had nausea and vomiting and is unable to eat. She develops dehydration and is subsequently admitted for rehydration with intravenous fluids.
276.51 Dehydration
787.01 Nausea with vomiting
787.02 Nausea alone
787.03 Vomiting alone
A. 276.51, 787.01
B. 276.51
C. 276.51, 787.02
D. 276.51, 787.02, 787.03
B
A patient is admitted for treatment of peripheral vascular disease, renal failure, and diabetes mellitus. The coder would
A. assign codes for PVD, renal failure, and diabetes.
B. assign codes for diabetes with peripheral vascular and renal manifestations.
C. query physician for causal relationship between the PVD, renal failure, and diabetes.
D. assign codes of diabetes with PVD and a code for renal failure.
C The coder cannot assume a causal
relationship between the diabetes
and conditions that are usually
related to the diabetes unless a
physician confirms this relationship.
Lucy is admitted because of diabetic coma. She is a type II diabetic with nephritic syndrome and gangrene of her toes, all due to her diabetes.
250.30 Diabetes mellitus with other coma, type II or unspecified type, not stated as uncontrolled
250.31 Diabetes mellitus with other coma, type I (juvenile type), not stated as uncontrolled
250.40 Diabetes mellitus with renal manifestations, type II or unspecified type, not stated as uncontrolled
250.41 Diabetes mellitus with renal manifestations, type I (juvenile type), not stated as uncontrolled
250.70 Diabetes mellitus with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled
581.81 Nephrotic syndrome in diseases classified elsewhere (manifestation)
785.4 Gangrene

A. 250.30, 250.40, 581.81, 250.70, 785.4
B. 250.31, 581.81, 785.4
C. 250.30, 250.40, 581.81
D. 250.30, 250.41, 785.4
A
George is a type II diabetic who is admitted in a coma with blood glucose of 876. He is diagnosed with diabetic ketoacidosis. George also has a diabetic cataract.
250.10 Diabetes mellitus with ketoacidosis, type II or unspecified type, not stated as
uncontrolled
250.11 Diabetes mellitus with ketoacidosis, type I (juvenile type), not stated as uncontrolled
250.30 Diabetes mellitus with other coma, type II or unspecified type, not stated as
uncontrolled
250.31 Diabetes mellitus with other coma, type I (juvenile type), not stated as uncontrolled
250.32 Diabetes mellitus with other coma, type II or unspecified type, uncontrolled
250.50 Diabetes mellitus with ophthalmic manifestations, type II or unspecified type, not
stated as uncontrolled
250.51 Diabetes mellitus with ophthalmic manifestations, type I (juvenile type), not stated as
uncontrolled
250.52 Diabetes mellitus with ophthalmic manifestations, type II or unspecified type, uncontrolled
366.41 Diabetic cataract (manifestation)
366.9 Unspecified cataract

A. 250.11, 250.31, 366.9
B. 250.10, 250.30, 250.50, 366.9
C. 250.32, 250.52, 366.41
D. 250.31, 250.51, 366.41
C Diabetic ketoacidosis by definition
is uncontrolled
Spencer has hypercholesterolemia and is treated with medication.
272.0 Pure hypercholesterolemia
272.1 Pure hyperglyceridemia
272.3 Hyperchylomicronemia
272.8 Other disorders of lipoid metabolism

A. 272.0
B. 272.1
C. 272.3
D. 272.8
A
Edward is diagnosed with syndrome of inappropriate antidiuretic hormone with resultant electrolyte imbalance.
253.6 Other disorders of neurophyophysis (syndrome of inappropriate secretion of antidiuretic hormone—ADH)
272.9 Unspecified disorder of lipoid metabolism
276.50 Volume depletion, unspecified
276.8 Hypopotassemia (hypokalemia)
276.9 Electrolyte and fluid disorders, not elsewhere classified

A. 276.50
B. 276.9, 272.9
C. 253.6, 276.9
D. 253.6. 276.8
C
Ruth is admitted for an axillary lymph node biopsy to determine the cause of her chronic lymphadenitis. She is on medication for gout and atrial fibrillation.
274.9 Gout, unspecified
289.1 Chronic lymphadenitis
289.2 Nonspecific mesenteric lymphadenitis
427.31 Atrial fibrillation
40.11 Biopsy of lymphatic structure
40.23 Excision of axillary lymph node
40.51 Radical excision of axillary lymph nodes

A. 289.1, 274.9, 427.31, 40.11
B. 274.9, 289.2, 427.31, 40.11
C. 289.1, 427.31, 40.23
D. 289.1, 427.31, 274.9, 40.51
A
Elizabeth has a history of von Willebrand's disease and frequently requires transfusions for chronic blood loss anemia associated with her condition. She presents to the outpatient department for routine blood transfusion.
280.0 Iron deficiency anemia secondary to blood loss (chronic)
280.1 Iron deficiency anemia secondary to inadequate dietary iron intake
285.1 Acute posthemorrhagic anemia
286.4 Von Willebrand's disease
286.7 Acquired coagulation factor deficiency

