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CIC (National Alliance) practice questions

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Question 1Inpatient coding guidelines, compliance, and regulatory requirements

Under the Uniform Hospital Discharge Data Set, which statement best defines the principal diagnosis for an inpatient stay?

  1. The condition chiefly responsible for the admission after study Correct answer.
  2. The first condition documented in the admission history by the attending physician
  3. The most severe condition treated during the inpatient stay
  4. The condition that required the greatest resource use

Explanation

The Uniform Hospital Discharge Data Set defines the principal diagnosis as the condition established after study to be chiefly responsible for the inpatient admission. Documentation order, severity, and resource use do not determine the principal diagnosis.

Question 2Inpatient coding guidelines, compliance, and regulatory requirements

A condition is documented as present when the inpatient admission order is written. Which present-on-admission indicator is assigned?

  1. U
  2. W
  3. Y Correct answer.
  4. N

Explanation

The POA indicator Y means the condition was present at the time of inpatient admission. Indicator N means not present on admission, U means unknown, and W means clinically undetermined.

Question 3Inpatient coding guidelines, compliance, and regulatory requirements

In ICD-10-CM, what does an Excludes1 note indicate?

  1. The excluded code requires a physician query before it is reported
  2. The excluded code is optional when the physician documents it
  3. The excluded code may still be reported as an additional diagnosis
  4. The two conditions cannot be reported together Correct answer.

Explanation

An Excludes1 note means the excluded condition is not coded here and the two codes cannot be reported together. Excludes2, by contrast, indicates a condition that is not included but may be reported separately when documented.

Question 4Inpatient coding guidelines, compliance, and regulatory requirements

What is the role of AHA Coding Clinic for ICD-10-CM/PCS?

  1. It replaces the ICD-10-CM Official Guidelines for Coding and Reporting
  2. It issues Medicare payment rates for inpatient hospitals
  3. It publishes the annual DRG relative weights used by Medicare
  4. It provides official coding guidance for ICD-10 Correct answer.

Explanation

Coding Clinic is the American Hospital Association's official publication for ICD-10-CM and ICD-10-PCS advice. CMS recognizes this advice as official coding guidance, but it does not set payment rates or replace the official guidelines.

Question 5Inpatient coding guidelines, compliance, and regulatory requirements

Which physician query is acceptable because it is non-leading?

  1. Please document pneumonia so that the record can be coded promptly.
  2. Clarify: acute systolic or diastolic heart failure? Correct answer.
  3. Isn't the diagnosis chronic kidney disease stage 4?
  4. Would you agree that the patient has sepsis for the coding review?

Explanation

A compliant query asks the physician to clarify documentation and presents reasonable options without steering toward a specific diagnosis. Queries should include clinical indicators and should not suggest a diagnosis or a payment outcome.

Question 6Inpatient coding guidelines, compliance, and regulatory requirements

Which factor directly determines assignment of a Medicare Severity DRG for an inpatient stay?

  1. The patient's insurer and the deductible amount paid
  2. The hospital's case-mix index from the prior fiscal year
  3. The number of days between admission and discharge date
  4. Principal diagnosis, secondary diagnoses, and procedures Correct answer.

Explanation

MS-DRG assignment is based on the principal diagnosis, secondary diagnoses that qualify as CCs or MCCs, significant procedures, discharge disposition, age, and sex. Length of stay and prior case-mix index do not assign the DRG.

Question 7Inpatient coding guidelines, compliance, and regulatory requirements

Under Medicare's Hospital-Acquired Condition policy, which condition is generally not paid as a secondary diagnosis when it was not present on admission?

  1. A condition that is exempt from present-on-admission reporting
  2. A condition that was present when the admission order was written
  3. A chronic condition documented during the admission history
  4. A selected HAC such as a retained foreign body Correct answer.

Explanation

Medicare does not pay for selected hospital-acquired conditions as secondary diagnoses when they were not present on admission. POA-exempt conditions and conditions genuinely present on admission are treated differently.

Question 8Inpatient coding guidelines, compliance, and regulatory requirements

When releasing protected health information for a coding review, what does the HIPAA minimum necessary standard require?

  1. Obtain a court warrant before releasing any record
  2. Disclose only the information needed for the purpose Correct answer.
  3. Release only records for patients covered by Medicare
  4. Release the entire medical record for every coding review

Explanation

The HIPAA minimum necessary standard requires covered entities to limit protected health information disclosures to the amount reasonably needed for the intended purpose. It does not require releasing the entire record or a warrant in ordinary coding review.

