Chapter 4: ICD-9-CM Coding Guidelines
TRUE/FALSE
1. ICD-9-CM diagnosis codes have been adopted under HIPAA for all health care settings.
ANS: T
PTS: 1
DIF: Easy
2. The ICD-9-CM Official Guidelines for Coding and Reporting is organized into four sections.
ANS: T
PTS: 1
DIF: Easy
3. ICD-9-CM procedure codes have been adopted for inpatient procedures by hospitals.
ANS: T
PTS: 1
DIF: Easy
4. A violation of the coding guidelines is a HIPAA violation.
ANS: T
PTS: 1
DIF: Easy
5. The condition or nature of a late effect should be reported as the secondary code.
ANS: F
PTS: 1
DIF: Moderate
6. The code for the acute phase of an illness that led to the late effect should always be reported with a
code for the late effect.
ANS: F
PTS: 1
DIF: Easy
7. A late effect is synonymous with complication.
ANS: F
PTS: 1
DIF: Easy
8. When coding both an acute and chronic condition, sequence the acute condition first.
ANS: T
PTS: 1
DIF: Easy
9. The coder should use both the ICD-9-CM Index to Diseases and the Tabular List of Diseases when
locating and assigning codes.
ANS: T
PTS: 1
DIF: Easy
10. Signs and symptoms that are integral to the disease process should be assigned as additional codes.
ANS: F
PTS: 1
DIF: Moderate
11. When a “code first” note is present and an underlying condition is documented in the patient record,
the underlying condition is reported first.
ANS: T
PTS: 1
DIF: Easy
12. There is no time limit on when a late effect or residual code can be reported.
ANS: T
PTS: 1
DIF: Easy
13. When a late effect is coded, the late effect code is sequenced first.
ANS: F
PTS: 1
DIF: Easy
14. ICD-9-CM procedure codes consist of alphanumeric codes.
ANS: F
PTS: 1
DIF: Easy
15. The ICD-9-CM coding system was developed in the 1980s.
ANS: F
PTS: 1
DIF: Easy
16. If the phrase —omit code is found after the main term or subterm, do not assign a code to the operative
approach.
ANS: T
PTS: 1
DIF: Easy
17. Procedure codes should always be assigned for an operative approach.
ANS: F
PTS: 1
DIF: Easy
18. Assignment of a combination code should take precedence over assignment of multiple codes.
ANS: T
PTS: 1
DIF: Easy
19. A colonoscopy is an example of an open procedure.
ANS: F
PTS: 1
DIF: Easy
20. When coding endoscopic procedures, if the endoscope is passed through more than one body cavity,
assign the code for the most distant site.
ANS: T
PTS: 1
DIF: Easy
21. When a coder finds the ICD-9 code in the alphabetic index, he or she doesn’t need to look it up in the
tabular list also.
ANS: F
PTS: 1
DIF: Easy
COMPLETION
1. A single code that is used to classify two diagnoses or procedures is referred to as a(n) __________
___________.
ANS: combination code
PTS: 1
DIF: Easy
2. Assigning two or more codes to completely classify the elements of a complex diagnosis or procedure
statement is referred to as __________ __________.
ANS:
multiple codes
multiple coding
PTS: 1
DIF: Easy
3. The residual condition that develops after the acute phase of an illness or injury has ended is referred
to as a(n) __________ __________.
ANS: late effect
PTS: 1
DIF: Easy
4. Complete and accurate code assignment and reporting of diagnoses and procedures is the
responsibility of the __________.
ANS: coder
PTS: 1
DIF: Easy
5. The ICD-9-CM Official Guidelines for Coding and Reporting is organized into __________ sections.
ANS:
four
4
PTS: 1
DIF: Easy
6. The term used to mean “physician or any qualified health care practitioner who is legally accountable
for establishing the patient’s diagnosis” is __________.
ANS: provider
PTS: 1
DIF: Easy
7. The structure of the ICD-9-CM Tabular List of Procedures is based on __________.
ANS: anatomy
PTS: 1
DIF: Easy
8. Surgical procedures indexed as eponyms are listed under the main term __________ and then the
eponym.
ANS: operation
PTS: 1
DIF: Easy
9. ICD-9-CM procedure codes contain __________ or __________ digits.
ANS:
three, four
3, 4
PTS: 1
DIF: Easy
10. When a patient undergoes both a biopsy and subsequent removal of additional tissue, assign
__________ codes.
ANS:
two
2
PTS: 1
DIF: Moderate
11. A patient was scheduled for biopsy of the bladder via cystoscopy. The scope was unable to advance
due to blockage. The coder should assign a code for __________.
ANS: cystoscopy
PTS: 1
DIF: Moderate
12. The condition established after study to be chiefly responsible for occasioning the admission of the
patient to the hospital for care is the definition of __________ __________.
