Questions and Answers to ICD-10-CM Chapter 1 Quiz - Coding for Infectious and Parasitic Diseases

1.   QUESTION 1

Patient with AIDS admitted for surgical treatment of Cholelithiasis and Acute Cholecystitis. What are the 2 diagnosis codes assigned?

K80.50

K80.00

Z21

B20

R75

I10

D62

2.   QUESTION 2

Patent admitted with a diagnosis of AIDS and candidal esophagitis due to the AIDS. What are the 2 diagnosis codes assigned?

B37.81

B20

I11.0

Z21

3.   QUESTION 3

Hemolytic uremic syndrome due to HIV Disease. What are the 2 diagnosis codes assigned?

Z21

B20

D59.31

I10

A41.9

4.   QUESTION 4

 When a patient is admitted due to hemolytic uremic syndrome due to HIV Disease, what is the principal diagnosis?

B37.1

B20

D59.31

I10

5.   QUESTION 5

What is the ICD-10-CM code for Inconclusive HIV Test?

B37.1

B20

I11.0

R75

Z20.6

6.   QUESTION 6

Patient presents for a convulsion due to previous viral encephalitis (1 year ago). What are the 2 diagnosis codes assigned?

B94.2

R56.9

B94.8

B94.1

R56.00

7.   QUESTION 7

When a patient is admitted for a convulsion due to previous viral encephalitis (1 year ago), what would be the principal diagnosis?

B94.2

R56.9

B94.8

B94.1

R56.00

8.   QUESTION 8

Gonococcal cystitis

A43.09

A54.01

N30.20

N30.80

9.   QUESTION 9

Scarlet Fever

A77.0

A38.9

A93.1

R50.9

10. QUESTION 10

Pneumonia due to schistosomiasis

J12.0

J16.0

B65.9

J17

J18.9

11. QUESTION 11

 When a patient is admitted for pneumonia due to schistosomiasis, what code would be the principal diagnosis?

J12.0

J16.0

B65.9

J17

J18.9

12. QUESTION 12

The provider documents "urosepsis" only. What code(s) are assigned?

N39.0

A41.9

No code is assigned, a query is needed to clarify the condition.

A48.0

A41.9 and N39.0

13. QUESTION 13

Patient is admitted to the hospital with streptococcal group B severe sepsis, pneumonia unspecified, and acute renal failure. What ICD-10-CM coding is reported?

A41.9

A40.1

J18.9

N17.9

R65.20

R65.21

N17.5

A40.9

14. QUESTION 14

Patient is admitted to the hospital with streptococcal group B severe sepsis, pneumonia unspecified, and acute renal failure. What is the principal diagnosis?

A41.9

A40.1

J18.9

N17.9

R65.20

R65.21

15. QUESTION 15

A confirmed HIV positive patient. What ICD-10-CM code(s) are reported?

R75

B20

Z21

Z71.7

16. QUESTION 16

Patient is a known carrier of MRSA per the documentation. She is now admitted with MRSA pneumonia. What are the ICD-10-CM diagnosis codes assigned?

Z22.322

Z16.11

J15.212

B95.62

17. QUESTION 17

A 28-year-old status post-surgery, lower right leg amputation (four days postoperatively) and developed a postoperative deep incisional wound infection. The patient quickly deteriorated and became septic and went into postprocedural septic shock. The provider’s final diagnostic statement documented staphylococcal sepsis with septic shock due to a postprocedural infection. With aggressive intravenous antibiotic management, the patient improved. What 4 ICD-10-CM codes are reported?

A41.2

R65.20

T81.44XA

T81.42XA

T81.12XA

R65.21

18. QUESTION 18

A 28-year-old status post-surgery, lower right leg amputation (four days postoperatively) and developed a postoperative deep incisional wound infection. The patient quickly deteriorated and became septic and went into postprocedural septic shock. The provider’s final diagnostic statement documented staphylococcal sepsis with septic shock due to a postprocedural infection. With aggressive intravenous antibiotic management, the patient improved. What is the principal diagnosis?

A41.2

R65.20

T81.44XA

T81.42XA

T81.12XA

R65.21

19. QUESTION 19

An HIV positive patient was admitted with skin lesions on the chest and back. Biopsies were taken, and the pathologic diagnosis was HIV-related Kaposi’s sarcoma. During the admission he was also treated and evaluated for hypertension, hyperlipidemia, diabetes mellitus type 1 controlled. Discharge Diagnoses: 1) Kaposi’s sarcoma, back and chest. 2) HIV Disease 3) Hypertension continue lisinopril 4) Hyperlipidemia continue statin therapy 5) DM type I treated and controlled with insulin. Will be discharged on home dosage of insulin. What are the 6 diagnosis codes reported?

