1. The newborn has been placed in NICU to treat herpetic vesicles on her torso and lower extremities. Tests have been ordered to rule out herpetic encephalitis, chorioretinitis, and sepsis, and prophylactic protocols will be put in place to prevent spread of the infection from rupturing lesions. Code the patient’s diagnosis.
A. 054.9 B. 771.2
C. 646.92 D. 054.0
2. Following the MUGA scan, the physician documents that the patient has developed congestive heart failure associated with the trastuzumab she received as a treatment for her breast cancer. The trastuzumab antineoplastic antibiotic therapy is being discontinued while he attempts to manage the heart failure pharmaceutically. Code the diagnosis.
A. 428.0, 960.7, V10.3, E930.7 B. 428.0, 963.1, 174.9, E930.7
C. 428.0, 174.9, E930.7 D. 428.0, 174.9, E933.1
3. The patient has a history of symptomatic HIV.
A. V08 B. 042
C. V12.2 D. 795.71
4. The mother, 38-weeks gestation, advances to severe pre-eclampsia during labor. Fetal decelerations during contractions are not improved with the administration of oxygen, so a low traverse cesarean section is performed. There is evidence of intrauterine growth retardation, and the placenta is noted to be small. The male infant weighs 1587 gm and has Apgars of 3 and 5. Select the best code sequence for the infant’s chart.
A. 760.0, 763.81, V27.0 B. 760.0, 763.82, 764.16, 763.4, V30.01
C. 760.0, 763.82, 764.16, 765.29, V30.01 D. 760.0, 763.81, 764.15, 765.29, V27.1
5. Which of the following V codes can be reported as a first listed code?
A. V27.0 B. V07.4
C. V13.61 D. V20.2
Answers
1. B
Congenital herpes is a bit tricky in the index. It isn’t listed under Herpes/herpetic. Instead, look under Infection/herpes/congenital to be directed to 771.2. By the process of elimination, the other codes are inappropriate: 054.9 and 054.0 are unacceptable based on an exclusion note at the beginning of category 054. Code 646.92 is incorrect because it is a maternal code, not a code for an infant, and because a fifth-digit 2 is not acceptable with 646.9x, based on the bracketed information presented under the code in the tabular section.
2. C
Congestive heart failure has many codes, but without more information, we must choose 428.0 (Failure/heart/congestive). The heart failure is an adverse effect of the drug trastuzumab, an antineoplastic antibiotic agent. The adverse affect in therapeutic use is reported with E930.7 (in therapeutic use), according to the table of drugs and chemicals. Finally, report the breast cancer, as suspension of therapy for the breast cancer will need to be addressed at some point in this patient’s plan of care. We don’t have enough information on the breast cancer to report anything but 174.9. Because the patient is still being treated with trastumumab and the physician notes that treatment is being discontinued for contraindications, she is still considered to have active cancer, and a history code would be inappropriate. Note that separate codes exist for antineoplastic drugs vs antineoplastic antibiotics. Answers B and D mix up the two types of drugs and are therefore in error. Only answer C captures the clinical situation correctly.
3. B
Always pause to consider the meaning of “history” when you see it in a note. Physician documentation does not always dovetail with the language of ICD-9-CM. History is a good example of this. A physician may document that the patient has a history of a disease, and this usually will mean that the disease has been eradicated. But it may mean that the disease is not a diagnosis new at this encounter, but something ongoing in the patient’s care. It may also mean that this is a problem that the patient has had and resolved in the past, and that it has recurred. In the case of “history of symptomatic HIV,” we all know this is not a disease that resolves. Once a patient has symptomatic HIV, the patient whether they have symptoms at the time of the service or not, the diagnosis is coded as 042. According to the Official Guidelines, once a patient with HIV develops symptoms or an opportunistic disease, report code 042.
4. C
Codes from V27 are reserved for the mother’s chart, so we can automatically eliminate A and D as options. Guidelines tell us that a code from 765.2 should be assigned in addition to a code from 764, and this code was omitted from B. Further, B listed as a diagnosis 763.4, indicating the patient was adversely affected by the C-section, and no adverse affects were documented.
