ICD-10 Practice Question — Medical Coding Practice Test

Q: (ICD-10 Practice Question) “I am having
a little trouble on this practice question, maybe I’m only over thinking. Can you help?
Thank you.” You know what, what an interesting thing is
that you usually are over thinking it A 23-year-old male who previously suffered a metacarpal
fracture of the left hand, 2nd metacarpal bone, as the result of a gunshot wound develops
a non-union of the metacarpal. A: You know what, I honestly don’t know
if I answered this. I don’t think I did. So, let’s talk through it. One of things
that is different in ICD-10 than ICD-9 is when a person comes in for a sequela which
is a late effect and this person has a late effect, it’s a nonunion of the metacarpal.
And the metacarpal bones are in the hand, you have the carpals are the little square
bones, and then the long bones in the hands are the metacarpals. Then you have the phalanges,
then you have the digits; your phalanges are your fingers. So, the long bones that are
between your wrist and that first knuckle in
your hand that you can feel in there, those long bones, that’s the metacarpals. So obviously,
this guy has an injury; he had a gunshot wound in the hand, and it developed a nonunion (the
bones didn’t stay lined up). [Ed. Note: Definition of nonunion: failure of the ends
of a fractured bone to unite.] So, you would be able to code for – there’s
literally a code for nonunion. And then, at the end of the code, remember in the previous
that we were talking about, the letters at the front, now you have letters at the end
that would say whether it was the initial encounter or a subsequent or sequela. An initial
encounter, a second visit or subsequent visit, then you had sequela (late effect).
Now, I see that someone asked, would there be an E-code? They’re in ICD-10; there are
not E-codes. There are E-codes, but they are not the E-codes as we know them in ICD-9.
They actually still have codes like E-codes, but they’re in the Z section. So, to be
able to tell that this guy suffered this injury from a gunshot wound, you can use that. Now,
in addition, E-codes in ICD-9 are only used the first time that the person is being seen;
you wouldn’t use it on a sequela or a subsequent visit. But with ICD-10, you can.

12 thoughts on “ICD-10 Practice Question — Medical Coding Practice Test

  1. I am glad you are working through the codes here. First, you can use and external cause code however we do not know from the information given what type of gun was used. The unspecified option some have mentioned was from X94. but we do not know that this was an assault. What if he shot himself by accident in the hand? Then you are looking at W34.00XD which in my opinion is a better external cause code.
    W34.00XD – Accidental discharge from unspecified firearms or gun, subsequent encounter
    Discharge from firearm NOS
    Gunshot wound NOS
    Shot NOS
    Now to the main code. Is this a subsequent encounter or a sequela? We do not have enough information. I am inclined to think this is a subsequent encounter. A non-union would be identified in follow up care. This is something that to get to the highest specificity you need more info again. I tend to lean towards S62.301K – Unspecified fracture of second metacarpal bone, left hand, subsequent encounter for fracture with nonunion.
    What are your thoughts?

  2. Question was answered on the CCO website: http://www.cco.us/forum/threads/icd-10-practice-question.1435/

    Color me shock that the GSW didn't need to be coded.

  3. Yeah, no offense but you didn't answer the question and do people still code with ICD-9? Anyway, would the answer be S62.301K (Unspecified fracture of second metacarpal bone, left hand, subsequent encounter for fracture with nonunion)? I'm not sure how or whether you need to detail the gunshot part of the problem in the code? Would that require a second code for that?

  4. Fuck! I don't know why KSA is using the Australian modification when this new version of coding is available?

  5. Winner of a video, I've been looking for "medical coding and billing certification exam" for a while now, and I think this has helped. You ever tried – Lukesey CPC Carnage – (Have a quick look on google cant remember the place now ) ? Ive heard some great things about it and my cousin got great success with it.

  6. Update 7th Digit A: Initial Encounter has been updated in the ICD10 guidelines to mean initial, acute phase of treatment. That means while in the Hospital getting the ORIF, ED Visit for initial Fx treatment, whatever. The recovery phase involves the subsequent encounter.

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