A. 285.1, 286.4
B. 286.7, 286.4
C. 286.4, 280.1
D. 280.0, 286.4
D
Steven, a 7 year old, is seen in the emergency department with severe joint pain. Following workup, it is discovered that he is having a severe crisis due to sickle cell anemia.
282.61 Sickle cell disease (Hb-SS disease without crisis)
282.62 Sickle cell disease (Hb-SS disease with crisis)
282.63 Sickle cell/Hb-C disease without crisis
282.69 Other sickle cell disease with crisis

A. 282.61
B. 282.62
C. 282.63
D. 282.69
B
Angela has just undergone orthopedic surgery. Documentation indicates that she lost 700 cc of blood during surgery. Her hemoglobin and hematocrit are monitored following surgery.
Subsequently she is transfused. The physician documents anemia as a secondary diagnosis. The coder would
A. query the physician to clarify the type of anemia as acute blood loss.
B. assign a code for unspecified anemia.
C. assign a code for acute blood loss anemia.
D. not assign a code for anemia.
A
Liza has been diagnosed with anemia. She is being admitted for a bone marrow aspiration to determine the specific type of anemia. The pathology report indicates that she has iron- deficiency anemia.
280.0 Iron deficiency anemia secondary to blood loss (chronic)
280.8 Other specified iron deficiency anemias
280.9 Iron deficiency anemia, unspecified
41.31 Biopsy of bone marrow
41.38 Other diagnostic procedures on bone marrow
41.91 Aspiration of bone marrow from donor for transplant

A. 280.0, 41.38
B. 280.9, 41.31
C. 280.9, 41.91
D. 280.8, 41.38
B
Peggy has thymic dysplasia with immunodeficiency.
254.0 Persistent hyperplasia of thymus
254.8 Other specified diseases of thymus gland
254.9 Unspecified disease of thymus gland
279.2 Combined immunity deficiency (thymic aplasia or dysplasia with immunodeficiency)
279.3 Unspecified immunity deficiency

A. 279.3, 254.8
B. 254.0
C. 279.2
D. 279.2, 254.9
C
Aaron has suffered a hypoglycemic reaction due to alcohol intoxication. Hypoglycemia is treated.
250.80 Diabetes mellitus with other specified manifestations, type II or unspecified type, not stated as uncontrolled
251.2 Hypoglycemia, unspecified
303.90 Other and unspecified alcohol dependence, unspecified
305.00 Alcohol abuse, unspecified
995.29 Unspecified adverse effect of other drug, medicinal, and biological substance

A. 251.2, 305.00
B. 251.2, 303.90
C. 995.29, 303.90
D. 250.80, 305.00
A
Joe is being admitted for treatment of chronic alcoholism. As a result of Joe's drinking he also has chronic alcoholic gastritis for which he receives medication. Joe is scheduled to spend 30 days in the inpatient rehab unit of Sunshine Hospital.
303.01 Acute alcoholic intoxication, continuous
303.90 Other and unspecified alcohol dependence, unspecified
303.91 Other and unspecified alcohol dependence, continuous
535.00 Acute gastritis without mention of hemorrhage
535.30 Alcoholic gastritis without mention of hemorrhage
535.31 Alcoholic gastritis with hemorrhage
94.61 Alcohol rehabilitation
94.62 Alcohol detoxification
94.63 Alcohol rehabilitation and detoxification
A. 303.01, 535.00, 94.63
C. 303.90, 535.30, 94.61
B. 303.91, 535.00, 94.63
D. 303.01, 303.90, 535.30, 94.63
C The term "continuous" refers to daily intake of large amounts of
alcohol, or regular heavy drinking
on weekends or days off. The coder
should not assume to use the fifth
digit "1" unless documented as
continuous.
Sheila has paranoid alcoholic psychosis with chronic alcoholism, continuous. She is admitted for treatment of her psychosis.
291.5 Alcohol induced psychotic disorder with delusions
303.91 Other and unspecified alcohol dependence, continuous
V57.89 Other specified rehabilitation procedure
A. 291.5, 303.91
C. V57.89, 303.91
B. 303.91, 291.5
D. 291.5, 303.91, V57.89
A
Sybil has been admitted to Shady Acres Psychiatric facility for treatment of schizophrenia. Sybil is also manic depressive and has been noncompliant with her medications.
295.40 Schizophreniform disorder, unspecified
295.41 Schizophreniform disorder, subchronic
295.90 Unspecified schizophrenia, unspecified
296.7 Bipolar I disorder, most recent episode (or current) unspecified
296.80 Bipolar disorder, unspecified
296.89 Other bipolar disorders (manic-depressive psychosis, mixed type)
V15.81 Personal history, presenting hazards to health (noncompliance with medical treatment)

A. V15.81, 296.89, 295.40
C. 296.7, 295.90
B. 296.89, 295.41, V15.81
D. 295.90, 296.80, V15.81
D
Allen is addicted to Vicodin. He has stopped taking the drug and is now having withdrawal symptoms. Allen has chronic back pain for which he has been prescribed the medication. Allen is admitted for treatment of his withdrawal symptoms.
292.0 Drug withdrawal
292.11 Drug-induced psychotic disorder with delusions
292.2 Pathological drug intoxication
304.00 Drug dependence, opioid type dependence, unspecified
304.91 Unspecified drug dependence, continuous
724.5 Backache, unspecified

