QUESTIONS VERIFIED
◍ Codes for symptoms, signs, and ill-defined conditions from chapter
18 of ICD-10CM cannot be used as principal diagnoses or reasons for
outpatient encounters when related diagnoses have been established..
Answer: True
◍ Codes from chapter 18 are assigned as secondary codes under
which of the following circumstances
a.When the symptom or sign is not integral to the underlying
condition
b.When it affects payment
c.When desired
d.Never. Answer: a.When the symptom or sign is not integral to the
underlying condition
◍ When is it appropriate to assign codes for abnormal findings in the
acute inpatient hospital setting?
a. Anytime
b. When the physician has not been able to arrive at a definitive
related diagnosis and lists the abnormal finding itself as a diagnosis
c. Never
d. When the abnormal findings are much higher than normal.
Answer: b. When the physician has not been able to arrive at a
,definitive related diagnosis and lists the abnormal finding itself as a
diagnosis
◍ If the coder notes clinical findings outside the normal range but no
related diagnosis is stated, what should the coder do?
a.
Review the conditions possibly responsible for the abnormal findings
and select a code for one of those conditions.
b.
Code the abnormal finding.
c.
Review the medical record to determine whether additional tests
and/or consultations were carried out related to these findings or
whether specific related care was given, and ask the physician
whether a code should be assigned.
d.
Review the medical record and code the abnormal finding as a
"possible, probable" diagnosis.. Answer: c.
Review the medical record to determine whether additional tests
and/or consultations were carried out related to these findings or
whether specific related care was given, and ask the physician
whether a code should be assigned.
◍ A 47-year-old obese man was admitted with chest pain and
difficulty swallowing, resulting in regurgitation. The patient has a
history of coronary artery disease (CAD), but tests ruled out angina.
, Based on negative test results and the patient's history, it was
established that the chest pain was probably related to a heavy meal.
Final diagnoses: (1) Probable gastroesophageal reflux disease
(GERD), (2) CAD, (3) obesity.
Assign the appropriate codes.. Answer: K21.9 (GERD w/out
esophagitis)
I25.10 (CAD)
E66.9 (obesity)
Comments: (1) Code K21.9 is assigned as the principal diagnosis. In
the inpatient setting, when a diagnosis is documented as "probable,"
"suspected," "likely," "questionable," "possible," or "still to be ruled
out," or other similar terminology of uncertainty, the condition is
coded as though it were an established diagnosis. (2) Codes for chest
pain and difficulty swallowing are not reported because they are
related to the definitive underlying condition.
Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2019
Revised Edition, pp. 57-58, 140-141.
◍ The female patient was admitted with right lower quadrant
abdominal pain, diarrhea, fever, chills, and nausea for the past 5 days.
Blood and stool cultures were negative. CT of the abdomen ruled out
colon disease but was positive for ascites and cirrhosis. This was
consistent with the patient's history of cirrhosis due to
hemochromatosis. The patient refused paracentesis. After antibiotics