C46.0

I11.0

E10.9

E78.5

B20

E86.1

I10

Z79.4

C46.9

20. QUESTION 20

An HIV positive patient was admitted with skin lesions on the chest and back. Biopsies were taken, and the pathologic diagnosis was HIV-related Kaposi’s sarcoma. During the admission he was also treated and evaluated for hypertension, hyperlipidemia, diabetes mellitus type 1 controlled. Discharge Diagnoses: 1) Kaposi’s sarcoma, back and chest due to HIV Disease. 2) HIV Disease 3) Hypertension continue lisinopril 4) Hyperlipidemia continue statin therapy 5) DM type I treated and controlled with insulin. Will be discharged on home dosage of insulin. What is the principal diagnosis report?

C46.0

I11.0

E10.9

E78.5

B20

E86.1

Z79.4

Z79.4

21. QUESTION 21

A patient presents to the ED with a high fever for 3 days, AMS, and gross hematuria. She has a diagnosis of HTN but hypotensive in the ED. Held lisinopril. Treated with IV fluids, antibiotics. Discharge Diagnoses: 1) Admitted for urinary tract infection due to pseudomonas aeruginosa, resistant to fluoroquinolones. 2) Gross hematuria, likely due to infection, resolved. Cystocospy ruled out malignancy as source of bleed. 3) Hypotension, likely due to dehydration, resolved with IV fluids. 4) Hypertension, resume home meds 5) Metabolic encephalopathy due to infection. What are the 8 ICD-10-CM Codes?

