- At an annual visit, the physician notes that the 15-year-old patient has obesity, with a BMI of 35. How is this coded?
A. Z68.53
B. Z68.54
C. Z68.55
D. Z68.56
Rationale:
The code changes in the ICD-10-CM Tabular List for fiscal year 2025 include one revised code (Z68.54) and two new codes (Z68.55, Z68.56). Z68.55 Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age correlates to a BMI of 35-39.9.
2. A patient presents to the emergency department with gastrointestinal bleeding after accidentally taking two doses of a direct oral anticoagulant within 12 hours. Which ICD-10-CM codes should be assigned to document this scenario?
A. Z79.01, I48.91
B. Z79.01, T45.515A
C. T45.511A, K92.2
D. T45.515D, K92.2
Rationale:
The correct codes are T45.511A for accidental poisoning by anticoagulants and K92.2 for gastrointestinal bleeding, the associated manifestation. While Z79.01 (long-term use of anticoagulants) might also be relevant in chronic use scenarios, it is not typically included as a priority in acute poisoning events. The D in T45.515D denotes that this is a subsequent encounter for an intentional self-harm incident.
3. What is the primary purpose of modifier 24?
A. To identify a separate E/M service
B. To report a subsequent procedure
C. To indicate a service unrelated to surgery
D. To notate a waived service
4. What is the ICD-10-CM code for memory loss due to alcohol use?
A. R41.3
B. F06.8
C. F10.96
D. F10.97
Rationale:
ICD-10-CM code F10. 96 corresponds to alcohol use, unspecified, with alcohol-induced persisting amnestic disorder.
5.For a highly complex procedure requiring skills of more than two surgeons, each surgeon will submit a claim with which modifier?
A. 62
B. 66
C. 80
D. Concept does not apply
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6.Which of the following conditions might a patient also have when in alcohol withdrawal?
A. Gastrointestinal bleeding
B. Pancreatitis
C. Cardiomyopathy
D. All of the above
Rationale:completed, as withdrawal signs can mimic other medical conditions such as meningitis, encephalitis, brain tumors, strokes, and brain hemorrhages. These possible conditions must be eliminated. Once it is determined that the patient is in withdrawal, there are myriad other conditions the patient might have in addition to their withdrawal symptoms. These include gastritis, gastrointestinal bleeding, liver disease, cardiomyopathy, pancreatitis, electrolyte imbalance/alcohol ketoacidosis, and deficiency in vitamins.
7. Which of the following ICD-10-CM codes is used to indicate long-term use of a direct oral anticoagulant for anticoagulation therapy?
A. T45.515A
B. Z79.01
C. I48.91
D. K92.2
Rationale:
Code Z79.01 is assigned to document the long-term (current) use of anticoagulants. This code applies when the patient is on chronic or prophylactic anticoagulation therapy. The other options are incorrect because T45.515A is used for accidental poisoning by anticoagulants; I48.91 represents atrial fibrillation, a condition often treated with anticoagulants; and K92.2 is for gastrointestinal bleeding, which may occur as a complication but is not related to long-term use documentation.
8.When an assistant surgeon is a physician’s assistant, nurse practitioner, or clinical nurse specialist, which modifier should be appended to the CPT® surgery code?
A. 80
B. 81
C. AS
D. Concept does not apply
Rationale:
When the assistant to a surgeon is a physician’s assistant, nurse practitioner, or clinical nurse specialist, append modifier AS. When the assistant at surgery is a physician, append modifier 80 to the CPT® code.
9. A patient with alcohol dependence states he is having trouble sleeping at night. How is this coded?
A. F10.182
B. F10.282
C. F10.982
D. F10.20, G47.09
Rationale:
Alcohol might induce sleep, but it will increase sleep disruption during the night and reduce the amount of rapid eye movement (REM) sleep. Alcohol with insomnia is coded in the F10 range, with the final code depending on whether it is use, abuse, or dependence. ICD-10-CM code F10.282 is for alcohol dependence with alcohol-induced sleep disorder.
10. What is the purpose of using modifier 59?
A. To indicate a procedure was performed bilaterally
B. To identify a procedure was staged or related
C. To show a distinct procedural service
D. To report a repeat procedure
Rationale:
Modifier 59 is used to indicate that a procedure or service was distinct and separate from other services provided, avoiding National Correct Coding Initiative edit denials.