Test Bank For Understanding Health Insurance 14th Edition by Green

Test Bank for Understanding Health Insurance 14th Edition by Green
Test Bank for Understanding Health Insurance 14th

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Name: Class: Date:
Chapter 06 ICD-10-CM Coding

1. The International Classification of Diseases, published by the World Health Organization, is used to classify
__________ data from death certificates.
a. moratory
b. morbidity
c. morphology
d. mortality
ANSWER: d
2. ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and
outpatient records, including provider-based office records.
a. moratory
b. morbidity
c. morphology
d. mortality
ANSWER: b
3. ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation.
a. contemporary
b. legacy
c. optional
d. updated
ANSWER: b
4. Physician office __________ codes are submitted for reimbursement purposes.

a. ICD-10-CM, CPT, and HCPCS level II
b. ICD-10-PCS, CPT, and HCPCS level II
ANSWER: a
5. Hospital inpatient __________ codes are submitted for reimbursement purposes.

a. CPT, and HCPCS level II
b. ICD-10-CM, CPT, and HCPCS level II
c. ICD-10-CM and ICD-10-PCS
d. ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II
ANSWER: c
6. Hospital outpatient __________ codes are submitted for reimbursement purposes.

a. CPT and HCPCS level II
b. ICD-10-CM, CPT, and HCPCS level II
c. ICD-10-CM and ICD-10-PCS
d. ICD-10-PCS, CPT, and HCPCS level II
ANSWER: b
7. General equivalency mappings are __________ of codes that can be used to roughly identify ICD-10-CM codes for
their ICD-9-CM equivalent codes (and vice versa).
a. crosswalks
Copyright Cengage Learning. Powered by Cognero. Page 1
Name: Class: Date:
b. details
c. indexes
d. registers
ANSWER: a
8. In the following sample GEM table, ICD-9-CM codes 649.50, 649.51, and 649.53 __________ ICD-10-CM codes.
Sample ICD-9-CM to ICD-10-CM General Equivalence Mapping (GEM)
ICD-9-CM Diagnosis Code and Description ICD-10-CM Diagnosis Code and Description
003.21 Salmonella meningitis A02.21 Salmonella meningitis
010.90 Primary tuberculous infection, unspecified A15.7 Primary respiratory tuberculosis
examination
010.91 Primary tuberculous infection,
bacteriological/histological exam not done
bacteriological/histological exam unknown (at
present)
010.93 Primary tuberculous infection, tubercle bacilli found
by microscopy
by bacterial culture
010.95 Primary tuberculous infection, tubercle bacilli
confirmed histologically
confirmed by other methods
205.01 Myeloid leukemia, acute, in remission C92.01 Acute myeloid leukemia, in remission
649.50 Spotting complicating pregnancy, unspecified O26.851 Spotting complicating pregnancy, first trimester
episode of care
649.51 Spotting complicating pregnancy, delivered O26.852 Spotting complicating pregnancy, second trimester
649.53 Spotting complicating pregnancy, antepartum O26.853 Spotting complicating pregnancy, third trimester
O26.859 Spotting complicating pregnancy, unspecified
trimester
a. cannot be mapped at all to

b. do not map exactly to
c. must be reported instead of
d. require the payer to select
ANSWER: b
9. In the sample GEM table below, ICD-9-CM code 003.21 maps to ICD-10-CM code(s) __________.
examination
present)
by microscopy
Name: Class: Date:

episode of care
trimester
a. A02.21
b. A15.7
c. C92.01
d. O26.851 through O26.859
ANSWER: a
10. In the sample GEM table below, ICD-10-CM code A15.7 maps to __________ ICD-9-CM code(s).
examination
present)
by microscopy
episode of care
trimester
a. 1
b. 5
c. 6
d. 7
ANSWER: d
11. In the sample GEM table below, ICD-10-CM code C92.01 maps to ICD-9-CM code(s) __________,
examination
Name: Class: Date:

present)
by microscopy
episode of care
trimester
a. 003.21
b. 205.01
c. 649.50
d. 649.53
ANSWER: b
12. ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding
conventions, such as Excludes1 and Excludes2.
a. five
b. six
c. seven
d. eight
ANSWER: c
13. ICD-10-CM and ICD-10-PCS incorporate much greater specificity and clinical information, which results in
__________.
a. decreased sensitivity when refining grouping and reimbursement methodologies.
b. enhanced ability to conduct public health surveillance
c. increased need to include supporting documentation with claims
d. reduced ability to measure health care services
ANSWER: b
14. The ICD-10-CM and ICD-10-PCS classifications include updated medical terminology and classification of diseases,
provide codes to allow for the comparison of mortality and morbidity data, and provide __________ for the purpose
of conducting research, designing payment systems, identifying fraud and abuse, and more.
a. clinical decisions
b. improved data
c. measurement of care
d. public health tracing
ANSWER: b

