FMS 6.1 Dx Coding

Question 1

Who published the ICD-10 codes?

Answer 1

W.H.O.

Question 2

What 2 organizations maintain the ICD-10 codes?

Answer 2

NCHS and CDC

Question 3

What does the “-CM” mean with ICD-10-CM?

Answer 3

Clinical modification

Question 4

What 2 things does “-CM” for ICD-10’s captur

Answer 4

Morbidity and mortality stats

Question 5

What is the difference between ICD and CPT codes.

Answer 5

ICD-10 is the reason why the CPT service was performed

• ICD = diagnosis code
• CPT = procedural code

Question 6

The Dx must be as ________ as possible when turning written notes into codes.

Answer 6

Specific

Question 7

Does the diagnosis need to be validated in the patient’s record?

Answer 7

Yes!!!

Question 8

Certain payers (insurance companies) require certain codes to be listed 1st. 
- - What does Medicare want 1st?

Answer 8

M99._ _ codes 1st

Question 9

What is the coding hierarchy?

Answer 9

• 1.) Neuro
• 2.) Structural
• 3.) Functional
• 4.) Soft tissue / pain / extremity

Question 10

According to the coding hierarchy, where does sciatica / M54.3 go?

Answer 10

Nerve related disorder so first with NEURO’S

Question 11

According to the coding hierarchy, where does Scoliosis / M41.35 go?

Answer 11

Structural so second

Question 12

According to the coding hierarchy, where does segmental dysfunction / M99.03 go?

Answer 12

Functional so 3rd

Question 13

According to the coding hierarchy, where does LBP / M54.5 go?

Answer 13

Pain related so 4th

Question 14

What is the coding hierarchy for the following:

• Low Back Pain / M54.5
• Scoliosis / M41.35
• Lumbar fixation / M99.03
• Sciatica / M54.3

Answer 14

Sciatica, Scoliosis, Lumbar fixation, LBP

• M41.35, M54.3, M99.03, M54.5

Question 15

As a coding guideline, what would you list/code first for Major Medical, most PPO plans, Cash?

Answer 15

Code CC 1st

Question 16

As a coding guideline, what would you list/code second for Major Medical, most PPO plans, Cash?

Answer 16

Group Dx together by regions (C, T, L, S, P)

Question 17

What is the Medicare (most states) coding hierarchy?

Answer 17

M99 code 1st relating to CC then

• Neuro
• Structural
• Functional
• Soft tissue / pain

Question 18

Does medicare cover extremities?

Answer 18

No

Question 19

Regarding worker’s comp / bodily injury, what will the carrier only pay for?

Answer 19

Injury resulting from the collision, accident, or incident

Question 20

With worker’s comp / bodily injury, what do you code first?

Answer 20

Injury in the area of the CC 1st

Question 21

If a medicare patient does not have neurologic diagnosis, what do you code for 1st?

Answer 21

M99 code then use hierarchy rules

Question 22

If a medicare patient does not have a neurological disorder and their only other diagnosis is pain…

• How would you code the pain diagnosis?

Answer 22

Use appropriate M99 code first, then pain would be the 2nd diagnosis

Question 23

What if a patient has been in a motor vehicle collision and has injured her left wrist, what would you code/list first?

Answer 23

The extremity Dx first

— (because that is her injury from the crash)

Question 24

On the CMS 1500 form, in which box do you enter the code for the primary diagnosis?

Answer 24

First line of box 21

Question 25

Co-existing conditions affecting treatment are recorded as what?

Answer 25

Secondary

Question 26

What is the coding hierarchy for the following? - patient with lumbar disc degeneration (M51.36) - subluxation of L3 (M99.03)

Answer 26

Both are Dx but lumbar disc degeneration is considered a secondary Dx - 1.) M99.03 2) M51.36

Question 27

If the patient is in for treatment of an acute condition and a chronic condition affects how the acute condition is handled. - Which do you code first?

Answer 27

Acute condition first - Code the chronic condition as secondary

Question 28

What does the letter “x” mean when coded with ICD-10?

Answer 28

Place-holds to allow for future additional entries

Question 29

Do you or do you not include a decimal on the 1500 written claim form?

Answer 29

No, don’t do it

Question 30

For ICD-10, what does the 7th character A mean?

Answer 30

It is used for injury/poisoning and other external causes - it is to be used for active phase of treatment

Question 31

For ICD-10, what does the 7th character D mean?

Answer 31

For the healing or recovery phase, not active care

Question 32

For ICD-10, what does the 7th character S mean?

Answer 32

Used to report a condition or complication that is the “result” of an injury

Question 33

Which type of coding is used to report services for reimbursement?

Answer 33

CPT

Question 34

What organization owns the CPT codes?

Answer 34

AMA

Question 35

HCPCS Level 2 codes were created and maintained by whom?

Answer 35

CMS

Question 36

What’s the CMT code for extra spinal regions?

Answer 36

98943

Question 37

3 components of evaluation and management codes?

Answer 37

- History - Examination - Clinical decision making

Question 38

New patient codes must have or exceed how many EM codes?

Answer 38

3/3

Question 39

What modifier must new patient codes have if with CMT?

Answer 39

-25

Question 40

Established patient codes must have or exceed how many EM codes?

Answer 40

2/3

Question 41

What modifier must old patient codes have if with CMT?

Answer 41

-25