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Clinical Coding > ICD-10 basics > Flashcards

ICD-10 basics Flashcards

1
Q

Whats the full name of ICD-10

A

International Statistical Classification of Diseases and Related Health Problems

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2
Q

How many volumes of ICD-10

A

3

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3
Q

Volume 1 of ICD-10 is

A

Tabular List

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4
Q

Volume 2 of ICD-10 is

A

Instruction Manual

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5
Q

Volume 3 of ICD-10 is

A

Alphabetical Index

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6
Q

What Volume of the ICD-10 is the Tabular List

A

1

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7
Q

What Volume of the ICD-10 is the Alphabetical Index

A

3

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8
Q

Which letter is used as a filler code with three-character categories in ICD-10

A

X

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9
Q

Which of the following is the Chapter;
a) K56.0 Acute Peritonitis
b) Disease of Peritoneum (K65-K67)
c) K65 Peritonitis
d) Chapter XI Diseases of the Digestive System (K00-K93)

A

d) Chapter XI Diseases of the Digestive System (K00-K93)

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10
Q

Which of the following is the Block;
a) K56.0 Acute Peritonitis
b) Disease of Peritoneum (K65-K67)
c) K65 Peritonitis
d) Chapter XI Diseases of the Digestive System (K00-K93)

A

b) Disease of Peritoneum (K65-K67)

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11
Q

Which of the following is the three-character Category;
a) K56.0 Acute Peritonitis
b) Disease of Peritoneum (K65-K67)
c) K65 Peritonitis
d) Chapter XI Diseases of the Digestive System (K00-K93)

A

c) K65 Peritonitis

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12
Q

Which of the following is the four-character sub-category;
a) K56.0 Acute Peritonitis
b) Disease of Peritoneum (K65-K67)
c) K65 Peritonitis
d) Chapter XI Diseases of the Digestive System (K00-K93)

A

a) K56.0 Acute Peritonitis

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13
Q

How do non-essential modifiers appear in the alphabetical index of ICD-10

A

enclosed in parentheses after the lead term

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14
Q

How do essential modifiers appear in the alphabetical index of ICD-10

A

indented sub-terms under the lead term

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15
Q

What is the 4 step coding process

A

1) Analyse - the medical terminology to determine he lead term and modifiers
2) Locate - the lead term in the alphabetical index
3) Assign - A tentative code using the alphabetical index
4) Verify - the code using tabular list

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16
Q

How many Chapters in the Tabular List (ICD-10)

A

22

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17
Q

How many Chapters in volume 1 of ICD-10

A

22

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18
Q

How many sections in the Alphabtical index (ICD-10)

A

3 Sections

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19
Q

How many sections in volume 3 of ICD-10

A

3

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20
Q

what category are chapters VI-XIV in ICD-10 Vol 1

A

Body Systems

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21
Q

What chapters in ICD-10 Vol 1 are on body systems

A

VI-XIV (6-14)

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22
Q

what category are chapters I-V, XV-XVII XIX in ICD-10 Vol 1

A

Special groups

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23
Q

What chapters in ICD-10 Vol 1 are special groups

A

I-V, XV-XVII XIX ( 1-5, 15-17, 19)

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24
Q

What category are chapters XVIII, XX-XXII in ICD-10 Vol 1

A

Other

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25
Q

What chapters in ICD-10 Vol 1 are called ‘other’

A

XVIII, XX-XXII (18, 20-22)

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26
Q

in ICD- 10 what would .8 indicated

A

other

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27
Q

in ICD-10 what would .9 indicated

A

unspecified

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28
Q

what are the 3 sections of the alphabetical index ICD-10

A

Section I Alphabetical index to diseases and nature of Injury (pg 9)
Section II External causes of injury (pg 663)
Section III Table of drugs and chemicals (pg 717)

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29
Q

DGCS.1 Primary Diagnosis

A

The primary diagnosis definition must always be applied when assigning ICD-10 codes on the coded clinical record:

i) The first diagnosis field(s) of the coded clinical record (the primary diagnosis) will contain the main condition treated or investigated during the relevant episode of healthcare.

ii) Where a definitive diagnosis has not been made by the responsible clinician the main symptom, abnormal findings, or problem should be recorded in the first diagnosis field of the coded clinical record.

