Category Archives: cpc

ICD 10 Questions

Practice Questions for 2018 – ICD – 10 CM

  1.  Patient presents with a sore throat and fever for 2 days. Assessment: Positive strep test with a diagnosis of tonsillitis.
  2. A female patient comes in with vaginal itching and burning on urination. Wet prep is positive for yeast vaginitis.
  3. A patient with a malignant neoplasm of the right ovary is being treated by the oncologist for anemia due to tumor.
  4. A patient states that she was begun to have symptoms of her depression again. she is tired, having trouble concentrating, and often agitated. she has a persistent low mood and lack of interest in activities. She is diagnosed with recurrence of her mild depression.
  5. Patient presents after working out and doing sit ups. She is experiencing musculoskeletal pain. She is diagnoses with muscle strain of abdominal muscles.
  6. A man with prostate cancer comes to the hospital for his second radiation therapy treatment.
  7. A former smoker is seen for a follow up. He has coronary artery disease with unstable angina.
  8. A 14 year old patient is seen in the ED for 1st degree burn on his right buttock. He was running away from a firework that tipped over and it struck him. He was at home in the yard.
  9. A patient comes in for her mammogram results. The patient is found to have microcalcifications.
  10. Patient present for vaginal bleeding for the last couple months, at irregular times other than when she is having her period. She is not in pain, and this generally occurs after intercourse. GYN exam is performed and a cervical polyp is seen in the cervical OS. The polyp is removed with ring forceps and sent to pathology.
  11. Patient presents with left shoulder pain after lifting heavy boxes in the attic. She did not fall but struck the wall. On exam  she can not raise the arm or place it behind her back without pain. She is diagnosed with a muscle strain of the left shoulder.
  12. A female patient is seen for obesity.
  13. An asthmatic patient presents for a check up. She has mild persistent asthma that is currently well controlled. She does, however, continue to smoke cigarettes. She states she has tried to quit, but just can’t. She is dependent, having smoked for 25 years.
  14. A patient comes in for a 22 week G2P1 complains of vaginal discharge. Wet prep shows Candida Vaginitis and the patient is instructed to use mycolog cream externally.
  15. A patient is seen by the ENT for chronic ethmoidal sinusitis.




  1. J03.00
  2. B37.3
  3. C56.1, D63.0
  4. F33.0
  5. S39.011A
  6. Z51.0, C61
  7. I25.110, Z87.79
  8. T21.15XA
  9. R92.0
  10. N84.1
  11. S46.912A
  12. E66.9
  13. J45.30
  14. O23.592, Z3A.22, B37.3
  15. J32.2



Practice Questions For CPC Exam 2017 -Part 1

Hello Guys!!

This is very first post of my next CPC Practice Questions 2017 series post. I will publish more questions in coming days. Do check these. Practice more and more these questions and find answers in the next post. Continue reading Practice Questions For CPC Exam 2017 -Part 1

How To Code – Wound Repair or Closure

Wound Repair or closure

Wound Types –

  1. Abrasion – skin scrapped off
  2. Laceration – ragged skin tear , crushed tissue
  3. Amputation – surgical removal of limb
  4. Incision – cut, wound from a sharp object
  5. Puncture – by penetrating or nailing object , by bullets
  6. Avulsion – tearing away of tissues from a body part

3 Factors to be considered while coding wound closure

  1. Length – length of wound (in cm)
  2. Complexity – complexity of repair
  3. Site – site of wound repair

Wound repair classification as per CPT manual

  • Simple Repair (12001 – 12021) –

    • Superficial wound repair or one layer closure.
    • Involves epidermis, dermis and subcutaneous tissue.
    • Require one layer suturing for closure
  • Intermediate Repair (12031- 12057)

    • One or more layers of subcutaneous tissue and superficial (non – muscle) fascia in addition of epidermis and dermis.
    • Simple closure of heavily contaminated wounds which requires extensive cleaning or removal of particulate matter also coded as intermediate closure
  • Complex Repair (13100 – 13160)

    • Involves complicated wound closure including revision, debridement, extensive undermining, stents or retention sutures.


