Deck 6: ICD-10-Cm Coding

Question 1

ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g., 047K04Z) that provides a unique code for all substantially different procedures, and it allows new procedures to be easily incorporated as new codes.

A) clinical
B) logical
C) multiaxial
D) relational

Answer 1

multiaxial

Question 2

ICD-10-CM and ICD-10-PCS incorporate much greater specificity and clinical information, which results in __________.

A) decreased sensitivity when refining grouping and reimbursement methodologies.
B) enhanced ability to conduct public health surveillance
C) increased need to include supporting documentation with claims
D) reduced ability to measure health care services

Answer 2

enhanced ability to conduct public health surveillance

Question 3

Which of the following will best assist medical coding staff as ICD-10-CM and ICD-10-PCS classifications are implemented?

A) ability to document information in patient records
B) basic knowledge of anatomy and physiology
C) effective communication with medical staff
D) reporting ICD-10-CM/PCS codes from indexes

Answer 3

effective communication with medical staff

Question 4

The International Classification of Diseases, published by the World Health Organization, is used to classify __________ data from death certificates.

A) moratory
B) morbidity
C) morphology
D) mortality

Question 5

ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and outpatient records, including provider-based office records.

A) moratory
B) morbidity
C) morphology
D) mortality

Question 6

ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2.

A) five
B) six
C) seven
D) eight

Question 7

Physician office __________ codes are submitted for reimbursement purposes.

A) ICD-10-CM, CPT, and HCPCS level II
B) ICD-10-PCS, CPT, and HCPCS level II

Question 8

ICD-10-PCS is an entirely new procedure classification system that was developed by CMS for use in __________ settings only, replacing Volume 3 of ICD-9-CM.

A) inpatient hospital
B) outpatient hospital
C) provider office
D) skilled nursing facility

Question 9

Hospital outpatient __________ codes are submitted for reimbursement purposes.

A) CPT and HCPCS level II
B) ICD-10-CM, CPT, and HCPCS level II
C) ICD-10-CM and ICD-10-PCS
D) ICD-10-PCS, CPT, and HCPCS level II

Question 10

ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation.

A) contemporary
B) legacy
C) optional
D) updated

Question 11

General equivalency mappings are __________ of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa).

A) crosswalks
B) details
C) indexes
D) registers

Question 12

In the following sample GEM table, ICD-9-CM codes 649.50, 649.51, and 649.53 __________ ICD-10-CM codes.

A) cannot be mapped at all to
B) do not map exactly to
C) must be reported instead of
D) require the payer to select

Question 13

In the sample GEM table below, ICD-10-CM code A15.7 maps to __________ ICD-9-CM code(s).

A) 1
B) 5
C) 6
D) 7

Question 14

ICD-10-CM far exceeds ICD-9-CM in the number of codes provided, having been expanded to __________.

A) delete fifth digits for some codes
B) include health-related conditions
C) mandate assignment of just three characters
D) reduce specificity at the sixth-digit level

Question 15

The ICD-10-CM and ICD-10-PCS classifications include updated medical terminology and classification of diseases, provide codes to allow for the comparison of mortality and morbidity data, and provide __________ for the purpose of conducting research, designing payment systems, identifying fraud and abuse, and more.

A) clinical decisions
B) improved data
C) measurement of care
D) public health tracing

Question 16

In the sample GEM table below, ICD-9-CM code 003.21 maps to ICD-10-CM code(s) __________.

A) A02.21
B) A15.7
C) C92.01
D) O26.851 through O26.859

Question 17

Hospital inpatient __________ codes are submitted for reimbursement purposes.

A) CPT, and HCPCS level II
B) ICD-10-CM, CPT, and HCPCS level II
C) ICD-10-CM and ICD-10-PCS
D) ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II

Question 18

Private companies publish __________, which automate the coding process so that computerized or web-based software is used instead of coding manuals.

A) converters
B) encoders
C) multiplexers
D) transducers

Question 19

In the sample GEM table below, ICD-10-CM code C92.01 maps to ICD-9-CM code(s) __________,

A) 003.21
B) 205.01
C) 649.50
D) 649.53

Question 20

When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned.

A) medical coordination
B) physician query
C) quality assurance
D) utilization management

Question 21

Which abbreviation means "unspecified" and identifies codes that are to be assigned when information needed to assign a more specific code cannot be obtained from the provider?

A) NEC
B) NOS

Question 22

Which of the following criteria is used to determine medical necessity?