Name: Class: Date:

15. Which of the following will best assist medical coding staff as ICD-10-CM and ICD-10-PCS classifications are
implemented?
a. ability to document information in patient records
b. basic knowledge of anatomy and physiology
c. effective communication with medical staff
d. reporting ICD-10-CM/PCS codes from indexes
ANSWER: c
16. When coders have questions about documented diagnoses or procedures/services, they should use a __________
process to contact the responsible physician to request clarification about documentation and the code(s) to be
assigned.
a. medical coordination
b. physician query
c. quality assurance
d. utilization management
ANSWER: b
17. ICD-10-CM far exceeds ICD-9-CM in the number of codes provided, having been expanded to __________.
a. delete fifth digits for some codes
b. include health-related conditions
c. mandate assignment of just three characters
d. reduce specificity at the sixth-digit level
ANSWER: b
18. ICD-10-PCS is an entirely new procedure classification system that was developed by CMS for use in __________
settings only, replacing Volume 3 of ICD-9-CM.
a. inpatient hospital
b. outpatient hospital
c. provider office
d. skilled nursing facility
ANSWER: a
19. ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g., 047K04Z) that provides a
unique code for all substantially different procedures, and it allows new procedures to be easily incorporated as new
codes.
a. clinical
b. logical
c. multiaxial
d. relational
ANSWER: c
20. Private companies publish __________, which automate the coding process so that computerized or web-based
software is used instead of coding manuals.
a. converters
b. encoders
Name: Class: Date:
c. multiplexers
d. transducers
ANSWER: b
21. The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and
modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency
mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for
__________.
a. diagnoses; procedures
b. diagnoses; conditions
c. procedures; diagnoses
d. services; procedures
ANSWER: a
22. The Medicare Prescription Drug, Improvement, and Modernization Act requires all code sets to be valid at the time
services are provided. This means that ICD-10-CM and ICD-10-PCS midyear and end-of-year coding updates must
be implemented immediately so accurate codes are reported on claims. Midyear updates are implemented on
__________, while end-of-year updates are implemented on __________.
a. April 1; October 1
b. August 1; February 1
c. July 1; January 1
d. June 1; December 1
ANSWER: a
23. Automating the medical coding process is the goal of __________, which uses a natural language processing engine
to “read” patient records and generate ICD-10-CM, ICD-10-PCS, HCPCS level II, and CPT codes.
a. computer-assisted coding
b. graphical user interfaces
c. mixed methods research
d. qualitative data analysis
ANSWER: a
24. Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim
submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the
diagnosis or treatment of an illness or injury. This concept is called __________.
a. advance beneficiary notice of nonpayment
b. medical necessity
c. quality assurance
d. utilization management
ANSWER: b
25. According to Medicare, if it is possible that scheduled tests, services, or procedures may be found medically
unnecessary, the patient must sign an advance beneficiary notice, which __________.
a. acknowledges the patient’s responsibility for payment if Medicare denies the claim
b. ensures that the provider will receive reimbursement from another third-party payer

Name: Class: Date:
c. guarantees that Medicare will deny payment for the claim, and the patient must pay
d. improves the chances that Medicare will approve the submitted claim for payment
ANSWER: a
26. Which is the face-to-face contact between a patient and a health care provider who assesses and treats the patient’s
condition?
a. benefit period
b. encounter
c. episode of care
d. spell of illness
ANSWER: b
27. Which of the following criteria is used to determine medical necessity?