Classification Site of Wound Length of Wound CPT Code
Simple repairs Scalp, neck, axillae, external genitalia, trunk, extremities including hands and feet 2.5 cm or less 12001
2.6 to 7.5 cm 12002
7.6 to 12.5 cm 12004
12.6 to 20.0 cm 12005
20.1 to 30.0 cm 12006
Over 30.0 cm 12007
Face, ears, eyelids, nose, lips, mucous membranes 2.5 cm or less 12011
2.6 to 5.0 cm 12013
5.1 to 7.5 cm 12014
7.6 to 12.5 cm 12015
12.6 to 20.0 cm 12016
20.1 to 30.0 cm 12017
Over 30.0 cm 12018
Intermediate Repair Scalp, axillae, trunk, extremities excluding hands and feet 2.5 cm or less 12031
  2.6 to 7.5 cm 12032
  7.6 to 12.5 cm 12034
  12.6 to 20.0 cm 12035
  20.1 to 30.0 cm 12036
  Over 30.0 cm 12037
Necks, hands, feet, external genitalia 2.5 cm or less 12041
  2.6 to 7.5 cm 12042
  7.6 to 12.5 cm 12044
  12.6 to 20.0 cm 12045
  20.1 to 30.0 cm 12046
  Over 30.0 cm 12047
Face, ears, eyelids, nose, lips and mucous membrane 2.5 cm or less 12051
  2.6 to 5.0 cm 12052
  5.1 to 7.5 cm 12053
  7.6 to 12.5 cm 12054
  12.6 to 20.0 cm 12055
  20.1 to 30.0 cm 12056
  Over 30.0 cm 12057
Complex Repair Trunk 1.1 to 2.5 cm 13100
  2.6 to 7.5 cm 13101
  Each additional 5 cm or less +13102
Scalp, arms, legs 1.1 to 2.5 cm 13120
  2.6 to 7.5 cm 13121
  Each additional 5 cm or less +13122
Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet 1.1 to 2.5 cm 13131
  2.6 to 7.5 cm 13132
  Each additional 5 cm or less +13133
Eyelids, nose, ears, and lips 1.1 to 2.5 cm 13151
  2.6 to 7.5 cm 13152
  Each additional 5 cm or less +13153


Coding Rules: For multiple wounds

  • When more than one classification of wound repair are given (more than one repair type), code more complicated as primary and less complicated as secondary with modifier -59 (distinct procedural service).


Hierarchy is


  • Same classification –
    1. Wounds from Same group of anatomic sites – Combine the length of all wounds
    2. Wounds from different group of anatomic sites – Don’t combine, coded separately (greater length wound will be coded as primary)
  • For each anatomic site, the lengths of wounds are totaled together by complexity (simple, intermediate, complex ). For Example All the simple wounds of the same site grouping are reported together; all the intermediate wounds of the same site grouping are reported together; and all the complex wounds of the same site grouping are reported together.
  • Three things are considered components (parts) of integumentary wound repair:
    1. Simple ligation (tying) of small vessels is considered part of the wound repair and is not reported separately. Simple ligation of medium or major arteries in a wound is, however, reported separately.
    2. Simple exploration of surrounding tissue, nerves, vessels, and tendons is considered part of the wound repair process and is not listed separately.
    3. Normal debridement (cleaning and removing skin or tissue from the wound until normal, healthy tissue is exposed) is not listed separately.

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Modifier 22

Modifier 22 – Procedural Service

  • The purpose of this modifier is to report services (surgical or nonsurgical) when the work required to provide a service is substantially greater than typically required.
  • This modifier must be used only when additional work factors requiring the physician’s technical skill involve significantly increased physician work, time, and complexity of than when the procedure is normally performed.

o   “Substantially Greater” refers to increased intensity, time, technical difficulty of procedure, severity of patient’s condition, and physical and mental effort required, etc.

o   Trauma extensive enough to complicate the procedure and cannot be reported with additional procedures.

o Significant scarring requiring extra time and work.

o Extra work resulting from morbid obesity.

o Increased time resulting from extra work by the physician.

