Ch 4 Introduction to ICD-10-CM

Select all that apply What information is given by the notation Use additional code in the ICD-10-CM book? Multiple select question. This code must be listed last. An additional code may be required. This is a cross reference code. Multiple codes are combined in one code.

This code must be listed last. An additional code may be required.

Which of the following is NOT a purpose of brackets? Multiple choice question. Show synonyms to provide detail or explanation to the description of the code Show alternate phrases in the description of the code Show alternate terms in the description of the code Use as a placeholder

Use as a placeholder

Which of the following is considered a combination code? Multiple choice question. Acute respiratory failure and chronic respiratory failure Acute respiratory failure and no second code Chronic respiratory failure and no second code Respiratory failure and no second code

Acute respiratory failure and chronic respiratory failure

Which statement best describes the Table of Drugs and Chemicals section? Multiple choice question. Codes for vaccines and injections Codes for accidental falls and injuries Codes for poison and adverse reactions to medicines Codes for late effects

Codes for poison and adverse reactions to medicines

Select all that apply What is the purpose of having the ICD-10-CM Official Guidelines for Coding and Reporting? Multiple select question. Codes you report make billing easier. Looking up codes is faster. Codes you report are presented in a legal manner. Codes you report support clear communication.

Codes you report are presented in a legal manner. Codes you report support clear communication.

What symbol is used to identify that additional characters are required? Multiple choice question. A comma between the codes A hyphen between the codes A box with a checkmark and number A bullet at the bottom of the page

A box with a checkmark and number

What is a systemic condition? Multiple choice question. A condition that affects the entire body A condition that only affects parts of the body A condition that requires a modifier A condition that can not be assigned a code

A condition that affects the entire body

Which of the following best explains the legends in the Tabular List? Multiple choice question. Table of contents for codes and descriptions Index of codes List of abbreviations Abbreviation of explanations of symbols

Abbreviation of explanations of symbols

In what order would you report acute vs. chronic when both are documented? Multiple choice question. Either is listed first. List them together. Acute would be listed first. Chronic would be listed first.

Acute would be listed first.

In the ICD-10-CM, where would a coder encounter italicized or slanted brackets? Multiple choice question. Alphabetic Index Table of Drugs External Cause Index Guidelines

Alphabetic Index

Not elsewhere classifiable may appear in the ___________. Multiple select question. Tabular List Guidelines Alphabetic Index Abbreviations

Alphabetic Index Tabular List

Not otherwise specified may appear in the ____________. Multiple select question. Guidelines Code Sets Alphabetic Index Tabular List

Alphabetic Index Tabular List

Select all that apply The term "with" can be seen in what parts of the ICD-10-CM book? Multiple select question. Appendix Tabular List Table of Drugs Alphabetic Index

Alphabetic Index Tabular List

The ________ guides you to the correct chapter and subsection in the ________. Multiple choice question. Alphabetic Index; Tabular List ICD-10-CM; Official Coding Guidelines Official Coding Guidelines; Alphabetic Index Tabular List; Alphabetic Index

Alphabetic Index; Tabular List

Name the parts listed in Section 1 of the ICD-10-CM book. Multiple choice question. Index, Appendix, and Glossary Conventions, General Guidelines, and Chapter Guidelines. Drug Tables, Neoplasm Tables, and Glossary Guidelines, Index, and Appendix

Conventions, General Guidelines, and Chapter Guidelines

Which of the following is considered by the physician when a patient has a systemic condition? Multiple choice question. No other conditions of the patient Combination codes No consideration is needed Any and all other conditions of the patient

Any and all other conditions of the patient

Which notation is similar to Use additional code? Multiple choice question. X And Code first Add on code

Code first

What does Code first denote in the ICD-10-CM book? Multiple choice question. A modifier must be used with this specific code. Multiple diagnoses are reported in one code. Certain conditions will require two codes and specific sequencing. The sub term must be coded also.

Certain conditions will require two codes and specific sequencing.

The ________ notation identifies codes that cannot be used together on the claim form. Multiple choice question. Excludes 1 Not elsewhere classified Not otherwise classified Includes

Excludes 1

The ______ notation may serve as an alert that you may need an additional code for the patient's condition.

