domains is essential for navigating complex societal interactions, particularly in professional, when actions
conflict with established laws or legal norms. The challenge arises in balancing both ethical and legal
considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of the sector
where ethical and legal issues are particularly pronounced. Medical professionals regularly face situations tha
require them to make complex decisions that not only have life-altering consequences for patients but also
raise profound moral questions. These issues include:#### 2.1 **Patient Autonomy and Informed
Consent**One of the fundamental ethical principles in healthcare is respect for patient autonomy—the right
of patients to make decisions about their own bodies and medical treatments. This principle is enshrined in th
legal concept of informed consent. Informed consent requires healthcare providers to disclose all relevant
information about the risks,
Note to instructors: This answer key contains the odd-only answers and rationales that are printed in the
back of the workbook. They have been updated to reflect 2017 codes and guidelines, and you may share
this key with your students if you wish.
Chapter 1: Certain Infectious and Parasitic Diseases
1. First-Listed Diagnosis: A56.09 Cervicitis, chlamydial
Secondary Diagnoses: None indicated by the documentation provided
Rationale: ICD-10-CM has a combination code that includes the diagnosis of cervicitis and the causative
infectious agent chlamydia.
3. First-Listed Diagnosis: B18.1 Hepatitis, viral, chronic, Type B
Secondary Diagnoses: K74.60 Cirrhosis of liver;
F11.21 Addiction, heroin, see Dependence, drug, opioid in remission
Rationale: The suspected liver failure is not coded because conditions documented as suspected are not
coded for outpatient encounters, guideline IV.H., Uncertain diagnosis
5. First-Listed Diagnosis: A46 Erysipelas
Secondary Diagnoses: None indicated by the documentation provided
Rationale: For the single diagnosis treated during this visit, see the Index entry term erysipelas, or the
main term cellulitis, subterm erysipelatous—see Erysipelas.
7. First-Listed Diagnosis: A54.01 Urethritis, gonococcal or Cystitis, gonococcal
Secondary Diagnoses: None indicated by the documentation provided
Rationale: ICD-10-CM provides a combination code that includes both sites of the infection and the
infectious organism.
9. First-Listed Diagnosis: G14 Syndrome, postpolio
Secondary Diagnoses: None indicated by the documentation provided
Rationale: Another code B91, sequela of poliomyelitis, is not used as a specific diagnosis is provided,
postpolio syndrome. There is an Excludes1 note present at B91 and G14 to indicate these two codes may
not be assigned together. Postpolio syndrome is a specific condition and it is more descriptive of the
patient than having a sequela of poliomyelitis and for that reason coded to G14 instead of B91. The
atrophy of the muscles is not coded separately as it is a symptom of the postpolio syndrome.
11. Principal Diagnosis: A41.59 Sepsis, gram negative (organism)
Secondary Diagnoses: N39.0 Infection, urinary tract;
B96.1 Infection, bacterial, as cause of disease classified, Klebsiella;
E87.1 Hyponatremia;
, E87.6 Hypokalemia;
C77.3 Neoplasm, malignant, secondary, axilla and upper limb lymph nodes;
Z85.3 History, personal malignant neoplasm, breast
(If information about the surgery (mastectomy, right or left) and acquired absence of breast is available,
two additional codes could be added.)
Principal Procedure: None Indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
Rationale: In this scenario the diagnosis of severe sepsis was not made. For that reason no additional
codes were added. In the Index under the main term of Sepsis, there is no subterm for Klebsiella but
Klebsiella is a gram negative organism so A41.59 was chosen instead of A41.50, which represents gram
negative sepsis, unspecified. In ICD-10-CM septicemia is referred to as sepsis as the main term. With the
urinary tract infectious organism of Klebsiella identified, the coder must follow the instructional note under
N39.0 to use an additional code to identify the Infectious organism. The coder must use the main term
Infection, bacterial, as cause of disease classified, Klebsiella to locate the additional code of B96.1.
Otherwise, if the coder used Infection, Klebsiella without following the ―as cause of disease classified
elsewhere,‖ an incorrect code would be assigned for another bloodstream infection, not the cause of the
urinary infection.
domains is essential for navigating complex societal interactions, particularly in professional, when
actions conflict with established laws or legal norms. The challenge arises in balancing both ethical and
legal considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of
the sectors where ethical and legal issues are particularly pronounced. Medical professionals regularly
face situations that require them to make complex decisions that not only have life-altering
consequences for patients but also raise profound moral questions. These issues include:#### 2.1
**Patient Autonomy and Informed Consent**One of the fundamental ethical principles in healthcare is
respect for patient autonomy—the right of patients to make decisions about their own bodies and
medical treatments. This principle is enshrined in the legal concept of informed consent. Informed
consent requires healthcare providers to disclose all relevant information about the risks,
13. First-Listed Diagnosis: B60.13 Keratoconjunctivitis, Acanthamoeba
Secondary Diagnoses: None indicated by the documentation provided
Rationale: There was a single reason for the office visit that was found to be the keratoconjunctivitis that
was coded as the first-listed diagnosis code.
