10 Inpatient Practice Scenarios ICD10 CM with rationale.

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 1. Patient is admitted with HTN, CHF exacerbation and ESRD. BNP was elevated and IV lasix was given to the patient. Patient also underwent dialysis treatment. Nephrology consultant documented the ESRD is secondary to congenital polycystic ovary disease. DS documented PT admitted with SOB and was found to have systolic CHF and also was treated for ESRD with dialysis. How will you proceed with such a scenario?

Options:


I13.2, N18.6, Q61.3, I50.23

I13.2, N18.6, Q61.3, DOA qry

None of the above

I13.2, N18.6, Q61.3


Answer: I13.2, N18.6, Q61.3, I50.23

Rationale: The patient has multiple conditions, including hypertension (I13.2), chronic kidney disease (N18.6), congenital polycystic ovary disease (Q61.3), and systolic heart failure (I50.23). These conditions should all be coded as they are relevant to the patient's care and treatment. Therefore, the correct answer is I13.2, N18.6, Q61.3, I50.23.


2. The patient was admitted with wheezing and shortness of breath. The provider's diagnostic statement listed, "Bacterial pneumonia on top of influenza A, exacerbation of chronic obstructive pulmonary disease (COPD)." Would a combination code be assigned for the influenza with pneumonia and COPD and pneumonia; or should each condition be coded separately? Does the fact that a combination code is assigned for COPD with acute lower respiratory infection affect assigning an additional code for influenza with pneumonia? How would this case be coded?

Options:

J10.08, J44.1

J10.08, J44.0, J15.9, J44.1

J10.08, J15.9, J44.1

J10.08, J44.0, J44.1


Answer: J10.08, J44.0, J15.9, J44.1

Rationale: In this case, the provider has documented bacterial pneumonia on top of influenza A, as well as exacerbation of COPD. According to coding guidelines, separate codes should be assigned for each of these conditions.

3.How should COPD, emphysema, and chronic bronchitis be coded?

a) J44.9

b) J44.0, J43.9, J44.1

c) J43.9, J44.0, J44.1

d) J44.0, J44.1

Answer: a) J44.9


Rationale: According to ICD-10-CM coding guidelines, COPD is a combination of chronic bronchitis and emphysema, and should be coded to J44.9. Separate codes for chronic bronchitis (J44.0) and emphysema (J43.9) should only be assigned if the medical record specifically documents both conditions separately.


4.Patient is admitted to the hospital with lower extremity edema, pulmonary edema, and SOB. The patient explains that he has missed dialysis twice because of a lack of transportation. The patient underwent emergent dialysis. The diagnostic statement clearly documented the patient was admitted with fluid overload due to missed dialysis, diastolic CHF exacerbation, and HTN. Do you require any QUERY in this scenario, if yes then what will be the appropriate query?

a) Yes

b) No

c) Unclear

d) Insufficient information

Answer: b) No


Rationale: No query is required in this scenario as the diagnostic statement clearly documents the patient's conditions and their relationship to one another. The patient's admission is due to fluid overload caused by missed dialysis, which led to diastolic CHF exacerbation and HTN.


5. A patient is admitted to the outpatient unit for appendectomy. The patient underwent lap. appendectomy with intraoperative cholangiogram. Post-surgery, the patient went into hypotension and was admitted to the hospital for further workup. What will be the appropriate PDx for this following scenario?

a) K80.20

b) I95.81

c) T81.4XXA

d) I89.0

Answer: b) I95.81


Rationale: In this scenario, the patient was admitted to the hospital for further workup after experiencing hypotension post-surgery. The appropriate PDx would be I95.81, which represents hypotension as the reason for admission to the hospital.



6.What is the guideline for the symptom following contrasting and comparative condition?

a) Both are considered as confirmed conditions, and higher DRG can be assigned as PDx.

b) Symptom should be coded first, and then both conditions should be considered as confirmed conditions and coded as SDx.

c) Only contrasting condition should be coded.

d) Only comparative condition should be coded.

Answer: a) Both are considered as confirmed conditions, and higher DRG can be assigned as PDx.


Rationale: According to the ICD-10-CM Official Guidelines for Coding and Reporting, when a symptom follows a confirmed condition (such as a contrast study), the symptom is considered part of the confirmed condition and should be coded as such. The higher weighted DRG can be assigned as the PDx.


7. A patient is admitted with acute Atrial fibrillation with rapid ventricular response and is also in Congestive heart failure with pulmonary edema. The patient is digitalized to reduce the ventricular rate and given intravenous Lasix to reduce the cardiogenic pulmonary edema. Give the PDX.

a) Either can be assigned as PDX

b) I48.91 Afib

c) I50.9 CHF

d) None of the above

Answer: a) Either can be assigned as PDX


Rationale: Both conditions, atrial fibrillation and congestive heart failure with pulmonary edema, are equally responsible for the patient's hospitalization and require active treatment. Therefore, either can be assigned as the principal diagnosis depending on the provider's documentation and coding guidelines.


8. A patient with benign hypertrophy of the prostate is admitted for the purpose of a transurethral resection of the prostate (TURP). Shortly after admission, but before the patient is taken to the operating suite, the patient falls and sustains a fracture of the left femur. The TURP is cancelled; hip pinning is carried out the following day. Give the PDX.

a) N40.

b) S72.001

c) W19.XXX

d) None of the abov

Answer: a) N40.


Rationale: The patient was admitted for the transurethral resection of the prostate (TURP), which was cancelled due to the femur fracture. Therefore, the principal diagnosis should reflect the reason for the admission, which is N40.0 - benign hypertrophy of the prostate.



9. If malnutrition is documented as moderate to severe PCM, we can go with highest level of specificity?

a) True

b) False

c) Cannot be determined

d) None of the above

Answer: b) False.


10. For a Medicare account(Hospice account), Z51.5 can be assigned as Pdx.

a) True

b) False

c) Cannot be determined

d) None of the above

Answer: b) False






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