Practice Management Alert

Discover where you should focus your training in the next few months. 

The conversion to ICD-10 diagnosis coding is just a few short months away. You are probably busy making sure all of your payers are ready, transitioning to the updated CMS-1500 form, and implementing practice-wide changes to prepare. But have you started focusing on the actual codes your practice will need to use?

Take this short quiz — and have your physicians, coders, and billers take it as well — to see if everyone involved in selecting the proper diagnosis is on track to be ready on Oct. 1. 

Hint: You’ll find the answers to all the questions in this quiz in next month’s special issue of Practice Management Alert, which will focus entirely on ICD-10 diagnosis coding. 

Question 1: Your physician reviews a 55-year-old patient with Type 2 diabetes and kidney complications. Your physician arrives at a diagnosis of diabetic nephropathy due to diabetes mellitus. What ICD-10 code should you report?

Question 2: A gastroenterologist diagnoses ulcerative colitis but does not record a specific location. Even when you ask for additional detail, the gastroenterologist is not be able to provide you with an exact location. How would you report this condition under ICD-10? 

Question 3: Your family practitioner assesses an 11-year-old boy brought in by his parents with complaints of restlessness and hyperactivity. The patient is new to the physician. The parents explain that he was having problems with discipline in school, was often disruptive during his classes, and was not able to keep up with the rest of the children in his studies. He was often rebellious at home, too, and was a source of tension and friction for the parents.

The parents first noticed this behavior of hyperactivity and restlessness when it was brought to their attention by the school authorities when he was about 10 years old, and his behavior was becoming more erratic and difficult by the day, which finally made the parents try and seek help.

Your physician conducts a thorough physical examination and a complete mental status examination, a complete psychiatric and medical history of the patient and family, and a thorough review of systems. Your physician also assesses the patient for anxiety and other learning disabilities.

Your physician also conducts interviews with the child’s parents and sends out standard evaluation forms to be filled in by his teachers at school.

Based on the signs and symptoms, observations of the child, assessment of the interviews conducted, and the assessment of the evaluation forms completed by his teachers, your physician arrives at a diagnosis of ADHD of predominantly hyperactive type. What is the proper ICD-10 code for this case?

Question 4: Your cardiologist documents that a patient has discomfort, pressure, and tightness in his chest. What ICD-10 code should you report?

Question 5: A 20-year-old male patient arrives at your office with complaints of severe persistent cough for a period of about 10 days with moderate amounts of sputum production. He also complains of fever with chills, nasal congestion, and generalized body and muscle aches.

Upon examination, the physician arrives at an initial diagnosis of acute bronchitis. Under ICD-10 what should you report as a preliminary diagnosis since the etiology is not confirmed? 

The physician suspects a bacterial origin, so he sends a sputum sample for culture. When the pathology result arrives, it confirms an infection due to streptococcus. Now that the etiology is confirmed, what should you report?