Questions/Answers for ICD-10-CM Coding for Chapter 5 Quiz - Mental, Behavioral, and Neurodevelopmental Disorders

1.     When it is documented that the patient is both using tobacco and has a dependence on tobacco, how is this reported in ICD-10-CM?

Correct answer: The dependence on tobacco is the only code reported based on the hierarchy in the ICD-10-CM guidelines.

2.    What is the ICD-10-CM code for habitual abuser of cannabis?

Correct answer: F12.10

3.    Patient is admitted to the hospital for delirium, nausea, vomiting, and had seizure-like activity with hallucinations. After workup, the provider documents patient's symptoms are due to cocaine abuse, accidental overdose. and intoxication. What ICD-10-CM coding is reported?

Correct answer: T40.5X1A, F14.121

4.    A patient with confusion and memory loss is diagnosed with early onset of Alzheimer’s disease with dementia. What ICD-10-CM coding is reported?

Correct answer: G30.0, F02.80

5.    A patient comes in combative and confused. Patient is diagnosed with early onset of Alzheimer’s disease with dementia. What ICD-10-CM coding is reported?

Correct answer: G30.0, F02.811

6.    A patient with chronic back and neck pain developed a drug dependency on oxycodone (opioid). After being taken off the drug, he was admitted to the hospital for withdrawal symptoms. What ICD-10-CM coding is reported?

Correct answer: F11.23, T40.2X5A

7.    Patient admitted for convulsions due to alcohol abuse with intoxication. What ICD-10-CM coding is reported?

Correct answer: R56.9, F10.129

8.    A patient is diagnosis with severe, recurrent, major depression with psychotic behavior and intractable epileptic seizure poorly controlled with medication. What ICD-10-CM coding is reported?

Correct answer: F33.3, G40.919

9.    True or False? If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.

Correct answer: True

10.True of False? If use, abuse and dependence are all documented, assign only the code for abuse?

Correct answer: False

Question 1

Rationale: In ICD-10-CM guideline I.C.5.b.2, there are codes for use, abuse, and dependence. Only one code is assigned to identify the pattern of use. This is based on the following hierarchy, listed in order of priority: dependence, abuse, use. If the documentation shows both use and dependence, only dependence is reported.

Question 2

Alphabetic Index: Abuse > Drug > Cannabis > F12.10. Verify in the Tabular List.

 Question 3

Rationale: Alphabetic Index: Abuse > drug > NEC > Cocaine > with > Intoxication > with > Delirium > F14.121.

The provider has documented this as an Overdose. Alphabetic Index: Overdose (drug) – See table of drugs and chemicals, by drug, poisoning.

In the table of drugs and chemicals: Cocaine > Under column Poisoning Accidental > T40.5X1- (7^th digit A for initial encounter).

Verify codes selection in the Tabular List.

When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined). If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings.

If there is also a diagnosis of abuse or dependence of the substance, the abuse or dependence is assigned as an additional code.

Question 4

Rationale:

Alphabetic Index: Disease, diseased > Alzheimer’s > Early onset > G30.0 [F02.80].

The code in brackets indicates a manifestation code. Verify the G30.0 code in the Tabular List. There is an instructional note under code section G30 that confirms that we should also code the dementia.

F02.80 is the correct code because the provider does not mention any behavioral disturbances.

Sequencing rules tell us that the manifestation code always follows the etiology code.

Question 5

Rationale:

Alphabetic Index: Disease, diseased > Alzheimer’s > Early onset > with Behavioral Disturbance > G30.0 [F02.81-].

The code in brackets indicates a manifestation code. Verify the G30.0 code in the Tabular List. There is an instructional note under code section G30 that confirms that we should also code the dementia.

F02.811 is the correct code because the provider mentions the patient is combative but does not mention the severity of the dementia. The sixth digit is found in the tabular.

Sequencing rules tell us that the manifestation code always follows the etiology code.                                                                                                                            

Question 6

Rationale:

Alphabetic Index: Dependence > Drug > Opioid > With > Withdrawal> F11.23.

In the Tabular List code F11.23 identifies opioid dependence withdrawal.

The patient took the medication for therapeutic reasons, which had led to a drug dependency, making it an adverse effect.

ICD-10-CM Table of Drugs for Oxycodone. Use the code from the Adverse Effect column, > T40.2X5-. In the Tabular List, 7^th character A is selected because the patient is actively being treated for the adverse effects.

ICD-10-CM guideline I.C.19.e.5.a instructs us to code first the nature of the adverse effect, followed by the appropriate code for the adverse effect of the drug (T code).

Question 7

Rationale:  

Alphabetic Index: Convulsions > R56.9.

Documentation states alcohol abuse, not alcoholism with intoxication.

Alphabetic Index: Abuse > Alcohol > with > Intoxication > F10.129. Verify code selection in the Tabular List.

There is no indication that the convulsions were an epileptic seizure and a code from subcategory G40.50- is not reported.

Question 8

Rationale:

Alphabetic Index: Disorder > Depressive > Major > Recurrent > With > Psychotic Features > F33.3.

Alphabetic Index: Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) seizure) > Intractable G40.919. The mention of poorly controlled with medication makes the epilepsy intractable.

Question 9

Per Chapter 5 Coding Guideline

Question 10

Per Chapter 5 Coding Guideline, “If use, abuse and dependence are all documented, assign only the code for dependence.”