A. 292.2, 724.5
B. 292.11, 292.2, 304.91
C. 292.0, 304.00, 724.5
D. 292.11, 304.91, 724.5
C
Acute epileptic twilight state with delirium
293.0 Delirium due to conditions classified elsewhere (epileptic twilight state)
293.1 Subacute delirium
294.0 Amnestic disorder in conditions classified elsewhere
345.00 Generalized nonconvulsive epilepsy without mention of intractable epilepsy
780.02 Transient alteration of awareness
A. 293.0
B. 780.02
C. 293.1
D. 294.0, 345.00
A
Sally has been diagnosed with panic attacks and is prescribed Xanax. She has been taking the medication as prescribed by her physician for 3 days and is now having hallucinations. Her physician advises her to stop taking the medication and her symptoms abate. Her doctor determines that the hallucinations were due to the Xanax.
292.12 Drug-induced psychotic disorder with hallucinations
300.01 Panic disorder without agoraphobia
E939.4 Benzodiazepine-based tranquilizers

A. 292.12, E939.4, 300.01
B. 292.12
C. E939.4, 292.12
D. 300.01, 292.12
A
Lou has profound mental retardation due to mongolism.
317 Mild mental retardation
318.0 Moderate mental retardation
318.2 Profound mental retardation
758.0 Down's syndrome
759.0 Congenital anomaly of spleen

A. 318.2, 758.0
B. 318.0, 759.0
C. 758.0, 318.2
D. 317, 758.0
A
Mark has a long history of epilepsy. He is brought to the emergency department and is admitted with intractable epileptic seizures. Mark's epilepsy is the result of a head injury he suffered several years ago.
345.11 Generalized convulsive epilepsy with intractable epilepsy
345.10 Generalized convulsive epilepsy, without mention of intractable epilepsy
345.3 Grand mal status
345.91 Epilepsy, unspecified, with intractable epilepsy
780.39 Other convulsions
907.0 Late effect of intracranial injury without mention of skull fracture

A. 780.39, 907.0
B. 345.91, 907.0
C. 345.3
D. 345.10, 780.39
B
Jeff was in a car accident when he was 25 years old and suffered a spinal cord injury. As a result, he is a paraplegic and has neurogenic bladder. Jeff also has chronic ulcers of the buttocks. He is being seen for evaluation of his paraplegia.

344.1 Paraplegia
344.60 Cauda equina syndrome without mention of neurogenic bladder
596.53 Paralysis of bladder
596.54 Neurogenic bladder, not otherwise specified
707.00 Chronic pressure ulcer of skin, unspecified site
707.8 Chronic ulcer of other specified sites
907.2 Late effect of spinal cord injury

A. 344.1, 907.2, 596.54, 707.8
B. 344.60, 596.53, 707.00, 907.2
C. 344.1, 596.53, 907.2
D. 344.1, 596.54, 707.8
A
Josephine has developed senile cataracts in both eyes. She is admitted for right extracapsular cataract extraction with synchronous lens insertion.

366.10 Senile cataract, unspecified
366.9 Unspecified cataract
13.59 Other extracapsular extraction of lens
13.71 Insertion of intraocular lens prosthesis at time of cataract extraction, one stage

A. 366.9, 13.71
B. 366.10, 13.59, 13.71
C. 366.9, 13.59, 13.71
D. 366.10, 13.59
B
A patient presents with diabetic macular or retinal edema.

250.50 Diabetes mellitus with ophthalmic manifestations, type II or unspecified type, not
stated as uncontrolled
250.51 Diabetes mellitus with ophthalmic manifestations, type I (juvenile type), not stated as
uncontrolled
362.01 Background diabetic retinopathy (manifestation)
362.02 Proliferative diabetic retinopathy (manifestation)
362.07 Diabetic macular edema

A. 250.51, 362.07, 360.02
B. 362.07, 250.51, 362.02
C. 250.50, 362.07, 362.01
D. 362.02, 362.07, 250.50
C
A patient presents with bilateral sensorineural conductive hearing loss.
389.20 Mixed hearing loss, unspecified
389.21 Mixed hearing loss, unilateral
389.22 Mixed hearing loss, bilateral
389.9 Unspecified hearing loss

A. 389.22
B. 389.21
C. 389.9
D. 389.20
A
Madeline is diagnosed with bilateral carotid stenosis. She is being admitted for a bilateral endarterectomy. Madeline is also treated for Parkinson's disease and glaucoma.

332.0 Paralysis agitans (Parkinson's disease)
365.9 Unspecified glaucoma
433.30 Occlusion and stenosis of precerebral arteries, multiple and bilateral, without mention of cerebral infarction
38.12 Endarterectomy, other vessels of head and neck

A. 433.30, 38.12
B. 433.30, 38.12, 38.12
C. 433.30, 332.0, 365.9, 38.12
D. 433.30, 332.0, 365.9, 38.12, 38.12
D
Jonathan is admitted with bleeding prolapsed internal hemorrhoids and chronic constipation. The physician performed a rubber band ligation of the internal hemorrhoids.