Question 9Inpatient coding guidelines, compliance, and regulatory requirements

A patient is admitted with sepsis due to Escherichia coli and develops acute respiratory failure on day two. How is the principal diagnosis selected?

  1. Sepsis due to E. coli is principal, with respiratory failure secondary Correct answer.
  2. The condition with the highest DRG weight is the principal diagnosis
  3. Both sepsis and acute respiratory failure are principal diagnoses
  4. Acute respiratory failure is principal because it occurred later in the stay

Explanation

The principal diagnosis is the condition established after study to be chiefly responsible for admission; sepsis present on admission meets that definition. A condition that develops later is reported as a secondary diagnosis when clinically significant. Only one principal diagnosis is assigned.

Question 10Inpatient coding guidelines, compliance, and regulatory requirements

A secondary diagnosis is a CC, but the principal diagnosis appears on the CC exclusion list for that secondary diagnosis. What is the effect?

  1. The principal diagnosis must be changed to match the secondary diagnosis
  2. The secondary diagnosis still increases severity because it is a CC
  3. The record must be returned to the physician for re-documentation
  4. It may not count as a CC for that principal diagnosis Correct answer.

Explanation

The CC/MCC exclusion list identifies secondary diagnoses that do not function as CCs or MCCs when paired with certain principal diagnoses. This rule affects DRG severity but does not by itself require changing the principal diagnosis or querying the physician.

Question 11Inpatient coding guidelines, compliance, and regulatory requirements

The physician documents "CHF" without specifying acuity. What is the appropriate coding action?

  1. Query the physician for the type of heart failure Correct answer.
  2. Assign acute systolic heart failure by default
  3. Report only the symptom of dyspnea for the encounter
  4. Assign chronic diastolic heart failure by default

Explanation

ICD-10-CM distinguishes types of heart failure, and documentation must support the specific code. When the record is ambiguous, the coder should query the physician rather than default to a type. Reporting only a symptom may also be incorrect when heart failure is documented.

Question 12Inpatient coding guidelines, compliance, and regulatory requirements

A patient is discharged from an acute care hospital to a skilled nursing facility for rehabilitation. Which data element captures this for MS-DRG assignment?

  1. The admission type code
  2. The principal diagnosis code assigned for the stay
  3. The discharge disposition code Correct answer.
  4. The POA indicator

Explanation

The discharge disposition identifies where the patient went after discharge and is one of the data elements used in MS-DRG assignment. The principal diagnosis, admission type, and POA indicator serve different purposes.

Question 13Inpatient coding guidelines, compliance, and regulatory requirements

A code has a notation "Code also the underlying condition." What does this mean for inpatient coding?

  1. Both the condition and the underlying condition are reported Correct answer.
  2. The underlying condition is reported only if it is the principal diagnosis
  3. The underlying condition is never reported separately
  4. The code also instruction is optional and may be ignored

Explanation

A "code also" instruction indicates that an additional code is required to fully describe the condition. Sequencing depends on the reason for admission and the applicable coding guidelines, but the additional code is not optional.

Question 14Inpatient coding guidelines, compliance, and regulatory requirements

A condition is documented at admission, but the physician cannot determine whether it was present on admission. Which POA indicator applies?

  1. Y
  2. W Correct answer.
  3. N
  4. 1

Explanation

The POA indicator W means the condition was clinically undetermined at the time of admission. Y means present, N means not present, and 1 means the diagnosis is exempt from POA reporting.

Question 15Inpatient coding guidelines, compliance, and regulatory requirements

What is the primary function of a Medicare Recovery Audit Contractor?

  1. Write the ICD-10-CM coding guidelines used by hospitals
  2. Identify and recover improper Medicare payments Correct answer.
  3. Process initial Medicare claims for payment
  4. Set annual DRG relative weights for hospitals

Explanation

Recovery Audit Contractors review Medicare claims to identify overpayments and underpayments and to recover improper payments. They do not set DRG weights, process initial claims, or write coding guidelines.

Question 16Inpatient coding guidelines, compliance, and regulatory requirements

A hospital coding manager discovers that coders are routinely assigning a higher-paying DRG without supporting documentation. What compliance concern does this raise?