5. D
In the Official ICD-9-CM Coding Guidelines, there is a listed of V codes that can be reported as a first listed diagnosis code.
A. 054.9 B. 771.2
C. 646.92 D. 054.0
2. Following the MUGA scan, the physician documents that the patient has developed congestive heart failure associated with the trastuzumab she received as a treatment for her breast cancer. The trastuzumab antineoplastic antibiotic therapy is being discontinued while he attempts to manage the heart failure pharmaceutically. Code the diagnosis.
A. 428.0, 960.7, V10.3, E930.7 B. 428.0, 963.1, 174.9, E930.7
C. 428.0, 174.9, E930.7 D. 428.0, 174.9, E933.1
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3. The patient has a history of symptomatic HIV.
A. V08 B. 042
C. V12.2 D. 795.71
4. The mother, 38-weeks gestation, advances to severe pre-eclampsia during labor. Fetal decelerations during contractions are not improved with the administration of oxygen, so a low traverse cesarean section is performed. There is evidence of intrauterine growth retardation, and the placenta is noted to be small. The male infant weighs 1587 gm and has Apgars of 3 and 5. Select the best code sequence for the infant’s chart.
A. 760.0, 763.81, V27.0 B. 760.0, 763.82, 764.16, 763.4, V30.01
C. 760.0, 763.82, 764.16, 765.29, V30.01 D. 760.0, 763.81, 764.15, 765.29, V27.1
5. Which of the following V codes can be reported as a first listed code?
A. V27.0 B. V07.4
C. V13.61 D. V20.2
Answers
1. B
Congenital herpes is a bit tricky in the index. It isn’t listed under Herpes/herpetic. Instead, look under Infection/herpes/congenital to be directed to 771.2. By the process of elimination, the other codes are inappropriate: 054.9 and 054.0 are unacceptable based on an exclusion note at the beginning of category 054. Code 646.92 is incorrect because it is a maternal code, not a code for an infant, and because a fifth-digit 2 is not acceptable with 646.9x, based on the bracketed information presented under the code in the tabular section.
2. C
Congestive heart failure has many codes, but without more information, we must choose 428.0 (Failure/heart/congestive). The heart failure is an adverse effect of the drug trastuzumab, an antineoplastic antibiotic agent. The adverse affect in therapeutic use is reported with E930.7 (in therapeutic use), according to the table of drugs and chemicals. Finally, report the breast cancer, as suspension of therapy for the breast cancer will need to be addressed at some point in this patient’s plan of care. We don’t have enough information on the breast cancer to report anything but 174.9. Because the patient is still being treated with trastumumab and the physician notes that treatment is being discontinued for contraindications, she is still considered to have active cancer, and a history code would be inappropriate. Note that separate codes exist for antineoplastic drugs vs antineoplastic antibiotics. Answers B and D mix up the two types of drugs and are therefore in error. Only answer C captures the clinical situation correctly.
3. B
Always pause to consider the meaning of “history” when you see it in a note. Physician documentation does not always dovetail with the language of ICD-9-CM. History is a good example of this. A physician may document that the patient has a history of a disease, and this usually will mean that the disease has been eradicated. But it may mean that the disease is not a diagnosis new at this encounter, but something ongoing in the patient’s care. It may also mean that this is a problem that the patient has had and resolved in the past, and that it has recurred. In the case of “history of symptomatic HIV,” we all know this is not a disease that resolves. Once a patient has symptomatic HIV, the patient whether they have symptoms at the time of the service or not, the diagnosis is coded as 042. According to the Official Guidelines, once a patient with HIV develops symptoms or an opportunistic disease, report code 042.
4. C
Codes from V27 are reserved for the mother’s chart, so we can automatically eliminate A and D as options. Guidelines tell us that a code from 765.2 should be assigned in addition to a code from 764, and this code was omitted from B. Further, B listed as a diagnosis 763.4, indicating the patient was adversely affected by the C-section, and no adverse affects were documented.
5. D
In the Official ICD-9-CM Coding Guidelines, there is a listed of V codes that can be reported as a first listed diagnosis code.
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