15. First-Listed Diagnosis: A02.0 Poisoning, food, due to salmonella, with gastroenteritis
Secondary Diagnoses: E86.0 Dehydration
Rationale: The main reason for the emergency department encounter was determined to be the
salmonella food poisoning that produced the complication of dehydration. ICD-10-CM has a combination
code that identifies salmonella food poisoning with gastroenteritis, so an individual code for the
gastroenteritis is not necessary. A secondary code for the dehydration is added to identify the
complication of the food poisoning.
17. Principal Diagnosis: A37.01 Whooping cough due to Bordetella pertussis with pneumonia
Secondary Diagnoses: None indicated by the documentation provided
Principal Procedure: None indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
Rationale: The child was in the hospital for a single reason, the diagnosis of whooping cough with
complicating pneumonia. ICD-10-CM has a combination code to include both conditions. No other
diagnoses were identified during the hospital stay. No procedures were performed.
, Chapter 2: Neoplasms
1. Principal Diagnosis: C34.01 Neoplasm, bronchus, main, malignant primary, right
Secondary Diagnoses: C79.51 Neoplasm, bone, malignant secondary;
J43.9 Emphysema;
Z87.891 History, personal, nicotine dependence
Principal Procedure: Endoscopic biopsy of bronchus 0BB38ZX
Character Code Explanation
Section 0 Medical and Surgical
Body System B Respiratory System
Root Operation B Excision
Body Part 3 Main Bronchus, Right
Approach 8 Via Natural or Artificial Opening Endoscopic
Device Z No Device
Qualifier X Diagnostic
INDEX: Excision, main bronchus, right
Secondary Procedure(s): None indicated by the documentation provided
Rationale: The reason for admission was to evaluate the patient's lung disease, which was found to be
complicated by the fact the patient now had lung cancer proven by a bronchoscopic biopsy. Further
imaging studies confirmed the presence of metastatic lesions in the bones. The patient's pre-existing
conditions that were relevant to this hospital admission were also coded, including the emphysema and the
history of smoking. The biopsy is coded in ICD-10-PCS as an excision procedure of the site with the
qualifier of X to indicate the excision was a diagnostic procedure. The nuclear medicine bone scan may be
coded according to department policy of the types of surgical versus diagnostic procedures to be coded.
domains is essential for navigating complex societal interactions, particularly in professional, when
actions conflict with established laws or legal norms. The challenge arises in balancing both ethical and
legal considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of
the sectors where ethical and legal issues are particularly pronounced. Medical professionals regularly
face situations that require them to make complex decisions that not only have life-altering
consequences for patients but also raise profound moral questions. These issues include:#### 2.1
**Patient Autonomy and Informed Consent**One of the fundamental ethical principles in healthcare is
respect for patient autonomy—the right of patients to make decisions about their own bodies and
medical treatments. This principle is enshrined in the legal concept of informed consent. Informed
consent requires healthcare providers to disclose all relevant information about the risks,
3. Principal Diagnosis: E87.1 Dehydration, hypotonic
Secondary Diagnoses: C18.7 Neoplasm, sigmoid colon, malignant, primary;
C78.7 Neoplasm, liver and intrahepatic bile duct, malignant, secondary;
Z51.5 Palliative care;
Z66 DNR (do not resuscitate status)
Principal Procedure: None indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
, Rationale: The reason for admission after study for the principal diagnosis was the hypotonic dehydration
in a patient with cancer of the sigmoid colon metastatic to the liver. The patient chose palliative care and a
do-not-resuscitate status prior to being discharged to home hospice care. No procedures were performed.
