Clinical Coding Workout: Practice

Exercises for Skill Development

2024 Chapter

Exercise Answer Key

Part I

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 Beginning Coding Exercises

CHAPTER 1

Basic Principles of

ICD-10-CM and ICD-10-PCS Coding

Unless otherwise stated, code set answers given in chapter 1 are ICD-10-CM and ICD-10-PCS.

Characteristics and Conventions of the ICD-10-CM

Classification System
1.1. b. Parentheses

Rationale: According to guideline I.A.7 (CMS 2023a), Parentheses are used in both the

Alphabetic Index and Tabular List to enclose supplementary words that may be present or

absent in the statement of a disease or procedure without affecting the code number to

which it is assigned. The terms within the parentheses are referred to as nonessential

modifiers. Square brackets in ICD-10-CM are used to enclose synonyms, alternative

wordings, and explanatory phrases. Boxes and braces are not a defined convention of

ICD10-CM.

1.2. a. Manifestation code

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 Rationale: According to guidelines I.A.7 and I.A.13 (CMS 2023a), brackets are used in the

Alphabetic Index to identify manifestation codes. Certain conditions have both an

underlying etiology and multiple body system manifestations due to the underlying etiology.

For such conditions, ICD-10-CM has a coding convention that requires the underlying

condition to be sequenced first followed by the manifestation code. A CC exclusion is a

term related to the prospective payment system based on diagnosis-related groups

(MSDRGs), which use ICD-10-CM codes.

1.3. Uniform Hospital Discharge Data Set

1.4. b. Not included here

Rationale: An Excludes2 note means “Not included here”. It indicates that the condition

excluded is not part of the condition represented by the code, but a patient may have both

conditions at the same time. When an Excludes2 note appears under a code, it is

acceptable to use both the code and the excluded code together, when appropriate (CMS

2023a, I.A.12.b).

1.5. b. The appropriate Z code

Rationale: This is an official guideline in ICD-10-CM (CMS 2023a, I.C.2.e.2, IV.L). When the

primary reason for the admission is chemotherapy or radiation therapy, the appropriate Z

code is listed first and the diagnosis for which the service is being performed is assigned as

a secondary code.

1.6. c. Burn of the highest degree

Rationale: Guideline I.C.19.d.1 instructs that the coding professional should sequence first

the code that reflects the highest degree of burn when more than one burn is present.

Treatment and anatomic location are not factors in the sequencing of burn conditions (CMS

2023a).

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1.7. c. Both heart disease and chronic kidney disease.

Rationale: According to the guidelines in I.C.9.a, the classification presumes a causal

relationship between hypertension and heart involvement and between hypertension and

kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic

Index. These conditions should be coded as related even in the absence of provider

documentation explicitly linking them, unless the documentation clearly states the

conditions are unrelated. When hypertension and heart disease are both present, a code

from category I11, Hypertensive heart disease, is assigned (CMS 2023a, I.C.9.a.1). When

hypertension and chronic kidney disease are both present, a code from category I12,

Hypertensive chronic kidney disease, is assigned (CMS 2023a, I.C.9.a.2). When

hypertension and both heart and chronic kidney disease are present, a code from

category I13, Hypertensive heart and chronic kidney disease, is assigned (CMS 2023a,

I.C.9.a.2). Choice (a) is incorrect because chronic kidney disease can also be

automatically linked with hypertension. Choice (b) is incorrect because heart disease can

also be automatically linked with hypertension. Choice (d) is incorrect because

retinopathy is not linked to hypertension by the term “with” in the Alphabetic Index.

1.8. d. X

Rationale: The ICD-10-CM utilizes a placeholder character X. The X is used as

placeholder at certain codes to allow for future expansion. Additionally, certain categories

have applicable seventh characters. The seventh character is required for all codes within

the category or as the notes in the Tabular List instruct. If a code that requires a seventh

character is less than six characters long, a placeholder X must be used to fill in the

empty characters. Where a placeholder is required, the X must be used for the code to be

considered a valid code (CMS 2023a, I.A.4, I.A.5).

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be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or
otherwise without prior permission from the publisher.
1.9. October 1, 10/1, 10/01, the first of October

1.10. Acute

Rationale: According to guideline I.B.8, if the same condition is described as both acute

(subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same

indentation level, code both and sequence the acute (subacute) code first (CMS 2023a).

1.11. a. The nature and status (primary, secondary, in situ) for malignancies

Rationale: The neoplasm table included in the Alphabetic Index of ICD-10-CM provides

codes by anatomic site. The table includes benign, malignant, uncertain behavior, and

unspecified categories, and for malignancies only, provides a method to reflect primary,

secondary, or in situ status. Complication codes are not found in the neoplasm table. A

benign neoplasm is not reported according to stage because metastasis is not a

characteristic of that behavior. External cause codes for adverse reactions to

chemotherapy are found in the Table of Drugs and Chemicals.

1.12. d. Are always sequenced after an etiology code

Rationale: Guideline I.A.13 states that the underlying condition (etiology) of a given

manifestation code must be coded first, followed by the manifestation code. The same

guideline also specifies that in an etiology/manifestation code pair, the manifestation code

is placed in brackets (CMS 2023a).

1.13. c. 3

Rationale: Acute organ dysfunction must be documented as associated with sepsis in

order to assign a code for severe sepsis according to guideline I.C.1.d.1.a.iv (CMS

2023a). Since the acute respiratory failure is said to be “due to pneumococcal sepsis,”

severe sepsis is coded. Severe sepsis requires a minimum of two codes per guideline

I.C.1.d.1.b: a code for the underlying systemic infection, followed by a code for severe

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 sepsis (CMS 2023a). Therefore, the diagnosis of acute respiratory failure due to

pneumococcal sepsis would require a code for the Sepsis due to streptococcal

pneumoniae (A40.3), followed by severe sepsis (R65.2-), and finally the respiratory failure

(J96.00).

1.14. c. Either principal diagnosis or secondary diagnosis, depending upon the code and the

circumstances of the admission

Rationale: Z codes may be used as a first listed (principal diagnosis code in the inpatient setting)

or secondary code depending upon the code and the circumstances of the encounter

(CMS 2023a, I.C.21.a).

1.15. d. A diagnosis with an associated complication

Rationale: According to guideline I.B.9, a combination code can report a diagnosis with an

associated complication (CMS 2023a).

Infectious and Parasitic Diseases

1.16. A08.0

Rationale: The Alphabetic Index main term is Enteritis, subterm Rotavirus. The Tabular

List entry reads Rotaviral enteritis.

1.17. B01.9

Rationale: The Alphabetic Index main term is Chickenpox, with an instruction to see

Varicella. It is necessary to reference the main term indicated with a “see” note to locate

the correct code.

1.18. A54.24

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