Questions and Answers
What is the coding and sequencing for the case of a patient with diabetic hyperosmolar state?
Which signs and symptoms characterize diabetes mellitus? Select all that apply.
What is the coding and sequencing for a 58-year-old male with type 1 diabetes and a diabetic left foot ulcer?
What is the coding and sequencing for a patient in a ketoacidotic coma due to insulin pump failure?
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What is the coding and sequencing for a 42-year-old male with acute exacerbation of chronic pancreatitis and diabetes?
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What code should be listed first for diabetes due to previous pancreatectomy?
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What is the coding for a 5-year-old boy with symptomatic encephalopathy associated with functional hyperinsulinism?
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What is the coding for a pregnant patient with type 2 gestational diabetes controlled by diet?
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A person may be considered diabetic if their blood glucose is consistently above 125 mg/dL.
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Which of the following can assist in controlling type 2 diabetes? Select all that apply.
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What is the coding and sequencing for the diagnosis 'Late onset of Alzheimer's dementia with behavioral disturbance?'
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What is the coding for the diagnosis 'Use, abuse and dependence on hallucinogens with hallucinogen-induced anxiety disorder?'
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What is the diagnosis coding and sequencing for a patient with uncontrolled hypertension, tobacco use, and depression?
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Which term is defined as the use of prescribed medications used to treat certain mental disorders?
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DSM-5 is used for reimbursement under PPS for psychiatric admissions.
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How are inpatient psychiatric facilities and distinct part units paid for inpatient psychiatric services rendered to Medicare beneficiaries?
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What is the correct principal diagnosis and sequencing for a patient with acute exacerbation of chronic paranoid schizophrenia and type 2 diabetes?
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Which condition is NOT coded in the F20 to F29 code block?
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Serious mental disorders such as schizophrenia and bipolar disorder result in functional impairment which substantially interferes with or limits one or more major life activities.
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What is the diagnosis coding and sequencing for a patient diagnosed with paranoid schizophrenia aggravated by recent alcohol abuse?
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The main difference between alcohol abuse and alcoholism is a physical dependence on alcohol.
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What is the best action for a coder if a patient has 'ETOH dependence' and hasn't had a drink in 5 years?
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What is the coding and sequencing for a patient diagnosed with 'alcohol dependence with alcohol-induced mood disorder, bipolar disorder, mild, current episode depressed.'?
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What symptoms typically suggest alcohol withdrawal in a patient?
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What effect do CNS depressants have when consumed with alcohol?
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What codes should be assigned for a diagnosis of 'accidental toxic effect of alcohol, alcohol abuse, severely intoxicated, intoxication delirium.'?
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What is the coding and sequencing for a patient admitted with severe abdominal pain and treated for chronic gastritis?
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What is the coding and sequencing for a patient diagnosed with acute pancreatitis due to relapse of alcohol dependence?
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Which medications are used to treat alcohol dependence?
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If a patient has documented alcohol use, abuse, and dependence, which code or codes should be assigned?
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What code category is used to report supportive care for terminal patients?
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What are the coding and sequencing for a patient admitted with metastasis to the right lung after breast cancer?
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In addition to reporting pneumonia, a patient with leukemia in remission should be reported with a Z code.
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What is the coding and sequencing for a patient receiving chemotherapy after removal of right ovarian cancer?
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Prophylactic organ removal is performed when the organ has a malignancy.
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Codes from Chapter 21 (Z codes) are for use only on inpatient encounters.
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What is the coding and sequencing for a patient diagnosed with malignancy-related pain due to castrate resistant prostate cancer?
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Which Z codes can be reported only as a principal diagnosis for situations with malignant neoplasms?
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What is the coding and sequencing for a patient admitted for a double mastectomy due to genetic susceptibility to breast cancer?
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What is the coding for a 6-year-old child diagnosed with an acute viral upper respiratory infection and a history of acute lymphoblastic leukemia?
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What type of Z codes are used to explain continuing surveillance after completed treatment for a malignant neoplasm?
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What is the coding and sequencing for a patient admitted with severe dehydration due to diabetic ketoacidosis?
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Study Notes
Diagnosis Coding and Sequencing
- "Late onset of Alzheimer's dementia with behavioral disturbance" is coded as G30.1 (Alzheimer's disease with late onset) and F02.81 (Dementia in other diseases with behavioral disturbance).