  1. A potential false claim for upcoded services Correct answer.
  2. Underpayment due to missed secondary diagnoses
  3. A clerical error with no regulatory consequence
  4. A breach of the HIPAA Privacy Rule only

Explanation

Assigning codes or DRGs that are not supported by the medical record can result in claims for services not documented, which is upcoding. This creates potential liability under laws such as the False Claims Act and requires compliance action.

Question 17Inpatient coding guidelines, compliance, and regulatory requirements

Under the Uniform Hospital Discharge Data Set, which definition applies to other diagnoses for inpatient reporting?

  1. Only conditions present at the time of admission
  2. All conditions documented anywhere in the medical record during the stay
  3. Only conditions that are life-threatening and require intensive care treatment
  4. Conditions that affect treatment, length of stay, or nursing care Correct answer.

Explanation

UHDDS defines other diagnoses as conditions that affect patient care by requiring treatment, diagnostic procedures, extended length of stay, or increased nursing care. They are not limited to life-threatening or present-on-admission conditions.

Question 18Inpatient coding guidelines, compliance, and regulatory requirements

A coder finds a discrepancy between the physician's progress note and the discharge summary regarding a diagnosis. What is the best action?

  1. Query the physician to reconcile the documentation Correct answer.
  2. Code the diagnosis from the progress note only
  3. Code the diagnosis exactly as written in the discharge summary only
  4. Report both conflicting diagnoses on the claim

Explanation

When documentation conflicts, the coder should query the physician to clarify the diagnosis rather than choosing one note arbitrarily. The physician's clarified response should be used to support coding.

Question 19Inpatient coding guidelines, compliance, and regulatory requirements

A code carries a "Code first" note. What does that instruction indicate?

  1. The code may be sequenced first if it is the principal diagnosis
  2. The code is optional and may be omitted from the claim
  3. The underlying condition should be sequenced before the code Correct answer.
  4. The code is not reportable for inpatient admissions

Explanation

A "code first" note appears with a manifestation or associated code and instructs the coder to sequence the underlying cause before the code carrying the note. Sequencing may be affected by the reason for admission and other guidelines.

Question 20Inpatient coding guidelines, compliance, and regulatory requirements

A patient is admitted for chest pain; after study, the physician documents that the chest pain was due to GERD. What is the principal diagnosis?

  1. GERD, the condition established after study as responsible Correct answer.
  2. Both chest pain and GERD are reported as principal diagnoses
  3. Chest pain, because it was the reason the patient was admitted
  4. The chest pain code, but only if it is classified as a CC

Explanation

The principal diagnosis is established after study, not simply the symptom that prompted admission. When a symptom is integral to a documented diagnosis, the symptom is not coded separately.

Question 21Inpatient coding guidelines, compliance, and regulatory requirements

A patient is admitted with both acute respiratory failure and severe sepsis, and the physician documents that each contributed equally to the need for admission. How should the principal diagnosis be selected?

  1. The condition with the lower numeric code is principal
  2. Both conditions are reported as principal diagnoses on the claim
  3. Either condition may be principal, applied consistently Correct answer.
  4. The condition listed first in the discharge summary must be principal

Explanation

When two conditions meet the definition of principal diagnosis, either may be sequenced as principal, and the facility should apply its choice consistently. Only one principal diagnosis is reported.

Question 22Inpatient coding guidelines, compliance, and regulatory requirements

A coder sends a query: "The patient's creatinine is elevated. Please document acute kidney injury so the DRG reflects severity." Why is this query problematic?

  1. It includes clinical indicators, which is not allowed
  2. It suggests the diagnosis and a payment motive Correct answer.
  3. It is too long for the physician to answer
  4. It should have been sent after discharge, not before

Explanation

Queries may include clinical indicators, but they must be non-leading and must not direct the physician to a specific diagnosis or payment outcome. This query suggests acute kidney injury and explicitly mentions DRG severity.

Question 23Inpatient coding guidelines, compliance, and regulatory requirements

A patient develops a stage 3 pressure ulcer on hospital day five. The ulcer was not present on admission. How does Medicare treat this diagnosis for MS-DRG payment?

  1. It is coded as the principal diagnosis for the inpatient stay
  2. It is reported with a POA indicator of Y
  3. It always increases payment because it is a CC
  4. It does not count as a CC because it is a HAC Correct answer.