5. First-Listed Diagnosis: D06.9 Neoplasm, cervix, Ca in situ
Secondary Diagnoses: None indicated by the documentation provided
Rationale: The patient's diagnosis of Ca in situ of the uterine cervix was confirmed by the outpatient
procedure and the reason for the outpatient visit. The outpatient procedure would be coded with CPT
procedure codes by the hospital coders.
domains is essential for navigating complex societal interactions, particularly in professional, when actions
conflict with established laws or legal norms. The challenge arises in balancing both ethical and legal
considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of the sectors
where ethical and legal issues are particularly pronounced. Medical professionals regularly face situations that
require them to make complex decisions that not only have life-altering consequences for patients but also raise
profound moral questions. These issues include:#### 2.1 **Patient Autonomy and Informed Consent**One of
the fundamental ethical principles in healthcare is respect for patient autonomy—the right of patients to make
decisions about their own bodies and medical treatments. This principle is enshrined in the legal concept of
informed consent. Informed consent requires healthcare providers to disclose all relevant information about the
risks,
7. First-Listed Diagnosis: C43.39 Melanoma (malignant), skin, forehead
Secondary Diagnoses: Z80.8 History, family, malignant neoplasm, specified site NEC;
Z77.123 Contact, radiation, naturally occurring
Rationale: Although there was no more malignant tissue found, because the treatment was directed at the
site of the melanoma, the code for the malignant melanoma is assigned as the first-listed diagnosis. The
other conditions or facts relevant to the scenario, the family history and exposure to sun, are coded as
additional diagnoses. The outpatient surgical procedure would be coded with CPT procedure codes by the
outpatient coders.
9. First-Listed Diagnosis: C79.51 Neoplasm, bone, malignant, secondary
Secondary Diagnoses: C79.31 Neoplasm, brain, malignant secondary;
C50.912 Neoplasm, breast, left, female, malignant, primary
Rationale: This is not an admission for chemotherapy as the Aredia is used for palliative treatment of
bone metastases and not to treat the cancer. The metastatic site of bone cancer is listed first as it is the site
where treatment was directed during this encounter. The other metastatic sites and the primary site of the
malignancy is also coded. The procedure for chemotherapy for an outpatient would be coded with CPT or
HCPCS by the outpatient coders.
11. Principal Diagnosis: C18.4 Neoplasm, intestine, large, colon, transverse, malignant, primary
Secondary Diagnoses: D63.0 Anemia in neoplastic disease
Principal Procedure: Blood transfusion 30233N1
Character Code Explanation
Section 3 Administration
Body System 0 Circulatory
Root Operation 2 Transfusion
Body Part 3 Peripheral Vein
conflict with established laws or legal norms. The challenge arises in balancing both ethical and legal
considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of the sector
where ethical and legal issues are particularly pronounced. Medical professionals regularly face situations tha
require them to make complex decisions that not only have life-altering consequences for patients but also
raise profound moral questions. These issues include:#### 2.1 **Patient Autonomy and Informed
Consent**One of the fundamental ethical principles in healthcare is respect for patient autonomy—the right
of patients to make decisions about their own bodies and medical treatments. This principle is enshrined in th
legal concept of informed consent. Informed consent requires healthcare providers to disclose all relevant
information about the risks,
Note to instructors: This answer key contains the odd-only answers and rationales that are printed in the
back of the workbook. They have been updated to reflect 2017 codes and guidelines, and you may share
this key with your students if you wish.
Chapter 1: Certain Infectious and Parasitic Diseases
1. First-Listed Diagnosis: A56.09 Cervicitis, chlamydial
Secondary Diagnoses: None indicated by the documentation provided
Rationale: ICD-10-CM has a combination code that includes the diagnosis of cervicitis and the causative
infectious agent chlamydia.
3. First-Listed Diagnosis: B18.1 Hepatitis, viral, chronic, Type B
Secondary Diagnoses: K74.60 Cirrhosis of liver;
F11.21 Addiction, heroin, see Dependence, drug, opioid in remission
Rationale: The suspected liver failure is not coded because conditions documented as suspected are not
coded for outpatient encounters, guideline IV.H., Uncertain diagnosis
5. First-Listed Diagnosis: A46 Erysipelas
Secondary Diagnoses: None indicated by the documentation provided
Rationale: For the single diagnosis treated during this visit, see the Index entry term erysipelas, or the
main term cellulitis, subterm erysipelatous—see Erysipelas.
7. First-Listed Diagnosis: A54.01 Urethritis, gonococcal or Cystitis, gonococcal
Secondary Diagnoses: None indicated by the documentation provided
Rationale: ICD-10-CM provides a combination code that includes both sites of the infection and the
infectious organism.