455.1 Internal thrombosed hemorrhoids
455.2 Internal hemorrhoids with other complication
564.09 Other constipation
49.44 Destruction of hemorrhoids by cryotherapy
49.45 Ligation of hemorrhoids
49.46 Excision of hemorrhoids

A. 455.1, 564.09, 49.44
B. 455.1, 49.45
C. 455.2, 564.09 49.45
D. 455.1, 455.2, 49.45
C
Frank has been diagnosed with sick sinus syndrome and is being admitted for dual chamber pacemaker and leads insertion. Frank also has type II diabetes on oral medication as well as insulin regimen. Surgery is carried out without complication.

250.00 Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
250.01 Diabetes mellitus without mention of complication, type I (juvenile type), not stated as uncontrolled
427.81 Sinoatrial node dysfunction
V58.67 Long-term (current) use of insulin
37.70 Initial insertion of lead (electrode), not otherwise specified
37.71 Initial insertion of transvenous lead (electrode) into ventricle
37.72 Initial insertion of transvenous leads (electrode) into atrium and ventricle
37.82 Initial insertion of single-chamber device, rate responsive
37.83 Initial insertion of dual chamber device

A. 427.81, 250.00, V58.67, 37.72, 37.83
B. 427.81, 250.01, 37.71, 37.83
C. 427.81, 37.70, 37.83
D. 427.81, 250.00, 250.01, 37.72, 37.83
A
A patient is treated for congestive heart failure with pleural effusion. A therapeutic thoracentesis is performed.

428.0 Congestive heart failure, unspecified
511.9 Unspecified pleural effusion
34.04 Insertion of intercostal catheter for drainage
34.91 Thoracentesis

A. 511.9, 34.91
B. 428.0, 34.04
C. 428.0, 511.9
D. 428.0, 511.9, 34.91
D
A patient presents to the emergency department complaining of a severe headache. Workup revealed a ruptured berry aneurysm.

430 Subarachnoid hemorrhage
437.3 Cerebral aneurysm, nonruptured
784.0 Headache

A. 430
B. 784.0
C. 784.0, 430
D. 437.3
A
Joseph has had cough, fever, and painful respirations for 2 days. He also has congestive heart failure and COPD. Joseph presents to the emergency department with severe shortness of breath, using accessory muscles to assist with breathing. Upon examination, Joseph is diagnosed with acute respiratory failure, congestive heart failure, pneumonia, and exacerbation of COPD. Joseph is intubated and placed on mechanical ventilation. He is weaned from the ventilator on the third day of admission. Two days later, he again goes into respiratory failure, requiring reintubation and placement on the ventilator. Fortunately, he is able to breathe on his own the following day, so was extubated.

428.0 Congestive heart failure, unspecified
486 Pneumonia, organism unspecified
491.21 Obstructive chronic bronchitis with (acute) exacerbation
496 Chronic airway obstruction, not elsewhere classified
518.81 Acute respiratory failure
96.04 Insertion of endotracheal tube
96.71 Continuous invasive mechanical ventilation for less than 96 consecutive hours
96.72 Continuous invasive mechanical ventilation for 96 consecutive hours or more

A. 428.0, 486, 496, 518.81, 96.04, 96.71
B. 518.81, 428.0, 491.21, 96.04, 96.71
C. 486, 428.0, 518.81, 491.21, 96.04, 96.72
D. 518.81, 486, 428.0, 491.21, 96.04, 96.71, 96.04, 96.71
D COPD (496) is a general term. It will
present as chronic obstructive
bronchitis
Ronald is admitted for stenosis of his tracheostomy. He is a quadriplegic, C1-C4 secondary to spinal cord injury suffered in a diving accident. He has chronic respiratory failure and is maintained on mechanical ventilation. He undergoes revision of his tracheostomy.
344.00 Quadriplegia, unspecified
344.01 Quadriplegia, C1-C4, complete
518.83 Chronic respiratory failure
519.02 Mechanical complication of tracheostomy
519.09 Other tracheostomy complications
907.2 Late effect of spinal cord injury
V46.11 Dependence on respirator status (ventilator)
31.74 Revision of tracheostomy
31.79 Other repair and plastic operations on trachea
96.71 Continuous invasive mechanical ventilation for less than 96 consecutive hours
96.72 Continuous invasive mechanical ventilation for 96 consecutive hours or more

A. 518.83, 519.09, 907.2, 31.74
B. 344.01, 518.83, 519.02, 31.79, V46.11
C. 519.02, 344.01, 518.83, 907.2, V46.11, 31.74, 96.72
D. 519.02, 518.83, 907.2, 31.74
C
Jennifer presents to the emergency department with severe chest pain and shortness of breath. Chest x-ray revealed a spontaneous pneumothorax. Jennifer also has acute bronchitis. The emergency department physician inserts a chest tube and Jennifer is admitted.

466.0 Acute bronchitis
491.20 Obstructive chronic bronchitis without exacerbation
491.21 Obstructive chronic bronchitis with (acute) exacerbation
512.0 Spontaneous tension pneumothorax
512.1 Iatrogenic pneumothorax
512.8 Other spontaneous pneumothorax
34.01 Incision of chest wall
34.04 Insertion of intercostal catheter for drainage

A. 512.8, 466.0, 34.04
B. 512.0, 491.21, 34.01
C. 466.0, 491.21, 512.1, 34.04
D. 491.20, 466.0, 512.8, 34.01
A
Dale is admitted with emphysematous nodules. He undergoes, without complication, a wedge resection of the right upper lobe. Dale developed atelectasis postoperatively that required monitoring with portable chest x-rays and extended his length of stay.