- "Hallucinogen dependence with hallucinogen-induced anxiety disorder" is coded as F16.280.
- For a patient with uncontrolled hypertension, nicotine dependence, and depression, the correct codes are I10 (Essential hypertension), F17.210 (Nicotine dependence, cigarettes, uncomplicated), and F32.9 (Major depressive disorder, unspecified).
Treatment and Coding Definitions
- Pharmacotherapy is the use of prescribed medications to treat mental illnesses.
- DSM-5 is not used for reimbursement under HIPAA.
- Inpatient psychiatric facilities are paid under the IPF PPS per diem rate for services rendered to Medicare beneficiaries.
Principal Diagnosis and Screening
- A case of acute exacerbation of chronic paranoid schizophrenia and type 2 diabetes is correctly coded as F20.0 (Paranoid schizophrenia) and E11.9 (Type 2 diabetes).
- Conditions like Post-schizophrenic depression fall under F32.8 rather than the F20-F29 code block.
Impact of Serious Mental Disorders
- Serious mental disorders such as schizophrenia significantly interfere with major life activities.
- Symptoms indicative of alcohol withdrawal include irritability, enlarged pupils, nausea, and headache.
Alcohol-related Diagnoses and Treatments
- Alcohol consumption coupled with CNS depressants intensifies effects of alcohol.
- Intoxication due to alcohol, with a BAL over 200 mg/100 mL, is coded as T51.0X1A, F10.121, and Y90.7.
- Medications used to treat alcohol dependence include Disulfiram, Naltrexone, Acamprosate, Campral, Depade, and ReVia.
- Only the code for dependence should be assigned when alcohol use, abuse, and dependence are documented.
Z Codes and Surgical Procedures
- Hospice care coding utilizes the Z51 category.
- Diagnoses following a metastatic cancer case involve using Z85.3 for personal history of breast cancer.
- For genetic testing positive for breast cancer susceptibility, the coding sequence includes Z40.01 (prophylactic mastectomy) and Z15.01 (genetic susceptibility).
Diabetes Conditions and Symptoms
- The signs of diabetes mellitus include unexplained weight loss, excessive thirst, and tingling/numbness in the extremities.
- Management of diabetic conditions involves recognizing complications like diabetic ketoacidosis (DKA) and using appropriate codes such as E10.10 and E86.0 for dehydration.
Special Cases in Patient History
- Patients with a history of leukemia presenting with infections require careful coding with patient history denoted as Z85.6.
- Patients undergoing chemotherapy are coded as Z51.11 for ongoing treatment.
- Appropriate coding for complications from diabetes involves multiple codes reflecting current conditions such as ulcers or kidney disease.
Miscellaneous Coding Instructions
- Certain Z codes are used exclusively as principal diagnoses.
- Continuous surveillance after treatment for malignancies is reported using follow-up Z codes.
- An insulin pump malfunction leading to ketoacidotic coma is an essential condition to document correctly for incidence and treatment management.### Coding for Chronic Pancreatitis and Diabetes
- A 42-year-old male with chronic pancreatitis and diabetes mellitus receiving insulin.
- Correct coding and sequencing: K85.90 (Acute pancreatitis), E08.8 (Diabetes mellitus due to an underlying condition), Z79.4 (Long-term insulin use).
Diagnosis After Pancreatectomy
- Newly admitted patient diagnosed with diabetes due to previous pancreatectomy.
- First-listed code to use: E89.1 (Postprocedural hypoinsulinemia).
Pediatric Symptomatic Encephalopathy
- A 5-year-old boy with symptomatic encephalopathy due to functional hyperinsulinism.
- Correct coding for management: E16.1 (Hypoglycemia due to excessive insulin), G94 (Other disorders of the nervous system).
Gestational Diabetes in Pregnancy
- Pregnant patient diagnosed with type 2 gestational diabetes managed by diet.
- Appropriate coding: O24.410 (Gestational diabetes mellitus).
Diagnostic Criteria for Diabetes
- A blood glucose level consistently above 125 mg/dL qualifies a person as diabetic.
- Statement verified as true.
Management of Type 2 Diabetes
- Effective methods for controlling type 2 diabetes include:
- A: Diet changes
- B: Oral medications
- C: Insulin therapy
- D: Increased physical activity
- F: Weight control.
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