Practice Inpatient Coding Question & Answers with Rationale

Question 1. Which is another term for “comfort care”?

1. Elder care
2. Respite care
3. Palliative care
4. Home healthcare

Rationale: “Comfort care” is also called “palliative care”. The goal of palliative care is not to cure or actively treat the condition. It is to control pain or to alleviate other distressing symptoms to make a terminally ill patient comfortable and able to live as normally as possible.

Read also: What are POA indicators in Inpatient coding

Question 2.

A patient undergoing chemotherapy for pharyngeal carcinoma is admitted with dehydration due to severe mucositis caused by chemotherapy. The patient is treated with IV fluids.

Which are the diagnosis codes and sequence?

Select one answer below

1. C14.0, K12.32, T45.1X5S, E86.0
2. E86.0, K12.31, T45.1X5A, C14.0
3. K12.31, T45.1X5A, E86.0, C14.0
4. T45.1X5A, K12.32, Z85.819, E86.0

Rationale:

The codes and sequence are E86.0, K12.31, T45.1X5A, C14.0. The reason for admission and principal diagnosis is dehydration due to severe mucositis due to chemotherapy. Dehydration is the principal diagnosis, because it was the condition that required the admission. Refer to the index main term Dehydration (E86.0). Go to the tabular list and confirm E86.0, Dehydration.

Refer to the index main term Mucositis, subterms mouth, due to antineoplastic therapy (K12.31). Go to the tabular list and confirm K12.31, Oral mucositis (ulcerative) due to antineoplastic therapy. Follow the instructional note to “use additional code for adverse effect, if applicable, to identify antineoplastic and immunosuppressive drugs (T45.1×5). Proceed to the tabular code T45.1×5. Assign 7th character A for initial encounter. The complete code is T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter.

Refer to the index main term Carcinoma, which directs to Neoplasm, by site, which directs to the Table of Neoplasms. In the Table of Neoplasms, see the anatomical site Pharynx, and the column Malignant Primary. Assign C14.0, Malignant neoplasm of pharynx, unspecified. This is a current condition, not history.

Read also: Sample Coded Medical coding charts for coders

Question 3.

A patient was admitted complaining of dyspnea. A chest x-ray revealed a lung mass. A bronchoscopy with lung biopsy was performed, determining a lung carcinoma. On the next day, a segmental lung resection was performed, along with excision of 5 suspicious-appearing thoracic lymph nodes. Pathology report findings included the previously determined lung cancer and metastases to 2 thoracic lymph nodes.

Which is the principal procedure?

Select one answer below.

A. Chest x-ray
B. Segmental lung resection
C. Bronchoscopy with lung biopsy
D. Excision of thoracic lymph nodes

Rationale: The segmental lung resection is the principal procedure. The principal procedure is the one that is related to the principal diagnosis and performed for definitive treatment (rather than for exploratory or diagnostic purposes), or one that is necessary to care for a complication.

Question 4.

How does the UHDDS define a significant procedure?

Select as many answers as apply.

A. Reimbursable
B. Surgical in nature
C. Has an anesthesia risk
D. Carries a procedural risk
E. Requires specialized training
F. Is performed in an operating room or suite

Rationale: Significant procedures are defined in the UHDDS as those that are surgical in nature, carry an anesthesia risk, carry a procedural risk, and require specialized training

Question 5.

A patient was admitted with pneumonia due to Streptococcus pneumoniae. After admission, the patient went into acute hypoxic respiratory failure and was intubated and placed on mechanical ventilation. A culture of the endotracheal tube was positive for MSSA. The provider documented pneumonia due to Strep pneumoniae, complicated by ventilator-associated pneumonia (VAP) due to MSSA and acute hypoxic respiratory failure.

Which are the codes, sequence, and present on admission indicators?

Select one answer below.

A. J13 (Y), J96.01 (N), J95.851 (N), B95.61 (N)
B. J13 (Y), J96.01 (N), J95.859 (N), J15.211 (N)
C. J15.3 (Y), B95.5 (Y), J96.02 (N), J13 (N), B95.61 (N)
D. J15.4 (Y), J96.02 (N), J95.859 (N), B95.5 (N)

Rationale:

The codes, sequence, and POA indicators are J13 (Y), J96.01 (N), J95.859 (N), J15.211 (N). The principal diagnosis is the Streptococcus pneumoniae. The patient’s other conditions did not develop until after admission. Assign Pneumonia due to Streptococcus pneumoniae, J13, with POA indicator Y (yes) as the principal diagnosis. Refer to the index main term Pneumonia, subterms in (due to), Streptococcus pneumoniae (J13). Go to the tabular list and confirm J13, Pneumonia due to Streptococcus pneumoniae.

Assign acute respiratory failure with hypoxia, J96.01, as a secondary diagnosis. Refer to the index main term Failure, subterms respiratory, acute, with, hypoxia (J96.01). Go to the tabular list and confirm J96.01, Acute respiratory failure with hypoxia. POA indicator N (No) because it developed after admission.

Assign J95.851, Ventilator-associated pneumonia, with POA indicator N (no) as a secondary diagnosis. Refer to the index main term Pneumonia, ventilator-associated (J95.851). Go to the tabular list and confirm J95.851, Ventilator-associated pneumonia. See ICD-10-CM Official Guidelines for Coding and ReportingSection I.C.10.d. 2., ventilator-associated pneumonia develops after admission. Follow the instruction note under code J95.851 to “use additional code to identify organism, if known.”

Assign MSSA infection as the cause of diseases classified elsewhere, with POA indicator N (no). Refer to the index main term, Infection, subterms staphylococcal, as cause of disease classified

elsewhere, aureus, (methicillin susceptible) (MSSA) (B95.61). Go to the tabular list and confirm B95.61, Methicillin-susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere.

Do not assign an additional pneumonia code with VAP, since the pneumonia is included in the VAP code.

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Question 6.

Which condition would respond best to being treated by an antibiotic?

Select one answer below.

A. Acute nasopharyngitis
B. Adenoviral pneumonia
C. Streptococcal pharyngitis
D. Influenza due to unidentified influenza virus with gastrointestinal manifestations

Rationale: Bronchiectasis with acute exacerbation is treated with antibiotics and increased efforts to clear sputum from the airways with the use of bronchodilators and mucolytics. Adenoviral pneumonia, acute nasopharyngitis (common cold), and influenza are not bacterial infections, so antibiotics are ineffective.

Question 7.

Which approach in ICD-10-PCS is assigned for “laparoscopic total appendectomy”?

Select one answer below.

A. External
B. Percutaneous
C. Percutaneous endoscopic
D. Via natural or artificial opening with percutaneous endoscopic assistance

Rationale: 

The approach assigned for “laparoscopic total appendectomy” is percutaneous endoscopic, character value 4, for laparoscopic technique to reach the site of the procedure.

The definition of percutaneous endoscopic is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure

Question 8.

What patient information is used to assign a case to an MS-DRG?

Select as many answers as apply.
A. Case mix
B. Gender
C. Length of stay
D. Principal diagnosis code
E. Specific secondary diagnosis codes
F. Specific procedures

Rationale: MS-DRG assignment is based upon the principal diagnosis, secondary diagnosis, operating room procedure codes, patient gender, discharge status, presence or absence of complications or comorbidities (CCs) or major complications or comorbidities (MCCs), and birth weight for neonates.