HCS-D Exam Questions With Complete Solutions
58 yo M with type 1 diabetes is treated for hyperglycemia. He
also has stage 3 CKD. His insulin pump was found to be
malfunctioning and underdosing Correct Answers T85.614D;
Breakdown (mechanical) of insulin pump, subsequent encounter
T38.3X6D; Underdosing of insulin and oral hypoglycemic
drugs, subsequent encounter
E10.65; Diabetes type 1 with hyperglycemia
E10.22; Type 1 DM with CKD
N18.30; CKD stage 3, unspecified
7th character for glaucoma Correct Answers 4 for
indeterminate stage: stage cannot be clinically determined
0 unspecified: no documentation regarding stage
A burn covered with a skin graft is a _____ Correct Answers
Surgical wound on the OASIS
* It is coded as a burn
A code from category I23, certain current complications
following ST elevation (STEM1) and non-ST elevation
(NSTEM1) myocardial infarction (within the 28 day period) is?
Correct Answers Sufficient by itself for a patient who suffers
complications following an MI, whether that complication
occurs within the 28 day acute period or not
* Additional code from I21 or I22 is not required
A complication code _____ ____ an aftercare Z code, which is
used for routine care only Correct Answers Always trumps
,A dash following the category or subcategory means? Correct
Answers An incomplete code
A patient admitted for management of diabetes due to cystic
fibrosis who requires insulin and an oral hypoglycemic drug
Correct Answers E84.8; Cystic fibrosis with other
manifestation
E08.9; Diabetes mellitus due to underlying condition without
complications
Z79.4; Long-term use of insulin
Z79.84; Long-term use of oral hypoglycemic agent
A patient admitted for management of diabetic nephropathy due
to an accidental overdose of prednisone being taken for asthma
Correct Answers * Coded as a poisoning
T38.0X1D; Poisoning by glucocorticoids and synthetic
analogues accidental, subsequent encounter
E09.21; Drug or chemical induced diabetes mellitus with
diabetic nephropathy
J45.909; Unspecified asthma, uncomplicated
Z79.52; Long-term use of systemic steroids
A patient admitted for management of diabetic polyneuropathy
due to long-term use of diazoxide for management of
hypertension Correct Answers * Coded as an adverse effect
E09.42; Drug or chemical induced diabetes mellitus with
neurological complications with diabetic polyneuropathy
T46.5X5D; Adverse effect of antihypertensive drug, subsequent
encounter
I10; Essential (primary) hypertension
Z79.899; Other long-term drug therapy
,A patient admitted with acute renal failure, HTN, stage 3 CKD,
CHF, and anemia due to CKD, with the acute renal failure as the
focus of care, this would be coded as_______ Correct Answers
N17.9; Acute kidney failure, unspecified
I13.0; Hypertensive heart and CKD with heart failure and stage
1 through 4 chronic kidney disease or unspecified CKD
N18.30; CKD, stage 3, unspecified
I50.9; Heart failure, unspecified
D63.1; Anemia in CKD
* Acute kidney failure is not as assumed manifestation of HTN
* Heart condition and stage of CKD must be sequenced after
HTN code
A patient has bilateral glaucoma and each eye is documented as
having the same type but different stage and the classification
does not distinguish laterality______ Correct Answers Assign
a code for the type of glaucoma for each eye with the 7th
character for the specific glaucoma stage documented for each
eye
A patient has skin necrosis at the site of a recent mastectomy
assign code _______ Correct Answers L76.82; Other
postprocedural complications of skin and subcutaneous tissue
I96; gangrene, NEC
A patient was referred to your agency for SN and PT due to
increased dyspnea and weakness. The physician's office nurse
filled out the F2F with these diagnoses, the physician signed and
dated it and it was faxed to the agency. There is no other
physician documentation. The nurse who did the SOC
, assessment noted the patient was started on a new
bronchodilator and documented exacerbation of COPD as the
primary diagnosis. Which of the following should you do?
Correct Answers A. Consult with the assessing nurse to see if
exacerbation of COPD was confirmed by the physician.
B. Code dyspnea and weakness, instead of exacerbation COPD,
since they are listed on the F2F.
C. Code exacerbation of COPD, as documented by the nurse,
because this is noted as the focus of care in the summary on the
OASIS and the patient is on a new bronchodilator.