ANS: principal diagnosis
PTS: 1
DIF: Easy
13. An outcome of delivery code (V27.0-V27.9) would be located on the __________ record.
ANS:
mother’s
mom’s
PTS: 1
DIF: Easy
14. The fourth-digit subcategory of a myocardial infarction code describes the __________ of the
myocardial infarction.
ANS:
location
site
PTS: 1
DIF: Moderate
15. Neoplasms should be coded directly from the __________ report.
ANS: pathology
PTS: 1
DIF: Easy
16. If a neoplasm is identified but the results of pathology examination are not available, the neoplasm is
said to be of __________ nature.
ANS: unspecified
PTS: 1
DIF: Easy
17. When the origin of a tumor involves two adjacent sites, the location is said to be overlapping, or
__________.
ANS: contiguous
PTS: 1
DIF: Moderate
18. The type of diabetes mellitus whereby the patient’s body is unable to produce insulin is type
__________.
ANS:
I
1
PTS: 1
DIF: Easy
19. A patient was brought to the emergency room at 4 a.m. and left against medical advice at 4:50 a.m.
without being examined. Report code __________.
ANS: V64.2
PTS: 1
DIF: Difficult
20. Mr. Dodd was diagnosed with tumor of the sacral spine. Report code __________.
ANS: 239.2
PTS: 1
DIF: Difficult
SHORT ANSWER
1. Describe the structure of an ICD-9-CM diagnosis code.
ANS:
An ICD-9-CM diagnosis code contains three, four, or five digits that may be further subdivided by
assigning fourth and/or fifth digits to provide greater detail.
PTS: 1
DIF: Moderate
2. What two organizations provide official coding guidelines for coding and reporting using the
International Classification of Diseases, 9th Revision, Clinical Modification?
ANS:
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics
(NCHS) provide official coding guidelines for coding and reporting using the International
Classification of Diseases, 9th Revision, Clinical Modification.
PTS: 1
DIF: Moderate
3. Why were the coding guidelines developed?
ANS:
Coding guidelines were developed to assist both the health care provider and the coder in identifying
diagnoses and procedures that are to be reported.
PTS: 1
DIF: Moderate
4. How are the main terms in the Index to Procedures organized?
ANS:
The main terms in the Index to Procedures are organized in alphabetical order according to type of
procedure, common name of the procedure, and eponyms.
PTS: 1
DIF: Moderate
5. A surgeon makes an incision to start a hysterectomy, but the surgery is stopped after the first incision.
How should the coder code the procedure?
ANS:
The coder should assign a code for the incision of the site.
PTS: 1
DIF: Moderate
6. A patient is treated for an HIV-related condition. How should this be reported on the health insurance
claim?
ANS:
The coder should report ICD-9-CM code 042 first on the health insurance claim and assign additional
diagnosis codes for all documented HIV-related conditions and infections.
PTS: 1
DIF: Moderate
7. When a “code first” note is present and an underlying condition is documented in the patient record,
which condition should be reported first?
ANS:
The underlying condition should be reported first.
PTS: 1
DIF: Moderate
8. A 44-year-old male patient with symptomatic HIV disease is admitted for treatment of a myocardial
infarction. Which condition should be sequenced first?
ANS:
The condition of myocardial infarction should be sequenced first.
PTS: 1
DIF: Difficult
9. What is malignant hypertension?
ANS:
It is a severe form of hypertension with vascular damage and a diastolic pressure reading of 130 mm
Hg or greater.
PTS: 1
DIF: Moderate
10. What is meant by uncontrolled hypertension?
ANS:
Uncontrolled hypertension is untreated hypertension or hypertension not responding to current
therapeutic regimen.
PTS: 1
DIF: Moderate
11. What terms are used to refer to a cerebral infarction?
ANS:
The terms stroke, CVA, and cerebrovascular accident are used to refer to a cerebral infarction.
PTS: 1
DIF: Moderate
12. What is meant by the term status asthmaticus?
ANS:
The term refers to a patient’s failure to respond to therapy administered during an asthmatic episode,
which is a life-threatening complication that requires emergency care.
PTS: 1
DIF: Moderate
13. Chronic renal failure is now referred to as what?
ANS:
Chronic renal failure is now referred to as chronic kidney disease.
PTS: 1
DIF: Easy
14. What conditions are classified under Chapter 11: Complications of Pregnancy, Childbirth, and the
Puerperium?
ANS:
Diseases and disorders that occur during pregnancy, childbirth, and the 6 weeks immediately following
childbirth are classified under Chapter 11.
PTS: 1
DIF: Moderate
15. A 23-year-old pregnant female fell and fractured her wrist. Which condition should be sequenced first?
ANS:
The fracture of wrist should be sequenced first.
PTS: 1
DIF: Moderate
16. What is a late stage of HIV disease?
ANS:
Acquired immune deficiency syndrome (AIDS) is a late stage of HIV disease.