Excludes 2

Which is a warning to stop and double-check the documentation before final code selection? Multiple choice question. NEC Excludes 1 Excludes 2 NOS

Excludes 2

Select all that apply What are the two principles in becoming a good ICD-10-CM coder? Multiple select question. Find external cause codes if needed Code directly from the Alphabetic Index Code from the Tables Abstract the main terms from documentation

Find external cause codes if needed Abstract the main terms from documentation

The __________ is the section of the ICD-10-CM book that lists diagnosis by the main word or term to guide the coder to the correct page. Multiple choice question. alphabetic subsection Appendix Index to Diseases Guidelines Chapter

Index to Diseases

Define see in the Alphabetic Index. Multiple choice question. Information is under a different term Information is in the same term See additional guidelines See multiple notations

Information is under a different term

How would a coder report and sequence a differential diagnosis? Multiple select question. List either diagnosis first. Code both diagnoses as if they were confirmed. Do not code either. List the more common diagnosis first.

List either diagnosis first Code both diagnoses as if they were confirmed

In the Alphabetic Index, what does the term see instruct the coder to do? Multiple choice question. Review modifiers. Use combination codes. Look at another term. Use additional codes.

Look at another term

Select all that apply Which of the following are examples of screenings or preventive services? Multiple select question. Knee replacement Mammogram Pacemaker Colonoscopy

Mammogram Colonoscopy

In the ICD-10-CM, what are additional terms called? Multiple choice question. Secondary code sets Default codes CPT codes Nonessential modifiers

Nonessential modifiers

What is the purpose of the box with a checkmark and number symbol? Multiple choice question. Notifies the coder to add any additional code Gives direction on modifier selection Offers suggestions in code sequencing Notifies the coder that an additional character is required

Notifies the coder that an additional character is required

In the ICD-10-CM, where would you find additional information on symbols from the legends? Multiple choice question. Glossary of Terms and Conventions Official Conventions and Additional Conventions External Causes and Index Appendix and Guidelines

Official Conventions and Additional Conventions

What would you find in the front of your code book that defines the rules and directions for accurate coding? Multiple choice question. Official Guidelines Glossary Appendix Code definitions

Official Guidelines

Where would a coder look to determine reporting order? Multiple choice question. Appendix Alphabetic Index Official Guidelines Tabular List

Official Guidelines

Which of the following is an example of an unrelated condition? Multiple choice question. Current labs Past history Current history Current diagnosis

Past history

Before reporting a NOS, the coder should query the _____. Multiple choice question. patient insurance company physician nurse

Physician

What does NOS denote? Multiple choice question. Physician documented details that are not identified in any code description. Reason: That is not elsewhere classifiable. Physician did not document details in available code descriptions. A modifier is required. Additional characters are required.

Physician did not document details in available code descriptions.

Which of the following describe the purpose of the Includes notation? Multiple select question. Place marks the code description Provides additional terms Provides variations of descriptions Documents the code

Provides additional terms Provides variations of descriptions

Which of the following statements are true of the Includes notation? Multiple choice question. Defines abbreviation terms Provides sequence structure Provides additional terms and diagnoses Gives placeholder terms

Provides additional terms and diagnoses

What is the function of see also in the Alphabetic Index? Multiple choice question. Provides an alternate main term for accuracy Provides additional documentation Offers suggestions in sequencing Provides the same main term

Provides an alternate main term for accuracy

Which notation directs the coder to a different term for additional details? Multiple choice question. See also See Includes Code first

See also

Which of the following statements defines NEC? Multiple choice question. Specifics are not described elsewhere Code is an unspecified code Additional codes are found The code description is classifiable

Specifics are not described elsewhere

Where in the ICD-10-CM would you find brackets? Multiple choice question. Code Set Guidelines Tabular List Tables

Tabular List

Where is the colon used? Multiple choice question. Appendix Drug Table Glossary Tabular List

Tabular List

Once you have found a suggested code from the Alphabetic Index, Neoplasm Table, Table of Drugs and Chemicals, or the Index to External Cause Codes, you must go to the _________ to confirm code selection. Multiple choice question. Guidelines section or subsection of the chapter Tabular List of Diseases and Injuries Appendix

Tabular List of Diseases and Injuries

What is usually the cause for a screening test? Multiple choice question. The calendar Signs and symptoms Feelings of patient Current health issues

The calendar

Which of the following is true regarding differential diagnosis? Multiple choice question. The physician determines signs and symptoms are equal to two diagnoses. Only one code is used: a combination code. Diagnoses are based on the sequence of onset of symptoms. Multiple codes based on the same diagnoses are reported.

The physician determines signs and symptoms are equal to two diagnoses.

Which of the following is true regarding unrelated conditions? Multiple choice question. All encounters can be added to a combination code. The physician may include information that reports a condition unrelated to the encounter. The physician may not include information that reports a condition unrelated to the encounter. Multiple past unrelated conditions must be reported.

