Chapter 23:

1. Chapter 15 codes take precedence over codes from other chapters, but
codes from other chapters may be used as additional codes when needed to
provide more specificity. True or False?

2. The nurse’s documentation of the number of weeks may be used to assign

the appropriate final character identifying the trimester. True or False?

3. If a condition complicating the pregnancy develops prior to the current

admission/encounter or represents a pre-existing condition, which trimester
character should be assigned?
A. The trimester character for the trimester at the time of the
admission/encounter.
B. The trimester character for the trimester when the condition developed.
C. The trimester character will depend on the circumstances of
admission.
D. The trimester character at the time of discharge.

4. When an inpatient hospitalization encompasses more than one trimester and

remains in the hospital into a subsequent trimester, which trimester character
should be assigned for the antepartum complication code?
A. The trimester character for the trimester at the time of the
admission/encounter.
B. The trimester character for the trimester when the condition developed.
C. The trimester character will depend on the circumstances of
admission.
D. The trimester character at the time of discharge.

5. Code O80, Encounter for full-term uncomplicated delivery, is used only when
the delivery is entirely normal with a single liveborn outcome. Which of the
following situations would not prevent the use of code O80?
A. Any postpartum complications.
B. An antepartum complication experienced during pregnancy has
resolved before the time of admission.
C. There is fetal manipulation with forceps.
D. There are multiple births.

6. The postpartum period, clinically termed the “puerperium,” begins

immediately after delivery and includes how many of the subsequent weeks?
A. Two
B. Four
C. Six
D. Eight
7. What is the correct ICD-10-PCS root operation for Cesarean deliveries?
A. Delivery
B. Removal
C. Extraction
D. Reposition

8. A patient is being treated for congestive heart failure (CHF) and dilated
cardiomyopathy related to previous pregnancy following delivery five months
ago. The patient complains of swelling of the feet, orthopnea, and
palpitations. CT was performed to rule out recurrent pulmonary embolus.
Patient was maintained on Coumadin due to previous pulmonary embolism.
Patient was admitted to monitor with full-dose heparinization and to treat CHF
with intravenous diuretic, ace inhibitors, beta blockers, and Digoxin. A
biventricular defibrillator is implanted in the chest (open approach) with
insertion of right and left ventricle lead and defibrillator lead into coronary vein
(percutaneous approach) vein during the hospitalization.

Final diagnoses: (1) Postpartum cardiomyopathy following delivery,

(2) congestive heart failure, (3) history of pulmonary embolism, (4) long-term
current anticoagulation therapy, (5) CRT-D, (6) CT chest, using low osmolar
contrast, (7) EKG.

Assign the appropriate codes.

Codes: O90.3, I50.9, Z86.711, Z79.01, 0JH609Z, 02H43KZ, 02HL3KZ,

02HK3KZ, BW241ZZ (CT scan w contrast)

Comments: (1) Code O90.3 identifies the cardiomyopathy, so an additional code is not
necessary. (2) Codes Z86.711 and Z79.01 are assigned as secondary diagnoses for
history of pulmonary embolism and Coumadin maintenance. Since the patient no longer
has pulmonary embolism, the condition would not be coded as a current condition. (3)
Codes 0JH609Z, 02HK0KZ, 02HL0KZ, and 02H40KZ are assigned for implantation of the
biventricular defibrillator total system, including lead placement.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2013 Revised Edition, p.

325.

9. A 23 years old patient at 22 weeks of pregnancy is admitted with severe

shortness of breath. Patient is HIV+ and workup indicates the patient has
PCP (Pneumocystis Carinii Pneumonia) which is HIV related.

Assign the appropriate codes.

O98.712, B20, B59, Z3A.22

See ICD-10-CM Coding Guideline in Pregnancy, Childbirth and the Puerperium

(I.C.15.f) which states “During pregnancy, childbirth, or the puerperium, a
patient admitted because of an HIV-related illness should be coded with a
principal diagnosis from subcategory O98.7-, Human immunodeficiency [HIV]
disease complicating pregnancy, childbirth, and the puerperium, followed by
a code for AIDS (B20) and code(s) for the HIV-related illness(es).” A sixth
character of 2 indicates that the patient is in the second trimester. An
instructional note appears under code B20 indicating that code O98.7- is
listed first. An instructional note appears under O98.7 that states to “Use an
additional code to identify the type of HIV disease.”

10. Patient at 37 weeks had spontaneous vaginal delivery of a female infant.

There was a urethral tear and first degree perineal tear. Perineal tear was
repaired with 2-0 vicryl in running lock fashion, with subcuticular closure of the
skin. The urethral tear was repaired with 4-0 vicryl in running lock fashion.
Mother and infant were stable.

Final diagnoses: (1) Normal spontaneous vaginal delivery, (2) repair of

urethral and perineal lacerations.

Assign the appropriate codes.