A
A patient who had a total pancreatectomy due to a malignant
neoplasm of the pancreas and as a result developed diabetes with
neuropathy which is the focus of care and requires insulin
Correct Answers E89.1; Postprocedural hypoinsulinemia
E13.40; Other specified diabetes mellitus with diabetic
neuropathy
C25.9; Malignant neoplasm of pancreas unspecified
Z90.410; Acquired total absence of pancreas
Z79.4; Long-term use of insulin
A patient with diabetes who has an ulcer on her second left toe
with limited skin breakdown that required wound care Correct
Answers E11.621; Type 2 diabetes mellitus with foot ulcer
L97.521; Non-pressure chronic ulcer of other part of left foot
limited to breakdown of skin
* if ulcer is not complicated Z48.00 (encounter for change or
removal of nonsurgical wound dressing) is optional but if
complicated must be coded
* Z48.00 can be primary or secondary
58 yo M with type 1 diabetes is treated for hyperglycemia. He
also has stage 3 CKD. His insulin pump was found to be
malfunctioning and underdosing Correct Answers T85.614D;
Breakdown (mechanical) of insulin pump, subsequent encounter
T38.3X6D; Underdosing of insulin and oral hypoglycemic
drugs, subsequent encounter
E10.65; Diabetes type 1 with hyperglycemia
E10.22; Type 1 DM with CKD
N18.30; CKD stage 3, unspecified
7th character for glaucoma Correct Answers 4 for
indeterminate stage: stage cannot be clinically determined
0 unspecified: no documentation regarding stage
A burn covered with a skin graft is a _____ Correct Answers
Surgical wound on the OASIS
* It is coded as a burn
A code from category I23, certain current complications
following ST elevation (STEM1) and non-ST elevation
(NSTEM1) myocardial infarction (within the 28 day period) is?
Correct Answers Sufficient by itself for a patient who suffers
complications following an MI, whether that complication
occurs within the 28 day acute period or not
* Additional code from I21 or I22 is not required
A complication code _____ ____ an aftercare Z code, which is
used for routine care only Correct Answers Always trumps
,A dash following the category or subcategory means? Correct
Answers An incomplete code
A patient admitted for management of diabetes due to cystic
fibrosis who requires insulin and an oral hypoglycemic drug
Correct Answers E84.8; Cystic fibrosis with other
manifestation
E08.9; Diabetes mellitus due to underlying condition without
complications
Z79.4; Long-term use of insulin
Z79.84; Long-term use of oral hypoglycemic agent
A patient admitted for management of diabetic nephropathy due
to an accidental overdose of prednisone being taken for asthma
Correct Answers * Coded as a poisoning
T38.0X1D; Poisoning by glucocorticoids and synthetic
analogues accidental, subsequent encounter
E09.21; Drug or chemical induced diabetes mellitus with
diabetic nephropathy
J45.909; Unspecified asthma, uncomplicated
Z79.52; Long-term use of systemic steroids
A patient admitted for management of diabetic polyneuropathy
due to long-term use of diazoxide for management of
hypertension Correct Answers * Coded as an adverse effect
E09.42; Drug or chemical induced diabetes mellitus with
neurological complications with diabetic polyneuropathy
T46.5X5D; Adverse effect of antihypertensive drug, subsequent
encounter
I10; Essential (primary) hypertension
Z79.899; Other long-term drug therapy
,A patient admitted with acute renal failure, HTN, stage 3 CKD,
CHF, and anemia due to CKD, with the acute renal failure as the
focus of care, this would be coded as_______ Correct Answers
N17.9; Acute kidney failure, unspecified
I13.0; Hypertensive heart and CKD with heart failure and stage
1 through 4 chronic kidney disease or unspecified CKD
N18.30; CKD, stage 3, unspecified
I50.9; Heart failure, unspecified
D63.1; Anemia in CKD
* Acute kidney failure is not as assumed manifestation of HTN
* Heart condition and stage of CKD must be sequenced after
HTN code
A patient has bilateral glaucoma and each eye is documented as
having the same type but different stage and the classification
does not distinguish laterality______ Correct Answers Assign
a code for the type of glaucoma for each eye with the 7th
character for the specific glaucoma stage documented for each
eye
A patient has skin necrosis at the site of a recent mastectomy
assign code _______ Correct Answers L76.82; Other
postprocedural complications of skin and subcutaneous tissue
I96; gangrene, NEC
A patient was referred to your agency for SN and PT due to
increased dyspnea and weakness. The physician's office nurse
filled out the F2F with these diagnoses, the physician signed and
dated it and it was faxed to the agency. There is no other
physician documentation. The nurse who did the SOC
, assessment noted the patient was started on a new
bronchodilator and documented exacerbation of COPD as the
primary diagnosis. Which of the following should you do?
Correct Answers A. Consult with the assessing nurse to see if
exacerbation of COPD was confirmed by the physician.
B. Code dyspnea and weakness, instead of exacerbation COPD,
since they are listed on the F2F.
C. Code exacerbation of COPD, as documented by the nurse,
because this is noted as the focus of care in the summary on the
OASIS and the patient is on a new bronchodilator.
A
A patient who had a total pancreatectomy due to a malignant
neoplasm of the pancreas and as a result developed diabetes with
neuropathy which is the focus of care and requires insulin
Correct Answers E89.1; Postprocedural hypoinsulinemia
E13.40; Other specified diabetes mellitus with diabetic
neuropathy
C25.9; Malignant neoplasm of pancreas unspecified
Z90.410; Acquired total absence of pancreas
Z79.4; Long-term use of insulin
A patient with diabetes who has an ulcer on her second left toe
with limited skin breakdown that required wound care Correct
Answers E11.621; Type 2 diabetes mellitus with foot ulcer
L97.521; Non-pressure chronic ulcer of other part of left foot
limited to breakdown of skin
* if ulcer is not complicated Z48.00 (encounter for change or
removal of nonsurgical wound dressing) is optional but if
complicated must be coded
* Z48.00 can be primary or secondary
