In the ICD-10-CM Tabular List, code J45 (Asthma) carries an Excludes1 note. What does an Excludes1 note tell the coder?
A. The excluded condition is never coded with the code above it because the two cannot occur together
B. The excluded condition is not part of the code above it, but both may be reported together when the patient has both
C. The excluded code is a synonym and either code may be used
D. The excluded condition must always be sequenced first
Show answer and reasoning
Correct answer: A. The excluded condition is never coded with the code above it because the two cannot occur together
Correct. Excludes1 means NOT CODED HERE: the two conditions are mutually exclusive, so both are not reported together unless the two conditions are documented as unrelated. Guideline I.A.12.a.
- B: This is the definition of Excludes2 (not included here), which allows both codes when both conditions exist. Guideline I.A.12.b.
- C: Excludes notes never mark synonyms; inclusion terms serve that purpose.
- D: Excludes1 says nothing about sequencing. It is a prohibition on reporting the pair together.
Source: ICD-10-CM Official Guidelines I.A.12.a
A patient is seen for a scar contracture of the left hand that developed after a burn treated two years ago. How is the encounter coded?
A. The burn code with 7th character A, followed by the contracture code
B. The contracture code first, followed by the burn code with 7th character S
C. Only the burn code with 7th character D
D. Only the burn code with 7th character S
Show answer and reasoning
Correct answer: B. The contracture code first, followed by the burn code with 7th character S
Correct. A sequela is coded with the residual condition first and the original injury code with 7th character S second. Guideline I.B.10.
- A: 7th character A is for active treatment of the injury itself. The burn is healed and is not being treated.
- C: D means subsequent encounter during the healing or recovery phase. The burn healed long ago and a residual condition exists.
- D: The sequela code alone is incomplete. The nature of the sequela (the contracture) must be sequenced first.
Source: ICD-10-CM Official Guidelines I.B.10
In a physician office note the assessment reads: chest pain, probable costochondritis. What should the coder report for this outpatient encounter?
A. Costochondritis, because the physician named the likely cause
B. Chest pain, because uncertain diagnoses are not coded in the outpatient setting
C. Both chest pain and costochondritis
D. An unspecified code for a disease of the musculoskeletal system
Show answer and reasoning
Correct answer: B. Chest pain, because uncertain diagnoses are not coded in the outpatient setting
Correct. Outpatient encounters code the sign or symptom to the highest degree of certainty when the diagnosis is qualified as probable. Guideline IV.H.
- A: Terms such as probable, suspected, questionable, rule out and working diagnosis are not coded as confirmed in the outpatient setting.
- C: Reporting the probable condition in any form violates the outpatient rule.
- D: There is no basis for an unspecified musculoskeletal code when the documented certain finding is chest pain.
Source: ICD-10-CM Official Guidelines IV.H
A hospital inpatient is discharged with the final diagnostic statement: pneumonia, likely aspiration. For the inpatient facility claim, how is this coded?
A. Code the condition as if it existed, because inpatient uncertain diagnoses at discharge are coded as established
B. Code only the symptoms documented during the stay
C. Query the physician; uncertain diagnoses can never be reported
D. Code pneumonia, unspecified organism, and ignore the aspiration qualifier
Show answer and reasoning
Correct answer: A. Code the condition as if it existed, because inpatient uncertain diagnoses at discharge are coded as established
Correct. For inpatient admissions, a diagnosis documented as probable, suspected, likely or questionable at the time of discharge is coded as if it existed. Guideline II.H.
- B: Symptom coding for uncertain diagnoses is the outpatient rule (IV.H), not the inpatient rule.
- C: Inpatient guidelines expressly permit coding uncertain diagnoses at discharge, so a query is not required for that reason alone.
- D: Dropping the qualifier ignores the guideline that lets the coder report the more specific likely diagnosis.
Source: ICD-10-CM Official Guidelines II.H
A code in the Tabular List is printed in italics with the instruction Code first underlying disease. What does this convention require?
A. The italic code is reported alone because it is the more specific code
B. The italic code is a manifestation code and must be sequenced after the code for the underlying etiology
C. The italic code is sequenced first and the underlying disease second
D. The italic code is reported only on inpatient claims
Show answer and reasoning
Correct answer: B. The italic code is a manifestation code and must be sequenced after the code for the underlying etiology
Correct. Etiology and manifestation pairs use a code first note at the manifestation and a use additional code note at the etiology. Etiology is sequenced first. Guideline I.A.13.
- A: Manifestation codes in italics are never reported as first-listed or alone.
- C: This reverses the required order.
- D: The convention applies in every setting, not only inpatient.
Source: ICD-10-CM Official Guidelines I.A.13
