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Scenarios for ICD 10 & 9

Established 50-year-old patient with end-stage renal disease, currently receiving dialysis, is seen for acute left upper quadrant pain. Chapter 3, ICD 10
R10.12, N18.6, Z99.2
Hint: In the ICD-10-CM index, locate the main term pain and subterms abdominal, upper, left quadrant, R10.12. Next, locate the main term disease and subterm end-stage renal (ESRD), N18.6. Note that an additional code is needed to identify dialysis status, Z99.2.
Patient is seen for unstable angina. He has a history of arteriosclerotic coronary artery disease. Chapter 3, ICD 10
Arteriosclerotic heart disease with unstable angina, I25.110. There is a combination code for arteriosclerotic heart disease and unstable angina. Even though the question states the patient has a history of arteriosclerotic heart disease, it means that the patient currently has coronary artery disease as the condition does not go away.
Patient is seen for follow-up for hypertension. He has end-stage renal disease. Chapter 3, ICD 10
Hypertension with end stage renal disease, I12.0; end stage renal disease, N18.6. There is a combination code for hypertension with end stage renal disease. I12.0 assumes a causal relation in this scenario. Under code I12.0 in the Tabular, a notation states “Use additional code to identify the stage of chronic kidney disease, N18.5, N18.6.
Following outpatient surgery for a right bunionectomy for hallux valgus, the patient was admitted to observation due to an exacerbation of her asthma post procedure. Chapter 3, ICD 10
Hallux valgus, M20.11; asthma with exacerbation, J45.901. The reason for the surgery is reported first followed by the asthma with exacerbation.
Patient presents with a fracture of the right femur shaft due to a fall from her horse while riding, initial encounter. Chapter 3, ICD 10
Fractured shaft of right femur, S72.301A; falling off horse being ridden; V80.010A, horseback riding, Y93.52. The external cause codes are never first-listed codes. If the activity at the time of the event is known, it is reported after the external cause code.
A patient who smokes 2 packs of cigarettes per day and suffers with chronic pulmonary disease is seen in follow-up for acute bronchitis. Chapter 3, ICD 10
1st-listed dx: Acute bronchitis, J20.0, other dx: COPD, J44.0, cigarette smoker, F17.210.
Patient was scheduled for outpatient surgery for right inguinal hernia repair; however, he has a fever and a URI and the procedure is canceled.
Chapter 3, ICD 10
K40.90, J06.9, J06, Z53.09
Hint: In the ICD-10-CM index, locate the main term hernia and subterm inguinal, K40.90. Next, locate the main term infection and subterms respiratory (tract), upper, J06.9. The fever is not reported as it is a symptom of the URI. Additionally, a code is needed to report the reason why the procedure was canceled. Locate the main term procedure and subterms not done, because of, contraindication, Z53.09.
Chronic osteomyelitis with draining sinuses of right first toe due to methicillin susceptible Staphylococcus aureus. Chapter 4, using ICD 10
M86.471, B95.61
Hint: In the ICD-10-CM index, locate the main term osteomyelitis and subterms chronic, with draining sinus, toe, M86.471. The sixth character “1” indicates right ankle and foot. Note that an additional code is needed to identify the infectious agent. Locate the main term staphylococcus and subterms as cause of disease classified elsewhere, aureus, B95.61.
Pathological fracture of the left femur, due to neoplastic disease, initial encounter. Chapter 4, ICD 10
M84.552A, D49.2
Hint: In the ICD-10-CM index, locate the main term fracture, pathological and subterms due to, neoplastic disease, femur, M84.552A. The seventh character “A” indicates initial encounter for fracture. Note that a code for the underlying neoplasm is also needed. See the Neoplasm table and locate the main term bone and subterm unspecified behavior, D49.2.
Type I diabetes mellitus with unspecified diabetic retinopathy and with diabetic cataract. Chapter 5, ICD 10
E10.319, E10.36,
Hint: In the ICD-10-CM index, locate the main term diabetes and subterms type I, with, retinopathy, E10.319. Under the same main term and subterm type 1, locate cataract, E10.36.
Hypertensive congestive heart failure with hypertension and chronic kidney disease, stage IV. Chapter 5, ICD 10
I13.0, I50.9, N18.4
Hint: In the ICD-10-CM index, locate the main term hypertensive and subterms cardiorenal (disease), with heart failure, I13.0. Remember that cardio = heart and renal = kidney. Also, note that additional codes are needed to identify the type of heart failure (I50.9) and stage of chronic kidney disease (N18.4, stage IV).
