AAPC CPC CHAPTER 4 (ICD-10-
CM CODING CHAPTERS 1-11)
A 12 year old's diabetes mellitus is well controlled with oral antidiabetic medications.
The patient has no complications. Applying the coding concept from ICD guidelines
I.C.4.a.1, I.C.4.a.2, and I.C.4.a.3, what ICD codes is/are reported?
A. E11.9, Z79.84
B. E10.9
C. E13.9, Z79.84
D. E08.9, Z79.84 - Answer: A. E11.9, Z79.84
Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a.1, the
age of the patient is not the determining factor in what type of diabetes is coded. In
addition, Section I.C.4.a.2 says if the type of diabetes mellitus is not documented in the
medical record the default type is type 2. To find the code, look in the ICD-10-CM
Alphabetic Index for Diabetes, diabetic (mellitus) (sugar). The default code is E11.9.
Verification in the Tabular List verifies code selection. ICD-10-CM guideline I.C.4.a.3
directs the coder to report Z79.84 to indicate the patient uses oral hypoglycemic or
antidiabetic drugs. Look in the Alphabetic Index for Long-term (current) (prophylactic)
drug therapy (use of)/oral/ antidiabetic Z79.84.
A 12-year-old child presents to the ED with an acute exacerbation of asthma. The
patient is wheezing and is having difficulty breathing. She is not responding to the
therapy. The physician documents as the final diagnosis asthma with status asthmatics.
What ICD code is reported?
A. J45.52
B. J45.901
C. J45.902
D. RO6.2, J45.901 - C. J45.902
Rationale: The final diagnosis is asthma with status asthmatics. To locate the code in
the ICD-10-CM Alphabetic Index, look for Asthma/with/status asthmatics, J45.902.
Verify code selection in the Tabular List.
A 22 year-old patient status post-surgery developed a postoperative infection. The
patient quickly deteriorated and became septic, developed gas gangrene (gas bacillus
infection) and went into post procedural septic shock. With aggressive intravenous
antibiotic management, the patient improved. What ICD-10-CM codes are reported? -
T81.44XA, A48.0, T81.12XA
Rationale: Per ICD-10-CM guideline I.C.1.d.5.c states when a post procedural infection
has resulted in post procedural septic shock, the code for the precipitating complication,
such as code T81.4-, infection following a procedure is coded first followed by code
T81.12- Procedural septic shock. A code for the systemic infection should also be
assigned. In the ICD-10-CM Alphabetic Index look for Sepsis/post procedural referring
,you to T81.44-. Verifying this code in the Tabular List we will need to place two X
placeholders and select the 7 th character of A since the treatment is active. Complete
code is T81.44XA. The Tabular List for T81.4, has an instructional note to code the
infection. For the systemic infection look in the Alphabetic Index for Gangrene,
gangrenous/gas (bacillus) which directs you to A48.0. Guideline I.C.1.d.5.c. Shows that
the systemic infection should also be assigned, but it does not state the order; however,
coding guideline I.C.1.d.2. Septic shock indicates that the systemic infection is
sequenced first, followed by T81.12 post procedural shock. Report T81.12- as the next
code. Verifying the code in the Tabular List add the X placeholder as the 6th character
and choose the 7th character of A. Code R65.21 is not reported which is indicated in
coding guideline I.C.1.d.5.c; also code T81.12- already indicates septic shock and there
is an EXCLUDES1 note under subcategory code T81.1- not to report code R65.21.
A 22-YEAR-OLD FEMALE IS ADMITTED TO ICU FOR ACUTE RENAL (KIDNEY)
FAILURE DUE TO SEPSIS (CASUAL ORGANISM UNKNOWN). APPLYING THE
CODING CONCEPT FORM ICD-10-CM GUIDELINE I.C.1.d.1.b WHAT ICD-10-CM
CODES ARE REPORTED (IN THE CORRECT SEQUENCING)?
A. A41.9, R65.20, N 17.9
B. N17.9, R65.20, A 41.9
C. R65.21, A41.9, N17.9
D. N17.9, R65.21, A41.01 - Answer: A. A41.9, R65.20, N17.9
Rationale: ICD-10-CM guideline I.C.1.d.1.b indicates: The coding of severe sepsis
requires a minimum of two codes. First, a code for the underlying systemic infection,
followed by a code from subcategory R65.2, Severe sepsis. If the causal organism is
not documented, assign code A41.9, Sepsis, unspecified organism, for the infection.