  • Procedure codes with modifier 22 appended will price at 120% of the allowable charge.
  • This modifier may be used with codes in the following sections:

o Anesthesia (00100-01999)

o Surgery (11100-69990)

o Radiology (70010-79999)

o Laboratory and pathology (80047-89356)

o Medicine (90281-99607)

  • This modifier is not appended to ELM services (99201-99499).

Clinical Information Requirements:

  • Medical records must be available upon request.
  • Clinical information documented in the patient’s medical records must support the use of this modifier.


Coding Tips for Multiple Fractures


Coding Multiple Injuries and/or Multiple Fractures

  •  When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned.  Multiple injury codes are provided in ICD-9-CM, but should not be assigned unless information for a more specific code is not available. These codes are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds.
  •  The code for the most serious injury, as determined by the physician, is sequenced first.
  •  Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site.
  •  When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional code(s) from categories 950-957, Injury to nerves and spinal cord, and/or 900-604, Injury to blood vessels. When the primary injury is to the blood vessels or nerves, that injury should be sequenced first.
  •  The principles of multiple coding of injuries should be followed in coding fractures.  Fractures of specified  sites  are  coded  individually  by  site  in  accordance  with  both  the  provisions  within categories 800-829 and the level  of detail  furnished by medical record content.   Combination categories for multiple fractures are provided for use when there is sufficient detail in the medical record (such as trauma cases transferred to another hospital), when the reporting form limits the number of codes that can be used in reporting pertinent clinical data, or when there is insufficient specificity at the fourth-digit or fifth-digit level. More specific guidelines are as follows:
  • Multiple fractures of same limb classifiable to the same three-digit or four-digit category are coded to that category.
  • Multiple unilateral or bilateral fractures of same bone(s) but classified to different fourth- digit subdivisions (bone part) within the same three-digit category are coded individually by site.
  • Multiple fracture categories 819 and 828 classify bilateral fractures of both upper limbs (819) and both lower limbs (828), but without any detail at the fourth-digit level other than open and closed type of fractures.
  • Multiple fractures are sequenced in accordance with the severity of the fracture and the physician should be asked to list the fracture diagnoses in the order of severity.


Coding tips for burns

Coding Tips for Burns

Coding Burns 

Current burns (940 – 948) are classified by depth, extent and by agent (E code). Burns are classified by depth as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement).

Sequence first the code that reflects the highest degree of burn when more than one burn is present.

Classify burns of the same local site three-digit category level, (940-947) but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis.

Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as non-healed burn.

Assign code  958.3,  Post-traumatic wound  infection, not  elsewhere classified, as  an additional code for any documented burn site.

When coding burns, assign separate codes for each burn site.  Category 946, burns of multiple specified sites, should only be used if the locations of the burns are not documented.  Category 949, burns, unspecified, is extremely vague and should rarely be used.

Assign codes form category 948, Burns classified according to extent of body surface involved, when the site of the burn is not specified or when there is a need for additional data. It is advisable to use category 948 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units.  It is also advisable to use category 948 as an additional code for reporting purposes when there is mention of a third-degree burn involving 20 percent or more of the body surface.

In assigning a code form category 948: Fourth-digit codes are used to  identify the percentage of total body surface involved in a burn (all degree).

Fifth-digits are assigned to identify the percentage of body surface involved in third- degree burn.

Fifth-digit zero (0) is assigned when less than 10 percent or when no body surface is involved in a third-degree burn.