Codes: O71.5, O70.0, Z37.0, Z3A.37, 0TQDXZZ, 0HQ9XZZ 10E0XZZ

Comments: (1) Code O71.5 is assigned for the urethral laceration. (2) Perineal laceration
is assigned to code O70.0. (3) Two procedure codes are used to most appropriately
report the different laceration repairs. NSVD would be added as an additional code to
show the NSVD per PCS rules for multiple procedures.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2013 Revised Edition, pp.
330-331.

11. The date of the admission should be used to determine weeks of gestation
for inpatient admissions that encompass more than one gestational week.
True or False?

12. The patient had a normal spontaneous vaginal delivery at 39 weeks and
experienced immediate postpartum bleeding. She had a 50-mL clot that
was evacuated from the lower uterine segment (LUS), with cessation of
bleeding.

Final diagnosis and procedure: (1) Normal spontaneous delivery, (2)

postpartum bleeding with evacuation of clot.

Assign the appropriate codes.

Codes: O72.1 Z37.0, Z3A.39, 0UC97ZZ,10E0XZZ

 Comments: (1) No acute or chronic condition were reasons for admission. Therefore,
the bleeding immediately following delivery code O72.1 is assigned. (2) The objective of
the procedure was to evacuate the clot, rather than control bleeding. The correct root

operation is “Extirpation,” which is defined as taking or cutting out solid matter from a
body part. O48.0 shows the post term pregnancy which is pregnancy 39 weeks and
over.

Reference: Coding Clinic, Fourth Quarter 2013, p. 38.

13. A patient underwent a repeat low transverse cesarean section. During the
cesarean delivery, vacuum extraction was used to assist with the delivery
of the infant. In this case, only the cesarean delivery is coded.
True or False?

14. The patient developed delayed postpartum hemorrhage following a

spontaneous vaginal delivery at 37 weeks. Control of bleeding was
accomplished using a Bakri balloon.

Final diagnoses and procedures: (1) Delayed postpartum hemorrhage, (2)

spontaneous vaginal delivery, (3) 37 weeks’ gestation, (4) assisted vaginal
delivery, (5) control of bleeding using Bakri balloon.

Assign the appropriate codes.

Codes: O72.2, Z37.0, Z3A.37, 0W3R7ZZ,10E0XZZ

Comments: (1) The root operation “Control” is used since the intent of the procedure is to
stop postprocedural (delivery) or other acute bleeding. (2) The root operation “Control” is
only available in the general anatomical regions; and in this case, “genitourinary tract” is
the appropriate general anatomical region.

Reference: Coding Clinic, Fourth Quarter 2014, p. 44

15. A patient, who delivered at 39 weeks had a routine vaginal delivery of a

normal infant. She has asthma for which she takes an inhaler. However,
she suffered an obstetrical periurethral laceration during delivery.

Final diagnoses and procedures: (1) Spontaneous vaginal delivery

complicated by periurethral obstetric laceration, (2) Asthma, (3) assisted
vaginal delivery, (4) suture of periurethral laceration.

Assign the appropriate codes.

Codes: O99.52, J45.909, O71.82, Z37.0, Z3A.39, 10E0XZZ, 0UQMXZZ

Comments: (1) The ICD-10-PCS guideline pertaining to “peri” (B4.1b) only applies when
a more specific body-part value is not available. (2) In this case, although the body part
was described as “peri-urethral,” it is the vulvar tissue, not the urethral tissue, that is torn;
a specific body part exists in ICD-10-PCS for “vulva.” (3) The patient has asthma for
 which she takes an inhaler. There were no complications of pregnancy other than the
patient having asthma. Therefore, per O99.52 would be principal.

Reference: Coding Clinic 1st Quarter, 2016 page 4.

16. A pregnant patient presents to the hospital at over 40 weeks gestation in

active labor. Artificial rupture of the fetal membranes (AROM) is carried
out, and Pitocin is given intravenously in the peripheral vein to augment
labor. The patient had a spontaneous vaginal delivery of a liveborn infant
without complication.

Final diagnoses and procedures: (1) Normal spontaneous vaginal delivery,

(2) manually assisted delivery, (3) artificial rupture of fetal membranes.

Assign the appropriate codes.

Codes: O48.0, Z3A.40, Z37.0, 10E0XZZ, 10907ZC

Comments: (1) The administration of Pitocin to augment active labor is not coded
separately. (2) In this case, the patient presented in active labor; therefore, do not assign
a separate code for the administration of Pitocin. When Pitocin is given to induce labor, it
should be coded. Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2017
revised Edition, p. 335.

Chapter 24:

1. The expulsion or extraction of all or part of the placenta or membrane with an

estimated gestation of less than 20 completed weeks is considered an
abortive outcome (abortion). True or False?

2. If an expelled fetus has a period of gestation of more than 20 weeks but less
than 37 weeks, what is it considered?
A. Spontaneous abortion
B. Abortion
C. Preterm labor with preterm delivery
D. Molar pregnancy

3. What does the term “incomplete abortion” refer to?

A. An elective termination of pregnancy whereby some of the products of
conception were inadequately removed
B. Retained products of conception from a spontaneous abortion
C. Retained products of conception—whether from a spontaneous
abortion or an elective termination of pregnancy
D. Spontaneous fetal death
4. When the provider documentation does not specify whether the spontaneous
abortion is complete or incomplete, ICD-10-CM classifies it to “complete or
unspecified.” True or False?