492.8 Other emphysema
518.0 Pulmonary collapse (atelectasis)
518.89 Other diseases of lung, not elsewhere classified
997.3 Respiratory complications
32.29 Other local excision or destruction of lesions or tissue of lung
32.30 Thoracoscopic segmental resection of lung

A. 518.89, 997.3, 32.30
B. 997.3, 518.0, 518.89, 32.29
C. 492.8, 997.3, 518.0, 32.29
D. 518.89, 518.0, 32.29
C The atelectasis is coded because it
required monitoring and extended
his length of stay
Agnes is admitted with cough, fever, and dysphagia. Chest x-ray shows infiltrates in both lower lobes. Sputum culture is positive for Staphylococcus aureus. Swallow study indicates that Agnes aspirates. Physician documents aspiration pneumonia and Staphylococcus aureus pneumonia. As a coder, you would assign codes for the following conditions in this proper sequence.

A. Staphylococcus aureus pneumonia, dysphagia
B. Staphylococcus aureus pneumonia, aspiration pneumonia
C. Aspiration pneumonia, dysphagia
D. Aspiration pneumonia, Staphylococcus aureus pneumonia, dysphagia
D
This patient has pneumonia. She also has acute exacerbation of COPD.
486 Pneumonia, organism unspecified
491.20 Obstructive chronic bronchitis, without exacerbation
491.21 Obstructive chronic bronchitis, with (acute) exacerbation

A. 491.21
B. 486, 491.21
C. 491.20, 486
D. 486
B
Matthew has acute and chronic maxillary sinusitis. He had a maxillary sinusectomy performed.
461.0 Acute maxillary sinusitis
461.2 Acute ethmoidal sinusitis
473.0 Chronic maxillary sinusitis
22.62 Excision of lesion of maxillary sinus with other approach

A. 461.0, 22.62
C. 461.0, 473.0, 22.62
B. 473.0, 22.62
D. 461.2, 22.62
C The alphabetic index is misleading
and directs the coder to use one
code for acute and chronic sinusitis.
The Tabular List, however, directs
the coder to use two separate codes.
Grace has been having abdominal pain for several weeks and has been vomiting blood for 2 days. Her physician performs an esophagogastroduodenoscopy and biopsies a lesion in the duodenum. The pathology report indicates Grace has acute and chronic gastritis.

532.00 Acute duodenal ulcer with hemorrhage without mention of obstruction
535.01 Acute gastritis with hemorrhage
535.11 Chronic (atrophic) gastritis with hemorrhage
789.00 Abdominal pain, unspecified site
45.13 Esophagogastroduodenoscopy
45.16 Esophagogastroduodenoscopy (EGD) with closed biopsy

A. 532.00, 789.00, 45.13
C. 535.01, 535.11, 789.00. 45.13
B. 535.01, 789.00, 45.16
D. 535.01, 535.11, 45.16
D
Mary presents to the emergency department with complaints of chest pain. Myocardial infarction is ruled out, however gastrointestinal studies indicate Mary is suffering from gastroesophageal reflux disease (GERD). Mary is given medication to relieve her symptoms and instructed to follow up with her physician.

410.91 Acute myocardial infarction, unspecified site, initial episode of care
530.81 Gastroesophageal reflux (GERD)
786.50 Chest pain, unspecified

A. 530.81
B. 786.50
C. 530.81, 410.91
D. 410.91, 786.50
A
Crystal has been vomiting for 24 hours with complaint of right lower quadrant pain.
Examination is suspicious for acute appendicitis. Crystal is taken to surgery and laparoscopic appendectomy is carried out. Pathological diagnosis is consistent with acute appendicitis. Crystal developed postoperative paralytic ileus.

540.0 Acute appendicitis with generalized peritonitis
540.9 Acute appendicitis, without mention of peritonitis
560.1 Paralytic ileus
997.4 Digestive system complications, not elsewhere classified
47.01 Laparoscopic appendectomy
47.09 Other appendectomy
47.11 Laparoscopic incidental appendectomy

A. 540.0, 997.4, 47.11
B. 540.0, 997.4, 47.09
C. 540.9, 997.4, 560.1, 47.01
D. 997.4, 560.1, 540.9, 47.09
C The note under category 997 instructs
the coder to "use additional code to
identify complication."
A patient presents with intestinal obstruction due to adhesions. He also has peripheral vascular disease and chronic urinary tract infections; both conditions were treated with oral medication.

443.9 Peripheral vascular disease, unspecified
560.81 Intestinal or peritoneal adhesions with obstruction (postoperative) (post infection)
560.89 Other specified intestinal obstruction
560.9 Unspecified intestinal obstruction
599.0 Urinary tract infection, site not specified

A. 560.81, 443.9, 599.0
B. 560.9
C. 560.9, 443.9, 599.0
D. 560.89, 443.9, 599.0
A
This patient has chronic diarrhea associated with Crohn's disease. She also has protein-calorie malnutrition. She is admitted for bowel resection of the diseased colon.