Chapter 6, ICD 10
PREOPERATIVE DIAGNOSIS: Left renal calculus.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE PERFORMED: Left ESWL (extracorporeal shock wave lithotripsy).
CLINICAL NOTE: This gentleman came in with renal colic, a stent was placed. He presents now for ESWL. The patient was given a general laryngeal mask anesthetic, prepped and draped in the supine position. Stone targeted and shock head engaged. A total of 2,400 shocks at maximum KV and stone partial fragmentation and dissolution could be seen. The patient tolerated the procedure well and transferred to the recovery room in good condition. He will be seen in follow-up in two weeks time for KUB.
N20.0 Hint: In the ICD-10-CM index, locate the main term calculus and subterm kidney, N20.0.
streptococcal group B arthritis of the metacarpus and phalanges, left hand. Chapter 6, ICD 10
M00.242, Arthritis, streptococcal NEC, Hand joint., B95.1, Streptococcus, group, B as cause of disease classified elsewhere
An established patient is seen in follow-up for coronary artery disease. Patient is also a diabetic on oral medications. The patient had a coronary artery bypass graft 6 months ago. Labs were reviewed and prescriptions for diabetic medications were renewed. Chapter 9, ICD 9
414.00, coronary artery disease, 250.00 diabetes, chronic coexisting conditions that were managed during the visit, V45.81 history of CABG, acceptable to code as this is important in a patient with coronary artery disease.
Patient is seen by internist for medical Clearance for inguinal hernia repair. The patient has a number of chronic medical conditions including hypertension, diabetes type 2, and atrial fibrillation. Chapter 9, ICD 9
V72.83, other specified preoperative exam, 550.90 inguinal hernia, 401.9 hypertension, 25000 diabetes type 2, 472.31 atrial fibrillation.
Established patient presents with dyspnea and lower extremity edema. The physician determined that the patient’s symptoms were due to an exacerbation of congestive heart failure. Chapter 9, ICD 9, text review
Congestive heart failure, 428.0. Dyspnea and lower extremity edema are not coded as they are symptoms of the patient’s CHF exacerbation.
Patient was admitted as an outpatient for an arthoscopic knee procedure to repair old anterior cruciate ligament tear. Chapter 9, ICD 9 Text review
Old anterior cruciate ligament tear, 717.83
Status post cardiac pacemaker placement. Chapter 9 Exam
In the ICD-9-CM index, locate the main term status (post) and subterms cardiac, device (in situ), pacemaker, V45.01.
Adjustment of a colostomy tube for fitting. Need answer, not in workbook, chapter exam or midterm Chapter 9
V55.3, fitting, colostomy or adjustment
Personal history of peptic ulcer. Chapter 9, exam
V12.71 Hint: In the ICD-9-CM index, locate the main term history (personal) and subterm ulcer, peptic, V12.71.
Dysphagia due to previous cerebrovascular accident – Chap 10 text review #20
438.82 (Late, effect(s) (of) cerebrovascular disease, with, dysphagia); 787.20 (Dysphagia). Instructional note states to assign an additional code for the dysphagia.
What is the code for respiratory syncytial virus, RSV? Chap 10 text review #21
079.6 (Respiratory syncytial virus). Note that condition is in the ICD-9-CM Index under “Respiratory,” not under “Virus.”
Gastroenteritis due to Norwalk virus? Chapter 10 workbook #20
008.63 Hint: In the ICD-9-CM index, locate the main term enteritis and subterms due to, Norwalk virus, 008.63.
Steptococcal Phayngitis
034.0 Hint: In the ICD-9-CM index, locate the main term pharyngitis and subterm streptococcal, 034.0.
Impending respiratory failure
No code is assigned as there is no code for impending respiratory failure and no other information is given.
Adenocarcinoma of the upper-outer quadrant right breast with metastasis to the axillary lymph nodes. Chap 11, text example
see page 300 in text book.
Arteriosclerotic dementia with delirium. Chapter 11
This is an example of using manifestation first
see page 309, with page 310 explanation
Chapter 11, chapter exam
PREOPERATIVE DIAGNOSIS: Mass, right breast.
POSTOPERATIVE DIAGNOSIS: Mass, right breast.
OPERATIVE PROCEDURE: Right breast mass excision.