a. Costly treatment is provided when compared with alternative methods.
b. Least expensive service is provided to patient, regardless of outcome.
c. Procedure or service is performed to treat a health care condition.
d. Treatment has a 50 percent chance of being effective for health outcome.
ANSWER: c
28. ICD-10-CM coding conventions are general rules used in the ICD-10-CM classification, which are independent of
official coding guidelines and are incorporated into ICD-10-CM as instructional __________.
a. annotations
b. explanations
c. notes
d. summaries
ANSWER: c
29. The ICD-10-CM index typically uses a(n) __________ format for ease in reference.
a. aligned
b. indented
c. notched
d. table
ANSWER: b
30. Which typeface is used for ICD-10-CM main term entries in the alphabetic index and all codes and descriptions of
codes in the tabular list?
a. all caps
b. bold
c. italics
d. underline
ANSWER: b
31. Which typeface is used for ICD-10-CM tabular list exclusion notes and to identify manifestation codes, which are
never reported as the first-listed diagnoses?
a. all caps
Name: Class: Date:
b. bold
c. italics
d. underline
ANSWER: c
32. Which are diseases or syndromes that are named for people and are listed in appropriate alphabetical sequence as
main terms in the ICD-10-CM index?
a. characters
b. eponyms
c. nouns
d. persons
ANSWER: b
33. Which abbreviation means “other” or “other specified” and identifies codes that are assigned when documentation
supports a condition for which a more specific code does not exist?
a. NEC
b. NOS
ANSWER: a
34. Which abbreviation means “unspecified” and identifies codes that are to be assigned when information needed to
assign a more specific code cannot be obtained from the provider?
a. NEC
b. NOS
ANSWER: b
35. Which punctuation is used after an incomplete term or phrase in the ICD-10-CM index and tabular list when one or
more modifiers (additional terms) is needed to assign a code?
a. braces
b. colons
c. parentheses
d. slanted brackets
ANSWER: b
36. Which punctuation is used in the ICD-10-CM index and tabular list to enclose nonessential modifiers, which are
supplementary words that may be present in or absent from the physician’s statement of a disease or procedure
without affecting the code number to which it is assigned?
a. braces
b. colons
c. parentheses
d. slanted brackets
ANSWER: c
37. Which punctuation is used in the ICD-10-CM index to identify manifestation codes and in the ICD-10-CM index and
tabular list to enclose abbreviations, synonyms, alternative wording, or explanatory phrases?
a. braces
Name: Class: Date:
b. colons
c. parentheses
d. slanted brackets
ANSWER: d
38. Which is a condition that occurs as the result of another condition and for which the codes are always reported as
secondary codes?
a. manifestation
b. sign
c. symptom
d. syndrome
ANSWER: a
39. Which is an alphabetic index of anatomic sites for which there are six possible ICD-10-CM code numbers according
to status as malignant primary, malignant secondary, malignant in situ, benign, of uncertain behavior, or of unspecified
nature?
a. Table of Drugs and Chemicals
b. Table of Neoplasms
ANSWER: b
40. Which is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse
effects for which ICD-10-CM codes are assigned?
a. Table of Drugs and Chemicals
b. Table of Neoplasms
ANSWER: a
41. Which appears in the ICD-10-CM tabular list below certain categories to further define, clarify, or give examples of
the content of a code category?
a. excludes1 notes
b. excludes2 notes
c. includes notes
d. inclusion terms
ANSWER: c
42. The includes note located below category code H80 Otosclerosis in the ICD-10-CM tabular list indicates that
otospongiosis is classified to that same category. This means that the provider __________, and a code from
category H80 would be assigned.
a. could document otosclerosis or otospongiosis
b. has the option of documenting otoscleritis
c. must document otosclerosis in the patient record
d. queries the coder to determine the condition to code
ANSWER: a
43. Which is a pure excludes note and means not coded here to indicate mutually exclusive codes, which means the
conditions cannot be reported together?

Name: Class: Date:
a. excludes1 note
b. excludes2 note
ANSWER: a
44. ICD-10-CM code Q03 Congenital hydrocephalus contains an Excludes1 note for acquired hydrocephalus
(G91.-). Thus, code G91.- __________.
a. can be reported with a category Q03 code due to interpretation of the Excludes1 note
b. may be reported with a code from category Q03 if documentation justifies both codes
c. is never reported with a code from category Q03 because of the Excludes1 note
d. results in coders submitting a physician query to request documentation clarification
ANSWER: c
45. Which means not included here and indicates that, although the excluded condition is not classified as part of the
condition it is excluded from, a patient may be diagnosed with all conditions at the same time?
a. excludes1 note
b. excludes2 note
ANSWER: b
46. ICD-10-CM code M19.14 Post-traumatic osteoarthritis, hand contains an Excludes2 note for post-traumatic
osteoarthritis of first carpometacarpal joint (M18.2-, M18.3-). The Excludes2note means that __________.
a. both codes can be assigned if the provider documented treatment of both conditions
b. just one of the codes is assigned because an Excludes2 note means “pure excludes”
c. neither code is assigned, and a physician query is generated to request clarification
d. patient record documentation must be modified to allow both codes to be assigned
ANSWER: a
47. Inclusion terms listed below codes in the ICD-10-CM tabular list are not meant to be exhaustive, and additional
terms found only in the index may also be associated with a code. This concept is called __________.
a. code verification
b. medical necessity
c. physician query
d. trust the index
ANSWER: d
48. When patient record documentation provides detail for which a specific code does not exist in ICD-10-CM, the index
entries contain the abbreviation NEC so that coders are alerted to classify such conditions as __________ codes in
the tabular list.
a. etiology
b. manifestation
c. other and other specified
d. unspecified
ANSWER: c
49. When patient record documentation is insufficient to assign a more specific code, __________ codes are assigned.
a. etiology
Name: Class: Date:
b. manifestation
c. other and other specified
d. unspecified
ANSWER: d
50. Which term describes the cause or origin of disease?