A) Costly treatment is provided when compared with alternative methods.
B) Least expensive service is provided to patient, regardless of outcome.
C) Procedure or service is performed to treat a health care condition.
D) Treatment has a 50 percent chance of being effective for health outcome.

Question 23

According to Medicare, if it is possible that scheduled tests, services, or procedures may be found medically unnecessary, the patient must sign an advance beneficiary notice, which __________.

A) acknowledges the patient's responsibility for payment if Medicare denies the claim
B) ensures that the provider will receive reimbursement from another third-party payer
C) guarantees that Medicare will deny payment for the claim, and the patient must pay
D) improves the chances that Medicare will approve the submitted claim for payment

Question 24

Which is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects for which ICD-10-CM codes are assigned?

A) Table of Drugs and Chemicals
B) Table of Neoplasms

Question 25

Which typeface is used for ICD-10-CM main term entries in the alphabetic index and all codes and descriptions of codes in the tabular list?

A) all caps
B) bold
C) italics
D) underline

Question 26

Which are diseases or syndromes that are named for people and are listed in appropriate alphabetical sequence as main terms in the ICD-10-CM index?

A) characters
B) eponyms
C) nouns
D) persons

Question 27

ICD-10-CM coding conventions are general rules used in the ICD-10-CM classification, which are independent of official coding guidelines and are incorporated into ICD-10-CM as instructional __________.

A) annotations
B) explanations
C) notes
D) summaries

Question 28

Automating the medical coding process is the goal of __________, which uses a natural language processing engine to "read" patient records and generate ICD-10-CM, ICD-10-PCS, HCPCS level II, and CPT codes.

A) computer-assisted coding
B) graphical user interfaces
C) mixed methods research
D) qualitative data analysis

Question 29

Which abbreviation means "other" or "other specified" and identifies codes that are assigned when documentation supports a condition for which a more specific code does not exist?

A) NEC
B) NOS

Question 30

The Medicare Prescription Drug, Improvement, and Modernization Act requires all code sets to be valid at the time services are provided. This means that ICD-10-CM and ICD-10-PCS midyear and end-of-year coding updates must be implemented immediately so accurate codes are reported on claims. Midyear updates are implemented on __________, while end-of-year updates are implemented on __________.

A) April 1; October 1
B) August 1; February 1
C) July 1; January 1
D) June 1; December 1

Question 31

Which punctuation is used in the ICD-10-CM index to identify manifestation codes and in the ICD-10-CM index and tabular list to enclose abbreviations, synonyms, alternative wording, or explanatory phrases?

A) braces
B) colons
C) parentheses
D) slanted brackets

Question 32

Which is a condition that occurs as the result of another condition and for which the codes are always reported as secondary codes?

A) manifestation
B) sign
C) symptom
D) syndrome

Question 33

Which punctuation is used after an incomplete term or phrase in the ICD-10-CM index and tabular list when one or more modifiers (additional terms) is needed to assign a code?

A) braces
B) colons
C) parentheses
D) slanted brackets

Question 34

Which typeface is used for ICD-10-CM tabular list exclusion notes and to identify manifestation codes, which are never reported as the first-listed diagnoses?

A) all caps
B) bold
C) italics
D) underline

Question 35

Which is an alphabetic index of anatomic sites for which there are six possible ICD-10-CM code numbers according to status as malignant primary, malignant secondary, malignant in situ, benign, of uncertain behavior, or of unspecified nature?

A) Table of Drugs and Chemicals
B) Table of Neoplasms

Question 36

Which is the face-to-face contact between a patient and a health care provider who assesses and treats the patient's condition?

A) benefit period
B) encounter
C) episode of care
D) spell of illness

Question 37

The ICD-10-CM index typically uses a(n) __________ format for ease in reference.

A) aligned
B) indented
C) notched
D) table

Question 38

Which punctuation is used in the ICD-10-CM index and tabular list to enclose nonessential modifiers, which are supplementary words that may be present in or absent from the physician's statement of a disease or procedure without affecting the code number to which it is assigned?

A) braces
B) colons
C) parentheses
D) slanted brackets

Question 39

Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the diagnosis or treatment of an illness or injury. This concept is called __________.

A) advance beneficiary notice of nonpayment
B) medical necessity
C) quality assurance
D) utilization management

Question 40

The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for __________.