263.9 Unspecified protein-calorie malnutrition
555.1 Regional enteritis, large intestine (Crohn's disease)
556.9 Ulcerative colitis, unspecified
787.91 Diarrhea
45.79 Other and unspecified partial excision of large intestine
45.94 Large-to-large intestinal anastomosis

A. 556.9, 263.9, 45.79, 45.94
B. 555.1, 263.9, 45.79
C. 555.1, 787.91, 263.9, 45.79
D. 556.9, 263.9, 45.79, 45.94
B
A patient is admitted with hepatic coma with ascites due to Laennec's cirrhosis.

571.2 Alcoholic cirrhosis of liver (Laennec's cirrhosis)
572.2 Hepatic encephalopathy (hepatic coma)
789.59 Other ascites

A. 572.2, 571.2, 789.59
B. 571.2, 789.59
C. 789.59, 572.2
D. 789.59, 572.2, 571.2
A
Chantel is admitted with infertility secondary to pelvic peritoneal adhesions. She had a laparoscopic lysis of adhesions performed.

614.6 Pelvic peritoneal adhesions, female (postoperative) (post infection)
628.2 Infertility, female, of tubal origin
54.21 Laparoscopy
65.81 Laparoscopic lysis of adhesions of ovary and fallopian tube

A. 628.2, 614.6, 65.81
B. 628.2, 54.21, 65.81
C. 614.6, 65.81, 54.21
D. 614.6, 54.21
A
Betsy has chronic pelvic inflammatory disease with dysmenorrhea. She undergoes a diagnostic laparoscopy.

614.4 Chronic or unspecified parametritis and pelvic cellulitis
625.3 Dysmenorrhea
54.21 Laparoscopy
54.4 Excision or destruction of peritoneal tissue

A. 625.3, 54.21
B. 614.4, 54.4
C. 625.3, 614.4, 54.21
D. 614.4, 625.3, 54.21
D
David has chronic interstitial cystitis. The physician performs a cystoscopy with biopsy.

595.1 Chronic interstitial cystitis
595.2 Other chronic cystitis
599.0 Urinary tract infection, site not specified
57.32 Other cystoscopy
57.33 Closed (transurethral) biopsy of bladder

A. 599.0, 57.32
B. 595.1, 57.33
C. 595.2, 57.32, 57.33
D. 595.1, 599.0, 57.32
B
Cynthia has fibrocystic disease of the breast and undergoes a needle biopsy of the breast.
610.1 Diffuse cystic mastopathy (fibrocystic disease of breast)

610.2 Fibroadenosis of breast
610.3 Fibrosclerosis of breast
610.9 Benign mammary dysplasia, unspecified
85.11 Closed (percutaneous) (needle) biopsy of breast
85.12 Open biopsy of breast

A. 610.1, 85.11
B. 610.3, 85.12
C. 610.2, 85.11
D. 610.9, 85.12
A
Tammy has an intrauterine pregnancy and delivers a set of twins at 33 weeks. She had premature rupture of membranes. The spontaneous delivery of the premature twins was via a vertex presentation, and both infants were born alive.

644.20 Early onset of delivery, unspecified episode of care
644.21 Early onset of delivery, delivered, with or without mention of antepartum condition
651.01 Twin pregnancy, delivered, with or without mention of antepartum condition
658.11 Premature rupture of membranes, delivered, with or without mention of antepartum condition
659.11 Failed medical or unspecified induction, delivered, with or without mention of
antepartum condition
V27.2 Outcome of delivery, twins, both live born
73.59 Other manually assisted delivery

A. 644.21, 658.11, 651.01, V27.2, 73.59
B. 644.20, 659.11, V27.2
C. 644.20, 658.11, 651.02, 73.59
D. 658.11, 651.01, V27.2, 73.59
A
A pregnant patient was admitted to the hospital with uncontrolled diabetes mellitus. She is a type I diabetic and was brought under control. The following code was assigned:
648.03 Other current conditions in the mother classifiable elsewhere but complicating pregnancy, childbirth or the puerperium, diabetes mellitus, antepartum condition, or complication Which of the following describe why the coding is in error?

A. The incorrect fifth digit was used.
B. The condition should have been coded as gestational diabetes because she is pregnant.
C. An additional code describing the diabetes mellitus should be used.
D. Only the code for the diabetes mellitus should be used.
C
Max is 80% bald. He is admitted for a hair transplant, which he undergoes without complication. Max is also treated for congestive heart failure and hypertension for which he is on medication.

401.9 Essential hypertension, unspecified benign or malignant
402.91 Hypertensive heart disease unspecified as to malignant or benign, with heart failure
428.0 Congestive heart failure, unspecified
704.00 Alopecia, unspecified
704.8 Other specified diseases of hair and hair follicles
86.64 Hair transplant

A. 704.00, 402.91, 86.64
B. 704.8, 401.9, 428.0, 86.64
C. 704.00, 401.9, 428.0, 86.64
D. 704.8, 402.91, 86.64
C
Melissa is status post mastectomy due to breast cancer. There has been no recurrence of the disease. She is admitted for insertion of unilateral breast implant.