a. consequence
b. etiology
c. manifestation
d. syndrome
ANSWER: b
51. Which term describes symptoms or conditions that result from another disease?
a. consequences
b. etiology
c. manifestation
d. syndrome
ANSWER: c
52. Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list etiology code
contains a(n) __________ note.
a. code first underlying disease
b. in diseases classifiable elsewhere
c. other and other specified codes
d. use additional code
ANSWER: d
53. Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list manifestation code
contains a(n) __________ note.
ANSWER: a
54. In the ICD-10-CM tabular list, a manifestation code usually has in its title __________ , which indicates that the
manifestation code is a component of the etiology/manifestation coding convention.
ANSWER: b
55. The __________ instruction requires the causal condition to be sequenced first if present.

Name: Class: Date:
a. code, if applicable, any causal condition first

ANSWER: a
56. When the word and appears in ICD-10-CM tabular list category titles and code descriptions, it is interpreted as
meaning __________.
a. and
b. and/or
c. or
d. instead of
ANSWER: b
57. ICD-10-CM code H61.0 Chondritis and perichondritis of external ear is interpreted as __________.
a. chondritis of external ear and perichondritis of external ear, which means code H61.0 is assigned only if both
conditions are documented in the patient record
b. chondritis of external ear and/or perichondritis of external ear, which means code H61.0 is assigned only if
either condition is documented in the patient record
c. chondritis of external ear or perichondritis of external ear, which means code H61.0 is assigned only if either
condition is documented in the patient record
d. chondritis of external ear due to perichondritis of external ear, which means code H61.0 is assigned only if the
provider documents the phrase due to in the record
ANSWER: b
58. The subterm due to is located in the ICD-10-CM index in alphabetical order below a main term to indicate the
presence of a __________ relationship between two conditions.
a. cause-and-effect
b. either/or
c. inclusionary
d. mutually exclusive
ANSWER: a
59. When the word in appears in the ICD-10-CM index, it is located in alphabetical order below the main term. To
assign a code from the list of qualifiers below the word in, the physician must document __________ condition(s) in
the patient record.
a. both
b. either
c. one
ANSWER: a
60. When the word with appears in the ICD-10-CM index, it is located immediately below the main term, not in
alphabetical order. To assign a code from the list of qualifiers below the word with, the physician must document the
presence of __________ condition(s) in the patient record.

Name: Class: Date:
a. both
b. either
c. one
ANSWER: a
61. Which instruction after a main term directs the coder to refer to another term in the ICD-10-CM index to locate the
code, and the coder must go to the referenced main term to locate the correct code?
a. See
b. See also
c. See category
d. See condition
ANSWER: a
62. Which instruction is located after a main term or subterm in the ICD-10-CM index and directs the coder to another
main term (or subterm) that may provide additional useful index entries?
a. See
b. See also
c. See category
d. See condition
ANSWER: b
63. Which instruction directs the coder to the ICD-10-CM tabular list, where a code can be selected from the options
provided there?
a. See
b. See also
c. See category
d. See condition
ANSWER: c
64. Which instruction directs the coder to the main term for a diagnosis code, found in the ICD-10-CM disease index?
a. See
b. See also
c. See category
d. See condition
ANSWER: d
65. The ICD-10-CM Index to Diseases and Injuries is a(n) __________, which include specific illnesses, injuries,
eponyms, abbreviations, and other descriptive diagnostic terms.
a. alphabetical listing of terms and corresponding codes
b. group of boldfaced procedure terms with subterms
c. set of tables organized according to body system
d. tabular list of codes and their code descriptions
ANSWER: a
Name: Class: Date:

66. A code listed next to a main term in the ICD-10-CM index is referred to as a(n) __________ code.
a. category
b. default
c. etiology
d. unspecified
ANSWER: b
67. Supplementary words located in parentheses after a main term in the ICD-10-CM index are called __________
modifiers, which means they do not have to be included in the diagnostic statement for the code to be assigned.
a. mandatory
b. nonessential
c. qualifying
d. unspecified
ANSWER: b
68. Which are supplementary terms used in the ICD-10-CM index to further modify subterms and other qualifiers?
a. neoplasms
b. nonessential modifiers
c. qualifiers
d. subterms
ANSWER: c
69. Which are essential modifiers that qualify the main term in the ICD-10-CM index by listing alternative sites, etiology,
or clinical status?
a. neoplasms
b. nonessential modifiers
c. qualifiers
d. subterms
ANSWER: d
70. Which term describes benign new growths or tumors, in which cell reproduction is out of control?
a. cancer
b. malignancy
c. neoplasms
d. tissues
ANSWER: c
71. Which is a term associated with neoplasms and defined as any discontinuity of tissue that may or may not be
malignant?
a. abrasion
b. laceration
c. lesion
d. wound
ANSWER: c
Name: Class: Date:

72. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications,
organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the
original cancerous tumor site?
a. primary malignant
b. secondary malignant
c. carcinoma in situ
d. unspecified nature
ANSWER: a
metastasis of cancer?
ANSWER: b
organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a
malignant tumor that is localized, circumscribed, encapsulated, and noninvasive?
ANSWER: c
noninvasive, nonspreading, nonmalignant tumor?
a. malignant
b. benign
c. uncertain behavior
ANSWER: b
neoplasm for which it is not possible to predict subsequent morphology or behavior from the submitted specimen?
a. malignant
b. benign
ANSWER: c

Name: Class: Date:

identification of a neoplasm, but for which no further indication of the histology or nature of the tumor is reflected in
the documented diagnosis?
a. malignant
b. benign
ANSWER: d
78. Cancer described as metastatic to a site is considered __________.

a. benign
b. in situ
c. secondary
d. unspecified
ANSWER: c
79. If the primary site of malignancy is no longer present, assign a code for __________.
a. personal history of malignant neoplasm
b. primary cancer
c. primary of unspecified site
d. secondary of unspecified site
ANSWER: a
80. For carcinoma of breast with spread to the lungs, the primary site is __________.
a. breast
b. lungs
c. undetermined
d. unspecified
ANSWER: a
81. Which term describes the origin of a tumor (primary site) that involves two adjacent sites?
a. benign tumor
b. contiguous sites
c. primary malignancy
d. uncertain behavior
ANSWER: b
82. The re-excision of a tumor occurs when the pathology report recommends that the surgeon perform a second
excision to widen the margins of the original tumor site. The re-excision is performed to ensure that all tumor cells
have been removed and that a clear border (margin) of normal tissue surrounds the excised specimen. To code the
reason for the re-excision, __________.
a. assign a code based on a review of the current operative and pathology reports
b. generate a physician query to ask for clarification about the patient’s condition
c. refer to the diagnostic statement found in the report of the original excision
Name: Class: Date:
d. use the pathology report that results from the re-excision of the tumor margins
ANSWER: c
83. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological
substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs
and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.
Which column is reviewed to locate a code for a poisoning that results from an inadvertent overdose, wrong
substance administered/taken, or intoxication that includes combining prescription drugs with nonprescription drugs or
alcohol?
a. Poisoning: Accidental (Unintentional)
b. Poisoning: Intentional Self-Harm
c. Poisoning: Assault
d. Poisoning: Undetermined
ANSWER: a
Which column is reviewed to locate a code for a poisoning that results from a deliberate overdose, such as a suicide
attempt, of substance(s) administered/taken or intoxication that includes purposely combining prescription drugs with
nonprescription drugs or alcohol?
ANSWER: b
Which column is reviewed to locate a code for a poisoning inflicted by another person who intended to kill or injure
the patient?
ANSWER: c
Which column is reviewed to locate a code when the patient record does not document whether the poisoning was
intentional or accidental?

Name: Class: Date:
ANSWER: d
Which column is reviewed to locate a code when the patient develops a pathologic condition that results from a drug
or chemical substance that was properly administered or taken?
a. Poisoning
b. Adverse Effect
c. Underdosing
d. Underdetermined
ANSWER: b
Which column is reviewed to locate a code when the patient takes less of a medication than is prescribed by a
provider or a manufacturer’s instruction?
a. Poisoning
b. Adverse Effect
c. Underdosing
d. Underdetermined
ANSWER: c
89. Combination codes that include the substances related to adverse effects, poisonings, toxic effects, and underdosing
are reported with __________.
a. codes T00–T35
b. codes T36–T65
c. numerous S and T codes
d. numerous Z codes
ANSWER: b
90. When assigning codes from the ICD-10-CM Table of Drugs and Chemicals, codes from categories T36–T65 are
sequenced first, followed by code(s) that specify the nature of the adverse effect, poisoning, or toxic effect. The
exception to this rule is that __________ code(s) are sequenced after the condition treated.
a. adverse effect
b. poisoning
c. toxic effect
d. underdosing
ANSWER: d
91. The ICD-10-CM Tabular List of Diseases and Injuries is a chronological list of codes contained within __________
chapters, which are based on body system or condition.
a. 18
b. 19
Name: Class: Date:
c. 20
d. 21
ANSWER: d
92. Major topic headings in the tabular list of ICD-10-CM are known as __________.
a. categories
b. code blocks
c. sections
d. subcategories
ANSWER: b
93. ICD-10-CM categories, subcategories, and codes contain __________.