9. First-Listed Diagnosis: G14 Syndrome, postpolio
Secondary Diagnoses: None indicated by the documentation provided
Rationale: Another code B91, sequela of poliomyelitis, is not used as a specific diagnosis is provided,
postpolio syndrome. There is an Excludes1 note present at B91 and G14 to indicate these two codes may
not be assigned together. Postpolio syndrome is a specific condition and it is more descriptive of the
patient than having a sequela of poliomyelitis and for that reason coded to G14 instead of B91. The
atrophy of the muscles is not coded separately as it is a symptom of the postpolio syndrome.
11. Principal Diagnosis: A41.59 Sepsis, gram negative (organism)
Secondary Diagnoses: N39.0 Infection, urinary tract;
B96.1 Infection, bacterial, as cause of disease classified, Klebsiella;
E87.1 Hyponatremia;
, E87.6 Hypokalemia;
C77.3 Neoplasm, malignant, secondary, axilla and upper limb lymph nodes;
Z85.3 History, personal malignant neoplasm, breast
(If information about the surgery (mastectomy, right or left) and acquired absence of breast is available,
two additional codes could be added.)
Principal Procedure: None Indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
Rationale: In this scenario the diagnosis of severe sepsis was not made. For that reason no additional
codes were added. In the Index under the main term of Sepsis, there is no subterm for Klebsiella but
Klebsiella is a gram negative organism so A41.59 was chosen instead of A41.50, which represents gram
negative sepsis, unspecified. In ICD-10-CM septicemia is referred to as sepsis as the main term. With the
urinary tract infectious organism of Klebsiella identified, the coder must follow the instructional note under
N39.0 to use an additional code to identify the Infectious organism. The coder must use the main term
Infection, bacterial, as cause of disease classified, Klebsiella to locate the additional code of B96.1.
Otherwise, if the coder used Infection, Klebsiella without following the ―as cause of disease classified
elsewhere,‖ an incorrect code would be assigned for another bloodstream infection, not the cause of the
urinary infection.
domains is essential for navigating complex societal interactions, particularly in professional, when
actions conflict with established laws or legal norms. The challenge arises in balancing both ethical and
legal considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of
the sectors where ethical and legal issues are particularly pronounced. Medical professionals regularly
face situations that require them to make complex decisions that not only have life-altering
consequences for patients but also raise profound moral questions. These issues include:#### 2.1
**Patient Autonomy and Informed Consent**One of the fundamental ethical principles in healthcare is
respect for patient autonomy—the right of patients to make decisions about their own bodies and
medical treatments. This principle is enshrined in the legal concept of informed consent. Informed
consent requires healthcare providers to disclose all relevant information about the risks,
13. First-Listed Diagnosis: B60.13 Keratoconjunctivitis, Acanthamoeba
Secondary Diagnoses: None indicated by the documentation provided
Rationale: There was a single reason for the office visit that was found to be the keratoconjunctivitis that
was coded as the first-listed diagnosis code.
15. First-Listed Diagnosis: A02.0 Poisoning, food, due to salmonella, with gastroenteritis
Secondary Diagnoses: E86.0 Dehydration
Rationale: The main reason for the emergency department encounter was determined to be the
salmonella food poisoning that produced the complication of dehydration. ICD-10-CM has a combination
code that identifies salmonella food poisoning with gastroenteritis, so an individual code for the
gastroenteritis is not necessary. A secondary code for the dehydration is added to identify the
complication of the food poisoning.
17. Principal Diagnosis: A37.01 Whooping cough due to Bordetella pertussis with pneumonia
Secondary Diagnoses: None indicated by the documentation provided
Principal Procedure: None indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
Rationale: The child was in the hospital for a single reason, the diagnosis of whooping cough with
complicating pneumonia. ICD-10-CM has a combination code to include both conditions. No other
diagnoses were identified during the hospital stay. No procedures were performed.
, Chapter 2: Neoplasms
1. Principal Diagnosis: C34.01 Neoplasm, bronchus, main, malignant primary, right
Secondary Diagnoses: C79.51 Neoplasm, bone, malignant secondary;
J43.9 Emphysema;
Z87.891 History, personal, nicotine dependence
Principal Procedure: Endoscopic biopsy of bronchus 0BB38ZX
Character Code Explanation
Section 0 Medical and Surgical
Body System B Respiratory System
Root Operation B Excision
Body Part 3 Main Bronchus, Right
Approach 8 Via Natural or Artificial Opening Endoscopic
Device Z No Device
Qualifier X Diagnostic
INDEX: Excision, main bronchus, right
Secondary Procedure(s): None indicated by the documentation provided
Rationale: The reason for admission was to evaluate the patient's lung disease, which was found to be
complicated by the fact the patient now had lung cancer proven by a bronchoscopic biopsy. Further
imaging studies confirmed the presence of metastatic lesions in the bones. The patient's pre-existing
conditions that were relevant to this hospital admission were also coded, including the emphysema and the
history of smoking. The biopsy is coded in ICD-10-PCS as an excision procedure of the site with the
qualifier of X to indicate the excision was a diagnostic procedure. The nuclear medicine bone scan may be
coded according to department policy of the types of surgical versus diagnostic procedures to be coded.