Explanation

Selected hospital-acquired conditions that are not present on admission are excluded from serving as CCs or MCCs for Medicare payment. The pressure ulcer would be reported with POA indicator N, not Y, and would not become the principal diagnosis.

Question 24Inpatient coding guidelines, compliance, and regulatory requirements

A patient is admitted with diabetic ketoacidosis and has type 1 diabetes. How are the diagnoses reported in ICD-10-CM?

  1. E10.10, a single combination code for both conditions Correct answer.
  2. R73.9 only, because ketoacidosis is considered a symptom
  3. E10.9 plus E87.2, reporting diabetes and ketoacidosis separately
  4. E11.65 plus R73.9 for hyperglycemia and abnormal glucose

Explanation

ICD-10-CM provides a combination code for type 1 diabetes mellitus with ketoacidosis: E10.10. The ketoacidosis is integral to the diabetes code and is not reported separately.

Question 25Inpatient coding guidelines, compliance, and regulatory requirements

A physician responds to a query by documenting "acute respiratory failure due to COPD exacerbation" in the discharge summary. What should the coder do?

  1. Send a second query asking the physician to confirm the same diagnosis
  2. Use the clarified documentation and keep the query with the record Correct answer.
  3. Assign the original DRG that was calculated before the query
  4. Ignore the response because a coder prompted the clarification

Explanation

A physician's response to a compliant query becomes part of the medical record and should support code assignment. The query and response should be retained to demonstrate the basis for coding and compliance review.

Question 26Inpatient coding guidelines, compliance, and regulatory requirements

Which activity is a recognized element of an effective hospital compliance program?

  1. Limiting compliance training to members of senior management
  2. Auditing and monitoring of coding and billing practices Correct answer.
  3. Delegating all coding decisions to the billing vendor under contract
  4. Reviewing claims for accuracy only after a payer has denied them

Explanation

The OIG's framework for an effective compliance program includes written policies, a designated compliance officer, training and education, open communication lines, internal auditing and monitoring, enforcement through discipline, and corrective action. Auditing and monitoring coding and billing is therefore a core element, and the hospital remains accountable even when vendors are used.

Question 27Inpatient coding guidelines, compliance, and regulatory requirements

Under the two-midnight rule, an inpatient admission is generally considered appropriate when which circumstance exists?

  1. The patient has received care in observation for longer than eight hours
  2. The patient was registered in the emergency department before the order was written
  3. The physician expects the stay to span at least two midnights Correct answer.
  4. The hospital assigns a bed on the unit that has the most open rooms

Explanation

The two-midnight benchmark looks at the physician's expectation at the time of admission that the patient will require hospital care spanning at least two midnights. Meeting the benchmark supports the medical necessity of an inpatient stay; time spent in observation or the emergency department does not count toward that expectation.

Question 28Inpatient coding guidelines, compliance, and regulatory requirements

An Excludes1 note listed under an ICD-10-CM code signifies which instruction?

  1. The excluded code may be reported as an additional diagnosis when documented
  2. The excluded code requires a physician query before reporting
  3. The excluded code should be reported only when it is the principal diagnosis
  4. The two conditions cannot be coded together Correct answer.

Explanation

An Excludes1 note means "not coded here" and is used when the two conditions are mutually exclusive, so they cannot occur together and cannot both be reported. An Excludes2 note, by contrast, indicates that the two conditions may coexist and both may be coded when documented.

Question 29Inpatient coding guidelines, compliance, and regulatory requirements

Which requirement must be met before an inpatient stay can be billed to Medicare Part A?

  1. The patient must be physically present in the hospital at midnight
  2. A prior authorization number must be obtained from the Medicare contractor
  3. A physician must order the admission Correct answer.
  4. A utilization review nurse must co-sign the discharge summary

Explanation

A physician order is required for an inpatient admission and must be documented in the record before the hospital bills Part A. The order alone is not sufficient, since the admission must also be medically necessary and supported by documentation, but the order is the foundational requirement.

Question 30Inpatient coding guidelines, compliance, and regulatory requirements

A hospital determines before discharge that an inpatient admission did not meet medical necessity criteria and the patient is still in the hospital. Which action is correct?

