AAPC ICD10 Physician Coding for CPC Preparation (All
Exams) with rationale
A PATIENT IS ADMITTED TO THE HOSPITAL FOR REPAIR OF AN OPEN
FRACTURE, TYPE I, OF THE HEAD OF THE LEFT FEMUR. THE PATIENT HAS
BEEN PREVIOUSLY DIAGNOSED WITH SYMPTOMATIC HIV. APPLYING THE
CODING CONCEPT FROM ICD-10-CM GUIDELINES I.C.1.a.2.b, WHAT ICD-10-CM
CODE(S) IS/ARE REPORTED FOR THE ADMISSION?
A. B20
B. S72.052B
C. B20, S72.052B
D. S72.052B, B20 - ✔✔ANSW✔✔..Answer: D. S72.052B, B20
Rationale: ICD-10-CM guideline I.C.1.a.2.b. states, "If a patient with HIV disease
is admitted for an unrelated condition (such as a traumatic injury), the code for
the unrelated condition (eg, the nature of the injury code) should be the principal
diagnosis. Other diagnoses would be B20 followed by additional diagnosis
codes for all reported HIV-related conditions." The open fracture of the head of
the femur (S72.052B) is reported first as the reason for the visit because it is
unrelated to HIV. To locate the diagnosis, look in the ICD-10-CM Alphabetic
Index for Fracture, traumatic/femur, femoral/upper end/head referring you to
subcategory code S72.05-. In the Tabular List, 6th character 2 indicates the left
femur. 7th character B indicates the initial encounter for a type 1 open fracture.
HIV is symptomatic so it is reported secondarily with B20.
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 - ✔✔ANSW✔✔..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 - ✔✔ANSW✔✔..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 PATIENT IS ADMITTED TO THE HOSPITAL WITH PNEUMONIA. TESTING
INDICATES THE PATIENT'S PNEUMONIA IS DUE TO STAPHYLOCOCCUS
AUREUS AND IS METHICILLIN RESISTANT (MRSA). APPLYING THE CODING
CONCEPT FROM ICD-10-CM GUIDELINES I.C.1.e.1.a, WHAT ICD-10-CM CODES
ARE REPORTED?
A. J18.9
B. J15.212
C. J15.212, A49.02
D. J18.9, A49.02 - ✔✔ANSW✔✔..Answer: B. J15.212
Rationale: Look in the ICD-10-CM Alphabetic Index for Pneumonia/in (due
to)/staphylococcus/aureus/methicillin resistant (MRSA) J15.212. According to
ICD-10-CM guideline 1.C.1.e.1.(a), when a combination code exists for MRSA
and the infection, only the combination code should be reported. Pneumonia due
to Methicillin-resistant Staphylococcus aureus is reported with J15.212.
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 - ✔✔ANSW✔✔..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 Index for Anemia/due to (in) (with)/antineoplastic
chemotherapy (D64.81). According to guideline 1.C.2.c.2. the malignancy is
reported secondarily followed by code T45.1X5. Look in the ICD-10-CM Table of
Neoplasms for ovary and report the code from the Malignant Primary column
(C56.-). In the Tabular List, C56.9 is reported because the laterality is not stated.
Next, to locate T45.1X5, look in the Table of Drugs and Chemicals for
Antineoplastic NEC and selecting the code from the Adverse effect column
(T45.1X5). In the Tabular List, T45.1X5 requires a 7th character extender. A is
selected because this is considered active treatment.
Mr. Mcfarland visits his oncologist for prostate cancer. He is reporting more
fatigue than usual. Lab test determine the patient has anemia due to cancer.
Applying the coding concept from ICD-10-CM guideline I.C.2.c.1, What codes
should be reported?
A. C61, D63.0
B. C61, D64.81
C. D63.0, C61
D. D64.81, C61 - ✔✔ANSW✔✔..Answer: A. C61, D63.0
Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.2.c.1, states when
the admission/encounter is for management of an anemia associated with the
malignancy, and the treatment is only for the anemia, the appropriate code for
the malignancy is sequenced as the principal or first-listed diagnosis followed by
the appropriate code for the anemia. The patient visited the oncologist for the
prostate cancer and the lab tests indicate anemia due to cancer. According to
the guidelines, the primary diagnosis reported for the visit, is prostate cancer.
Look in the Table of Neoplasms for prostate (gland) and select the code from the
Malignant Primary column C61. Then look in the Alphabetic Index for Anemia/in
(due to) (with)/neoplastic disease D63.0. Verify codes in the Tabular List.
CASE 2
PREOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing loss.
POSTOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing
loss.(Report the postoperative diagnosis.)
PROCEDURES PERFORMED: 1. Placement of left Nucleus cochlear implant. 2.
Facial nerve monitoring for an hour. 3. Microscope use.
ANESTHESIA: General.