A) diagnoses; procedures
B) diagnoses; conditions
C) procedures; diagnoses
D) services; procedures

Question 41

ICD-10-CM code H61.0 Chondritis and perichondritis of external ear is interpreted as __________.

A) chondritis of external ear and perichondritis of external ear, which means code H61.0 is assigned only if both conditions are documented in the patient record
B) chondritis of external ear and/or perichondritis of external ear, which means code H61.0 is assigned only if either condition is documented in the patient record
C) chondritis of external ear or perichondritis of external ear, which means code H61.0 is assigned only if either condition is documented in the patient record
D) chondritis of external ear due to perichondritis of external ear, which means code H61.0 is assigned only if the provider documents the phrase due to in the record

Question 42

Which is a pure excludes note and means not coded here to indicate mutually exclusive codes, which means the conditions cannot be reported together?

A) excludes1 note
B) excludes2 note

Question 43

When patient record documentation is insufficient to assign a more specific code, __________ codes are assigned.

A) etiology
B) manifestation
C) other and other specified
D) unspecified

Question 44

The subterm due to is located in the ICD-10-CM index in alphabetical order below a main term to indicate the presence of a __________ relationship between two conditions.

A) cause-and-effect
B) either/or
C) inclusionary
D) mutually exclusive

Question 45

ICD-10-CM code M19.14 Post-traumatic osteoarthritis, hand contains an Excludes2 note for post-traumatic osteoarthritis of first carpometacarpal joint (M18.2-, M18.3-). The Excludes2note means that __________.

A) both codes can be assigned if the provider documented treatment of both conditions
B) just one of the codes is assigned because an Excludes2 note means "pure excludes"
C) neither code is assigned, and a physician query is generated to request clarification
D) patient record documentation must be modified to allow both codes to be assigned

Question 46

The __________ instruction requires the causal condition to be sequenced first if present.

A) code, if applicable, any causal condition first
B) in diseases classifiable elsewhere
C) other and other specified codes
D) use additional code

Question 47

Inclusion terms listed below codes in the ICD-10-CM tabular list are not meant to be exhaustive, and additional terms found only in the index may also be associated with a code. This concept is called __________.

A) code verification
B) medical necessity
C) physician query
D) trust the index

Question 48

Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list etiology code contains a(n) __________ note.

A) code first underlying disease
B) in diseases classifiable elsewhere
C) other and other specified codes
D) use additional code

Question 49

When the word with appears in the ICD-10-CM index, it is located immediately below the main term, not in alphabetical order. To assign a code from the list of qualifiers below the word with, the physician must document the presence of __________ condition(s) in the patient record.

A) both
B) either
C) one
D) mutually exclusive

Question 50

When patient record documentation provides detail for which a specific code does not exist in ICD-10-CM, the index entries contain the abbreviation NEC so that coders are alerted to classify such conditions as __________ codes in the tabular list.

A) etiology
B) manifestation
C) other and other specified
D) unspecified

Question 51

ICD-10-CM code Q03 Congenital hydrocephalus contains an Excludes1 note for acquired hydrocephalus (G91.-). Thus, code G91.- __________.

A) can be reported with a category Q03 code due to interpretation of the Excludes1 note
B) may be reported with a code from category Q03 if documentation justifies both codes
C) is never reported with a code from category Q03 because of the Excludes1 note
D) results in coders submitting a physician query to request documentation clarification

Question 52

Which appears in the ICD-10-CM tabular list below certain categories to further define, clarify, or give examples of the content of a code category?

A) excludes1 notes
B) excludes2 notes
C) includes notes
D) inclusion terms

Question 53

When the word in appears in the ICD-10-CM index, it is located in alphabetical order below the main term. To assign a code from the list of qualifiers below the word in, the physician must document __________ condition(s) in the patient record.

A) both
B) either
C) one
D) mutually exclusive

Question 54

In the ICD-10-CM tabular list, a manifestation code usually has in its title __________ , which indicates that the manifestation code is a component of the etiology/manifestation coding convention.

A) code first underlying disease
B) in diseases classifiable elsewhere
C) other and other specified codes
D) use additional code

Question 55

When the word and appears in ICD-10-CM tabular list category titles and code descriptions, it is interpreted as meaning __________.

A) and
B) and/or
C) or
D) instead of

Question 56

Which term describes the cause or origin of disease?

A) consequence
B) etiology
C) manifestation
D) syndrome

Question 57

Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list manifestation code contains a(n) __________ note.