The physician may include information that reports a condition unrelated to the encounter

What may the Excludes 1 notation identify about two codes? Multiple select question. They are contradictory to each other. They cannot coexist in the same person at the same time. They must be coded together. They are redundant.

They are contradictory to each other. They cannot coexist in the same person at the same time. They are redundant.

Select all that apply Why must coders read all associated code descriptions in the Tabular List? Multiple select question. You do not need to read the descriptions To match details in physician documentation To code only one particular encounter To be in compliance with the rules and guidelines

To match details in physician documentation To code only one particular encounter To be in compliance with the rules and guidelines

Which of the following is an example of how parentheses are used in the ICD-10-CM? Multiple choice question. To show which modifiers apply to the code To show the secondary codes to apply To show spacing between the code and the descriptions To show additional terms or phrases included in the description of a code

To show additional terms or phrases included in the description of a code

Which of the following explains how italicized or slanted brackets are used? Multiple choice question. To show how many characters the code will have once submitted To explain a symbol To add a modifier To surround an additional code or codes that must be included with the initial code

To surround an additional code or codes that must be included with the initial code

What does the Code also notation indicate? Multiple choice question. Place codes are in alphabetical order. Two codes are required with specific sequencing Two codes may be required to describe the condition. One code reports multiple diagnoses.

Two codes may be required to describe the condition.

What do the terms "with" or "associated with" in the physician's documentation indicate? Multiple choice question. NOS An additional character is required. Two conditions should be coded together. NEC

Two conditions should not be coded together.

For what type of diagnosis must you code signs and symptoms in an outpatient setting? Multiple choice question. Confirmed Unconfirmed Combination Multiple

Unconfirmed

For what type of diagnosis must you code signs and symptoms in an outpatient setting? Multiple choice question. Unconfirmed Multiple Combination Confirmed

Unconfirmed

Which of the following require the use of multiple codes? Multiple select question. Underlying conditions Principal diagnosis Manifestations Signs

Underlying conditions Manifestations

_____ has the same meaning as Not Otherwise Specified in reporting codes. Multiple choice question. See also Specified Unspecified See condition

Unspecified

The Excludes 2 notation can indicate that Multiple choice question. two modifiers are needed. alternate codes exist. codes are contradictory. a condition is not coded with the selected code.

alternate codes exist

In the Neoplasm Table, malignant and benign neoplasms are listed by _________. Multiple choice question. signs and symptoms anatomical location co-morbidity severity

anatomical location

A ________ is used emphasize descriptors that are required to make a code valid for a diagnosis. Multiple choice question. circle colon bullet triangle

colon

A ___________ code is two or more diagnoses for one patient on the same encounter that includes as many conditions as possible in one code. Multiple choice question. cross-reference consolidated placeholder combination

combination

The Alphabetic Index lists items by Multiple choice question. tabular, index, and glossary. conditions, eponyms, and other descriptors. terms, diagnosis, and subcategories. diagnosis, conditions, and categories.

conditions, eponyms, and other descriptors.

Section 1: Conventions, Coding Guidelines, and Chapter Specific Guidelines contains Multiple choice question. rules for special non-coverage. rules for defining code terms. rules for submitting claims. rules for reporting accurate diagnosis codes.

rules for reporting accurate diagnosis codes.

The term ____ best describes acute conditions?

severe

The Neoplasm Table is a section in the Alphabetic Index that lists codes for Multiple select question. late effects. malignant neoplasms. external causes. benign neoplasms.

malignant neoplasms benign neoplasms

The Table of Drugs and Chemicals section provides codes related to __________. Multiple choice question. chemicals burns neoplasms poisoning accidental falls

poisoning

The code that reports the most important reason for the patient's encounter is called the ___________. Multiple choice question. principal diagnosis default code combination code top diagnosis

principal diagnosis

For outpatient services, if a physician has been unable to confirm a diagnosis, a coder must report Multiple choice question. signs, symptoms, abnormal tests, or other reasons for the encounter. the last diagnosis reported. any diagnoses listed on the encounter form. a probable, suspected, or rule out diagnosis. Reason: The outpatient coder can only code confirmed diagnoses.

signs, symptoms, abnormal tests, or other reasons for the encounter.

The codes found after a term in the Alphabetic Index should always be considered a(n) __________, this is why you must confirm in the Tabular List. Multiple Choice suggestion confirmed absolute complete

suggestion