PROCEDURE: With the female patient under general anesthesia, the breast and chest were prepped and draped in a sterile manner. An elliptical incision was made in the central portion of the breast about the palpated mass, including the area of the nipple. This was excised all the way down to the fascia of the breast and then submitted for frozen section. Frozen section revealed a carcinoma of the breast with what appeared to be a good margin all the way around it. We then maintained hemostasis with electrocautery and proceeded to close the breast tissue using 2-0 and 3-0 chromic. The skin was closed using 4-0 Vicryl in a subcuticular manner. Steri-Strips were applied. The patient tolerated the procedure well and was discharged from the operating room in stable condition.
PATHOLOGY REPORTED LATER INDICATED: Primary, malignant neoplasm.
Locate the main term breast and subterms central portion, malignant, primary, 174.1.
Malignant hypertensive heart disease, with heart failure.
Chapter 11, workbook #34
402.01, 428.9 (Hypertension, cardiovascular disease, with heart failure). An additional code is added to describe the heart failure and in this case, it is unspecified.
ASHD of native coronary artery and COPD
Chapter 11, workbook #49
414.01, Arteriosclerosis, coronary artery, native artery; 496, disease, lung, obstructive, chronic, COPD
Bacteremia due to pseudomonas Chapter 11, wb#52
790.7 (Findings, abnormal, without diagnosis, culture, positive, blood) 041.7 (Infection, pseudomonas)
Malignant ascities, primary site unknown. Chapter 11, #54
199.1 (Neoplasm, unknown site, primary, no mention of secondary site) 789.51 (Ascites, malignant)
Alcoholic delirium tremens due to dependence on alcohol. Chapter 11,#56
291.0 (Alcohol, delirium, tremens) 303.90 (Dependence, alcohol)
Type 2 diabetes mononeuropathy of the legs. Chapter 11, wb#62
250.60 (Diabetes, mononeuropathy) 355.8 (Mononeuropathy, diabetic, lower limb). Code in this order.
cardiac insufficiency 6 months after coronary artery bypass surgery. Chapter 11, wb#66
429.4 (Insufficiency, cardiac, postoperative, long-term effect of cardiac surgery) V45.81 (Status, coronary artery bypass or shunt)
Mrs. Smith is at 32 weeks’ gestation and is admitted with sever bleeding with abdominal cramping. An emergency ultrasound is done and fetal monitors are applied. She is diagnosed with total placenta previa with indications of fetal distress. An emergency cesarean section is done, with delivery of a viable male infant.
ICD9-641.11 (Pregnancy, complicated, placenta, previa), 656.31 (Distress, fetal, affecting management of pregnancy), 644.21 (Pregnancy, complicated, early onset of delivery), V27.0 (Outcome, of, delivery, single, liveborn)
ICD10-O44.13 (Pregnancy, complicated by, placenta previa); O77.8 (Stress, fetal, complicating pregnancy); O60.14×0 (Pregnancy, complicated by, preterm labor, third trimester, with third trimester preterm delivery); Z3A.32 (Pregnancy, weeks of gestation, 32 weeks); Z37.0 (Outcome of delivery, single, liveborn)
Scenario regarding surgery after traumatic open fracture accident on page 367
733.82 (Nonunion, fracture), 285.1 (Anemia, posthemorrhagic, acute), 905.4 (Late effects, fracture, extremity lower), E929.0 (Late effects, motor vehicle accident)
Patient is lethargic with severe abdominal cramping and vomiting following an accidental ingestion of 5 tablets of Tylenol with codeine and a bottle of vodka. There are 9 codes for this case:
ICD 9 only:
a. 965.09 (Table of Drugs and Chemicals, Codeine, Poisoning) E850.2 (Table of Drugs and Chemicals, Codeine, Accident)
b. 965.4 (Table of Drugs and Chemicals, Acetaminophen, Poisoning) E850.4 (Table of Drugs and Chemicals, Acetaminophen, Accident)
c. 980.0 (Table of Drugs and Chemicals, Alcohol, Grain, Beverage, Poisoning) E860.0 (Table of Drugs and Chemicals, Alcohol, Grain, Beverage, Accident)
d. 780.79 (Lethargy)
e. 787.03 (Vomiting)
f. 789.00 (Cramps, abdominal)
PREOPERATIVE DIAGNOSIS: Excess skin of the right heel./Bulky free flap.
POSTOPERATIVE DIAGNOSIS: Same.
SURGICAL FINDINGS: 10.5 x 8.5 cm area of redundant fat of flap of right heel.
PROCEDURE PERFORMED: Defatting of flap of right heel with excision of redundant skin (benign).