5. A 36-year-old female was admitted with weakness, dizziness, cramping, and

delayed hemorrhage with passing large clots. Hemoglobin was found to be
low with blood loss anemia. Copious products of conception were removed
with suction dilatation and sharp curettage of the uterus. Patient is three days
status post elective legal abortion.

Final diagnoses: (1) Acute blood loss anemia, (2) retained products of
conception, (3) dilatation and curettage, (4) chronic hypertension, (5) tobacco
smoker.

Assign the appropriate codes.

Codes: O07.1, D62, I10, F17.200, 10D17ZZ

Comments: (1) Code O07.1 is assigned as principal diagnosis as this is a complication of

a previous legal abortion. (2) Codes D62, I10, F17.200is assigned as additional
diagnosis. Chapter 15 “Complication of Pregnancy” codes are no longer reported for the
hypertension and tobacco abuse for the subsequent admission due to complication of
legal abortion when the patient is no longer pregnant.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2013 Revised Edition, pp.
342-343.

6. Patient was admitted with retained products of conception after a

spontaneous abortion at 12 weeks gestation. During suction curettage, an
abnormal piece of tissue was brought down that was not in scale with the
remaining tissue. Laparotomy showed uterine perforation. Repair was
performed as well as application of interceed adhesion barrier substance, to
decrease formation of adhesions.

Final diagnoses: (1) Retained products of conception, (2) uterine perforation

following spontaneous abortion, (3) suction curettage, (4) repair of uterus and
application of interceed adhesive barrier substance.

Assign the appropriate codes.

Codes: O03.34, 10D17ZZ, 0UQ90ZZ, 3E0P05Z

Comments: (1) Code O03.34 includes perforation of the uterus following spontaneous
abortion.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2013 Revised Edition, pp.
343-344.
7. ER note: pelvic pain, positive Beta HCG, and positive Chandelier’s sign with
vaginal bleeding. Diagnosis consistent with ectopic pregnancy. Patient was
admitted and agreed to proceed with left salpingectomy and removal of tubal
pregnancy. Two additional cystic lesions made up a large part of the ovary.
When they were excised, the small segment of the remaining left ovary was
judged to be unsuitable due to endometriosis, so a left oophorectomy was
performed en toto.

Final diagnoses: (1) Ruptured left tubal ectopic pregnancy, (2) left ovarian
follicular cysts, (3) Left ovarian endometriosis, (4) laparoscopic removal of left
tubal pregnancy and left ovary cystectomy was performed.

Assign the appropriate codes.

Codes: O00.102, N83.02, N80.102, 10T24ZZ, 0UT64ZZ, 0UT14ZZ,

Comments: (1) The cyst and endometriosis are not reported with Chapter 15 codes since
these conditions are not complications of a viable pregnancy. (2) Codes 10T24ZZ and
0UT64ZZ are assigned for the removal of tubal pregnancy with total removal of the tube.
(3) Code 0UT14ZZ is assigned for removal of the left ovary due to cysts and
endometriosis.
Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2013 Revised Edition, pp.
349-350.

8. A pregnant patient at 18 weeks’ gestation presents for elective termination

of pregnancy due to fetal anomalies. Potassium chloride (KCl) was
injected into the fetal heart with cessation of fetal cardiac activity. A
laminaria was then placed and followed by Pitocin in the peripheral vein,
percutaneous approach. The fetus was expelled spontaneously without
complication.

Final diagnosis: Elective abortion due to fetal anomalies.

Assign the appropriate codes.

Codes: Z33.2, 035.9XX0, 10A07ZX, 10A07ZW, 3E033VJ

Comments: (1) Code Z33.2 is assigned as the principal diagnosis since the patient
presented for a legally induced abortion due to known or suspected fetal abnormalities.
(2) Since an abortifacient and laminaria were both used, codes 10A03ZZ and 10A07ZW
are assigned. Code 3E033VJ describes the Pitocin induction .

9. A patient diagnosed with blighted ovum underwent vacuum dilation and

curettage (D&C). During the surgery, a curette was placed into the uterine
cavity, and suction was applied to remove the tissue/products of
conception.

Final diagnosis and procedure: (1) Blighted ovum, (2) vacuum dilation and
curettage (D&C).
 Assign the appropriate codes.

Codes: O02.0, 10D07Z6

Comments: (1) Codes in category Z3A, Weeks of gestation, are not applicable for
pregnancy with abortive outcome (categories O00–O08), elective termination of
pregnancy (code Z33.32), nor for postpartum conditions.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2017 Revised Edition,

pp. 353–354.

Chapter 25:

1. Codes for congenital anomalies may only be used on newborn records.

True or False?

