CRC CASE STUDIES 1 QUESTIONS AND ANSWERS 100% VERIFIED

CRC CASE STUDIES 1 QUESTIONS AND ANSWERS 100% VERIFIED ANS: N18.6, I12.0, E10.22, E10.40, E10.319, Z99.2, I70.209, E78.00, M81.0, Z94.0, Z94.83 Rationale: In this example the patient has hypertension and end stage renal disease. According to the ICD-10-CM guideline I.C.9.a.2, Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. ICD-10-CM presumes a cause-and-effect relationship. To locate this code, look in the Alphabetic Index for Hypertension/with/kidney/with/stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) I12.0. There is an instructional note that states to "Use additional code to identify the stage of chronic kidney disease (N18.5, N18.6). In this case the patient has end stage renal disease so N18.6 is assigned. The patient is also a type 1 diabetic with diabetic retinopathy and diabetic neuropathy. Combination codes - answer1. TRANSPLANT SURGERY Mr. X is a 66 year-old white male who had end stage renal disease and type I diabetes mellitus and underwent combined kidney and pancreas transplantation. He lost his renal allograft from BK viral nephropathy and underwent retransplantation ten years ago. He had problems with renal allograft dysfunction and underwent percutaneous renal allograft biopsy eleven years ago, which revealed hypertensive changes within his kidney. He recently had his lisinopril discontinued. His blood pressures again climbed to an unacceptable level. He had atenolol added. He states that his pulse has slowed down with the atenolol. He has had no trouble with dizziness. He brings his blood pressure cuff with him today. His cuff reads 170/90. My reading with the electronic cuff is 173/84. I am unable to auscultate a pressure in this patient. His log of his blood pressure readings at home in the standing position are usually in the 130 range. I feel that this is an acceptable blood pressure for this patient. We will add no additional antihypertensive medicines. LABORATORY REVIEW (xx/xx/20xx) Sodium 144; potassium 5.0; chloride 109; carbon dioxide 20; white count 7000; hematocrit 31.9; platelet count 264,000; BUN 43; creatinine 1.82; Prograf level 6.4; amylase 28; lipase 69. ASSESSMENT: 1. Hypertension - reasonably controlled. 2. End stage renal disease. On dialysis. 3. Diabetes mellitus type I. 4. Diabetic retinopathy - stable. 5. Diabetic neuropathy. 6. BK allograft nephropathy. 7. Renal allograft rejection - June 1999. 8. Hypercholesterolemia. 9. Atherosclerosis, extremities. 10. Osteoporosis. PLAN: The patient is to continue on the current antihypertensive regimen. We will schedule him for a bone densitometry study on his return. He is provided three cards for stool sampling for guaiac testing. He is to get a blood check ANS: Z00.01, Z89.511, E11.9, I10, G54.6, Z68.28, Z79.82, Z82.0, Z83.3, Z79.84 Rationale: In this case, the patient presents for a comprehensive medical examination. Look in the Alphabetic Index for Examination/with abnormal findings which directs the coder to Z00.01 (On exam, the provider indicates Phantom Limb on occasion). He had a BKA. To code for this look for Absence/leg/below knee (acquired) which directs the coder to Z89.51-.When referenced in the Tabular List a sixth character is required for laterality. This is of the right leg with correct code Z89.511. The patient also has diabetes. The type of diabetes is not documented. According to ICD-10-CM guideline, I.C.4.a.2, states if the type of diabetes mellitus is not documented in the medical record the default Is E11.-, Type 2 diabetes mellitus. Look in the Alphabetic Index for Diabetes, diabetic (mellitus) (sugar)/type 2 which directs the coder to E11.9. The - answer2. DATE 04/01/20xx Medical Office Exam DOB 03/01/XXXX BP: 128/70; Left arm. Pulse: 60, Regular. Temperature: 98 .6 F, Oral. HT: 5'4.5". WT:169 lbs. Respirations: 16. BMI: 28 .59 kg/m2 Smoking status: Never Subjective: This 67 year-old male presents for comprehensive medical examination. Lives with no one. Interim problems since last visit: None Review of Systems: Constitutional: Negative Eyes: Negative Ears, Nose, Mouth, Throat: Negative Cardiovascular: Negative Respiratory: Negative Gastrointestinal: Negative Genitourinary: Negative Musculoskeletal: Negative Skin and /or breasts: Negative: Neurological: Negative Psychiatric: Negative Endocrine: Negative Hematologic/Lymphatic: Negative Allergy/ Immunologic: Negative Past Medical History: HTN NIDDM Past Surgical History: Left Shoulder Rotator Cuff Repair at age xx