a. combinations of letters and numbers
b. codes that begin with numbers
c. letters, based on a multi-axial classification
d. numbers that start with three digits and then a decimal
ANSWER: a
94. ICD-10-CM category codes contain __________ characters.

a. 3
b. 4
c. 5
d. 6
ANSWER: a
95. A three-character ICD-10-CM category code that has no further subdivision is a(n) __________ code.
a. incomplete
b. other or other specified
c. unspecified
d. valid
ANSWER: d
96. ICD-10-CM subcategory codes contain __________ characters.

a. 3 or 4
b. 4 or 5
c. 5 or 6
d. 6 or 7
ANSWER: b
97. Valid codes may contain __________ characters.

a. 3, 4, 5, 6, or 7
b. 4, 5, 6, or 7
c. 5, 6, or 7
d. 6 or 7
Name: Class: Date:
ANSWER: a
98. The final level of an ICD-10-CM tabular list subdivision is a(n) __________.
a. code
b. index
c. subterm
d. table
ANSWER: a
99. All codes in the ICD-10-CM tabular list are __________.

a. boldfaced
b. italicized
c. title cased
d. underlined
ANSWER: a
100. Codes that have an applicable seventh character are considered __________ without the seventh character.
a. codes
b. complete
c. invalid
d. unspecified
ANSWER: c
101. Which character is used as a placeholder in ICD-10-CM?

a. a
b. m
c. x
d. z
ANSWER: c
102. ICD-10-CM’s Injury, Poisoning, and Certain Other Consequences of External Causes and External Causes
of Morbidity are incorporated into the tabular list as chapters __________.
a. 17 and 18
b. 18 and 19
c. 19 and 20
d. 20 and 21
ANSWER: c
103. ICD-10-CM’s Factors Influencing Health Status and Contact with Health Services are incorporated into the
tabular list as chapter __________.
a. 18
b. 19
c. 20
d. 21
Name: Class: Date:
ANSWER: d
104. Which indicates the tissue type of a neoplasm and is reported to state cancer registries?
a. biology
b. morphology
c. oncology
d. topography
ANSWER: b
105. The ICD-10-CM Official Guidelines for Coding and Reporting and the ICD-10-PCS Coding
Guidelines are approved by the __________.
a. Centers for Medicare and Medicaid Services
b. Cooperating Parties for ICD-10-CM and ICD-10-PCS
c. Department of Health and Human Services
d. National Center for Health Statistics
ANSWER: b
106. The ICD-10-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services — Hospital-Based
Outpatient Services and Provider-Based Office Visits were developed by the federal government and approved
for use by hospitals and providers for coding and reporting __________ services and provider-based office visits.
a. ambulatory surgical center
b. home health care/hospice
c. hospital-based outpatient
d. skilled nursing facility
ANSWER: c
107. The Uniform Hospital Discharge Data Set definition of principal diagnosis applies to __________.
a. clinics
b. inpatients
c. outpatients
d. skilled nursing care
ANSWER: b
108. In the outpatient setting, the __________ diagnosis is reported to reflect the reason for the encounter.
a. first-listed
b. primary
c. principal
d. sign or symptom
ANSWER: a
109. An outpatient is treated in which of the following settings?

a. acute inpatient admission
b. domiciliary care facility
c. hospital observation unit

Name: Class: Date:
d. nursing home
ANSWER: c
110. Diagnoses documented as probable, suspected, questionable, rule out, or working diagnosis, or other similar terms
indicating uncertainty, are considered __________ diagnoses, and are not coded in an outpatient setting.
a. first-listed
b. primary
c. qualified
d. signs/symptoms
ANSWER: c
111. Which is a concurrent condition that coexists with the first-listed diagnosis, has the potential to affect treatment of
the first-listed diagnosis, and is an active condition for which the patient is treated and/or monitored?
a. comorbidity
b. complication
c. qualified diagnosis
d. sign/symptom
ANSWER: a
112. Which is a condition that develops after outpatient care has been provided?
a. comorbidity
b. complication
c. qualified diagnosis
d. sign/symptom
ANSWER: b
113. Which is routinely completed prior to an inpatient admission or outpatient surgery to facilitate the patient’s treatment
and reduce the length of stay?
a. history and physical exam
b. preadmission testing
c. preauthorization
d. routine follow-up
ANSWER: b
114. Amebic cystitis is represented by which ICD-10-CM code?

a. A06.06
b. A06.81
c. A06.89
d. A06.9
ANSWER: b
115. Malignant carcinoid tumor of the duodenum is represented by which ICD-10-CM code?
a. C7A.0
b. C7A.01

Name: Class: Date:
c. C7A.010
d. C7A.019
ANSWER: c
116. Hereditary spherocytosis is represented by which ICD-10-CM code?