2. When the type of congenital anomaly is specified, but no specific code is

provided, what should the coder do?
A. Assign the code for other specified anomaly of that type and site.
B. Assign additional codes for manifestations of the anomaly.
C. Query the physician for instructions.
D. A and B

3. When may congenital conditions be reported for newborns?

A. Only if they meet the definition of principal diagnosis
B. Only if they are treated or evaluated during the current episode of care
C. If they have future health care implications
D. If they were initially diagnosed during the current episode of care

4. Conditions due to birth injury are classified as:

A. Congenital anomalies
B. Perinatal conditions
C. Accidents
D. Malformation anomalies

5. Which of the following conditions refers to incomplete formation of the

pulmonary valve, which obstructs the flow of blood through the leaflets and
into the lungs?
A. Pulmonary arteriovenous malformation
 B. Pulmonary artery atresia
C. Pulmonary artery coarctation
D. Pulmonary artery stenosis

6. A three-week-old infant is admitted with projectile vomiting and dehydration.

The vomiting is due to pyloric stenosis. A pyloromyotomy is performed for
pyloric stenosis.

Final diagnoses: (1) Pyloric stenosis, (2) dehydration, (3) pyloromyotomy.

Assign the appropriate codes.

Codes: Q40.0, P74.1, 0D870ZZ (root operation division)

Comments: (1) Code Q40.0 is assigned for congenital hypertrophic pyloric stenosis. (2)
Code P74.1 is assigned to identify dehydration of newborn. (3) Pyloromyotomy is
classified to the root operation “Division” and body part “stomach, pylorus.” The objective
of the root operation is to expand the opening.

7. A newborn infant was found to be affected by noxious substance from the

mother’s use of opiates. The infant was born via C-section and was noted to
experience withdrawal symptoms immediately after delivery. The mother
admitted to use of opiates.

Final diagnoses: (1) Newborn affected by mother’s use of opiates with

withdrawal symptoms.
Assign the appropriate codes.

Codes: Z38.01, P96.1, P04.14

Comments: (1) Z38.01 (newborn born in hospital via C-section is the first listed diagnosis
as the patient was born during this admission. P96.1 would show the withdrawal
symptoms and P04.14 would use the infant affected by maternal use of opiates. P96.1
would be sequenced before P04.14.

Reference: Coding Clinic 4th Quarter, 2018, page 24.

8. A 10-day-old male infant was admitted at hospital A for difficulty breathing

and poor feeding. He was diagnosed with coarctation of the transverse aorta
and congestive heart failure secondary to congenital heart disease (smallish
left ventricle and ventricular septal defect).
 Final diagnoses: (1) Coarctation of aorta, (2) neonatal congenital congestive
heart failure with ventricular septal defect.

Assign the appropriate codes.

Codes: Q25.1, Q21.0, P29.0

Comment: Code I50.9 is not appropriate for the congestive heart failure since this is a
neonatal heart failure. P29.0 is now coded separately as there is an excludes 2 note
which allows these codes to be coded together.

9. A 2-year-old child was admitted with a patent ductus arteriosus and

underwent a right and left cardiac catheterization with left coil occlusion of a
patent ductus arteriosus in the cardiac catheterization lab.

Assign the appropriate codes.

Codes: Q25.0, 02LR3DT, 4A023N8

11. A newborn had an uncomplicated spontaneous vaginal delivery. The provider

noted a flammeus nevus in the sacral area on the newborn physical and
progress record for the birth admission.

Final diagnosis: Normal newborn, flammeus sacral nevus

Assign the appropriate codes.

Codes: Z38.00, Q82.5

Comment: It is appropriate to code the sacral nevus because it is a congenital anomaly

present at birth. Congenital anomalies are coded, when identified by the provider,
because they can have implications for further evaluation.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting, p. 64.

12. The patient is a ten-year-old girl with severe juvenile scoliosis of the
thoracic spine and status post placement of growing rods. The proximal
hooks have become dislodged, and she is admitted for removal and
replacement of growing rods and proximal hooks. During surgery, the
entire growth rod was removed, and a new device was placed. A pedicle
hook was placed in the fusion mass on the left, and then a down-going
laminar hook was placed around the fusion mass. At the T3 level on the
right, a claw construct with an up-going pedicle hook and a down-going
laminar hook was placed. The rods were then cut and contoured, and
replaced first on the left. The same procedure was repeated on the right.
Intraoperative neuromonitoring was also done during surgery.
 Final diagnosis and procedures: (1) Juvenile scoliosis, (2) dislodged
proximal growing rods, (3) removal and replacement of growing rods.

Assign the appropriate codes.

Codes: T84.328A, M41.114, 0PS404Z, 0PP404Z, 4A1134G

Comments: The complication code would be assigned first as reason for visit with
M41.114 identifying the thoracic level Juvenile Scoliosis. (1) At surgery, the old hooks and
rods were removed, and new ones were placed. The root operation “Insertion” is not
appropriate since the intent of the procedure is to reposition the spine to a suitable
location. Therefore, the root operation Reposition is used. (2) “Removal” is the correct
root operation for removal of the old rods (3) Intraoperative monitoring of the nervous
system during surgery provides recordings and critical detail, which assists the surgeon in
preventing neural insults. The monitoring code includes both motor and sensory
monitoring.
Reference: Coding Clinic, 1st Quarter 2020.

