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Questions and Answers
What is the coding and sequencing for the case of a patient with diabetic hyperosmolar state?
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.
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 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?
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?
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?
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?
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?
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.
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.
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?'
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?'
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?
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?
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.
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?
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?
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?
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.
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?
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.
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?
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.'?
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?
What symptoms typically suggest alcohol withdrawal in a patient?
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What effect do CNS depressants have when consumed with alcohol?
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.'?
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?
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?
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?
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?
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?
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?
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.
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?
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.
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.
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?
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?
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?
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?
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?
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?
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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