  1. Change the status to outpatient and report condition code 44 Correct answer.
  2. Submit the inpatient claim with a reduced DRG payment and no special code
  3. Discharge and readmit the patient on the same day with a new order
  4. Bill the entire stay as observation and notify the Quality Improvement Organization

Explanation

When a hospital changes a patient's status from inpatient to outpatient before discharge, it reports condition code 44 on the outpatient claim and does not submit an inpatient claim. The utilization review committee or a physician must concur with the status change, and the beneficiary must be notified.

Question 31Inpatient coding guidelines, compliance, and regulatory requirements

When a single inpatient stay includes several procedures, how is the principal procedure determined?

  1. The procedure that generated the greatest charges for the stay
  2. The first procedure documented in the operative report
  3. The procedure with the highest relative value units performed during the stay
  4. The procedure most closely related to the principal diagnosis Correct answer.

Explanation

The principal procedure is the one performed for definitive treatment that is most closely related to the principal diagnosis, or the one necessary to treat a complication of the principal diagnosis. Charge amounts, relative value units, and the order in which procedures appear in the record do not determine selection.

Question 32Inpatient coding guidelines, compliance, and regulatory requirements

What is the purpose of the hospital PEPPER report?

  1. It compares a hospital's billing patterns with those of its peers Correct answer.
  2. It lists beneficiaries who owe deductible amounts to the hospital
  3. It establishes the annual payment rate for each Medicare severity DRG
  4. It issues a final audit determination for previously paid claims

Explanation

The Program for Evaluating Payment Patterns Electronic Report summarizes a hospital's claims data for targeted risk areas and compares its statistics with those of peer hospitals. It is a compliance monitoring tool that can prompt internal review but does not itself change payment or constitute an audit finding.

Question 33Inpatient coding guidelines, compliance, and regulatory requirements

A Medicare patient is discharged from an acute care hospital to a skilled nursing facility for continued care. How does the post-acute transfer policy affect payment?

  1. Payment is denied because the discharge destination is not the patient's home
  2. The hospital bills the skilled nursing facility for the remaining portion of the DRG payment
  3. Payment may be reduced to a per diem amount for part of the stay Correct answer.
  4. The hospital receives the full DRG payment regardless of the length of stay

Explanation

For specified DRGs, discharge to a post-acute setting such as a skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health triggers a graduated per diem payment for the days before the transfer instead of the full DRG amount. Discharge to a post-acute provider is a covered event; the effect is an adjustment, not a denial.

Question 34Inpatient coding guidelines, compliance, and regulatory requirements

A patient spends three days in observation and is then admitted as an inpatient for two days before transfer to a skilled nursing facility. Which statement about the Medicare three-day qualifying stay is correct?

  1. Observation days do not count toward the three-day requirement Correct answer.
  2. Observation days count if the patient was in a nursing unit bed
  3. The stay qualifies if the physician certifies the observation as acute
  4. The stay qualifies because total hospital days exceed three

Explanation

Medicare requires three consecutive inpatient days, not counting the discharge day, for skilled nursing facility coverage after a hospital stay. Time in observation or in the emergency department does not count toward those inpatient days, so this patient has only two qualifying inpatient days.

Question 35Inpatient coding guidelines, compliance, and regulatory requirements

Which source is recognized as providing official coding advice for ICD-10-PCS in the United States?

  1. The American Medical Association's CPT Assistant
  2. The Medicare National Coverage Determination manual
  3. The hospital's own internal coding policy manual
  4. The AHA Coding Clinic for ICD-10-CM/PCS Correct answer.

Explanation

Coding Clinic for ICD-10-CM/PCS, published by the American Hospital Association with the cooperating parties, is the official source of coding advice and interpretation for ICD-10-CM and ICD-10-PCS. Coders apply that guidance when the classification does not fully address a documentation scenario.

Question 36Inpatient coding guidelines, compliance, and regulatory requirements

After a physician responds to a written coding query, what is the recommended practice?

  1. Record the response only in the coding software notes
  2. Discard the query once the code has been assigned
  3. Retain the query and response as part of the medical record Correct answer.
  4. Send the query to the payer as supporting documentation for the claim

Explanation

The query and the physician's response document the clarification that supports code assignment and should be retained in the medical record so the basis for the coded data is transparent to auditors and reviewers. Queries are internal review documentation and are not routinely attached to the claim.

Question 37Inpatient coding guidelines, compliance, and regulatory requirements

How does the Hospital Readmissions Reduction Program affect participating hospitals?