13. A 13-year-old female with adolescent idiopathic scoliosis of the thoracic

spine is admitted for correction of spinal curvature via anterior vertebral
tethering. Endoscopic instrumentation was then placed and incisions
made over every other rib. Right sided vertebral screws were placed
sequentially from T4 – T9 and the tethering cord attached to each screw.
Left sided vertebral screws were placed sequentially from T10 – L3. The
tethering cord was attached to each screw. The cords were tightened until
adequate correction was achieved.

Assign the appropriate ICD-10-PCS Codes.

Codes:_M41.124,_0PS443Z, 0QS043Z

Comments: M41.124 appropriate describes adolescent idiopathic scoliosis of the

thoracic spine. The objective of the procedure is to “reposition” the spine. Therefore, the
root operation would be assigned. Two codes are assigned as the tethering was done on
the thoracic as well as the lumbar spine.

14. A baby with transposition of the great arteries and pulmonary stenosis
presents for right modified Blalock-Taussig shunt procedure to augment
pulmonary blood flow. At surgery, the aorta and pulmonary artery were
separated, and the branch pulmonary arteries were mobilized. The
innominate artery was mobilized, an arteriotomy was made, and the
proximal anastomosis was created with a Gore-Tex graft. A longitudinal
arteriotomy was performed, and the distal anastomosis of the shunt was
created to the right pulmonary artery using Prolene suture.

Final diagnosis and procedures: (1) Transposition of the great arteries, (2)
pulmonary stenosis, (3) modified Blalock-Taussig shunt.
 Assign the appropriate codes.

Codes: Q20.3, Q25.6, 021Q0JA

Comment: Modified Blalock-Taussig shunt involves creation of a “bypass” from the
innominate artery to the pulmonary artery with a synthetic type of tissue substitute. In this
procedure, the surgeon reroutes the blood flow by placing a graft (usually Gore-Tex) from
the innominate or subclavian artery to the pulmonary trunk or to the right or left
pulmonary artery.

Reference: Coding Clinic, Fourth Quarter 2016.

15. A four-month-old boy with Tetralogy of Fallot was admitted for surgical
repair. At surgery, cardiopulmonary bypass was established; the
ligamentum was ligated; the thymus was resected; the right ventricle
outflow tract (RVOT) was divided and widened; and closure of VSD was
done with a Gore-Tex patch.

Final diagnosis: Tetralogy of Fallot.

Assign the appropriate codes.

Codes: Q21.3, 02NK0ZZ, 02UM0JZ, 07TM0ZZ, 5A1221Z

Comments: (1) No separate diagnosis code is assigned for the obstruction of the right
ventricular outflow tract muscle bundles, since the obstruction is a component of the
Tetralogy of Fallot. (2) The ICD-10-PCS code assignments for the surgery to correct
Tetralogy of Fallot may be different for each case, since the repair can be performed at
various stages. (3) ICD-10-PCS codes are assigned based on what is being done during
each surgical episode.

Reference: Coding Clinic, Third Quarter 2014, pp. 16–17.

Chapter 26:

1. The perinatal period is defined as:

A. Birth through the first 28 days after birth
B. The first month of life
C. The first 3 months of life
D. Birth through discharge from the hospital

2. When a newborn has a condition and the documentation does not specify
whether the condition is due to the birth process or acquired, what should the
default code be?
A. The code for the acquired condition.
B. The code for the condition due to the birth process.
 C. The unspecified code.
D. There is no default; the condition should not be coded.

3. Up to what age can the codes from chapter 16, Conditions originating in the
perinatal period, be assigned?
A. Through the perinatal period.
B. Up to one year of age.
C. There is no age limit, if the condition is still present.
D. Up to the patient’s reaching adulthood.

4. Codes from category Z38, Liveborn infants according to place of birth and
type of delivery, may be assigned:
A. On the mother’s record
B. On the newborn record for the episode in which the birth occurred
C. On the newborn record, including when the newborn is discharged and
readmitted or transferred to another facility
D. All of the above

5. When is a newborn condition considered to be clinically significant, and

therefore reportable?
A. When it is documented in the record
B. When it is treated or evaluated
C. When it has implications for the newborn’s future health care
D. B and C

6. A 13-day-old infant presents for weight recheck and feeding problems. What
are the appropriate codes?
A. Z00.111
B. Z00.111, P92.9
C. Z00.121, P92.9
D. Z00.70

7. A 20-day-old girl was admitted with severe congestive heart failure. She had
experienced worsening dyspnea with a respiratory rate of 60 bpm. Clinical
examination revealed a low volume pulse with a delayed peak at a rate of
150 bpm and blood pressure of 80/50 mmHg. The child was treated with
dopamine, digoxin, furosemide, spironolactone, and acenocoumarol, and her
condition improved.