a. D58.0
b. D58.00
c. D58.09
d. D58.2
ANSWER: a
117. Diabetes insipidus is represented by which ICD-10-CM code?

a. E13.9
b. E15
c. E23.2
d. E23.7
ANSWER: c
118. Opioid abuse with intoxication delirium is represented by which ICD-10-CM code?
a. F11.10
b. F11.12
c. F11.121
d. F11.129
ANSWER: c
119. Vascular parkinsonism is represented by which ICD-10-CM code?

a. G21.2
b. G21.4
c. G21.40
d. G21.9
ANSWER: b
120. Vitiligo of the right lower eyelid and periocular area is represented by which ICD-10-CM code?
a. H02.73
b. H02.731
c. H02.732
d. H02.739
ANSWER: c
121. Atherosclerosis of native arteries of extremities with gangrene, bilateral legs is represented by which ICD-10-CM
code?
a. I70.261
b. I70.262
c. I70.263
Name: Class: Date:
d. I70.268
ANSWER: c
122. Obstructive rhinitis is represented by which ICD-10-CM code?

a. J30.0
b. J30.9
c. J31.0
d. J31.9
ANSWER: c
123. Chronic hepatic failure with coma is represented by which ICD-10-CM code?
a. K72.01
b. K72.10
c. K72.11
d. K72.91
ANSWER: c
124. Postimmunization arthropathy, left elbow is represented by which ICD-10-CM code?

a. M02.2x2
b. M02.22x2
c. M02.222
d. M02.229
ANSWER: c
125. Late vomiting in pregnancy is represented by which ICD-10-CM code?

a. O21.1
b. O21.2
c. O21.8
d. O21.9
ANSWER: b
126. Old age is represented by which ICD-10-CM code?

a. R53.1
b. R53.83
c. R54
d. R55
ANSWER: c
127. Sprain of thyroid cartilage, initial encounter is represented by which ICD-10-CM code?
a. S12.5
b. S13.5
c. S13.5xxA
d. S13.5xAx
ANSWER: c
Name: Class: Date:
128. Tobacco use is represented by which ICD-10-CM code?

a. F17.209
b. F17.219
c. Z87.891
d. Z72.0
ANSWER: d
129. A 35-year-old male patient was admitted to the hospital with pneumonia due to Pneumocystis carinii. The patient
had been diagnosed with AIDS several years ago and has been undergoing treatment. Which ICD-10-CM codes
should be assigned?
a. B20, B59
b. B20, J15.9
c. B59, B20
d. J15.9, B20
ANSWER: a
130. The final diagnosis for a 76-year-old woman is congestive heart failure, acute pulmonary edema, hypertension, and
type 2 diabetes mellitus. Which ICD-10-CM codes should be assigned?
a. I11.0, E11.9, J81.0
b. I11.0, J81.0, I10, E11.9
c. I50.9, J81.0, I11.0, E11.9
d. J81.0, I10, E11.9
ANSWER: c
131. Fever of unknown etiology. Rule out tuberculosis. Which ICD-10-CM code is assigned for an inpatient admission?
a. A15.0
b. R50.9
c. R50.9, A15.0
d. R50.9, Z03.89
ANSWER: a
132. Renal heart disease due to hypertension. Which ICD-10-CM code(s) should be assigned?
a. I11.9, I10
b. I13.10
c. I13.10, I10
d. I13.10, I11.9, I12.9
ANSWER: b
133. Failed medical induction of labor at 43 weeks’ gestation. Which ICD-10-CM code(s) are assigned?
a. O48.0
b. O61.0, O48.0
c. O61.0, O48.0, T48.0x5A
d. O61.9

Name: Class: Date:
ANSWER: b
134. Malunion of nondisplaced bimalleolar fracture, right ankle. Which ICD-10-CM code should be assigned?
a. S82.844P
b. S82.844S
c. S82.899K
d. S82.899P
ANSWER: a
135. Displacement of cardiac pacemaker electrode. Which ICD-10-CM codes should be assigned?
a. I97.191, Y83.1
b. T82.110A, Y83.1
c. T82.120A, Y83.1
d. T85.79xA, Y83.1
ANSWER: c
136. Elective abortion (complete) due to suspected damage to single fetus from maternal rubella. Which ICD-10-CM
codes should be assigned?
a. O04.89, O35.3xx0
b. O04.89, O35.3xx1
c. Z33.2, O35.3xx0
d. Z33.2, O35.3xx1
ANSWER: d
137. Major stab wound to thoracic aorta. Patient fell on a pitchfork in hay that was stored in the barn. Which ICD-10-CM
codes should be assigned?
a. S21.139A, W27.1xxA, Y92.71
b. S21.309A, W27.1xxA, Y92.71
c. S21.339A, W27.1xxA, Y92.71
d. S25.02xA, W27.1xxA, Y92.71
ANSWER: d
138. Acute gangrenous appendicitis. Postoperative paralytic ileus. Which ICD-10-CM codes should be assigned?
a. K35.2, K91.89
b. K35.3, K56.609
c. K35.80, K91.30
d. K35.89, K56.0
ANSWER: c
139. Five-hour-old low birth weight infant, premature at 30 weeks, spontaneous vaginal birth, is transferred to a tertiary
care hospital’s neonatal intensive care unit. Final diagnoses at the tertiary care hospital include male newborn
suspected of having respiratory distress syndrome due to prematurity. Which ICD-10-CM codes are assigned for the
tertiary care hospital care?
a. P22.0, P07.10, P07.33
b. P22.0, P07.10, Z38.00
Name: Class: Date:
c. Z38.00, P07.10, P07.33

