ICD-10-CM Coding Practice Questions with Answers

What this set covers

Explanations are based on the FY2027 ICD-10-CM Official Guidelines, written in plain language; check anything important in your own guideline book. You see the answers only after you respond.

1. In the ICD-10-CM Tabular List, what does an Excludes1 note under a code mean?
2. A code in the Tabular List carries an Excludes2 note listing a second condition. The provider documents that the patient has both conditions. How should they be reported?
3. What is the difference between the abbreviations NEC and NOS in ICD-10-CM?
4. A code category requires a 7th character, but the code you selected has only five characters. What must you do?
5. A patient has type 2 diabetes and peripheral neuropathy. The provider does not state whether the neuropathy is caused by the diabetes, and does not say it is unrelated. How does the ICD-10-CM "with" convention apply?
6. A patient is seen for right lower quadrant abdominal pain. After workup, the physician documents a final diagnosis of acute appendicitis (no perforation, abscess or peritonitis documented). Which ICD-10-CM coding is correct?
7. In a physician office visit, a patient presents with cough and fever. The provider documents "rule out pneumonia" and orders a chest X-ray; the result is not yet available. Which coding is correct for this outpatient encounter?
8. A patient has essential hypertension and chronic kidney disease, stage 4. The provider does not explicitly link the two conditions. Which codes are correct?
9. A patient with hypertension is treated for chronic diastolic (congestive) heart failure. The provider does not state a link between the two. Which codes are correct?
10. A patient with type 2 diabetes mellitus has chronic kidney disease, stage 3a. Which codes are correct?
11. For most fracture categories in Chapter 19, what does the 7th character "D" indicate?
12. An asymptomatic, average-risk 50-year-old has a screening colonoscopy. No abnormalities are found. Which first-listed diagnosis code is correct?
13. A coder looks up a patient's diagnosis in the Alphabetic Index of Diseases and Injury. The entry shows a code with no dash at the end. What should the coder do next?
14. A provider documents a rare, specifically named disorder. In the Alphabetic Index, the subterm for this disorder is followed by the abbreviation NEC and points to a code. How should the coder interpret this?
15. A coder looks up a patient's condition in the Alphabetic Index. The entry lists one code followed by a second code enclosed in square brackets. How should the coder report this?
16. A coder looks up a main term in the Alphabetic Index. A "see also" instruction next to the main term points to a different main term. Under the original main term, a subterm exactly matches the provider's documentation and lists a code. What should the coder do?
17. A patient is seen in the emergency department. The provider's final diagnosis is simply "appendicitis." There is no mention of acute, chronic, perforation, abscess, or peritonitis anywhere in the record. How should the coder select the code?
18. A 66-year-old patient is seen for follow-up. The provider documents atherosclerotic heart disease of the native coronary arteries with angina pectoris and does not specify the type of angina. Nothing in the record suggests the angina has another cause. Which code assignment is correct?
19. A patient has age-related cataracts in both eyes. The right eye was operated on last month, and the cataract in that eye was fully removed. The patient now returns for surgery on the left eye. Which diagnosis coding approach is correct for today's encounter?
20. A provider diagnoses a patient with a rare named syndrome and documents the patient's specific manifestations: muscle weakness, recurrent seizures, and hearing loss. The coder searches the Alphabetic Index and finds no entry or guidance for this syndrome, and the syndrome has no unique code. How should the encounter be coded?
21. A coder is assigning a code within a category that contains several specific codes and an "other specified" code, but no "unspecified" code. The provider's documentation names the general condition but gives no further detail about its type. Which code should be assigned?
22. A coder selects a code whose Tabular List entry has a "code also" note pointing to a second, related condition. The provider documents that the patient also has that second condition, and it was addressed during the visit. How should the coder handle the note?
23. An 81-year-old patient is seen in the office because of worsening memory. The provider documents dementia due to Parkinson's disease, without behavioral disturbance, with severity not specified. The visit focuses entirely on the dementia. How should the codes be reported?
24. A provider documents a diagnosis using a specific clinical term. The coder finds that term in the Alphabetic Index, and it directs to a particular code. In the Tabular List, that exact term does not appear among the inclusion terms listed under the code, and no instructional note excludes it. What should the coder do?
25. A patient is treated for psychogenic dysmenorrhea, which is an inclusion term under F45.8, Other somatoform disorders. The provider also diagnoses sleep related teeth grinding, G47.63. Code F45.8 has an Excludes1 note for sleep related teeth grinding, because teeth grinding is also an inclusion term under F45.8. The provider clearly documents that the two conditions are unrelated. Which code assignment is correct?
26. A patient is seen in the office with cough and fever. A chest x-ray is performed, and the provider's final diagnosis is simply "pneumonia." An oral antibiotic is prescribed. The record does not state the organism or the type of pneumonia. Which code should be assigned?
27. A patient is seen for a condition that the provider documents as a manifestation of an underlying systemic disease. In the Tabular List, the manifestation code has a "code first" note for the underlying disease, and the underlying disease code has a "use additional code" note for the manifestation. The manifestation code title does NOT contain the phrase "in diseases classified elsewhere." The visit focuses mainly on the manifestation. How should the codes be reported?