Category 948  is  based  on  the  classic  “Rule  of  Nines”  in  estimating  body  surface involved: head and neck are assigned nine percent, each arm nine percent, each leg 18 percent, the anterior trunk 18 percent, posterior trunk 18 percent, and genitalia one percent.          Physicians  may  change  these  percentage  assignments  where  necessary  to accommodate infants and children who have proportionately larger heads than adults and patients who have large buttocks, thighs, or abdomens that involve burns.

Encounters for the treatment of the late effects of burns (i.e., scars or joint contractures) should be coded to the residual condition (sequelae) followed by the appropriate late effect code (906.5-906.9). A late effect E code may also be used if desired.

When appropriate, both a sequelae with a late effect code, and a current burn code may be assigned on the same record.

The body is divided into eight areas:

Head and Neck 9%
Posterior Trunk 18%
Anterior Trunk 18%
Left Arm 9%
Right Arm 9%
Posterior Leg 18%
Anterior Leg 18%
Genitalia 1%
Total body 100%


ICD 9 – Coding Tables

Volume 2 Coding Tables

Three main tables are presented in the Alphabetic Index as tables.  The Hypertension and Neoplasm tables  are  found  in  their  proper alphabetical place  in  the  Index, but  the  Table  of  Drugs  and Chemicals follows the alphabetic listing.



Hypertension Table  The hypertension table is found under the main heading “Hypertension/hypertensive”   This table contains the  complications, etiology (cause) and clinical manifestations of hypertension.  There are three subcategories for each listing in this category.


Malignant Benign Unspecified
Malignant hypertension is usually defined as very high blood pressure withswelling of the optic nerve behind the eye, called papilledema. Malignant hypertension is usually accompanied by other organ damage like heart failure, kidney failure, and hypertensive encephalopathy. Malignant hypertension is a medical emergency. In a benign (nonmalignant) hypertension, in which hypertensive neuroretinopathy is absent, a hypertensive crisis mayoccur based on the development of concomitant acute end-organ dysfunction. This form indicates that the type of hypertension has not yet been determined by the physician.


Hypertension, Essential, or NOS: Assign hypertension arterial (essential)(primary)(systems)(NOS) to category code 401 with the appropriate fourth digit to indicate malignant (0.0), benign (0.1), or unspecified (0.9). Do not use either malignant (0.0) or benign (0.1) unless medical record documentation supports such a designation.


Hypertension with Heart Disease: Heart conditions (425.8., 429.0-429.3, 429.8,429.9) are assigned to a code from category 402 when a causal relationship is stated (due to hypertension) or implied (hypertensive). The same heart conditions with hypertension, but without a stated casual relationship are coded separately.


Hypertensive Renal Disease with Chronic Renal Failure: Assign category  code  403,  hypertensive  renal  disease,  when  conditions  classified  to categories  (585-587)  are  present.  Unlike  hypertension  with  heart  disease,  ICD-9-CM presumes a cause-and-effect relationship and classifies renal failure with hypertension as hypertensive renal disease.





Hypertensive Heart and Renal Disease: Assign codes from combination category 404 when both hypertensive heart and hypertensive renal disease are stated in the diagnosis.


Hypertensive Cerebrovascular Disease: First assign category codes from 430-438 (cerebrovascular disease) and then the appropriate hypertension code from categories (401-405).


  • Hypertensive Retinopathy: Two codes are necessary to identify the condition. First assign the code from the subcategory 362.11 (hypertensive retinopathy), then the appropriate code from categories 401-405 to indicate the type of hypertension.


Hypertension, Secondary:Two codes are required: One to identify the underlying etiology and one from category 405 to identify the hypertension.


Hypertension, Transient or Elevated Blood Pressure: Assign code 796.2, elevated blood pressure reading without diagnosis of hypertension. Use codes 642.3X for transient hypertension of pregnancy.


Hypertension, Controlled/Uncontrolled: Assign appropriate code from categories (401-405). Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to the current therapeutic regimen.