Final diagnosis: Congestive heart failure.

 Assign the appropriate codes.

Code: P29.0

Comments: Code P29.0 identifies the condition, congestive heart failure, occurring
during the perinatal period. Code I50.9 is not appropriate because of the excludes1 note,
which excludes neonatal heart failure.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2014 Revised Edition, p.

368.

8. Full-term newborn born in hospital during this admission is now one day old.
She had a seizure that was determined to be secondary to intrauterine
hypoxia and birth asphyxia. The baby expires two days after delivery.

Final diagnoses: (1) Seizures, (2) Severe hypoxic ischemic encephalopathy

due to severe birth asphyxia.

Assign the appropriate codes.

Codes: Z38.00, P90, P91.63

Comments: (1) Code P90 is assigned for the seizures. (2) Code P84 is not assigned for
severe birth asphyxia as there is an excludes 1 note with P91.63. P91.63 describes the
severe hypoxic ischemic encephalopathy.

9. An infant is admitted with apnea eight weeks following birth. The pediatrician
states that the apnea is a birth-related condition.
Assign the appropriate codes.

Code: P28.4

10. Physicians will often document twins as fetus A and fetus B. The fetal
extensions in chapter 15, Pregnancy, childbirth and the puerperium, for codes
related to complications of multiple gestation (e.g., O31, O32, etc.) refer to
fetus 1, fetus 2, and so on. For the purposes of selecting the seventh
character for these codes, it is appropriate to assume that fetus A is fetus 1
and B is 2, etc.
True or False?
11. A 20-day-old infant who was healthy at birth, without any respiratory
problems, presents to the emergency department with fever, coughing, and
 rapid breathing. The provider documented respiratory syncytial virus (RSV)
bronchiolitis in his final diagnostic statement.

Final diagnosis: RSV bronchiolitis

Assign the appropriate code.

Code: J21.0

Comment: RSV bronchiolitis is a community-acquired infection.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting, p. 61.

Chapter 27:
1. When the diagnostic statement includes more than one condition affecting the mitral
valves, one of which is presumed to be rheumatic, all are classified as rheumatic.
True or False?

2. A diagnosis of heart failure in a patient who has rheumatic heart disease is classified
as I09.81, Rheumatic heart failure, unless the physician specifies a different cause.
True or False?

3. Which of the following terms does NOT refer to ischemic heart disease?
A. Arteriosclerotic heart disease
B. Coronary artery disease
C. Rheumatic heart disease
D. Coronary atherosclerosis

4. What is the time frame for when an acute myocardial infarction may be classified to
category I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial
infarction?
A. 4 weeks or less.
B. 8 weeks or less.
C. 10 weeks or less.
D. There is no time frame.

5. When the diagnostic statement includes both hypertension and chronic kidney
disease or renal sclerosis, what does ICD-10-CM assume?
A. That the hypertension and chronic kidney disease are two separate unrelated
conditions
B. That the hypertension is due to acute kidney failure
C. That there is a cause and effect relationship
D. That the chronic kidney disease is irreversible
6. Match the following ICD-10-PCS root operations or root types to the procedures
below:
A. Extirpation
B. Measurement
C. Insertion
D. Revision
E. Dilation
F. Introduction
i. Percutaneous transluminar coronary angioplasty E
ii. Cardiac catheterization B
iii. Common carotid artery atherectomy A
iv. Implantation of pacemaker C
v. Relocation of cardiac device pocket D
vi. Administration of thrombolytic agent F

7. What are the correct ICD-10-PCS procedure codes for the insertion of a dual
chamber pacemaker, open approach, with the pulse generator inserted into a chest
pocket and percutaneous insertion of electrodes into the right ventricle and right
atrium?
A. 0JH604Z, 02H63JZ, 02HK3JZ
B. 0JH606Z
C. 0JH606Z, 02H63JZ, 02HK3JZ
D. 0JH639Z, 02H63JZ, 02HK3JZ

8. An 81-year-old female with past history of transient ischemic attack (TIA) and
hypertension was admitted with headache and onset of neurological problems. The
patient had difficulty finding words to communicate and was only able to understand
words minimally. Because the symptoms appeared close to the time of arrival at the
Emergency Department, tissue plasminogen activator (tPA) was administered
intravenously via a peripheral vein immediately to abort an impending stroke.

Final diagnoses: (1) Aborted cerebral infarction of the left middle cerebral artery,

(2) hyperlipedemia, (3) hypertension, (4) history of TIA, (5) administration of tPA.

Assign the appropriate codes.

Codes: I63.512, E78.5, I10, Z86.73, 3E03317

Comments: (1) Although the stroke is described as an aborted stroke, the patient was
admitted with symptoms. The code for the stroke is assigned even though tPA was
 administered. Code I63.512 specifies the location of the stroke as the left middle cerebral
artery. (2) Code 3E03317 is assigned for the tPA administration.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2014 Revised Edition, pp.
394-396.