domains is essential for navigating complex societal interactions, particularly in professional, when
actions conflict with established laws or legal norms. The challenge arises in balancing both ethical and
legal considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of
the sectors where ethical and legal issues are particularly pronounced. Medical professionals regularly
face situations that require them to make complex decisions that not only have life-altering
consequences for patients but also raise profound moral questions. These issues include:#### 2.1
**Patient Autonomy and Informed Consent**One of the fundamental ethical principles in healthcare is
respect for patient autonomy—the right of patients to make decisions about their own bodies and
medical treatments. This principle is enshrined in the legal concept of informed consent. Informed
consent requires healthcare providers to disclose all relevant information about the risks,
3. Principal Diagnosis: E87.1 Dehydration, hypotonic
Secondary Diagnoses: C18.7 Neoplasm, sigmoid colon, malignant, primary;
C78.7 Neoplasm, liver and intrahepatic bile duct, malignant, secondary;
Z51.5 Palliative care;
Z66 DNR (do not resuscitate status)
Principal Procedure: None indicated by the documentation provided
Secondary Procedure(s): None indicated by the documentation provided
, Rationale: The reason for admission after study for the principal diagnosis was the hypotonic dehydration
in a patient with cancer of the sigmoid colon metastatic to the liver. The patient chose palliative care and a
do-not-resuscitate status prior to being discharged to home hospice care. No procedures were performed.
5. First-Listed Diagnosis: D06.9 Neoplasm, cervix, Ca in situ
Secondary Diagnoses: None indicated by the documentation provided
Rationale: The patient's diagnosis of Ca in situ of the uterine cervix was confirmed by the outpatient
procedure and the reason for the outpatient visit. The outpatient procedure would be coded with CPT
procedure codes by the hospital coders.
domains is essential for navigating complex societal interactions, particularly in professional, when actions
conflict with established laws or legal norms. The challenge arises in balancing both ethical and legal
considerations when making decisions.### 2. **Ethical Issues in Healthcare**Healthcare is one of the sectors
where ethical and legal issues are particularly pronounced. Medical professionals regularly face situations that
require them to make complex decisions that not only have life-altering consequences for patients but also raise
profound moral questions. These issues include:#### 2.1 **Patient Autonomy and Informed Consent**One of
the fundamental ethical principles in healthcare is respect for patient autonomy—the right of patients to make
decisions about their own bodies and medical treatments. This principle is enshrined in the legal concept of
informed consent. Informed consent requires healthcare providers to disclose all relevant information about the
risks,
7. First-Listed Diagnosis: C43.39 Melanoma (malignant), skin, forehead
Secondary Diagnoses: Z80.8 History, family, malignant neoplasm, specified site NEC;
Z77.123 Contact, radiation, naturally occurring
Rationale: Although there was no more malignant tissue found, because the treatment was directed at the
site of the melanoma, the code for the malignant melanoma is assigned as the first-listed diagnosis. The
other conditions or facts relevant to the scenario, the family history and exposure to sun, are coded as
additional diagnoses. The outpatient surgical procedure would be coded with CPT procedure codes by the
outpatient coders.
9. First-Listed Diagnosis: C79.51 Neoplasm, bone, malignant, secondary
Secondary Diagnoses: C79.31 Neoplasm, brain, malignant secondary;
C50.912 Neoplasm, breast, left, female, malignant, primary
Rationale: This is not an admission for chemotherapy as the Aredia is used for palliative treatment of
bone metastases and not to treat the cancer. The metastatic site of bone cancer is listed first as it is the site
where treatment was directed during this encounter. The other metastatic sites and the primary site of the
malignancy is also coded. The procedure for chemotherapy for an outpatient would be coded with CPT or
HCPCS by the outpatient coders.
11. Principal Diagnosis: C18.4 Neoplasm, intestine, large, colon, transverse, malignant, primary
Secondary Diagnoses: D63.0 Anemia in neoplastic disease
Principal Procedure: Blood transfusion 30233N1
Character Code Explanation
Section 3 Administration
Body System 0 Circulatory
Root Operation 2 Transfusion
Body Part 3 Peripheral Vein