174.9 Malignant neoplasm of breast (female), unspecified
V10.3 Personal history of malignant neoplasm of breast
V45.71 Acquired absence of breast and nipple
V51.0 Encounter for breast reconstruction following mastectomy
V58.42 Aftercare following surgery for neoplasm
85.53 Unilateral breast implant
85.54 Bilateral breast implant

A. V51.0, V10.3, 85.54
B. V58.42, V51.0, V45.71, V10.3, 85.53
C. V45.71, 174.9, 85.53
D. V51.0, V45.71, V10.3, 85.53
B
Roscoe is 57 years old and has been diagnosed with gynecomastia. Roscoe also is on medication for temporal arteritis. Roscoe is admitted and bilateral mammectomy is performed. Roscoe's intravenous catheter infiltrates and he develops cellulitis at the IV site in the arm. This condition requires additional treatment.

446.5 Giant cell arteritis
611.1 Hypertrophy of breast
682.3 Other cellulitis and abscess upper arm and forearm
999.39 Infection following other infusion, injection, transfusion, or vaccination
85.34 Other unilateral subcutaneous mammectomy
85.36 Other bilateral subcutaneous mammectomy

A. 611.1, 85.36, 85.36
B. 611.1, 999.39, 446.5, 85.36
C. 611.1, 999.39, 682.3, 446.5, 85.36
D. 611.1, 682.3, 446.5, 85.34
C
Brandon has an infected ingrown toenail that his physician removes.

681.11 Onychia and paronychia of toe
703.0 Ingrowing nail
77.89 Other partial ostectomy, other site
86.23 Removal of nail, nail bed, or nail fold
86.27 Debridement of nail, nail bed, or nail fold

A. 703.0, 86.23
B. 681.11, 86.23
C. 681.11, 86.27
D. 703.0, 86.23, 77.89
A
Julia is an 80-year-old female with osteoporosis. She presents to the emergency department complaining of severe back pain. X-rays revealed pathological compression fractures of several vertebrae.

721.90 Spondylosis of unspecified site without mention of myelopathy
733.00 Osteoporosis, unspecified
733.13 Pathological fracture of vertebrae
805.8 Fracture of vertebral column without mention of spinal cord injury, unspecified, closed

A. 733.13, 733.00
C. 721.90, 733.13
B. 805.8, 733.00
D. 733.00, 733.13
A
Scott has a deformity of his left ring finger, due to an old tendon injury. He is admitted and undergoes a transfer of the flexor tendon from the distal phalanx to the middle phalanx.

727.82 Calcium deposits in tendon and bursa
736.20 Unspecified deformity of finger (acquired)
834.02 Closed dislocation of finger, interphalangeal (joint), hand
905.8 Late effect of tendon injury
82.55 Other change in hand muscle or tendon length
82.56 Other hand tendon transfer or transportation

A. 727.82, 82.56
B. 736.20, 905.8, 82.56
C. 834.02, 82.55
D. 727.82, 82.55
B
Sara has Dupuytren's contracture of the right middle finger. She has an incision and division of the palmar fascia.

728.6 Contracture of palmar fascia (Dupuytren's contracture)
728.71 Plantar fascial fibromatosis
728.86 Necrotizing fasciaitis
82.12 Fasciotomy of hand
82.19 Other division of soft tissue of hand

A. 728.6, 82.12
B. 728.71, 82.19
C. 728.6, 82.19
D. 728.86, 82.12
A
Cheryl has had chronic worsening pain of her left knee from rheumatoid arthritis. She has decided to undergo a total knee replacement as recommended by her physician. The surgery goes well; however, she develops a urinary tract infection that requires an additional day of stay in the hospital.

599.0 Urinary tract infection, site not specified
714.0 Rheumatoid arthritis
714.31 Polyarticular juvenile rheumatoid arthritis, acute
715.96 Osteoarthrosis, unspecified whether generalized or localized, low leg
81.53 Revision of hip replacement, not otherwise specified
81.54 Total knee replacement

A. 715.96, 599.0, 81.54
B. 714.0, 599.0, 81.54
C. 714.31, 81.53
D. 714.31, 81.54
B
A patient who is HIV positive and currently asymptomatic is admitted with a compound fracture of the tibia. The patient was treated previously for pneumocystis carinii pneumonia. Given the following codes, which is the correct coding and sequencing?

042 Human Immunodeficiency Virus (HIV) disease
136.3 Pneumocystosis (pneumonia due to Pneumocystis carinii)
V08 Asymptomatic HIV infection status
823.80 Fracture of tibia alone, unspecified part, closed
823.90 Fracture of tibia alone, unspecified part, open

A. 823.90, V08
B. 823.90, 042
C. 823.80, V08, 136.3
D. 823.80, 042
B A "compound" fracture is considered
an "open" fracture.
The diagnosis reads "first-, second-, and third-degree burns of the right arm." You would code:

A. the first degree only.
B. the second degree only.
C. the third degree only.
D. each degree of burn separately.
C Code the highest degree burn
ONLY of the same site.
A patient is admitted for elective cholecystectomy to treat chronic cholecystitis with cholelithiasis. Prior to administration of general anesthesia, the patient suffers cerebral thrombosis. The surgery is subsequently canceled. Code and sequence appropriately the codes.