PTS: 1
DIF: Easy
17. What is meant by the term idiopathic?
ANS:
The term idiopathic means “has an unknown etiology.”
PTS: 1
DIF: Easy
18. When may codes from Chapter 14: Congenital Anomalies be assigned?
ANS:
Codes from Chapter 14 may be assigned throughout the life of the patient.
PTS: 1
DIF: Moderate
19. What is the perinatal period?
ANS:
The perinatal period is the interval of time occurring before, during, and up to 28 days following birth.
PTS: 1
DIF: Moderate
20. A patient enters the emergency room with abdominal pain and undergoes emergency appendectomy
for acute appendicitis. What condition is reported as the principal diagnosis?
ANS:
Acute appendicitis is reported as the principal diagnosis.
PTS: 1
DIF: Moderate
MULTIPLE CHOICE
1. A patient suffered a fracture of the radius and ulna due to a fall on the ice a year ago. The patient
presents today with pain due to nonunion of the fracture. Which should be coded as a late effect?
a. fracture of radius
c. pain
b. fracture of ulna
d. nonunion
ANS: D
PTS: 1
DIF: Difficult
2. Which of the following diagnostic statements is an example of a late effect?
a. fracture of ankle due to fall out of bed
b. infected burn of hand
c. postoperative wound infection
d. traumatic arthritis of the knee
ANS: D
PTS: 1
DIF: Difficult
3. A malignant neoplasm that is localized, circumscribed, encapsulated, and noninvasive but has not
spread to deeper or adjacent tissues or organs is _____.
a. a tumor
c. metastatic
b. benign
d. in situ
ANS: D
PTS: 1
DIF: Moderate
4. Given the diagnosis “metastatic carcinoma from breast to lung,” breast would be coded as _____.
a. malignant primary
b. malignant secondary
ANS: A
PTS: 1
c. in situ
d. benign
DIF: Difficult
5. Adenocarcinoma of prostate gland. Squamous cell carcinoma, bronchogenic, left lung. Report codes
_____.
a. 185, M8140/3, 162.9, M8070/3
c. 198.82, M8104/6, 162.9, M8070/3
b. 185, M8140/3, 197.0, M8070/6
d. 198.82, M8140/6, 197.0, M8070/6
ANS: A
PTS: 1
DIF: Difficult
6. Yung Lee was diagnosed with angina; permanent cardiac pacemaker inserted 1 year ago, functioning
well. Report codes _____.
a. 413.9, V45.01
c. 413.9, V42.2
b. 428.9, V53.3
d. 413.9, V43.3
ANS: A
PTS: 1
DIF: Moderate
7. A 16-year-old male patient suffered an missile (open) fracture of tibial shaft, upper section. Report
code(s) _____.
a. 823.20
c. 823.00, 823.20
b. 823.30
d. 823.10
ANS: B
PTS: 1
DIF: Difficult
8. Hypertensive cardiovascular disease with congestive heart failure; benign essential hypertension.
Report codes _____.
a. 402.11, 401.1
c. 401.1, 428.0, 429.2
b. 428.0, 429, 440.9
d. 402.11, 428.0
ANS: D
PTS: 1
DIF: Difficult
9. Five-hour-old infant, premature at 30 weeks, spontaneous birth, is transferred to general hospital for
treatment in the neonatal intensive care unit. Final diagnosis: male newborn, suspected respiratory
distress syndrome due to prematurity. Report codes _____ for the general hospital inpatient stay.
a. V30.00, 765.00, 73.59
c. 765.10, V71.8
b. 769, 765.10, 765.25
d. V30.00, 765.10, 769
ANS: B
PTS: 1
DIF: Difficult
10. Peritonitis due to catheter inserted into abdomen for ambulatory peritoneal dialysis. Removal of
catheter. Report codes _____.