9. Patient was admitted with ST-segment elevation myocardial infarction (MI). Right
cardiac catheterization showed occlusion of the second diagonal branch between the
two prior placed stents. The patient was taken to surgery for a percutaneous
transluminal coronary angioplasty (PTCA) of the occluded vessel, with placement of
two additional stents and integrilin intravenous drip and Plavix. There is significant
history of hypertension, coronary artery disease (CAD), and PTCA with placement of
stent, but no history of coronary artery bypass graft (CABG).

Final diagnoses: (1) Acute anterior wall MI involving the diagonal coronary artery due
to CAD, (2) hypertension,

(3) angioplasty and stenting of diagonal branch, (4) previous PTCA with stent.

Assign the appropriate codes.

Codes: I21.02, I25.10, I10, Z95.5, 02703EZ, 3E033PZ, 4A023N6

Comments: (1) Code I21.02 is assigned for an acute myocardial infarction of the anterior
wall. (2) Code I25.10 is used for CAD of the native artery since there is documentation
that the patient has not had a CABG. (3) Codes 02703EZ indicate a coronary angioplasty
performed on one vessel with insertion of non-drug eluting stents. ICD-10-PCS does not
provide detail on the number of stents inserted, unless there are different stents (for
example, one drug-eluting and one non-drug-eluting).

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2014 Revised Edition, pp.
382-384, 417-418.

10. Inpatient Operative Report

Pre-Op Diagnosis: Coronary artery disease

Post-Op Diagnosis: Same.
 Procedure: Percutaneous transluminal coronary angioplasty (PTCA) of the left
anterior descending (LAD) with coronary angiogram.

Procedure in Detail: The patient was prepped and draped in the usual fashion. The left
femoral artery was chosen because of recent cardiac catheterization from the right side
with use of VasoSeal. A 7 French sheath was placed in the left femoral artery and 6
French in the left femoral vein over the wire with Seldinger technique.
A diagnostic left coronary angiogram with high osmolar contrast was performed, using a
6 French JL4 catheter, which was advanced over a wire to the left coronary ostium. It
revealed no change in the mid-LAD lesion. A 7 French short-tip JL4 guide without side
holes was then advanced to the left coronary ostium over the wire, after the regular-tip
JL4 could not engage the left coronary ostium satisfactorily. A 0.014-inch Patriot wire
with a Ranger 2.5 × 20-mm balloon was advanced as a unit in the guide. Heparin 10,000
units was given IV. Activated coagulation time before the procedure was 350 seconds.
The wire was advanced across the lesion without difficulty, and initial PTCA was
accomplished with a 2.5-mm Ranger balloon inflated to four atmospheres for 25 seconds
and then six atmospheres for 60 seconds. Angiogram after this revealed residual lesion.
Therefore, a decision was made to proceed with stenting. A 2.5 × 16-mm drug eluting
stent was advanced across the lesion and deployed at 11 atmospheres. A poststent
angiogram revealed a 0% residual lesion, no evidence of dissection visible, TIMI-III flow,
and the closing ACT was 335 seconds. There were no complications.
Assign the appropriate codes.

Answer:

PTCA:

I25.10 Coronary Artery Disease

027034Z PTCA w DES
B2050ZZ Coronary angiogram

Rationale:
Documentation indicates coronary angioplasty with drug eluting stent was performed on the left
anterior descending artery. This would be coded to the root operation dilation and body part 4 th
character 0 for 1 artery, percutaneous approach (3) and device intraluminal w DES (4) and no
qualifier. An angiogram was performed. However, no mention of fluoroscopy. Therefore, plain
radiograph was selected with other contrast.

11. A patient who suffered a type 1 non-ST-segment elevation myocardial

infarction (NSTEMI) is readmitted. The provider diagnosed the patient with
a new type 2 acute myocardial infarction, which occurred within 4 weeks
of his previous type 1 NSTEMI.

Final diagnosis: (1) Acute type 2 myocardial infarction, (2) Old NSTEMI
 Assign the appropriate code.

Code: I21.A1

Comment: According to the ICD-10-CM Official Guidelines for Coding and Reporting, “Do
not assign code I22 for subsequent myocardial infarctions other than type 1 or
unspecified. For subsequent type 2 AMI assign only code I21.A1.” The “Excludes1” note
under category I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI)
myocardial infarction, makes the point that a subsequent type 2 MI is assigned code
I21.A1, not code I22.

12. The patient presented with headache, elevated blood pressure readings of 240/160,
and blurred vision. While being examined in the ED, the patient had 3 separate tonic
seizures. The patient’s medical history is significant for epilepsy, hypertension, end-
stage kidney disease, and status post kidney transplant. History also shows that the
transplanted kidney failed and a nephrectomy had previously been performed to
remove the transplanted kidney. CT and MRI evaluation ruled out bleeding.
Antihypertensive drips started for control of elevated blood pressures and seizures
resolved with ativan; epilepsy medications were titrated due to hypertension.
Seizures were felt to be secondary to malignant hypertensive emergency.