  1. Hospitals lose their Medicare provider agreement after one excess readmission
  2. Hospitals are required to provide any readmission within 30 days free of charge
  3. Hospitals may have base operating DRG payments reduced for excess readmissions Correct answer.
  4. Hospitals receive a bonus for readmissions that are lower than the national average

Explanation

The Hospital Readmissions Reduction Program reduces a hospital's base operating DRG payments when its risk-adjusted readmission rates for specified conditions exceed expected rates for peer hospitals. The program imposes payment reductions rather than offering bonuses or affecting the provider agreement.

Question 38Inpatient coding guidelines, compliance, and regulatory requirements

A claim for a 12-year-old patient contains a procedure code that is restricted to adults. Which Medicare edit is designed to identify this conflict?

  1. The National Correct Coding Initiative procedure-to-procedure edit
  2. The Medicare Code Editor age conflict edit Correct answer.
  3. The Recovery Audit Contractor automated review edit
  4. The inpatient outlier threshold edit

Explanation

The Medicare Code Editor screens inpatient claims before payment and includes age conflict edits that flag procedure or diagnosis codes inconsistent with the patient's age. NCCI edits address code pair conflicts, and outlier thresholds concern payment for unusually costly cases.

Question 39Inpatient coding guidelines, compliance, and regulatory requirements

A 68-year-old patient who is still working full time is admitted and is covered by an employer group health plan that has 25 employees. Which payer is primary for this stay?

  1. Medicare and the employer plan share the payment equally
  2. Medicare, because the patient has reached age 65
  3. The employer group health plan Correct answer.
  4. The employer plan is secondary for a 30-month coordination period

Explanation

Under Medicare Secondary Payer working-aged provisions, an employer group health plan based on current employment is primary for a beneficiary aged 65 or older when the employer has 20 or more employees. Medicare pays secondary in that situation.

Question 40Inpatient coding guidelines, compliance, and regulatory requirements

A hospital's internal audit identifies Medicare overpayments resulting from incorrect DRG assignments. Under the 60-day overpayment rule, what must the hospital do?

  1. Refer the matter to the Medicare Administrative Contractor only if fraud is suspected
  2. Report and return the overpayment within 60 days of identifying it Correct answer.
  3. Adjust the DRG codes on future claims to offset the overpayment
  4. Wait until the next cost report to reconcile the amount

Explanation

The 60-day rule requires a provider that has identified an overpayment to report and return the overpayment within 60 days of identification, generally with a written explanation of the reason for the refund. Overpayments that are not returned within that period can create liability under the False Claims Act.

Question 41ICD-10-CM diagnosis coding for the inpatient hospital setting

Under the UHDDS definition used for inpatient records, the principal diagnosis is the condition that:

  1. appears first in the admission history and physical examination
  2. required the greatest number of physician consultations during the stay
  3. after study is chiefly responsible for occasioning the admission Correct answer.
  4. was present on admission regardless of the resources it consumed

Explanation

The UHDDS defines the principal diagnosis as that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. It is determined by the circumstances of admission, diagnostic workup, and therapy provided, not by documentation order or resource consumption.

Question 42ICD-10-CM diagnosis coding for the inpatient hospital setting

Which statement about external cause codes in inpatient hospital records is correct?

  1. They are reported as additional codes following the nature-of-injury code and are never the principal diagnosis. Correct answer.
  2. They may be sequenced as the principal diagnosis when an injury is the reason for admission.
  3. They are optional in inpatient records but mandatory in outpatient records.
  4. They are reported only when the injury or poisoning is work-related.

Explanation

External cause codes (V00–Y99) describe how an injury or poisoning occurred and are always secondary to the code describing the nature of the condition. The nature-of-injury code is sequenced first, and an external cause code never serves as the principal diagnosis.

Question 43ICD-10-CM diagnosis coding for the inpatient hospital setting

A patient with chronic obstructive pulmonary disease is admitted with an acute exacerbation. Which code is assigned as the principal diagnosis?

  1. J44.1, COPD with (acute) exacerbation Correct answer.
  2. J44.0, COPD with acute lower respiratory infection
  3. J44.9, chronic obstructive pulmonary disease, unspecified
  4. J43.9, emphysema, unspecified

Explanation

When COPD is documented with an acute exacerbation, the specific combination code J44.1 is assigned. J44.0 is reserved for COPD with a documented acute lower respiratory infection, and J44.9 is used only when neither an exacerbation nor an infection is documented.

