Questions/Answer for ICD-10-CM Coding for Chapter 6 Quiz - Diseases of the Nervous System

1.    A patient is admitted to the hospital for low back pain. Work up was inconclusive. What ICD-10-CM coding is reported.

Correct answer: M54.50

2.    What is the time frame defining when pain becomes chronic?

Correct answer: No time frame

3.    All of the below terms are considered equivalent to "intractable" when considering a diagnosis for a migraine EXCEPT?

Correct answer: Severe

4.    A patient with an ophthalmoplegic migraine is not responding to medication and is admitted to the hospital for further management. What ICD-10-CM coding is reported?

Correct answer: G43.B1

5.    A patient is admitted to the hospital for confusion and loss of memory. The provider diagnoses the patient with early onset stages of Alzheimer’s disease with dementia. What ICD-10-CM coding is reported?

Correct answer: G30.0, F02.80

6.    A patient presents to receive an intercostal nerve block to mitigate the debilitating pain of her malignancy. His cancer has metastasized to the bones in his thoracic spine. What ICD-10-CM codes are reported? Select all that apply.

Correct answers: G89.3, C79.51, C80.1

7.    A patient presents to receive an intercostal nerve block to mitigate the debilitating pain of her malignancy. His cancer has metastasized to the bones in his thoracic spine. What ICD-10-CM codes are reported? What is the first listed code?

Correct answer: G89.3

8.    Epileptic seizure poorly controlled with medication. What ICD-10-CM coding is reported?

Correct answer: G40.919

9.    True/False: If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code G89.11, Acute pain due to trauma, followed by code M54.2, Cervicalgia, to identify the site of pain).

Correct answer: True

10.Central pain syndrome (G89.0) and chronic pain syndrome (G89.4) are the same as the term “chronic pain.”

Correct answer: False

Question 1 Rationale

Rationale: Per ICD-10-CM guideline I.C.6.b.1, if the pain is not specified as acute or chronic, do not assign codes from category G89, except for post-thoracotomy pain, postoperative pain, neoplasm-related pain, or central pain syndrome. Look in the ICD-10-CM Alphabetic Index for Pain > low back > M54.50. Verify code selection in the Tabular List.

Question 2 Rationale

Rationale: Per ICD-10-CM guidelines Section I.C.6.b.4, there is no time frame defining when pain becomes chronic pain. The provider’s documentation is used to guide when the pain is acute and when it is chronic.

Question 3 Rationale

In the tabular, the note under category code G43 Migraine confirms the terms that are considered intractable.

Question 4 Rationale

Rationale: When a migraine does not respond to medication it is considered intractable. In the ICD-10-CM Alphabetic Index, look for Migraine > ophthalmoplegic > intractable > G43.B1. Verify code selection in the Tabular List. The note under category code G43 Migraine confirms that pharmacoresistant is considered intractable.

Question 5 Rationale 

Rationale: In the ICD-10-CM Alphabetic Index, look for Alzheimer’s diseases or sclerosis > “see” Disease, Alzheimer’s. 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.

Psychosis and Memory loss are not reported because these are signs and symptoms of Alzheimer’s. See ICD-10-CM guideline I.B.4.

Question 6/7 Rationale

Rationale: The reason for this encounter is pain management. According to ICD-10-CM guideline I.C.6.b.5, pain in neoplastic disease (G89.3) is the first-listed diagnosis when the reason for the encounter is documented as pain control or pain management.

The patient has metastatic cancer (secondary malignancy) of the thoracic spine. Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic > Spine, spinal (column) > use the code from the Malignant Secondary column > C79.51.

Primary cancer is unknown, so report code C80.1. Verify code selection in the Tabular List.

Question 8 Rationale

Next, in the Alphabetic Index look for Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) seizure)/intractable G40.919. The mention of poorly controlled with medication makes the epilepsy intractable. In the tabular, the note under category code G40 Epilepsy and recurrent seizures confirms the terms that are considered intractable.

Question 9 Rationale

Rationale:

If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code G89.11, Acute pain due to trauma, followed by code M54.2, Cervicalgia, to identify the site of pain). Chapter 6 Coding Guidelines, sequencing of category G89 codes with site- specific pain codes.

Question 10 Rationale

Central pain syndrome (G89.0) and chronic pain syndrome (G89.4) are different than the term “chronic pain,” and therefore codes should only be used when the provider has specifically documented this condition.