Final diagnoses: (1) Seizures secondary to malignant hypertensive emergency, (2)

epilepsy, (3) end-stage kidney disease, (4) dialysis maintenance, (5) CT head, (6)
MRI brain.

Assign the appropriate codes.

Codes: I16.1, I12.0, N18.6, G40.409, Z99.2, Z98.85, BW28ZZZ, B030ZZZ

Comments: (1) Code I16.1 would be used for the hypertensive urgency and I12.0 is
assigned for hypertension with end-stage kidney disease. (2) Code N18.6 is assigned to
specify the end-stage kidney disease. (3) Code Z98.85 shows status post removal of the
transplanted organ due to complication.

Reference: ICD-10-CM and ICD-10-PCS Coding Handbook, 2014 Revised Edition, p.

400.
13. A 59-year-old male patient was admitted to the hospital due to an acute ST
elevation transmural myocardial infarction of the anterior wall. A week after
admission, while the patient was still in the hospital, the patient suffered another
acute myocardial infarction (AMI); but this time, the event was determined to be a
transmural infarction of the inferior wall.

Final diagnoses: (1) Acute transmural myocardial infarction of the anterior wall, (2)
transmural infarction of the inferior wall.

Assign the appropriate codes.

Codes: I21.09, I22.1

Comments: (1) Code I21.09 is assigned as the principal diagnosis, and code I22.1 is
assigned as a secondary diagnosis. (2) The sequencing of the I22 and I21 codes
depends on the circumstances of the encounter.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting, p. 46.

14. Codes in category G81 and subcategories G83.2 and G83.3 describe whether the
dominant or nondominant side is affected. When the left side is affected, the correct
default is dominant. True or False?

Reference: ICD-10-CM Official Guidelines for Coding and Reporting, p. 36.

15. A patient is admitted to the hospital for a planned carotid artery

endarterectomy. Diagnostic imaging had previously demonstrated right
carotid stenosis. Upon surgical exploration, no significant carotid artery
stenosis was found, and endarterectomy was not performed.

Final diagnosis and procedure: (1) Carotid artery stenosis, (2) procedure
not carried out due to contraindication, (3) inspection of carotid artery.

Assign the appropriate codes.

Codes: I65.21, Z53.09, 03JY0ZZ

 Comments: (1) The planned surgery was discontinued, so inspection of the carotid artery
is the only procedure performed. (2) Although the physician described the carotid artery
stenosis as insignificant, the condition is still present.

Reference: Coding Clinic, First Quarter 2015, p. 29.

16. A patient is admitted for treatment of an acute cerebral infarction. The final
diagnostic statement listed “Acute cerebral infarction involving the right
hemisphere with left-sided (nondominant) weakness.”

Final diagnoses: (1) Acute cerebral infarction, right hemisphere, (2)

nondominant left-sided weakness.

Assign the appropriate codes.

Codes: I63.9, G81.94

Comments: (1) When unilateral weakness is clearly documented as being associated

with a stroke, it is considered synonymous with hemiparesis/hemiplegia. (2) Unilateral
weakness outside of this clear association cannot be assumed to be
hemiparesis/hemiplegia, unless it is associated with some other brain disorder or injury.

References: ICD-10-CM and ICD-10-PCS Coding Handbook, 2017Revised Edition, p.

401; and Coding Clinic, First Quarter 2015, p. 25.

17. The patient presents with a clotted left femoral popliteal artery bypass
graft of the left leg. Percutaneous mechanical thrombectomy is performed
on the left femoral vein to re-establish blood flow.

Final diagnosis and procedure: (1) Clotted femoropopliteal bypass graft,

(2) thrombectomy fem-pop bypass graft.

Assign the appropriate codes.

Codes: T82.868A, 182.412, 04CL3ZZ

Comments: (1) “Extirpation” is the correct root operation for the thrombectomy of the fem-
pop bypass graft. (2) Extirpation is defined as “taking or cutting out solid matter from a
body part.” (3) The solid matter may be an abnormal byproduct of a biological function or
a foreign body; it may be embedded in a body part or in the lumen of a tubular body part.

Reference: Coding Clinic, First Quarter 2015, p. 36.

18. A patient, status post coronary artery bypass graft (CABG), is admitted
due to significant in-stent restenosis due to progression of disease in a
previously placed stent in the autologous saphenous vein graft within the
distal anastomosis. A percutaneous transluminal coronary angioplasty
(PTCA) was performed on the right coronary artery with deployment of a
single drug-eluting stent.
Final diagnosis and procedure: (1) In-stent restenosis of CABG, (2) PTCA
of previously placed stent in the saphenous vein graft.

Assign the appropriate codes.

Codes: T82.855A, I25.810 027034Z

Comments: (1) The saphenous vein is now functioning as a coronary artery. (2) The
current surgery was performed on what is now serving as a coronary artery; therefore,
the coronary artery is the site of the procedure, and the procedure is coded to the
appropriate coronary artery body-part value.

Reference: Coding Clinic, Second Quarter 2014, p. 4.