Question

ICD-10-CM Coding

1. Ahisha presents with fever, leukocytosis, and tachycardia. She has had a urinary treat infection as an outpatient but is not getting better. The diagnosis of E coli sepsis with associated acute renal failure is made and IV antibiotics are started.

1. Where is the localized infection that is the underlying cause of the systemic infection (sepsis)?

2. Should the signs and symptoms be coded?

3. Does the patient have severe sepsis?

4. Code all the diagnoses for the case; be certain you have listed the primary diagnosis first (Hint: 4 codes!).

2. John is a type 1 diabetic who presents with hypoglycemia caused by overdoes of insulin. The hypoglycemia resulted from a mechanical problem with his insulin pump. John also has diabetic nephropathy and neuropathy.
   1. Is the first listed diagnosis a complication of the insulin pump?

2. What is the title of the column from the Table of Drugs and Chemicals that is used in this case?

3. What art the associated complications of his diabetes?

4. Code all the diagnoses; be certain you have listed the primary diagnosis first (hint: 5 codes!) .

3. Walter presents in cocaine withdrawal and alcohol withdrawal with delirium. He also smokes cigarettes. Because of years of alcohol dependence, Walter has alcoholic cirrhosis of the liver. To complicate his care, he also suffers from paranoid schizophrenia.
   1. Can either drug withdrawal or alcohol withdrawal be listed first?

2. Code all the diagnoses for the case (Hint: 5 codes!).

4. Bridget presents for her second radiation therapy visit for treatment of her left-sided breast carcinoma located in the left outer quadrant. She is morbidly obese with a BMI of 50.2
   1. Which section of the ICD-10-CM Official Guidelines provides guidance in sequencing the principal diagnosis for this case?

2. What is the first-listed diagnosis code?

3. Code the diagnoses for this case (hint: 4 codes!).

5. Jaclyn has dysuria and flank pain. Further evaluation is positive for acute on chronic cystitis. Cultures are positive for MRSA. She also has hypokalemia and hypomagnesemia, which is treated with intravenous fluid additives.
   1. Will the acute or chronic cystitis be sequenced first?

2. Code the diagnoses for this case (hint: five codes!).

6. Benton presents because of gangrene of the left second toe. He is a type 2 insulin-dependent diabetic with known diabetic peripheral vascular disease. After physician query, it is determined that the gangrene is caused by the diabetes.
   1. Will the phrase “long term” be used when coding this case?

2. Code all the diagnoses for the case, listing the primary diagnosis first (hint: 2 codes!).

7. Clayton has enlarged lymph nodes, weakness, fever and flu-like symptoms. He is a known IV heroin user. Also noted on chest x-ray is Pneumocystis carinii pneumonia. HIV testing is positive and the physician documentation supports HIV disease with pneumonia.

1. Code the diagnoses for the case (hint: 3 codes!).

Answer 1

1)

a) As the patient was already having UTI even as an outpatient, the E Coli infection could have been localised in the urinary tract, which later got spread to the kidney.

b) No, as a definitive diagnosis has already been established there is no need for coding the signs and symptoms.

c) No, the patient is having a tachycardia which implies that the patient is having a hypertension. When a patient undergoing severe sepsis he/ she will have hypotension.

d)Code for primary diagnosis Fever - R50

Leukocytosis - D72. 829

Tachycardia- R00. 0

Sepsis due to E coli - A41. 51

2)

a. Here, the first listed diagnosis is that the patient is type 1 diabetic. As it is an autoimmune disease, his insulin pump has no role in it except it helps him to maintain the glucose level in his blood.

b) Insulin overdose.

c) Hyperglycaemia, Hypoglycaemia, Diabetic ketoacidosis, foot ulcers, peripheral artery diseases, heart disease and stroke etc.

d) Primary diagnosis - Hypoglycemia - E16. 2

Poisoning by insulin - T38. 3X1A

Type 1 diabetes - E10. 9

Diabetic nephropathy - E10. 21

Diabetic neuropathy - E10. 40

3)

a)In this case, both alcohol and drug withdrawal should be listed together. Although, as the patient is suffering from liver cirrhosis, alcohol withdrawal can be given prime importance.

b) Alcohol dependence with withdrawal - F10.239

Cocain dependence with withdrawal - F14. 23

Delirium - F05

Alcoholic cirrhosis of liver- K70. 3

Paranoid Schizophrenia - F20. 0

4).

a) Section 2 of the ICD-10 CM official guidelines.

b) C50. 412 - malignant neoplasm of upper outer quadrant of left female breast. OR

C50. 512- Malignant neoplasm of lower outer quadrant of left female breast

c) C50. 412

C50. 512

Radiation therapy - Z51. 0

Morbid obesity - Z68. 43

5).

a) Acute condition is sequenced first.

b) *)Dysuria - R30.0. *)flank pain- R10.90

*) chronic cystitis - N30. 20 *)MRSA- E83. 42

*) Hypokalemia- E87. 6

6).

a)Yes, Long term use(current) of insulin should be assigned to indicate that the patient usea insulin for type 2 diabetes mellitus.

b) Z79. 4- diabetes mellitus with long term use of insulin

E11. 52- type 2 diabetes mellitus with peripheral angiopathy and foot gangrene