Question 44ICD-10-CM diagnosis coding for the inpatient hospital setting

A patient with documented morbid obesity and a documented BMI of 41.2 is admitted for hernia repair. How are the obesity and BMI reported?

  1. Z68.41 only, because the BMI code alone identifies obesity
  2. E66.9 and Z68.41 only if the physician lists BMI as a diagnosis
  3. E66.01 only, because BMI codes are not used in inpatient records
  4. E66.01 and Z68.41 as additional diagnoses Correct answer.

Explanation

A code from category E66 is assigned based on the provider's documentation of obesity, and a code from Z68 is added when the provider documents the BMI. BMI codes are secondary codes, are valid in inpatient records, and the specific E66.01 reflects the documented morbid obesity.

Question 45ICD-10-CM diagnosis coding for the inpatient hospital setting

Which seventh character identifies an initial encounter for an injury in which the patient is receiving active treatment?

  1. S
  2. D
  3. A Correct answer.
  4. G

Explanation

The seventh character A denotes an initial encounter, defined as active treatment of the injury or condition. D denotes a subsequent encounter with routine healing, G a subsequent encounter with delayed healing, and S a sequela.

Question 46ICD-10-CM diagnosis coding for the inpatient hospital setting

A patient with type 2 diabetes mellitus and stage 3a chronic kidney disease, documented as diabetic kidney disease, is admitted. Which two codes are reported?

  1. E11.22 and N18.31 Correct answer.
  2. E11.29 and N18.9
  3. E11.9 and N18.31
  4. E11.21 and N18.31

Explanation

Diabetic chronic kidney disease is coded with the combination code E11.22, and the stage of chronic kidney disease is reported with a code from N18. In this case stage 3a is N18.31, and the N18 code is sequenced after the diabetes code.

Question 47ICD-10-CM diagnosis coding for the inpatient hospital setting

An 80-year-old is admitted with sepsis and an E. coli urinary tract infection, and the physician documents urosepsis due to E. coli. What is the principal diagnosis?

  1. B96.20, unspecified Escherichia coli as the cause of disease classified elsewhere
  2. R65.20, severe sepsis without septic shock
  3. A41.51, sepsis due to Escherichia coli Correct answer.
  4. N39.0, urinary tract infection, site not specified

Explanation

When sepsis is present on admission, the code for sepsis is sequenced first, followed by the code for the localized infection. Because the organism is documented as E. coli causing sepsis, A41.51 is the appropriate sepsis code.

Question 48ICD-10-CM diagnosis coding for the inpatient hospital setting

A patient with an existing feeding gastrostomy is admitted with aspiration pneumonia. In addition to the pneumonia code, which code should be reported?

  1. Z43.0, encounter for attention to tracheostomy
  2. Z93.0, tracheostomy status
  3. Z93.1, gastrostomy status Correct answer.
  4. Z98.0, intestinal bypass status

Explanation

Z codes from category Z93 describe artificial opening status. A patient with a feeding gastrostomy is coded with Z93.1, which is reported as an additional diagnosis to describe the device present.

Question 49ICD-10-CM diagnosis coding for the inpatient hospital setting

A patient is admitted with sepsis due to methicillin-resistant Staphylococcus aureus and septic shock, with a documented skin and soft tissue source. What is the correct code assignment and sequence?

  1. A41.02 and R65.20 only
  2. R65.21, A41.02, then the code for the localized infection
  3. A41.02, R65.21, then the code for the localized infection Correct answer.
  4. A41.02 only

Explanation

The sepsis code is sequenced first, followed immediately by the code for severe sepsis with septic shock (R65.21) when shock is documented, then the localized infection code, then any organ dysfunction codes. A41.02 identifies sepsis due to MRSA.

Question 50ICD-10-CM diagnosis coding for the inpatient hospital setting

An HIV-positive patient is admitted with Pneumocystis jirovecii pneumonia. Which coding is correct?

  1. B20 and J18.9 for pneumonia, organism unspecified
  2. B59 as principal, followed by B20
  3. B20 as principal, followed by B59 for the pneumonia Correct answer.
  4. B20 only, because HIV disease is reported with a single code

Explanation

For a patient with HIV disease admitted for an HIV-related condition, B20 is sequenced first and the code for the manifestation is reported additionally. Pneumocystis pneumonia is classified to B59, and it follows B20.