1. Q: What does ICD-10-CM stand for? ANSWER International
Classification of Diseases, 10th Revision, Clinical Modification
2. Q: How many characters can an ICD-10-CM code contain? ANSWER
ICD-10-CM codes can range from 3 to 7 characters
3. Q: What does the 7th character in an ICD-10-CM code typically
represent? ANSWER The 7th character typically represents encounter type,
extension, or fetus identification
4. Q: What is a placeholder "X" used for in ICD-10-CM? ANSWER A
placeholder "X" is used to fill empty character positions when a 7th character is
required
5. Q: What does the ICD-10-CM convention "NEC" mean? ANSWER
NEC stands for "Not Elsewhere Classifiable" and indicates the medical record
provides detail but no specific code exists
6. Q: What does "NOS" mean in ICD-10-CM? ANSWER NOS stands for
"Not Otherwise Specified" and is equivalent to "unspecified"
7. Q: What type of code is used when a definitive diagnosis has not been
established? ANSWER Sign and symptom codes from Chapter 18 (R codes)
8. Q: Can you code "rule out" diagnoses in the outpatient setting?
ANSWER No, you should code the documented signs and symptoms instead
9. Q: What is the difference between "and" and "with" in ICD-10-CM?
ANSWER "And" means and/or, while "with" means associated with or due to
10. Q: What does a code first notation indicate? ANSWER It indicates that
another code should be sequenced before the current code
,11. Q: What is the purpose of the Alphabetic Index in ICD-10-CM?
ANSWER To locate the appropriate code or code range based on the diagnostic
statement
12. Q: Should you code directly from the Alphabetic Index? ANSWER No,
you must always verify the code in the Tabular List
13. Q: What do square brackets [ ] indicate in ICD-10-CM? ANSWER
Square brackets enclose synonyms, alternative wordings, or explanatory phrases
14. Q: What do parentheses ( ) indicate in ICD-10-CM? ANSWER
Parentheses enclose supplementary words that may be present without affecting
code assignment
15. Q: What does a "see" notation mean? ANSWER It directs you to another
term in the Alphabetic Index
16. Q: What does "see also" mean? ANSWER It provides an alternative term
to check if the main term entry doesn't provide the appropriate code
17. Q: What is the default code? ANSWER It is the code listed next to the
main term in the Alphabetic Index, representing the unspecified condition
18. Q: How are laterality designations indicated in ICD-10-CM? ANSWER
By using 5th, 6th, or 7th characters to specify right, left, bilateral, or unspecified
19. Q: What does an "excludes1" note mean? ANSWER It means "NOT
CODED HERE" and indicates two conditions cannot be reported together
20. Q: What does an "excludes2" note mean? ANSWER It means "NOT
INCLUDED HERE" but the excluded condition may be reported separately if
present
21. Q: What is the principal diagnosis? ANSWER The condition established
after study to be chiefly responsible for the admission (inpatient only)
22. Q: What is the first-listed diagnosis? ANSWER The diagnosis or
condition chiefly responsible for the outpatient services provided
23. Q: Can you assign a code for a condition that was previously treated
and no longer exists? ANSWER No, unless it's a history code (Z codes)
indicating past conditions affecting current care
24. Q: What chapter contains infectious and parasitic diseases? ANSWER
Chapter 1 (codes A00-B99)
, 25. Q: What chapter contains neoplasm codes? ANSWER Chapter 2 (codes
C00-D49)
26. Q: What chapter contains endocrine, nutritional and metabolic
diseases? ANSWER Chapter 4 (codes E00-E89)
27. Q: What chapter contains circulatory system diseases? ANSWER
Chapter 9 (codes I00-I99)
28. Q: What chapter contains respiratory system diseases? ANSWER
Chapter 10 (codes J00-J99)
29. Q: What chapter contains digestive system diseases? ANSWER Chapter
11 (codes K00-K95)
30. Q: What chapter contains injury and poisoning codes? ANSWER
Chapter 19 (codes S00-T88)
31. Q: What are Z codes used for? ANSWER Z codes are used for
circumstances other than disease or injury, such as health encounters,
screenings, and history
32. Q: Can a Z code be used as a principal diagnosis? ANSWER Yes, when
the encounter is primarily for a circumstance rather than treatment of a disease
33. Q: What is the appropriate code for a follow-up examination after
treatment for malignancy? ANSWER Z08, Encounter for follow-up
examination after completed treatment for malignant neoplasm
34. Q: What is sequencing? ANSWER The order in which diagnosis codes
are listed on a claim, with the most significant condition first
35. Q: What is a combination code? ANSWER A single code that classifies
two diagnoses, a diagnosis with a manifestation, or a diagnosis with a
complication
36. Q: Should you use a combination code when available? ANSWER Yes,
combination codes should be used when they fully describe the condition
37. Q: What is multiple coding? ANSWER Using more than one code to fully
describe a condition when a combination code is not available
38. Q: What does "use additional code" mean? ANSWER It indicates that
an additional code should be assigned to provide more complete information
39. Q: What is etiology? ANSWER The underlying cause of a disease or
condition
Classification of Diseases, 10th Revision, Clinical Modification
2. Q: How many characters can an ICD-10-CM code contain? ANSWER
ICD-10-CM codes can range from 3 to 7 characters
3. Q: What does the 7th character in an ICD-10-CM code typically
represent? ANSWER The 7th character typically represents encounter type,
extension, or fetus identification
4. Q: What is a placeholder "X" used for in ICD-10-CM? ANSWER A
placeholder "X" is used to fill empty character positions when a 7th character is
required
5. Q: What does the ICD-10-CM convention "NEC" mean? ANSWER
NEC stands for "Not Elsewhere Classifiable" and indicates the medical record
provides detail but no specific code exists
6. Q: What does "NOS" mean in ICD-10-CM? ANSWER NOS stands for
"Not Otherwise Specified" and is equivalent to "unspecified"
7. Q: What type of code is used when a definitive diagnosis has not been
established? ANSWER Sign and symptom codes from Chapter 18 (R codes)