B96.5

R31.0

I95.89

E86.9

G93.41

I13.0

I10

B96.4

N39.0

E86.0

Z16.23

Z16.30

Rationales for Answers to Chapter 1 Quiz

1. K80.00 would be the principal diagnosis since it is the reason for admission and unrelated to the AIDS. See Alphabetic Index for the combination code: Calculus > Gallbladder > with > cholecystitis > acute K80.00. B20 is the correct code assignment for a patient who has a diagnosis of AIDS.
2. B20 is the correct code for AIDS and would be the principal diagnosis per the chapter specific coding guideline indicating AIDS would be principal if it meets the definition of a principal diagnosis and the reason for the admission is an AIDS-related condition. B37.81 is an additional code for candidal esophagitis.
3. See Alphabetic Index: Syndrome > hemolytic-uremic > infection related = D59.31. In the Tabular List, there is a "use an additional code" note stating, "use additional code to identify the associated infection, such as... HIV Disease B20."
4. See Alphabetic Index: Syndrome > hemolytic-uremic > infection related = D59.31. In the Tabular List, there is a "use an additional code" note stating, "use additional code to identify the associated infection, such as... HIV Disease B20." Also see the Chapter-specific Coding Guidelines when a patient is admitted for an HIV Related Condition; this is an exception to the rule.
5. In the alphabetic index, see HIV>Nonconclusive test = R75.
6. In this case, the convulsion is considered a sequela of the previous viral encephalitis. The correct coding is R56.9 for convulsion and a secondary diagnosis of B94.1 (Sequela of viral encephalitis). Look in the alphabetic index under Sequala > Viral > Encephalitis B94.1. In the tabular, we see an instructional note at B90 to B94 (Code First condition resulting from Sequela the infectious or parasitic disease).
7. In this case, the convulsion is considered a sequela of the previous viral encephalitis. The correct coding is R56.9 for convulsion and a secondary diagnosis of B94.1 (Sequela of viral encephalitis). Look in the alphabetic index under Sequala > Viral > Encephalitis B94.1. In the tabular, we see an instructional note at B90 to B94 "Code First condition resulting from (Sequela) the infectious or parasitic disease."
8. See alphabetic index, Cystitis > Gonococcal = A54.01; Cross reference the tabular.
9. See Alphabetic Index: Fever, Scarlet = A38.9; Cross reference the tabular.
10. 2 Codes are required to fully capture the condition. See Alphabetic Index: Pneumonia > in (due to) Schistosomiasis B65.9 [J17]. Confirm the codes in Tabular. See Alphabetic Index: Pneumonia > in (due to) Schistosomiasis B65.9 [J17]. Confirm the codes in Tabular.
11. See Alphabetic Index: Pneumonia > in (due to) > Schistosomiasis B65.9 [J17]. Confirm the codes in Tabular. The brackets around the [J17] indicate this a secondary code. In the tabular at J17, we see a "Code First" note directing us to "code first" the underlying disease, such as schistosomiasis.  
12. Urosepsis is a nonspecific term that cannot be indexed in the Alphabetic Index. Per Chapter 1 Coding Guidelines, "The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification."
13. If the reason for admission is sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first (in this case A40.1) and the code for the localized infection should be assigned as a secondary diagnosis (in this case unspecified PNA). If the patient has severe sepsis, a code from subcategory R65.2 should also be assigned as a secondary diagnosis (in this case R65.20). The patient also has acute renal failure, which is coded to N17.9.
14. If the reason for admission is sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first (in this case A40.1).
15. See Alphabetic Index: HIV > Positive, Seropositive = Z21. Cross reference in tabular.
16. See Alphabetic Index: Carrier > Staphylococci > Methicillin Resistant Z22.322. See Alphabetic Index: Pneumonia > Staphylococcal > Methicillin Resistant (MRSA) J15.212. Per Chapter 1 Coding Guidelines, "If a patient is documented as having both MRSA colonization and infection during a hospital admission, code Z22.322, Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus, and a code for the MRSA infection may both be assigned."
17. For infections following a procedure, a code from T81.40, to T81.43 Infection following a procedure that identifies the site of the infection should be coded first, if known. Assign an additional code for sepsis following a procedure (T81.44). Use an additional code to identify the infectious agent (in this case A41.2). If a postprocedural infection has resulted in postprocedural septic shock, assign the codes indicated above for sepsis due to a postprocedural infection, followed by code T81.12-, Postprocedural septic shock. Do not assign code R65.21, Severe sepsis with septic shock. Additional code(s) should be assigned for any acute organ dysfunction. See Alphabetic Index: Infection > Postoperative Wound > Surgical Site > Deep Incisional=T81.42-- (Check Tabular: Will need an X Placeholder for the 6th character and A for the 7th Character since this is an initial encounter/active infection). See Alphabetic Index: Sepsis > Postprocedural = T81.44-- (Check Tabular: Will need an X Placeholder for the 6th character and A for the 7th Character since this is an initial encounter/active infection). See Alphabetic Index: Sepsis > Staphylococcal = A41.2. See Alphabetic Index: Shock > Postprocedural > Septic = T81.12-- (Check Tabular: Will need an X Placeholder for the 6th character and A for the 7th Character since this is an initial encounter/active infection).
18. Per Chapter 1 Guidelines, "For infections following a procedure, a code from T81.40, to T81.43 Infection following a procedure that identifies the site of the infection should be coded first."
19. See Alphabetic Index: Sarcoma > Kaposi's > Skin = C46.0, Cross Reference in Tabular. See Alphabetic Index: Disease > HIV = B20, Cross Reference in Tabular. See Alphabetic Index: Hypertension = I10 (There is no mention of heart or kidney disease). See Alphabetic Index: Hyperlipidemia = E78.5. See Alphabetic Index: Diabetes > Type 1 > E10.9, Cross Reference in Tabular. See Alphabetic Index: Long-Term Drug Therapy > Insulin > Z79.4 (patient was on home use of insulin as well, not just while in hospital).
20. If a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease followed by additional diagnosis codes for all reported HIV-related conditions. In the Tabular, there is a "Code First" note, stating Code first any HIV Disease (B20).
21. The principal diagnosis is UTI. See Alphabetic Index: Infection > Urinary Tract = N39.0. Cross reference the tabular that states, "Use an additional code (B95 to B97) to identify the infectious agent. See Alphabetic Index: Pseudomonas aeruginosa, as cause of disease classified elsewhere = B96.5; Cross reference the tabular. See Alphabetic Index: Resistance to > Organism to > drug > fluoroquinolones = Z16.3; Cross reference the tabular. See Alphabetic Index: Hematuria > Gross = R31.0; Cross reference the tabular...(sometimes there can be small amounts of visible blood in the urine with UTIs; however, since this was persistent gross hematuria, and there was an additional procedure done (cystoscopy) to rule out other sources of bleeding, the symptom code can be coded additionally and would not be integral to the UTI. See Alphabetic Index: Hypotension > Specified NEC = I95.89; Cross reference the tabular (since the underlying cause of the hypotension is suspected to be dehydration and documented as such at the time of discharge, this would code to Hypotension, specified, NEC; Cross reference the tabular. See Alphabetic Index: Dehydration = E86.0; Cross reference the tabular. See Alphabetic Index: Hypertension = I10 (There is no mention of heart or kidney disease). See Alphabetic Index: Encephalopathy > Metabolic = G93.41; Cross reference the tabular.