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30
Q

Which symbols denote aetiology and manifestation in ICD-10

A

Dagger and asterisks

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31
Q

What is step 4 of the four step coding process

A

Verify the code using the tabular list (ICD-10 vol 1)

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32
Q

In which table within the ICD-10 alphabetical index and the cross hatch and diamond symbols found

A

Neoplasm table

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33
Q

What two classification abbreviations are used in ICD-10?

A

NEC NOS

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34
Q

How many dimensions of coding accuracy are there?

A

3

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35
Q

When is it permissible to sequence an asterisk code in primary position

A

When the manifestation is the main condition treated or investigated during the consultant episode

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36
Q

Which of the following types of punctuation does not have a specific meaning in the ICD-10 tabular list:
colon,
vertical line,
brackets,
semicolon,
parentheses

A

semicolon

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37
Q

Which of the following are types of cross reference found in the ICD-10 Alphabetical Index:
see also,
NOS,
Modifier,
See

A

See Also, See

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38
Q

Which type of modifier affects code assignment

A

Essential

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39
Q

How many types of cross references are found in the ICD-10 Alphabetical Index

A

2

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40
Q

What is step 3 of the four step coding process

A

Assign a tentative code using the alphabetical index (ICD-10 Vol 3)

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41
Q

How many types of modifier are found in ICD-10

A

2

42
Q

Which type of note found in ICD-10 Tabular List instructs the coder to assign a additional code:
use note,
includes note,
excludes note

A

use note

43
Q

Indirect care uses of codes

A

Case mix planning commissioning
National tariff payment system and HRC 4+
Resource management
epidemiological/ aetiology studies
Health trends

44
Q

Clinical uses of codes

A

Treatment effectiveness
Clinical audits
Outcome measurements

45
Q

What healthcare professionals are involved in the coding process

A

Clinical coder
Designated representative
Responsible consultant

46
Q

What does HRG stand for

A

Healthcare resource group

47
Q

How are updates to the national clinical coding standards notified

A

via coding clinic

48
Q

In what document would you find the designated representatives for each speciality within your organisation

A

policy and procedures document

49
Q

The terminology and classifications delivery service aim to provide a answer to queries in how many working days

A

10

50
Q

EPR stands for

A

Electronic patient record

51
Q

Clinical coding allows data to be

A

Globally compared, consistently recorded, compared over time

52
Q

How often is SNOMED CT updated

A

six monthly

53
Q

Which of the following is not a classification:
ICD-10,
OPCS-4,
SNOMED CT

A

SNOMED CT

54
Q

Which of the two main uses of coded data is said to be indirect

A

Statistical

55
Q

Which of the two main uses of coded data said to be direct

A

Clinical

56
Q

Comorbidities are and where to find

A

Conditions that contribute to an accurate clinical picture.
Appendix 1 co morbidity list in the national clinical coding standards icd-10

57
Q

Interventions are classified in

A

OPCS-4

58
Q

What does WHO stand for

A

world health organisation

59
Q

True or false, the primary diagnosis will always be the condition, injury or problem the patient is admitted with

A

False

60
Q

Which of the following is a diagnostic classification:
ICD-10,
OPCS-4

A

ICD-10

61
Q

What type of coding is used to code hospital spells

A

morbidity coding

62
Q

A consultant episode is

A

the time a patient spends in the continuous care of one consultant

63
Q

what are the three dimensions of coding accuracy

A

1) Individual codes
2) totality of codes
3) sequencing of codes

64
Q

how are lead terms shown in ICD-10

A

in bold

65
Q

what are instructional notes used for in ICD-10

A

-tell you how to define things
-tell you what instructions you should follow next
-tell you what fourth character codes you should use

66
Q

what does NEC stand for

A

not elsewhere classified

67
Q

what does NOS stand for

A

not otherwise specified

68
Q

what is a hospital provider spell

A

spell from admission to discharge, can include multiple consultant episodes

69
Q

who codes mortality

A

ONS

70
Q

What edition of ICD-10 are we currently using and when was it released?