434.00 Cerebral thrombosis, without mention of cerebral infarction
574.10 Calculus of gallbladder with other cholecystitis without mention of obstruction
V64.1 Surgical or other procedure not carried out because of contraindication
997.02 Iatrogenic cerebrovascular infarction or hemorrhage
51.22 Cholecystectomy

A. 997.02, 574.10, 51.22
B. 574.10, 434.00, V64.1
C. 997.02, 434.00, V64.1
D. 434.00, V64.1
B
A physician lists the final diagnosis as diarrhea and constipation due to either irritable bowel syndrome or diverticulitis. The following codes are assigned:

562.10 Diverticulosis of colon without mention of hemorrhage
562.11 Diverticulitis of colon without mention of hemorrhage
564.00 Constipation, unspecified
564.1 Irritable bowel syndrome
787.91 Diarrhea

A. 564.1, 562.11
B. 562.10, 564.1
C. 564.00, 787.91, 564.1, 562.11
D. 564.1, 562.10, 564.00, 787.91
C
When an open biopsy is followed by a more extensive definitive procedure the coder reports:

A. the open biopsy.
B. the extensive definitive procedure and the open biopsy.
C. no procedures.
D. the extensive definitive procedure.
B
In ICD-9-CM, when an exploratory laparotomy is performed followed by a therapeutic procedure, the coder reports:

A. therapeutic procedure first, exploratory laparotomy second.
B. exploratory laparotomy, therapeutic procedure, closure of wound.
C. exploratory laparotomy first, therapeutic procedure second.
D. therapeutic procedure only.
D
Codes from category 655, known or suspected fetal abnormality affecting the mother, should:

A. be assigned if the fetal conditions are documented.
B. be assigned at the discretion of the physician.
C. be assigned when they affect the management of the mother.
D. never be assigned.
C
There are a limited number of late effect codes in ICD-9-CM. When coding a residual condition where there is no applicable late effect code, one should code:

A. the residual condition followed by its cause.
B. the cause followed by the residual condition.
C. only the residual condition.
D. only the cause of the residual condition.
C
A patient is admitted for a total hip replacement because of rheumatoid arthritis. Following admission, but prior to surgery, the patient develops congestive heart failure, which necessitates transfer to ICU. The hip replacement is canceled and the patient is treated for the heart failure. What is the principal diagnosis?

A. Congestive heart failure
B. Rheumatoid arthritis
C. Hip replacement
D. Canceled surgical procedure
B
201. According to the UHDDS guidelines, the principal procedure is performed for
__________________ rather than for __________________.

A. diagnostic or exploratory purposes; definitive treatment
B. exploratory purposes; complications
C. definitive treatment; diagnostic or exploratory purposes
D. complications; definitive treatment
C
A diabetic patient is admitted to the hospital with acute gastrointestinal hemorrhage due to ulcer disease. In this case, the diabetes would be

A. the principal diagnosis.
B. a comorbid condition.
C. a complication.
D. irrelevant and not coded
B
Which of the following are considered late effects regardless of time?

A. Congenital defect
B. Nonunion, malunion, scarring
C. Fracture, burn
D. Poisoning
B
When a patient is admitted in respiratory failure due to a chronic nonrespiratory condition:

A. the respiratory failure is the principal diagnosis.
B. the chronic nonrespiratory problem is the principal diagnosis.
C. only the respiratory failure is coded.
D. only the chronic nonrespiratory condition is coded.
A
When Robert was discharged, his physician listed his diagnoses as congestive heart failure with acute pulmonary edema. You will code:

A. the CHF only.
B. the edema only.
C. both the CHF and the edema; sequence the CHF first.
D. both the CHF and the edema; sequence the edema first.
A
A patient was admitted with severe abdominal pain, elevated temperature, and nausea. The physical examination indicated possible cholecystitis. Acute and chronic pancreatitis secondary to alcoholism was recorded on the face sheet as the final diagnosis. The principal diagnosis is:

A. alcoholism.
B. abdominal pain.
C. cholecystitis.
D. acute pancreatitis.
D
A patient was admitted to the hospital with hemiplegia and aphasia. The hemiplegia and aphasia were resolved before discharge and the patient was diagnosed with cerebral thrombosis. What is the correct coding and sequencing?

A. Hemiplegia; aphasia
B. Cerebral thrombosis
C. Cerebral thrombosis; hemiplegia; aphasia
D. Hemiplegia; cerebral thrombosis; aphasia
C Effective October 1, 2010, the Official
ICD-9-CM Coding Guidelines state,
"Additional codes should be
assigned for any neurologic deficits
associated with the acute CVA,
regardless of whether or not the
neurologic deficit resolves prior to
discharge."
The physician explicitly documents that a condition is not present at the time of admission.
A. Y = Yes
B. N = No
C. U = Unknown
D. W = clinically undetermined
E. Unreported/Not Used (Exempt from POA) reporting
B
The physician explicitly documents that a condition is not present at the time of admission.
A. Y = Yes
B. N = No
C. U = Unknown
D. W = clinically undetermined
E. Unreported/Not Used (Exempt from POA) reporting
A
The medical record documentation is unclear as to whether the condition was present on
admission.
A. Y = Yes
B. N = No
C. U = Unknown
D. W = clinically undetermined
E. Unreported/Not Used (Exempt from POA) reporting
C