A) code first underlying disease
B) in diseases classifiable elsewhere
C) other and other specified codes
D) use additional code

Question 58

Which means not included here and indicates that, although the excluded condition is not classified as part of the condition it is excluded from, a patient may be diagnosed with all conditions at the same time?

A) excludes1 note
B) excludes2 note

Question 59

The includes note located below category code H80 Otosclerosis in the ICD-10-CM tabular list indicates that otospongiosis is classified to that same category. This means that the provider __________, and a code from category H80 would be assigned.

A) could document otosclerosis or otospongiosis
B) has the option of documenting otoscleritis
C) must document otosclerosis in the patient record
D) queries the coder to determine the condition to code

Question 60

Which term describes symptoms or conditions that result from another disease?

A) consequences
B) etiology
C) manifestation
D) syndrome

Question 61

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a neoplasm for which it is not possible to predict subsequent morphology or behavior from the submitted specimen?

A) malignant
B) benign
C) uncertain behavior
D) unspecified nature

Question 62

Which are essential modifiers that qualify the main term in the ICD-10-CM index by listing alternative sites, etiology, or clinical status?

A) neoplasms
B) nonessential modifiers
C) qualifiers
D) subterms

Question 63

If the primary site of malignancy is no longer present, assign a code for __________.

A) personal history of malignant neoplasm
B) primary cancer
C) primary of unspecified site
D) secondary of unspecified site

Question 64

The ICD-10-CM Index to Diseases and Injuries is a(n) __________, which include specific illnesses, injuries, eponyms, abbreviations, and other descriptive diagnostic terms.

A) alphabetical listing of terms and corresponding codes
B) group of boldfaced procedure terms with subterms
C) set of tables organized according to body system
D) tabular list of codes and their code descriptions

Question 65

Supplementary words located in parentheses after a main term in the ICD-10-CM index are called __________ modifiers, which means they do not have to be included in the diagnostic statement for the code to be assigned.

A) mandatory
B) nonessential
C) qualifying
D) unspecified

Question 66

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the identification of a neoplasm, but for which no further indication of the histology or nature of the tumor is reflected in the documented diagnosis?

A) malignant
B) benign
C) uncertain behavior
D) unspecified nature

Question 67

For carcinoma of breast with spread to the lungs, the primary site is __________.

A) breast
B) lungs
C) undetermined
D) unspecified

Question 68

Which instruction is located after a main term or subterm in the ICD-10-CM index and directs the coder to another main term (or subterm) that may provide additional useful index entries?

A) See
B) See also
C) See category
D) See condition

Question 69

Cancer described as metastatic to a site is considered __________.

A) benign
B) in situ
C) secondary
D) unspecified

Question 70

Which is a term associated with neoplasms and defined as any discontinuity of tissue that may or may not be malignant?

A) abrasion
B) laceration
C) lesion
D) wound

Question 71

Which term describes benign new growths or tumors, in which cell reproduction is out of control?

A) cancer
B) malignancy
C) neoplasms
D) tissues

Question 72

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the original cancerous tumor site?

A) primary malignant
B) secondary malignant
C) carcinoma in situ
D) unspecified nature

Question 73

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive?

A) primary malignant
B) secondary malignant
C) carcinoma in situ
D) unspecified nature

Question 74

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the metastasis of cancer?

A) primary malignant
B) secondary malignant
C) carcinoma in situ
D) unspecified nature

Question 75

Which are supplementary terms used in the ICD-10-CM index to further modify subterms and other qualifiers?

A) neoplasms
B) nonessential modifiers
C) qualifiers
D) subterms

Question 76

Which instruction directs the coder to the main term for a diagnosis code, found in the ICD-10-CM disease index?

A) See
B) See also
C) See category
D) See condition

Question 77

A code listed next to a main term in the ICD-10-CM index is referred to as a(n) __________ code..

A) category
B) default
C) etiology
D) unspecified

Question 78

Which instruction after a main term directs the coder to refer to another term in the ICD-10-CM index to locate the code, and the coder must go to the referenced main term to locate the correct code?

A) See
B) See also
C) See category
D) See condition

Question 79

Which instruction directs the coder to the ICD-10-CM tabular list, where a code can be selected from the options provided there?

A) See
B) See also
C) See category
D) See condition

Question 80

The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a noninvasive, nonspreading, nonmalignant tumor?

A) malignant
B) benign
C) uncertain behavior
D) unspecified nature