Neoplasm Table


The neoplasm table is found under the main term Neoplasm, neoplastic.  The table gives the code numbers for neoplasm by anatomical site.   For each site, there are six possible code numbers according to whether the neoplasm in question is malignant, benign, in situ, of uncertain behavior or of unspecified nature. The description of the neoplasm will often indicate which of the six columns is appropriate.


The word   neoplasm simply means new growth. Neoplasm may remain benign (non-cancerous), become cancerous (malignant), spread to other areas (metastasis) or, remain in one designated area (ca in situ). It should be noted, the term mass is not synonymous with neoplasm, as it is often used to describe cysts and thickenings such as those occurring with hematoma or infection.




Primary Secondary CA  in Benign Uncertain Unspecified
Situ Behavior





To properly code a neoplasm it is necessary to determine from the record if the neoplasm is benign, in-situ, malignant, or of uncertain histologic behavior. If malignant, any secondary (metastatic) sites should also be determined.


The neoplasm table in the Alphabetic Index should be referenced first.  If the histological term is documented, that term should be referenced first, rather than going immediately to the Neoplasm Table, in order to determine which column in the Neoplasm Table is appropriate.  For example, if the documentation indicates “adenoma”, refer to the term in the Alphabetic Index to review the entries under this term and the instructional note to “see also neoplasm, by site, benign.”  The table provides the proper code based on the type of neoplasm and the site.  It is important to select the proper column in the table that corresponds to the type of neoplasm.  The tabular list should then be referenced to verify that the correct code has been selected from the table and that a more specific site code does not exist.


  • If the treatment is directed at the malignancy, designate the malignancy as the principal diagnosis.


  • When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward  the  secondary  site  only,  the  secondary  neoplasm  is  designated  as  the principal diagnosis even though the primary malignancy is still present.


  • Coding and sequencing of complications associated with the malignant neoplasm or with the therapy thereof are subject to the following guidelines;


o When admission/encounter is  for  management of  an  anemia associated with the malignancy, and the treatment is only for anemia, the anemia is designated as the principal diagnosis and is followed by the appropriate code(s) for the malignancy.


o When the  admission/encounter is  for  management of  an  anemia associated with chemotherapy or radiotherapy and the only treatment is for the anemia, the anemia is sequenced first followed by the appropriate code(s) for the malignancy.


o When  the  admission/encounter  is  for  management  of  dehydration  due  to  the malignancy or the therapy, or a combination of both, and only the dehydration is being treated (intravenous rehydration), the dehydration is sequenced first, followed by the code(s) for the malignancy.


o When the admission/encounter is for treatment of a complication resulting from a surgical procedure performed for the treatment of an intestinal malignancy, designate the complication as the principal or first-listed diagnosis if treatment is directed at resolving the complication.


  • When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site.  The secondary site may be the principal or first-listed with the V10 code used as a secondary code.





  • Admissions/Encounters involving chemotherapy and radiation therapy:


o When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by chemotherapy or radiation treatment, the neoplasm code should be assigned as principal or first-listed diagnosis. When an episode of inpatient care involves surgical removal of a primary or secondary site malignancy followed by adjunct chemotherapy or radiotherapy, code the malignancy as the principal or first- listed diagnosis, using codes in the 140-198 series or where appropriate in the 200-

203 series.


o If a patient admission/encounter is solely for the administration of chemotherapy or radiation therapy code V58.0, Encounter for radiation therapy,   this should be the first-listed  or  principal  diagnosis.    If  a  patient  receives  both  chemotherapy and radiation therapy, both codes should be listed, in either order of sequence.


o When a patient is admitted for the purpose of radiotherapy or chemotherapy and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is V58.0, Encounter for radiotherapy, or V58.1, Encounter for chemotherapy.


  • When the reason for admission/encounter is to determine the extent of the malignancy, or for a procedure such as paracentesis or thoracentesis, the primary malignancy or appropriate metastatic site is designated as the principal or first-listed diagnosis, even though chemotherapy or radiotherapy is administered.