ANESTHESIA: General endotracheal anesthesia.
POSITION: Prone.
ESTIMATED BLOOD LOSS: Negligible.
DESCRIPTION OF PROCEDURE: The patient was intubated and turned into prone position. The right foot and lower leg were prepped with Betadine scrub and solution and draped in the routine sterile fashion. The medial aspect of the flap was elevated excising the old scar in the process, and the flap was elevated to about 60% of its extent to include all of the redundant fat that was within the flap. We removed about 1.5 cm thickness of flap from the bottom of the flap and left a layer of padding of about a cm on the bed. Hemostasis was secured, and then we closed the wound with a combination of plain 3-0 Prolene and horizontal mattress sutures and some horizontal half mattress sutures of 3-0 Prolene. We dressed the wound temporarily with Kerlix and Kling. Dr. Miller will then proceed with his portion of the procedure.
CPT: 15839
I10: L91.8
I9: 701.9 Hint: In the ICD-9-CM index, locate the main term excess and subterm skin, 701.9.
Sally, a 16-year-old, was lighting a bonfire in the backyard of her home when she sustained the following burns:
Second-degree (1%) and third-degree burns—left upper arm (5%):
First-degree burn—left anterior leg (9%):
Total body surface:
Caused by:
Place of occurrence:
Hint: Second-degree (1%) and third-degree burns—left upper arm: (5%): 943.33 (Burn, arm, upper, third-degree). According to the ICD-9-CM guidelines, burns located in the same site but of different degrees are coded to the highest degree. Thus, only the third-degree burn of the upper arm is coded.
First-degree burn—left anterior leg: (9%): 945.10 (Burn, leg, first degree)
Total body surface: 948.10 (Burn, extent (percent of body surface), 10-19 percent)
Caused by: E897 (See the Index to External Causes of Injury. Fire, controlled, bonfire)
Place of occurrence: E849.0 (See the Index to External Causes of Injury. Accident, occurring (at) (in), residence, home (private))
Preoperative examination for a patient who will receive a renal transplant due to ESRD, currently on dialysis.
Progress Exam 1 – ICD 10
Index, examination subterm pre-procedural, specified NEC – Z01.818, next locate the main term disease and subterm end stage RD – N18.6, note that there is an additional code to identify the dialysis status – Z99.2
Patient is admitted for radiation therapy for metastatic bone cancer, primary unknown. Patient develops severe vomiting secondary to the course of radiation and is kept an extra day for stabilization. I9
In ICD 9 Index, locate the main term admission and subterm, for, radiation management, V58.0. BC the patient develops severe vomiting due to the treatment, this should be coded next, -see vomiting 787.03. the neoplasm table and locate the main term bone and subterm, malignant, secondary, 198.5. In the same table, locate the main term unknown site or unspecified and subterm malignant primary, 199.1. Lastly, see the External Cause Index and locate the term reaction & subterm radiological procedure or therapy, E879.2.
INDICATION: Septic Shock due to severe sepsis and the need to initiate mechanical ventilation.
PROCEDURE PREFORMED: Elective intubation.
ANESTHESIA: Versed and fentanyl
PROCEDURE: After the procedure was explained to and consent was obtained. . . .
Prog exam 1, ICD 10
In ICD 10 index, locate the main term sepsis, A41.9. Next, locate the main term shock and subterm septic, due to severe sepsis, R65.21.
Preoperative Examination for elective cholecystectomy due to gallstones. Patient is seen by a pulmonologist because of COPD – I9
locate main term examination and subterm preoperative, respiratory, V72.82. Note that when looking up the code for gallstones, the index directs you to see cholelithiasis,574.20. The fifth digit “0” indicates cholelithiasis without mention of obstruction. Next, locate the main term obstruction and subterm, lung, chronic NEC, 496.
Arteriosclerosis of native arteries of the left leg with gangrene. – I10
locate main term arteriosclerosis and subterms extremities, leg, left, with, gangerene, I70.262
Dysphagia, oropharyngeal phase, due to previous stroke. I9
the code for dysphagia, oropharyngeal phase, 787.22, requires that the code for the late effects of the cerebrovascular disease or stroke, 438.82, must be sequenced first.
Malignant hypertension with Stage IV chronic kidney disease. ICD 10
locate main term hypertension and subterm kidney, with, stage I through stage IV chronic kidney disease, I12.9. Note that an additional code is required to identify the stage of chronic disease, N18.4.

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