28. A patient is referred to a hospital outpatient department for an abdominal ultrasound because of right upper quadrant abdominal pain. The radiologist interprets the study, and the signed final report, available at the time of coding, states: cholelithiasis, with no evidence of cholecystitis or obstruction. Which coding is correct for this outpatient diagnostic encounter?
29. In a physician office visit, a patient presents with fever and cough. After examination, the provider documents a final diagnosis of pneumonia; no organism is identified. The provider does not mention any other signs, symptoms, or conditions. Which coding is correct?
30. A patient is seen for evaluation of a hypertrophic scar on the left forearm. The scar resulted from a laceration of the forearm that was repaired 18 months ago and has fully healed. The provider documents the scar as a residual effect of the old laceration. How should this encounter be coded?
31. A patient is admitted after a crush injury to the left lower leg. On discharge, the provider's final diagnostic statement reads: "Contusion of left lower leg; impending compartment syndrome, did not develop." The coder checks the Alphabetic Index. There is no 'impending' or 'threatened' subentry under the condition, and no relevant entry under the main terms Impending or Threatened. How should the impending condition be handled?
32. A patient is admitted with sepsis due to pneumonia. Both conditions are present on admission, and no organism is identified for either. The attending physician documents acute kidney failure due to the sepsis and describes the condition as severe sepsis. Septic shock is not present. Which code set and sequence is correct?
33. A patient is seen for diabetic polyneuropathy. The provider documents "diabetes mellitus on long-term insulin" but does not state the type of diabetes. No oral or other injectable antidiabetic drugs are documented. Which codes are correct?
34. A patient has hypertension, chronic systolic (congestive) heart failure, and chronic kidney disease, stage 3b. The provider does not state whether the heart failure or the kidney disease is related to the hypertension, and does not state that either is unrelated. Which codes are correct?
35. A patient took her prescribed sleep medication at exactly the dose directed. That same evening she also drank several glasses of wine. She is brought to the emergency department with excessive drowsiness. The provider attributes the drowsiness to the interaction between the drug and the alcohol. The intent is not documented. How should this encounter be classified and sequenced?
36. A patient at 32 weeks of gestation is seen in the obstetrician's office for management of gestational diabetes. The condition is being controlled with both a diabetic diet and insulin. No other complications are documented. Which codes are correct?
37. Three years ago, a patient was treated for cancer of the breast with a lumpectomy followed by radiation therapy. All treatment is complete. She now presents for a scheduled surveillance examination. The provider documents no evidence of recurrence, and no further cancer treatment is planned. Which codes are correct?
38. A patient is seen in her primary care physician's office solely for preoperative clearance. She is scheduled for a laparoscopic cholecystectomy to treat calculus of the gallbladder with chronic cholecystitis, without obstruction. She also has type 2 diabetes mellitus without complications. An ECG is performed during the visit and is normal. No treatment is given. Which codes are correct for this office visit?
39. A patient arrives at a hospital outpatient surgery center for scheduled removal of an age-related nuclear cataract of the right eye. In the preoperative area, her blood pressure is markedly elevated, and the surgeon cancels the procedure. The surgeon documents 'elevated blood pressure, possible hypertension, refer to PCP.' The patient has no prior diagnosis of hypertension. Which codes are correct?
40. A patient has a known primary carcinoma of the upper lobe of the right lung. The lung tumor is still present and has not been removed. She is admitted for surgical resection of a brain metastasis, and all treatment during this stay is directed at the brain lesion only. Which codes are correct?
41. A patient with type 2 diabetes mellitus without complications is seen for a routine diabetes management visit. Her regimen is metformin tablets daily plus a once-weekly injectable GLP-1 receptor agonist, which is a non-insulin antidiabetic drug. She does not use insulin. Which codes are correct?
42. A patient with long-standing hypertension is seen for kidney disease follow-up. In the same note, the nephrologist documents both 'chronic kidney disease, stage 5' and 'end-stage renal disease.' The patient is not yet on dialysis. The provider does not state that the kidney disease is unrelated to the hypertension. Which codes are correct?
43. Twelve days ago, a patient was treated for a type 1 non-ST elevation myocardial infarction (NSTEMI). She is now admitted with acute blood loss anemia. During this stay, the provider documents a type 2 myocardial infarction due to demand ischemia caused by the anemia. Considering only the anemia and the myocardial infarctions, which codes are correct?
44. A patient with chronic obstructive pulmonary disease is admitted with community-acquired pneumonia; no organism is identified. The provider treats the pneumonia but does not document an acute exacerbation of the COPD. Which codes are correct?
45. A patient is seen in a physician's office for burning epigastric pain after meals. The provider's assessment reads 'probable gastroesophageal reflux disease' and orders a trial of dietary changes. At the same visit, the provider reviews the patient's essential hypertension. It is managed with diet and exercise only, and the provider documents that plan to continue it. Which codes are correct for this encounter?