INDICATIONS: This is a 69-year-old woman who has had progressive hearing
loss (The diagnosis is documented as the indication for the surgery.) over the
Exams) with rationale
A PATIENT IS ADMITTED TO THE HOSPITAL FOR REPAIR OF AN OPEN
FRACTURE, TYPE I, OF THE HEAD OF THE LEFT FEMUR. THE PATIENT HAS
BEEN PREVIOUSLY DIAGNOSED WITH SYMPTOMATIC HIV. APPLYING THE
CODING CONCEPT FROM ICD-10-CM GUIDELINES I.C.1.a.2.b, WHAT ICD-10-CM
CODE(S) IS/ARE REPORTED FOR THE ADMISSION?
A. B20
B. S72.052B
C. B20, S72.052B
D. S72.052B, B20 - ✔✔ANSW✔✔..Answer: D. S72.052B, B20
Rationale: ICD-10-CM guideline I.C.1.a.2.b. states, "If a patient with HIV disease
is admitted for an unrelated condition (such as a traumatic injury), the code for
the unrelated condition (eg, the nature of the injury code) should be the principal
diagnosis. Other diagnoses would be B20 followed by additional diagnosis
codes for all reported HIV-related conditions." The open fracture of the head of
the femur (S72.052B) is reported first as the reason for the visit because it is
unrelated to HIV. To locate the diagnosis, look in the ICD-10-CM Alphabetic
Index for Fracture, traumatic/femur, femoral/upper end/head referring you to
subcategory code S72.05-. In the Tabular List, 6th character 2 indicates the left
femur. 7th character B indicates the initial encounter for a type 1 open fracture.
HIV is symptomatic so it is reported secondarily with B20.
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 - ✔✔ANSW✔✔..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 - ✔✔ANSW✔✔..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 PATIENT IS ADMITTED TO THE HOSPITAL WITH PNEUMONIA. TESTING
INDICATES THE PATIENT'S PNEUMONIA IS DUE TO STAPHYLOCOCCUS
AUREUS AND IS METHICILLIN RESISTANT (MRSA). APPLYING THE CODING
CONCEPT FROM ICD-10-CM GUIDELINES I.C.1.e.1.a, WHAT ICD-10-CM CODES
ARE REPORTED?
A. J18.9
B. J15.212
C. J15.212, A49.02
D. J18.9, A49.02 - ✔✔ANSW✔✔..Answer: B. J15.212
Rationale: Look in the ICD-10-CM Alphabetic Index for Pneumonia/in (due
to)/staphylococcus/aureus/methicillin resistant (MRSA) J15.212. According to
ICD-10-CM guideline 1.C.1.e.1.(a), when a combination code exists for MRSA
and the infection, only the combination code should be reported. Pneumonia due
to Methicillin-resistant Staphylococcus aureus is reported with J15.212.
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 - ✔✔ANSW✔✔..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 Index for Anemia/due to (in) (with)/antineoplastic
chemotherapy (D64.81). According to guideline 1.C.2.c.2. the malignancy is
reported secondarily followed by code T45.1X5. Look in the ICD-10-CM Table of
Neoplasms for ovary and report the code from the Malignant Primary column
(C56.-). In the Tabular List, C56.9 is reported because the laterality is not stated.
Next, to locate T45.1X5, look in the Table of Drugs and Chemicals for
Antineoplastic NEC and selecting the code from the Adverse effect column
(T45.1X5). In the Tabular List, T45.1X5 requires a 7th character extender. A is
selected because this is considered active treatment.
Mr. Mcfarland visits his oncologist for prostate cancer. He is reporting more
fatigue than usual. Lab test determine the patient has anemia due to cancer.
Applying the coding concept from ICD-10-CM guideline I.C.2.c.1, What codes
should be reported?
A. C61, D63.0
B. C61, D64.81
C. D63.0, C61
D. D64.81, C61 - ✔✔ANSW✔✔..Answer: A. C61, D63.0
Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.2.c.1, states when
the admission/encounter is for management of an anemia associated with the
malignancy, and the treatment is only for the anemia, the appropriate code for
the malignancy is sequenced as the principal or first-listed diagnosis followed by
the appropriate code for the anemia. The patient visited the oncologist for the
prostate cancer and the lab tests indicate anemia due to cancer. According to
the guidelines, the primary diagnosis reported for the visit, is prostate cancer.
Look in the Table of Neoplasms for prostate (gland) and select the code from the
Malignant Primary column C61. Then look in the Alphabetic Index for Anemia/in
(due to) (with)/neoplastic disease D63.0. Verify codes in the Tabular List.
CASE 2
PREOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing loss.
POSTOPERATIVE DIAGNOSIS: Bilateral profound sensorineural hearing
loss.(Report the postoperative diagnosis.)
PROCEDURES PERFORMED: 1. Placement of left Nucleus cochlear implant. 2.
Facial nerve monitoring for an hour. 3. Microscope use.
ANESTHESIA: General.
INDICATIONS: This is a 69-year-old woman who has had progressive hearing
loss (The diagnosis is documented as the indication for the surgery.) over the