Additional codes(s) for the associated acute organ dysfunction are also required (if
present). The first code to report is sepsis; look for the main term Sepsis in the ICD-10-
CM Alphabetic Index referring you to code A41.9. Next, look for Sepsis/with organ
dysfunction (acute) (multiple) referring you to code R65.20. For the last code, look for
Failure/renal/acute referring you to code N17.9. In the Tabular List, you will find an
instructional note under subcategory R65.2 indicating what codes should be reported
first and what codes should be reported as additional codes.
A 32 year old female had a mastectomy for breast cancer. The mastectomy completely
removed the breast cancer with no further treatment. On a follow up visit to her
oncologist, it is determined the cancer has metastasized to the right lung. The patient is
now undergoing a lung resection for the lung cancer. What codes are reported?
A. C50.911, C78.01,
B. Z85.3, C78.01
C. C78.01, C50.911
D. C78.01, Z85.3 - Answer: D. C78.01, Z85.3
Rationale: According to ICD-10-CM guidelines 1.C.2.d., when a primary malignancy has
been previously excised and there is no evidence of any existing primary malignancy, a
code from category Z85.-, Personal history of malignant neoplasm should be used. Any
mention of metastasis to another site is coded as a secondary malignant neoplasm to
that site and the secondary site may be the first-listed with the Z85- code used as a
, secondary code. For the metastasized lung cancer, look in the Table of Neoplasms for
lung and use the code from the Malignant Secondary column (C78.0-). In the Tabular
List, C78.01 is selected for the right lung. For the history of breast cancer, look in the
ICD-10-CM Alphabetic Index for History/personal (of)/malignant neoplasm (of)/breast
Z85.3. The correct codes and sequencing are C78.01 and Z85.3.
A 32 year-old patient with hyperthyroidism has an ultrasound to determine why her neck
is enlarged. The results of the ultrasound reveal a uninodular goiter. What ICD-10-CM
code is reported? - E05.10
Rationale: In the ICD-10-CM Alphabetic Index look for
Hyperthyroidism/with/goiter/nodular/uninodular which directs you to E05.10. The code
can also be found by looking in the Alphabetic Index for Goiter/uninodular/toxic or with
hyperthyroidism which guides you to code E05.10. Verify code selection in the Tabular
List.
A 33 year-old patient visits his primary care provider to discuss lap band procedure for
his morbid obesity. His caloric intake is in excess of 4,000 calories per day and his BMI
is currently 45. What ICD-10-CM code(s) is/are reported? - E66.01, Z68.42
Rationale: In the ICD-10-CM Alphabetic Index look for Obesity/morbid guiding you to
code E66.01. In the Tabular List there is note under subcategory code E66 to use an
additional code to identify the BMI (Z68.1-Z68.45). Look at this range in the Tabular List.
The second code is Z68.42 indicating a BMI of 45.0 - 49.9 adult. This can be found in
the Alphabetic Index by looking for Body, bodies/mass index (BMI)/adult/45.0-49.9
referring you to Z68.42. Verify code selection in the Tabular List.
A 39-year-old patient underwent a left femoral hernia repair. The postoperative
diagnosis was recurrent left femoral hernia. What is the diagnosis code for this
encounter?
A. K41.41
B. K41.91
C. K41.21
D. K40.91 - B. K41.91
Rationale: In the ICD-10-CM Alphabetic Index, look for Hernia/femoral/recurrent. You
are directed to K41.91. Verify the code selection in Tabular List.
A 45 year old female with ovarian cancer visits her oncologist to receive an injection of
Procrit. The Procrit has been prescribed to her for treatment of her anemia resulting
from antineoplastic chemotherapy treatment. What codes should be reported?
A. D64.81, C56.9, T45.1X5A
B. D64.81, C56.9
C. C56.9, D64.81
D. T45.1X5A, D64.81, C56.9 - Answer: A. D64.81, C56.9, T45.1X5A
Rationale: According to ICD-10-CM guidelines 1.C.2.c.2., because the treatment is
directed at the anemia associated with chemotherapy, and the treatment is only for the
anemia, the anemia should be sequenced first, followed by the appropriate codes for
the neoplasm and the adverse effect (T45.1X5). Look in the ICD-10-CM Alphabetic
CM CODING CHAPTERS 1-11)
A 12 year old's diabetes mellitus is well controlled with oral antidiabetic medications.
