1.

Ahisha presents with fever, leukocytosis, and tachycardia. She has had a urinary treat infection as an outpatient but is not getting better. The diagnosis of E colisepsis with associated acute renal failure is made and IV antibiotics are started.

Think about the physiology and guidelines for this case. Where is the localized infection that is the underlying cause of the systemic infection (sepsis)? Should the signs and symptoms be coded? Does the patient have severe sepsis?

2.

John is a type 1 diabetic who presents with hypoglycemia caused by overdoes of insulin. The hypoglycemia resulted from a mechanical problem with his insulin pump. John also has diabetic nephropathy and neuropathy.

Think about the pathophysiology and the guidelines for this case. Is the first listed diagnosis a complication of the insulin pump? What is the title of the column from the Table of Drugs and Chemicals that is used in this case? What art the associated complications of his diabetes?

Hint: 5 codes total!

3.

Walter presents in cocaine withdrawal and alcohol withdrawal with delirium. He also smokes cigarettes. Because of years of alcohol dependence, Walter has alcoholic cirrhosis of the liver. To complicate his care, he also suffers from paranoid schizophrenia.

Think about the guidelines for this case. Can either drug withdrawal or alcohol withdrawal be listed first? (Hint: 5 codes!)

4.

Bridget presents for her second radiation therapy visit for treatment of her left-sided breast carcinoma located in the left lower outer quadrant. She is morbidly obese with a BMI of 50.2

Think about the guidelines for this case. Which section of the ICD-10-CM Official Guidelines provides guidance in sequencing the principal diagnosis for this case? Which code should be listed first? (hint: 4 codes!)

5.

Jaclyn has dysuria and flank pain. Further evaluation is positive for acute on chronic cystitis. Cultures are positive for MRSA. She also has hypokalemia and hypomagnesemia, which is treated with intravenous fluid additives.

Think about the guidelines for this case. Will the acute or chronic cystitis be sequenced first?

(hint: five codes!)

6.

Benton presents because of gangrene of the left second toe. He is a type 2 insulin-dependent diabetic with known diabetic peripheral vascular disease. After physician query, it is determined that the gangrene is caused by the diabetes.

Think about main terms in the alphabetic index. Will the phrase "long term" be used when coding this case? (hint: two codes!)

7.

Clayton has enlarged lymph nodes, weakness, fever and flu-like symptoms. He is a known IV heroin user. Also noted on chest x-ray is Pneumocystis cariniipneumonia. HIV testing is positive and the physician documentation supports HIV disease with pneumonia. (hint: 3 codes!)

8.

Delores presents with left upper quadrant abdominal pain. Work-up is positive for alcohol-induced acute on chronic pancreatitis. She is alcohol dependent and received counseling.

Think about the coding guidelines. Is the symptom of left upper quadrant pain coded? Which diagnosis will be listed first?

(hint: 4 codes!)

9.

Johan is admitted for treatment of a right thoracic mass. The physician performs a right thoracotomy and bronchoscopy. The mass is excised and is determined to be a malignant Schwannoma.

Think about how to look up neoplasms. Do you look in the neoplasm table first, or the index?

10.

Akihio presented with fatigue and low hemoglobin and hematocrit support the diagnosis of aplastic anemia. Further evaluation supports that the anemia is caused by chemotherapy. He has received chemotherapy for three sessions to treat his sigmoid colon cancer with liver metastasis.

Think about the coding guidelines. Review the documented signs and symptoms, and identify which are integral to the definitive diagnosis. Is anemia an adverse effect of the chemotherapy, antineoplastic drug? Which diagnosis should be listed first?. (hint: 4 codes!)