Chapter 4 Endocrine, Nutrition, Metabolic Quiz Questions and Answers

1.    What does the 4th character in diabetes mellitus codes indicate?

Correct answer: Any complication associated with diabetes.

2.    What is the default code for diabetes mellitus?

Correct answer: E11.9

3.    Patient with hyperthyroidism is admitted to the hospital for swelling in the neck, difficulty swallowing, and pain in the throat. An ultrasound reveals a uninodular goiter. What ICD-10-CM coding is reported?

Correct answer: E05.10

4.    Patient is admitted to hospital with palpitations, weight loss, bulging eyes, and extreme nervousness. The tests ordered come back positive with Graves’ disease. What ICD-10-CM coding is reported?

Correct answer: E05.00

5.    A patient is admitted for ketoacidosis and diabetic coma due to malignant neoplasm of the pancreatic body. The patient uses insulin routinely. What ICD-10-CM coding is reported?

Correct answer: C25.1, E08.11, Z79.4

6.    A patient is admitted to hospital with Type 1 diabetes with ketoacidosis in a comatose state. Treatment included saline hydration with insulin drip. After regaining consciousness, the patient reported that she was experiencing nausea and vomiting that morning and decided not to take her insulin, because she had not eaten. What ICD-10-CM coding is reported?

Correct answer: E10.11, T38.3X6A

7.    A patient admitted with amyloidosis being treated for glomerulonephritis. What ICD-10-CM coding is reported?

Correct answer: E85.4, N08

8.    Patient is admitted for a gastric bypass procedure for his morbid obesity. BMI is currently 48. What ICD-10-CM coding is reported?

Correct answer: E66.01, Z68.42

9.    While admitted to the hospital for an unrelated issue, a patient with type 2 diabetes is discovered to have diabetic macular edema and proliferative diabetic retinopathy in the right eye. What ICD-10-CM coding is reported for these secondary diagnoses?

Correct answer: E11.3511

10.A patient developed an ulcer on her upper back. She has diabetes and is on insulin. The provider documents the ulcer is due to the diabetes. She is admitted to the hospital for ulcer debridement and IV antibiotics. What ICD-10-CM coding is reported?

Correct answer: E11.622, L98.429, Z79.4

Question 1

Rationale: The 4^th character in diabetes mellitus codes indicates the complication associated with diabetes. For example, subcategory code E10.2 indicates a person that has renal (kidney) complications due to diabetes. 

Question 2

Rationale: ICD-10-CM guideline I.C.4.a.2 indicates when the type of diabetes mellitus is not documented the default is E11.-, Type 2 diabetes mellitus. 

Alphabetic Index for Diabetes, diabetic (mellitus) (sugar) > E11.9. Verify code selection in the Tabular List. 

Question 3

Rationale: In the ICD-10-CM Alphabetic Index look for Goiter > with > hyperthyroidism (See - Hyperthyroidism with goiter). The see note requires us to go to Hyperthyroidism > with > Goiter > Nodular > Uninodular > E05.10. Verify code selection in the Tabular List.

Question 4

Rationale:

Alphabetic Index: Disease > Graves > See - Hyperthyroidism with goiter (diffuse). The see note requires us to go to Hyperthyroidism > with > Goiter (diffuse) E05.00 - Verify code selection in the Tabular List. 

The palpitations, weight loss, bulging eyes, and extreme nervousness are symptoms of the Graves’ disease and not reported separately.  

Question 5

Rationale: The patient’s diabetes is due to the pancreatic cancer as an underlying condition. In the ICD-10-CM Alphabetic Index look for Diabetes, diabetic (mellitus) (sugar) > due to > underlying condition > with > ketoacidosis > with coma > E08.11. Confirm in the Tabular. In the Tabular List, under category code E08, an instructional note indicates to code the underlying condition first.  

In the Table of Neoplasms look for Neoplasm, neoplastic > Pancreas > Head and select the code from the Malignant Primary Column, which directs to C25.0. There is also coding guidance under category code E08 to use additional code for patients who routinely use insulin.  

Report code Z79.4. Refer to Alphabetic Index: Long-term (current) (prophylactic) drug therapy (use of) > Insulin > Z79.4. Verify the code in the Tabular List.

Question 6

Rationale: In the ICD-10-CM Alphabetic Index look for Diabetes, diabetic (mellitus) (sugar) > type 1 > with> ketoacidosis > with > coma > E10.11. Verify code selection in the Tabular List. 

R40.20 is a symptom code and would not be coded separately, as it is inherent to E10.11.

Underdosing: Table of Drugs and Chemicals > insulin > underusing column > T38.3X6- Verify code selection in the Tabular List and the final character A for initial encounter.

Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. Discontinuing the use of a prescribed medication on the patient's own initiative (not directed by the patient's provider) is also classified as an underdosing. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).

Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.

Question 7

Rationale:

Alphabetic Index look for Glomerulonephritis > in (due to) > amyloidosis > E85.4 [N08]. In the Alphabetic Index the brackets identify manifestation codes.

 In the Tabular List, code N08 has an instructional note to code first underlying disease, such as amyloidosis (E85.-).

The first listed or principal diagnosis is E85.4 for amyloidosis, followed by N08 for the manifested glomerulonephritis. Verify code selection in the Tabular List.

Question 8

Rationale:

Alphabetic Index look for Obesity > Morbid > E66.01.

In the Tabular List there is note under subcategory code E66 to use an additional code to identify the BMI (Z68.-).

The second code is Z68.42, indicating a BMI of 45.0-49.9 adult.

Alphabetic Index: Body, bodies > mass index (BMI) > Adult > 45.0-49.9 > Z68.42. Verify code selection in the Tabular List.

Question 9

Rationale: Alphabetic Index Diabetes, diabetic (mellitus) (sugar) > type2 > with > retinopathy > proliferative > with > macular edema > E11.351-. There is a dash next to the code in the Alphabetic Index as a reminder to check the Tabular List for the 7^th character to show laterality.

From the Tabular List, assign 7^th character 1 to identify the right eye.

Question 10

Rationale: Alphabetic Index: Diabetes, diabetic (mellitus) (sugar) > with > skin ulcer NEC > E11.622.

The Tabular List E11.622 has a note to use an additional code to identify the site of the ulcer.

Alphabetic Index: Ulcer > Back > L98.429. The severity of the ulcer is not provided.

Also look for Long-term (current) (prophylactic) drug therapy (use of) > Insulin > Z79.4. Verify code selections in the Tabular List.

ICD-10-CM guideline I.C.4.a.2 indicates if the type of diabetes is not documented in the medical record, the default type is 2.

ICD-10-CM guideline I.C.4.a.3 indicates the use of insulin does not mean that a patient is a type 1 diabetic. If the documentation indicates that the patient uses insulin but does not indicate the type of diabetes, you report type 2. For type 2 patients, code Z79.4 is reported to indicate long-term use of insulin. The ulcer is due to the diabetes.