The patient has no complications. Applying the coding concept from ICD guidelines
I.C.4.a.1, I.C.4.a.2, and I.C.4.a.3, what ICD codes is/are reported?
A. E11.9, Z79.84
B. E10.9
C. E13.9, Z79.84
D. E08.9, Z79.84 - Answer: A. E11.9, Z79.84
Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a.1, the
age of the patient is not the determining factor in what type of diabetes is coded. In
addition, Section I.C.4.a.2 says if the type of diabetes mellitus is not documented in the
medical record the default type is type 2. To find the code, look in the ICD-10-CM
Alphabetic Index for Diabetes, diabetic (mellitus) (sugar). The default code is E11.9.
Verification in the Tabular List verifies code selection. ICD-10-CM guideline I.C.4.a.3
directs the coder to report Z79.84 to indicate the patient uses oral hypoglycemic or
antidiabetic drugs. Look in the Alphabetic Index for Long-term (current) (prophylactic)
drug therapy (use of)/oral/ antidiabetic Z79.84.
A 12-year-old child presents to the ED with an acute exacerbation of asthma. The
patient is wheezing and is having difficulty breathing. She is not responding to the
therapy. The physician documents as the final diagnosis asthma with status asthmatics.
What ICD code is reported?
A. J45.52
B. J45.901
C. J45.902
D. RO6.2, J45.901 - C. J45.902
Rationale: The final diagnosis is asthma with status asthmatics. To locate the code in
the ICD-10-CM Alphabetic Index, look for Asthma/with/status asthmatics, J45.902.
Verify code selection in the Tabular List.
A 22 year-old patient status post-surgery developed a postoperative infection. The
patient quickly deteriorated and became septic, developed gas gangrene (gas bacillus
infection) and went into post procedural septic shock. With aggressive intravenous
antibiotic management, the patient improved. What ICD-10-CM codes are reported? -
T81.44XA, A48.0, T81.12XA
Rationale: Per ICD-10-CM guideline I.C.1.d.5.c states when a post procedural infection
has resulted in post procedural septic shock, the code for the precipitating complication,
such as code T81.4-, infection following a procedure is coded first followed by code
T81.12- Procedural septic shock. A code for the systemic infection should also be
assigned. In the ICD-10-CM Alphabetic Index look for Sepsis/post procedural referring
,you to T81.44-. Verifying this code in the Tabular List we will need to place two X
placeholders and select the 7 th character of A since the treatment is active. Complete
code is T81.44XA. The Tabular List for T81.4, has an instructional note to code the
infection. For the systemic infection look in the Alphabetic Index for Gangrene,
gangrenous/gas (bacillus) which directs you to A48.0. Guideline I.C.1.d.5.c. Shows that
the systemic infection should also be assigned, but it does not state the order; however,
coding guideline I.C.1.d.2. Septic shock indicates that the systemic infection is
sequenced first, followed by T81.12 post procedural shock. Report T81.12- as the next
code. Verifying the code in the Tabular List add the X placeholder as the 6th character
and choose the 7th character of A. Code R65.21 is not reported which is indicated in
coding guideline I.C.1.d.5.c; also code T81.12- already indicates septic shock and there
is an EXCLUDES1 note under subcategory code T81.1- not to report code R65.21.
A 22-YEAR-OLD FEMALE IS ADMITTED TO ICU FOR ACUTE RENAL (KIDNEY)
FAILURE DUE TO SEPSIS (CASUAL ORGANISM UNKNOWN). APPLYING THE
CODING CONCEPT FORM ICD-10-CM GUIDELINE I.C.1.d.1.b WHAT ICD-10-CM
CODES ARE REPORTED (IN THE CORRECT SEQUENCING)?
A. A41.9, R65.20, N 17.9
B. N17.9, R65.20, A 41.9
C. R65.21, A41.9, N17.9
D. N17.9, R65.21, A41.01 - Answer: A. A41.9, R65.20, N17.9
Rationale: ICD-10-CM guideline I.C.1.d.1.b indicates: The coding of severe sepsis
requires a minimum of two codes. First, a code for the underlying systemic infection,
followed by a code from subcategory R65.2, Severe sepsis. If the causal organism is
not documented, assign code A41.9, Sepsis, unspecified organism, for the infection.