“V” Codes Associated with Neoplasms


V10 Personal history of malignant neoplasm
V16 Family history of malignant neoplasm
V71 Observation and evaluation for suspected conditions not found
V76 Special screening for malignant neoplasms


Table of Drugs and Chemicals


The  Table  of  Drugs  and  Chemicals  contains  an  extensive  list  of  drugs,  and  other  chemical substances to identify poisoning states and other external causes of adverse effects set in a six- column format.  The first column is used to code the substance involved in the poisoning situation. The next five columns are grouped under the heading “External Cause (E Code)” and identify the circumstances involved.


The E codes in the five columns in this table are defined as:


Accidental Poisoning Codes (E850-E869) identify accidental overdose of drug, wrong substance given or taken inadvertently, accidents in the usage of drugs and biologicals in medical and surgical procedures, and to show external causes of poisoning classifiable to 980 – 989. Therapeutic Uses





Codes  (E930-E949)  indicates  a  correct  substance  properly  administered  in  therapeutic  or prophylactic dosage as the external cause of adverse effects.


Suicide  Attempt  Codes  (E950-E952)  identify  instances  in  which  self-inflicted  injuries  or poisonings are involved.


Assault Codes (E961-E962) indicate injury or poisoning inflicted by another person with the intent to injure or kill.


Undetermined Codes (E980-E982) are to be used when the intent of the poisoning or injury cannot be determined (i.e., whether it was intentional or accidental).


ICD 9 Coding Tips

ICD 9 – Introduction

Volume 2 Footnotes, Symbols and Conventions


Volume 2 (Index) Example

Directs the coder to a more specific term under which the correct code can be found.


Bursting – see Fracture, phalanx, hand, distal


Indicates the coder should review the category specified before assigning the code.




late effect – see category 326


Indicates where supplemental information is available that may provide another code.

Bartholin’s …. 

Adenitis (See also Bartholinitis) 616.

NEC Not elsewhere classifiable 

This abbreviation is used when the ICD-9- CM  system  does  not  provide  a  code specific for the patient’s condition.

Metabolism disorder 277.9 specified type NEC 277.89
( ) 

Parentheses enclose supplementary words, called non-essential modifiers, which may be present in the narrative description of a disease without affecting the code assignment.

198.4 Other parts of nervous system meninges (cerebral) (spinal)

Italicized  type  is  used  for  all  exclusion notes and to identify codes that should not be used for describing the primary diagnosis.

Foreign body
Note – For foreign body with open wound or other injury,  see  Wound,  open,  or  the  type  of  injury specified.


Supplemental classification V Codes

Supplementary Classification of Factors Influencing Health Status and Contact With Health Services (V01-V84)



Supplementary Classification of Factors Influencing Health Status and Contact With Health Services (V01-V84)

This classification system is provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of ICD-9-CM) are recorded as “diagnoses” or “problems”. This can arise in three main ways:

  • When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury.
  • When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury.(e.g. dialysis for renal disease, chemotherapy for malignancy, or a cast change).
  • When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.  Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories 001-999.


Supplementary Classification of Factors Influencing Health Status and

Contact with Health Services (V01 – V84)



Persons with Potential Health Hazards Related to Communicable Disease V01 – V06
Persons with Need for Isolation, Other Potential Health Hazards and ProphylacticMeasures V07 – V09
Persons with Potential Health Hazards Related to Personal and Family History V10 – V19
Persons Encountering Health Services in Circumstances Related to Reproduction and Development V20 – V29
Liveborn Infants According to Type of Birth V30 – V39





Persons with a Condition Influencing Their Health Status V40 – V49
Persons Encountering Health Services for Specific Procedures and Aftercare V50 – V59
Persons Encountering Health Services in Other Circumstances V60 – V69
Persons  without  Reported  Diagnosis  Encountered  during  Examination  andInvestigation of Individuals and Populations V70 – V84