d. Z38.00, P22.0, P07.10
ANSWER: a
140. Arteriosclerotic cardiovascular disease (ASCVD). Which ICD-10-CM code is assigned?

a. I25.10
b. I25.70
c. I25.83
d. I25.84
ANSWER: a
141. Patient treated for sepsis during subsequent encounter, following induced termination of pregnancy that was
performed during a previous admission. Which ICD-10-CM code(s) should be assigned?
a. O04.87
b. O04.80, Z33.2
c. O08.0
d. Z33.2, O08.0
ANSWER: a
142. Bronchogenic squamous cell carcinoma, left lung. Which ICD-10-CM code(s) should be assigned?
a. C34.92
b. C34.92, C80.1
c. C78.02
d. C80.1
ANSWER: a
143. Patient presented to the emergency department with chest pain. Diagnosis of myocardial infarction was ruled out.
Patient was released for follow up with primary care physician. Which ICD-10-CM code should be assigned?
a. I21.3
b. I25.2
c. R07.9
d. Z03.89
ANSWER: c
144. Essential hypertension with congestive heart failure. Which ICD-10-CM code(s) should be assigned?
a. I10, I50.9
b. I11.0
c. I11.0, I10
d. I11.0, I50.9
ANSWER: d
145. Evidence-based coding is used with __________ software.

a. abstracting
b. computer-assisted coding
Test Bank for Understanding Health Insurance 14th Edition by Green
Name: Class: Date:
c. encoder
d. grouper
ANSWER: b
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Chapter 06 ICD-10-CM Coding

4. Physician office __________ codes are submitted for reimbursement purposes.

5. Hospital inpatient __________ codes are submitted for reimbursement purposes.

6. Hospital outpatient __________ codes are submitted for reimbursement purposes.

Chapter 06 ICD-10-CM Coding

a. cannot be mapped at all to

Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

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Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

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Chapter 06 ICD-10-CM Coding

27. Which of the following criteria is used to determine medical necessity?

Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

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Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

50. Which term describes the cause or origin of disease?

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Chapter 06 ICD-10-CM Coding

a. code, if applicable, any causal condition first

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Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

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Chapter 06 ICD-10-CM Coding

78. Cancer described as metastatic to a site is considered __________.

Chapter 06 ICD-10-CM Coding

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Chapter 06 ICD-10-CM Coding

Chapter 06 ICD-10-CM Coding

93. ICD-10-CM categories, subcategories, and codes contain __________.

94. ICD-10-CM category codes contain __________ characters.

96. ICD-10-CM subcategory codes contain __________ characters.

97. Valid codes may contain __________ characters.

Chapter 06 ICD-10-CM Coding

99. All codes in the ICD-10-CM tabular list are __________.

101. Which character is used as a placeholder in ICD-10-CM?

Chapter 06 ICD-10-CM Coding

109. An outpatient is treated in which of the following settings?

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Chapter 06 ICD-10-CM Coding

114. Amebic cystitis is represented by which ICD-10-CM code?

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Chapter 06 ICD-10-CM Coding

116. Hereditary spherocytosis is represented by which ICD-10-CM code?

117. Diabetes insipidus is represented by which ICD-10-CM code?

119. Vascular parkinsonism is represented by which ICD-10-CM code?

Chapter 06 ICD-10-CM Coding

122. Obstructive rhinitis is represented by which ICD-10-CM code?

124. Postimmunization arthropathy, left elbow is represented by which ICD-10-CM code?

125. Late vomiting in pregnancy is represented by which ICD-10-CM code?

126. Old age is represented by which ICD-10-CM code?

Chapter 06 ICD-10-CM Coding

128. Tobacco use is represented by which ICD-10-CM code?

Copyright Cengage Learning. Powered by Cognero. Page 25