CPC Exam Study Guide: ICD-10-CM Rules & Guidelines
1. Precedence Instructions and Guidelines of the classification take precedence over
guidelines.
2. Section I general coding guidelines and chapter specific guidelines
3. Section II selection of principal diagnosis for non outpatient settings
4. Section III Additional diagnoses in non-outpatient settings
5. Section IV Outpatient coding and reporting
6. E&M physicians' work
7. New Patient one who has not received any medical services by same physician or
physician of the same specialty in the practice within the last 3 yrs.
8. Established
Pa- tient someone who has received medical services with in the last 3 yrs from the
physician or another physician of the same specialty who belongs to the
same group practice
9. Chief Complaint a brief statement describing the symptom, problem, diagnosis, or
condition that is the reason a patient seeks medical care
10. Volume 1 aka Tabular, contains the disease and condition codes and the
descriptions with the V codes and E codes
11. Volume 2 this is the alphabetic index of volume 1
12. Volume 3 NOT USED ON CPC EXAM contains codes for surgical, therapeutic, and
diagnostic procedures; used primarily by hospitals
13. Volume 1 & used in the inpatient and outpatient settings by physicians
Vol-
ume 2
14. V codes used to identify health care encounters that occur for other reasons
other than illness or injury or to identify patients whose illness is
influenced by special circumstances or problems
1/
6
, CPC Exam Study Guide: ICD-10-CM Rules & Guidelines
15. E codes used to describe the reason or external cause of injury, poisoning and
other
adverse ettects.
16. ICD updates Yearly usually in October
17. Tabular List aka Volume I Consists of 17 chapters based on either body system or
cause or type of disease. The codes range from 001-999.
18. Alphabetic Index aka Volume II, look here first for codes
19. Chapters are the main division in the ICD-9-CM
20. Sections are composed of a group of three-digit codes representing a group of
conditions or related conditions
21. Categories Composed of three-digit codes representing a single disease or
condition. The three-digit code is used only if it is not further
subdivided.
22. Subcategories Provide a 4th digit which is more specific then a category code in terms
of cause, site, or manifestation of the condition. This must be used if
available.
23. Subclassification Provides a 5th digit which gives the highest specificity of description to a
condition. Use of it is mandatory if it is available. A code not reported to
the full number of digits required is invalid
24. nonessentia
l modifiers Terms in parenthesis who's presence/absences has no ettect on the code.
25. essential
modi- fiers are not enclosed in parentheses and are SUB TERMS that DO attect the
26. Malignant selection of appropriate code
hyper- tension
severe form of hypertension w/vascular damage and a diastolic
pressure of 130 mmHg or greater
2/
6
1. Precedence Instructions and Guidelines of the classification take precedence over
guidelines.
2. Section I general coding guidelines and chapter specific guidelines
3. Section II selection of principal diagnosis for non outpatient settings
4. Section III Additional diagnoses in non-outpatient settings
5. Section IV Outpatient coding and reporting
6. E&M physicians' work
7. New Patient one who has not received any medical services by same physician or
physician of the same specialty in the practice within the last 3 yrs.
8. Established
Pa- tient someone who has received medical services with in the last 3 yrs from the
physician or another physician of the same specialty who belongs to the
same group practice
9. Chief Complaint a brief statement describing the symptom, problem, diagnosis, or
condition that is the reason a patient seeks medical care
10. Volume 1 aka Tabular, contains the disease and condition codes and the
descriptions with the V codes and E codes
11. Volume 2 this is the alphabetic index of volume 1
12. Volume 3 NOT USED ON CPC EXAM contains codes for surgical, therapeutic, and
diagnostic procedures; used primarily by hospitals
13. Volume 1 & used in the inpatient and outpatient settings by physicians
Vol-
ume 2
14. V codes used to identify health care encounters that occur for other reasons
other than illness or injury or to identify patients whose illness is
influenced by special circumstances or problems
1/
6
, CPC Exam Study Guide: ICD-10-CM Rules & Guidelines
15. E codes used to describe the reason or external cause of injury, poisoning and
other
adverse ettects.
16. ICD updates Yearly usually in October
17. Tabular List aka Volume I Consists of 17 chapters based on either body system or
cause or type of disease. The codes range from 001-999.
18. Alphabetic Index aka Volume II, look here first for codes
19. Chapters are the main division in the ICD-9-CM
20. Sections are composed of a group of three-digit codes representing a group of
conditions or related conditions
21. Categories Composed of three-digit codes representing a single disease or
condition. The three-digit code is used only if it is not further
subdivided.
22. Subcategories Provide a 4th digit which is more specific then a category code in terms
of cause, site, or manifestation of the condition. This must be used if
available.
23. Subclassification Provides a 5th digit which gives the highest specificity of description to a
condition. Use of it is mandatory if it is available. A code not reported to
the full number of digits required is invalid
24. nonessentia
l modifiers Terms in parenthesis who's presence/absences has no ettect on the code.
25. essential
modi- fiers are not enclosed in parentheses and are SUB TERMS that DO attect the
26. Malignant selection of appropriate code
hyper- tension
severe form of hypertension w/vascular damage and a diastolic
pressure of 130 mmHg or greater
2/
6