a. 996.68, 567.89, 97.82
c. 998.5, 97.82
b. 567.89, 97.82
d. 996.1, 97.82
ANS: A
PTS: 1
DIF: Difficult
11. Acute gangrenous appendicitis. Postoperative paralytic ileus. Appendectomy. Report codes _____.
a. 540.9, 560.1, 47.09
c. 540.0, 560.9, 47.09
b. 540.9, 564.4, 47.09
d. 540.9, 997.4, 47.09
ANS: D
PTS: 1
DIF: Moderate
12. Hemiplegia secondary to cerebral artery thrombosis 1 year ago. Report code(s) _____.
a. 342.90, 436
c. 438.20
b. 434.0, 342.90
ANS: C
d. 433.9, 342.90
PTS: 1
DIF: Difficult
13. Infected second-degree burns of the hand from boiling water. Report codes _____.
a. 906.6, 958.3, E924.0
c. 958.3, 906.6, E929.8
b. 958.3, 944.20, E924.0
d. 944.20, 958.3, E924.0
ANS: D
PTS: 1
DIF: Difficult
14. Uremia; cardiomegaly; malignant hypertension. Report code(s) _____.
a. 586, 429.3, 401.1
c. 405.01, 429.3
b. 404.00
d. 403.00, 429.3
ANS: D
PTS: 1
DIF: Difficult
15. Suspected myocardial infarction, ruled out. Report code(s) _____.
a. 410.91
c. 410.91; V71.7
b. V71.7
d. 412
ANS: B
PTS: 1
DIF: Moderate
16. Gram-negative septicemia due to bacteroides. Report code _____.
a. 038.3
c. 038.40
b. 038.9
d. 038.41
ANS: A
PTS: 1
DIF: Easy
17. Displacement of cardiac pacemaker electrode. Report code _____.
a. 996.61
c. 996.69
b. 996.01
d. 750.6
ANS: B
PTS: 1
DIF: Difficult
18. A 19-year-old patient was treated as an inpatient for “fever of unknown origin.” Report code(s) _____.
a. 780.6
c. 780.6, V71.2
b. 780.6, 011.90
d. V71.2
ANS: A
PTS: 1
DIF: Difficult
19. Malunion of fracture, right ankle. Patient fell down stairs 3 months ago and fractured her ankle; it was
healing until recently, when the patient complained of pain and the physician noted the malunion.
Report codes _____.
a. 733.81, 905.4, E880.9, E929.3
c. 824.8, 905.4, E880.9, E929.3
b. 733.81, 824.8, E880.9, E929.3
d. 788.82, 824.8, E880.9, E929.3
ANS: A
PTS: 1
DIF: Difficult
20. Arteriosclerotic cardiovascular disease. Acute myocardial infarction. Report codes _____.
a. 410.91, 429.2
c. 410.90, 429.2
b. 410.92, 440.9
d. 414.0, 429.2, 410.91
ANS: C
MATCHING
PTS: 1
DIF: Difficult
Match each diagnostic statement with the type of code assignment listed below.
a. M code
b. E code
c. V code
1.
2.
3.
4.
5.
burn of foot due to bonfire incident
normal newborn female
carbon monoxide poisoning
carcinoma of the lung
family history of breast cancer
1.
2.
3.
4.
5.
ANS:
ANS:
ANS:
ANS:
ANS:
B
C
B
A
C
PTS:
PTS:
PTS:
PTS:
PTS:
1
1
1
1
1
DIF:
DIF:
DIF:
DIF:
DIF:
Difficult
Difficult
Difficult
Difficult
Difficult
Match each diagnostic statement with a neoplasm description listed below.
a. malignant primary
b. malignant secondary
c. benign
d. uncertain behavior
e. unspecified
6.
7.
8.
9.
10.
brain tumor
testicular adenoma
neuroastrocytoma
adenocarcinoma of the lung
metastatic carcinoma to the brain
6.
7.
8.
9.
10.
ANS:
ANS:
ANS:
ANS:
ANS:
E
C
D
A
B
PTS:
PTS:
PTS:
PTS:
PTS:
1
1
1
1
1
DIF:
DIF:
DIF:
DIF:
DIF:
Difficult
Difficult
Difficult
Difficult
Difficult
Match each diagnostic statement with an episode of care listed below.
a. 0 unspecified
b. 1 delivered with/without antepartum complication
c. 2 delivered with postpartum complication
d. 3 antepartum complication
e. 4 postpartum complication
11.
12.
13.
14.
15.
pre-eclampsia, 32 weeks, pregnancy undelivered
IUP delivered, first-degree perineal laceration
IUP delivered, postpartum hemorrhage
infected episiotomy, 1 week after previous delivery
patient readmitted 2 weeks after delivery with severe hemorrhage
11.
12.
13.
14.
ANS:
ANS:
ANS:
ANS:
D
B
C
E
PTS:
PTS:
PTS:
PTS:
1
1
1
1
DIF:
DIF:
DIF:
DIF:
Difficult
Difficult
Difficult
Difficult
15. ANS: A
PTS: 1
DIF: Difficult
Match each diagnostic statement with a type of condition listed below.
a. poisoning
b. adverse effect
c. poisoning late effect
d. adverse effect late effect
16.
17.
18.
19.
20.
allergy to amoxicillin
toxic effect of carbon monoxide
sequelae of previous hypersensitivity to Darvon
brain damage due to previous drug overdose
stupor due to combination of Nyquil and Valium
16.
17.
18.
19.
20.
ANS:
ANS:
ANS:
ANS:
ANS:
B
A
D
C
A
PTS:
PTS:
PTS:
PTS:
PTS:
1
1
1
1
1
DIF:
DIF:
DIF:
DIF:
DIF:
Difficult
Difficult
Difficult
Difficult
Difficult