Advanced ICD-10 Coding QUESTIONS WITH
COMPLETE SOLUTIONS
Case 1
Page 589, Case 5: Outpatient Clinic Visit
1. What is the correct coding and sequencing for this case? Correct Answer: Your Answer: B20,
F11.20, Z53.1
Code B20 is assigned for all HIV infections and is designated as the reason for the encounter
when the patient was seen for HIV infection or a related condition. Code L04.0, acute
lymphadenitis of face, head and neck should NOT be assigned along with code B20 because of
the Excludes 1 note at category L04 excluding HIV disease resulting in generalized
lymphadenopathy (B20). Reference the index for reference to F11.20 for opioid dependence.
Code Z53.1 may be assigned to show the refusal of medication for religious reasons.
Case 2
Page 598, Case 6: Inpatient Admission
1. What code is the principal diagnosis for this case? Correct Answer: Your Answer: K29.01
K29.01 is a combination code that includes both the gastritis and hemorrhage.
Case 3
Page 610, Case 5: Outpatient Visit
1. The diverticular disease mentioned in the case study would be classified to which of the
following? Correct Answer: Your Answer: large intestine
The classification system differentiates between diverticulitis and diverticulosis. In addition,
codes are provided to identify the site, in this case the large intestine.
Case 4
Page 626, Case 1: Inpatient Admission
1. What is the correct ICD-10-CM coding and sequencing for this case? Correct Answer: Your
Answer: S01.01xA, L03.811, H60.12
Note the Excludes 2 note under L03.211 specifically states "cellulitis of ear."
Case 5
Page 685, Case 14: Emergency Department Visit
1. What is the correct ICD-10-CM code assignment for this visit? Correct Answer: Your
Answer: R56.9
Code R56.9 is appropriate for this encounter. "Probable" conditions are not coded in the
outpatient setting.
Case 6
,Page 642, Case 18: Physician Office Visit
1. What is the first-listed code for this visit? Correct Answer: Your Answer: Z34.01
Primigravida indicates that it is the patient's first pregnancy.
Case 7
Page 668, Case 6: Physician Office Visit
1. What is the correct ICD-10-CM code assignment for this case? Be careful to enter the
alphabetic letters, such as O instead of 0 (zero) and place a decimal point in the correct location.
Note the example for hypothyroidism: E03.9 Correct Answer: 1. __________,
Your Answer: Z01.411
Category Z01 is used to report other special examinations without complaint, suspected or
reported diagnosis. Since the patient presented for a routine exam with no complaints, a code
from this category is assigned as the primary diagnosis.
2. __________,
Your Answer: N89.8
A mass is not classified to the Neoplasm chapter unless it has been evaluated and determined to
be neoplastic. There is no Alphabetic Index entry for the specific site of vagina under Mass. The
Index provides direction to "see Disease of specified organ or site for Mass, specified organ
NEC." Searching under Disease, vagina, specified NEC leads to code N89.8
Case 8
Page 670, Case 11: Outpatient Visit
1. Which of the following Official Coding Guidelines governs a coder's action for classifying the
diagnosis of "probable neoplastic disease?" Correct Answer: Your Answer: Section IV. H
The guideline states "do not code diagnoses documented as "probable," "suspected,"
"questionable," "rule out," or "working diagnosis" or other similar terms indicating uncertainty.
Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as
symptoms, signs, abnormal test results, or other reason for visit. "Please note: This differs from
the coding practices used by short-term, acute care, long-term care, and psychiatric hospitals.
Case 9
Page 586, Case 11: Inpatient Admission
1. What is the principal diagnosis for this case? Be careful to enter the alphabetic letters, such as
O instead of 0 (zero) and place a decimal point in the correct location. Note the example for
hypothyroidism: E03.9 Correct Answer: Your Answer: H66.92
Fever is a symptom and is an inherent part of otitis media and is not coded in this case.
Case 10
Page 635, Case 1 (episode 2): Inpatient Admission
The coding professional opts to query the physician for clarification of the postoperative wound
infection since he/she perceives it as a quality of care issue. According to AHIMA's Standards
,for Ethical Coding this is an appropriate use of the query system. Correct Answer: Your
Answer: false
The documentation is clear; see 4.4 that states: "coding professionals shall not query the provider
when there is no clinical information in the health record prompting the need for a query."
Case 11
Page 636, Case 2: Inpatient Admission
1. What is the principal diagnosis for this case? Be careful to enter the alphabetic letters, such as
O instead of 0 (zero) and place a decimal point in the correct location. Note the example for
hypothyroidism: E03.9 Correct Answer: Your Answer: O90.2
Go to the index locate 'Complications', go down to 'cesarean delivery wound', and then to
'hematoma' to code 'O90.2'
Case 12
Page 659, Case 10: Inpatient Admission
1. The computerized software program assigned code I82.442 for this case. What type of error is
depicted in this code assignment? Correct Answer: Your Answer: site
The code assigned was for left tibial vein but it should be iliac vein (I82.522)
Case 13
Page 669, Case 8 (episode 2): Inpatient Admission
In ICD-10-CM, which of the following would be selected as the primary site? Correct Answer:
Your Answer: unspecified site
The primary site was not established.
Case 14
Page 675, Case 22: Inpatient Admission
1. What is the ICD-10-CM code assignment for the principal diagnosis? Be careful to enter the
alphabetic letters, such as O instead of 0 (zero) and place a decimal point in the correct location.
Note the example for hypothyroidism: E03.9 Correct Answer: Your Answer: Z51.11
Z51.11 is assigned because the patient was admitted for chemotherapy.
Case 15
Page 686, Case 14: Inpatient admission (episode 2)
Be careful to enter the alphabetic letters, such as O instead of 0 (zero) and place a decimal point
in the correct location. Note the example for hypothyroidism: E03.9
MULTIPLE CHOICE.
The shoulder dislocation was not further specified in this case. When using the Index to code this
diagnosis, which one of the following does not have a more specific subentry offering a more
specific code for site?
, FILL IN THE BLANK.
What code is the principal diagnosis code in this case?
TRUE/FALSE.
A subluxation of the shoulder joint would be coded in the S43.0 subcategory.
FILL IN THE BLANK.
Assign the code for the alcohol withdrawal.
TRUE/FALSE.
The code for the alcohol withdrawal was found under "Withdrawal state" in the Index. Correct
Answer: MULTIPLE CHOICE.
Your Answer: blade
The term "blade" is a nonessential modifier under shoulder, but there is no more specific code
available than the nonspecific code option
FILL IN THE BLANK.
Your Answer: S43.005A
Because attempts to reduce the dislocation were unsuccessful in the emergency department, the
patient was admitted. Therefore, shoulder dislocation is the principal diagnosis.
TRUE/FALSE.
Your Answer: true
The subcategory S43.0 includes subluxation and dislocation of the shoulder joint
(glenohumeral).
FILL IN THE BLANK.
Your Answer: F10.239
TRUE/FALSE.
Your Answer: true
Case 16
Page 699, Case 15: Inpatient Admission
The coding professional assigned T40.2X4A to capture the patient's diagnosis associated with
morphine. What error is depicted with this code assignment? Correct Answer: Your Answer:
The classification of poisoning, undetermined should be replaced with the code for adverse effect
(T40.2x5A)
Nausea and vomiting and urinary retention represent adverse reactions to morphine.
Case 17