8. Q: Can you code "rule out" diagnoses in the outpatient setting?
ANSWER No, you should code the documented signs and symptoms instead
9. Q: What is the difference between "and" and "with" in ICD-10-CM?
ANSWER "And" means and/or, while "with" means associated with or due to
10. Q: What does a code first notation indicate? ANSWER It indicates that
another code should be sequenced before the current code
,11. Q: What is the purpose of the Alphabetic Index in ICD-10-CM?
ANSWER To locate the appropriate code or code range based on the diagnostic
statement
12. Q: Should you code directly from the Alphabetic Index? ANSWER No,
you must always verify the code in the Tabular List
13. Q: What do square brackets [ ] indicate in ICD-10-CM? ANSWER
Square brackets enclose synonyms, alternative wordings, or explanatory phrases
14. Q: What do parentheses ( ) indicate in ICD-10-CM? ANSWER
Parentheses enclose supplementary words that may be present without affecting
code assignment
15. Q: What does a "see" notation mean? ANSWER It directs you to another
term in the Alphabetic Index
16. Q: What does "see also" mean? ANSWER It provides an alternative term
to check if the main term entry doesn't provide the appropriate code
17. Q: What is the default code? ANSWER It is the code listed next to the
main term in the Alphabetic Index, representing the unspecified condition
18. Q: How are laterality designations indicated in ICD-10-CM? ANSWER
By using 5th, 6th, or 7th characters to specify right, left, bilateral, or unspecified
19. Q: What does an "excludes1" note mean? ANSWER It means "NOT
CODED HERE" and indicates two conditions cannot be reported together
20. Q: What does an "excludes2" note mean? ANSWER It means "NOT
INCLUDED HERE" but the excluded condition may be reported separately if
present
21. Q: What is the principal diagnosis? ANSWER The condition established
after study to be chiefly responsible for the admission (inpatient only)
22. Q: What is the first-listed diagnosis? ANSWER The diagnosis or
condition chiefly responsible for the outpatient services provided
23. Q: Can you assign a code for a condition that was previously treated
and no longer exists? ANSWER No, unless it's a history code (Z codes)
indicating past conditions affecting current care
24. Q: What chapter contains infectious and parasitic diseases? ANSWER
Chapter 1 (codes A00-B99)
, 25. Q: What chapter contains neoplasm codes? ANSWER Chapter 2 (codes
C00-D49)
26. Q: What chapter contains endocrine, nutritional and metabolic
diseases? ANSWER Chapter 4 (codes E00-E89)
27. Q: What chapter contains circulatory system diseases? ANSWER
Chapter 9 (codes I00-I99)
28. Q: What chapter contains respiratory system diseases? ANSWER
Chapter 10 (codes J00-J99)
29. Q: What chapter contains digestive system diseases? ANSWER Chapter
11 (codes K00-K95)
30. Q: What chapter contains injury and poisoning codes? ANSWER
Chapter 19 (codes S00-T88)
31. Q: What are Z codes used for? ANSWER Z codes are used for
circumstances other than disease or injury, such as health encounters,
screenings, and history
32. Q: Can a Z code be used as a principal diagnosis? ANSWER Yes, when
the encounter is primarily for a circumstance rather than treatment of a disease
33. Q: What is the appropriate code for a follow-up examination after
treatment for malignancy? ANSWER Z08, Encounter for follow-up
examination after completed treatment for malignant neoplasm
34. Q: What is sequencing? ANSWER The order in which diagnosis codes
are listed on a claim, with the most significant condition first
35. Q: What is a combination code? ANSWER A single code that classifies
two diagnoses, a diagnosis with a manifestation, or a diagnosis with a
complication
36. Q: Should you use a combination code when available? ANSWER Yes,
combination codes should be used when they fully describe the condition
37. Q: What is multiple coding? ANSWER Using more than one code to fully
describe a condition when a combination code is not available
38. Q: What does "use additional code" mean? ANSWER It indicates that
an additional code should be assigned to provide more complete information
39. Q: What is etiology? ANSWER The underlying cause of a disease or
condition