A

5th edition 1st April 2016

71
Q

What is step 1 of the 4 step coding process

A

1) Analyse - the medical terminology to determine he lead term and modifiers

72
Q

What is step 2 of the 4 step coding process

A

2) Locate - the lead term in the alphabetical index

73
Q

What is step 3 of the 4 step coding process

A

3) Assign - A tentative code using the alphabetical index

74
Q

What is step 4 of the 4 step coding process

A

4) Verify - the code using tabular list

75
Q

How many chapters in ICD-10 are on body systems

A

9

76
Q

How may chapters in ICD-10 are special groups

A

9

77
Q

How many chapters in ICD-10 are ‘other’

A

4

78
Q

How many sections are in volume 2 of ICD 10

A

7

79
Q

Name the sections in volume 2 of ICD 10

A

1) Introduction
2) Description of ICD-10
3) How to use ICD-10
4) Rules and guidelines for mortality and morbidity coding
5) Statistical presentation
6) History of the development of the ICD 10
7) Annexes

80
Q

How many chapters in ICD 10 use 5th characters and which chapters are they

A

4 chapters
9, 10, 13, 19

81
Q

If there is doubt over which chapter to look for a code in what group of chapters takes priority?

A

Special Groups

82
Q

are ICD-10 chapters numbered or lettered

A

Numbered (multiple letters in each chapter)

83
Q

Do you follow the Instruction Manuals instructions or the Standards instructions? why?

A

Standards - Instruction manual is worldwide, standards are UK based

84
Q

What is section 1 in the Alphabetical Index

A

Section I Alphabetical index to diseases and nature of Injury (pg 9)

85
Q

What is section 2 in the Alphabetical Index

A

Section II External causes of injury (pg 663)

86
Q

What is section 3 in the Alphabetical Index

A

Section III Table of drugs and chemicals (pg 717)

87
Q

when was the primary diagnosis first mandated for use

A

1st April 1997

88
Q

definition of a lead term

A

refers to name of disease or pathological condition or reason for seeking medical attention

89
Q

What does a dagger represent

A

Aetiology or underlying disease

90
Q

what does a asterisk represent

A

Manifestation and effect of the disease

91
Q

what is the default order for dagger and asterisk codes

A

dagger followed by asterisk

92
Q

can dagger codes be used alone

A

yes

93
Q

can asterisk codes be used alone

A

No

94
Q

where can you find a list of asterisk codes

A

at the beginning of each chapter

95
Q

how many asterisk codes are there

A

83

96
Q

how can a dagger code appear

A

1) listed with asterisk codes the end of the code description (both must be assigned)
2) listed with asterisk codes only on some of the inclusion list
3) a code can not be marked with a dagger but an inclusion can be

97
Q

how can a asterisk code appear

A

1) when an associated dagger code is listed at the end of an asterisk code (must be assigned
2) when associated dagger code is listed as an inclusion
3) when there is no dagger code listed in description or inclusion (a non asterisk code must be assigned and ‘made’ into a dagger code)

98
Q

what cross references are used in ICD 10? what do they mean?

A

see (must look elsewhere)
see also (can look elsewhere)

99
Q

how can numbers appear in ICD-10 when they are in a lead term/modifier?

A

1) spelled as words
2) listed as Arabic numbers
3) listed as Roman numbers

100
Q

what types of notes are used in ICD 10

A

Inclusions
Exclusions
use notes

Clinical Coding (7 decks)

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