Additional codes(s) for the associated acute organ dysfunction are also required (if
present). The first code to report is sepsis; look for the main term Sepsis in the ICD-10-
CM Alphabetic Index referring you to code A41.9. Next, look for Sepsis/with organ
dysfunction (acute) (multiple) referring you to code R65.20. For the last code, look for
Failure/renal/acute referring you to code N17.9. In the Tabular List, you will find an
instructional note under subcategory R65.2 indicating what codes should be reported
first and what codes should be reported as additional codes.
A 32 year old female had a mastectomy for breast cancer. The mastectomy completely
removed the breast cancer with no further treatment. On a follow up visit to her
oncologist, it is determined the cancer has metastasized to the right lung. The patient is
now undergoing a lung resection for the lung cancer. What codes are reported?
A. C50.911, C78.01,
B. Z85.3, C78.01
C. C78.01, C50.911
D. C78.01, Z85.3 - Answer: D. C78.01, Z85.3
Rationale: According to ICD-10-CM guidelines 1.C.2.d., when a primary malignancy has
been previously excised and there is no evidence of any existing primary malignancy, a
code from category Z85.-, Personal history of malignant neoplasm should be used. Any
mention of metastasis to another site is coded as a secondary malignant neoplasm to
that site and the secondary site may be the first-listed with the Z85- code used as a
, secondary code. For the metastasized lung cancer, look in the Table of Neoplasms for
lung and use the code from the Malignant Secondary column (C78.0-). In the Tabular
List, C78.01 is selected for the right lung. For the history of breast cancer, look in the
ICD-10-CM Alphabetic Index for History/personal (of)/malignant neoplasm (of)/breast
Z85.3. The correct codes and sequencing are C78.01 and Z85.3.
A 32 year-old patient with hyperthyroidism has an ultrasound to determine why her neck
is enlarged. The results of the ultrasound reveal a uninodular goiter. What ICD-10-CM
code is reported? - E05.10
Rationale: In the ICD-10-CM Alphabetic Index look for
Hyperthyroidism/with/goiter/nodular/uninodular which directs you to E05.10. The code
can also be found by looking in the Alphabetic Index for Goiter/uninodular/toxic or with
hyperthyroidism which guides you to code E05.10. Verify code selection in the Tabular
List.
A 33 year-old patient visits his primary care provider to discuss lap band procedure for
his morbid obesity. His caloric intake is in excess of 4,000 calories per day and his BMI
is currently 45. What ICD-10-CM code(s) is/are reported? - E66.01, Z68.42
Rationale: In the ICD-10-CM Alphabetic Index look for Obesity/morbid guiding you to
code E66.01. In the Tabular List there is note under subcategory code E66 to use an
additional code to identify the BMI (Z68.1-Z68.45). Look at this range in the Tabular List.
The second code is Z68.42 indicating a BMI of 45.0 - 49.9 adult. This can be found in
the Alphabetic Index by looking for Body, bodies/mass index (BMI)/adult/45.0-49.9
referring you to Z68.42. Verify code selection in the Tabular List.
A 39-year-old patient underwent a left femoral hernia repair. The postoperative
diagnosis was recurrent left femoral hernia. What is the diagnosis code for this
encounter?
A. K41.41
B. K41.91
C. K41.21
D. K40.91 - B. K41.91
Rationale: In the ICD-10-CM Alphabetic Index, look for Hernia/femoral/recurrent. You
are directed to K41.91. Verify the code selection in Tabular List.
A 45 year old female with ovarian cancer visits her oncologist to receive an injection of
Procrit. The Procrit has been prescribed to her for treatment of her anemia resulting
from antineoplastic chemotherapy treatment. What codes should be reported?
A. D64.81, C56.9, T45.1X5A
B. D64.81, C56.9
C. C56.9, D64.81
D. T45.1X5A, D64.81, C56.9 - Answer: A. D64.81, C56.9, T45.1X5A
Rationale: According to ICD-10-CM guidelines 1.C.2.c.2., because the treatment is
directed at the anemia associated with chemotherapy, and the treatment is only for the
anemia, the anemia should be sequenced first, followed by the appropriate codes for
the neoplasm and the adverse effect (T45.1X5). Look in the ICD-10-CM Alphabetic
