Question 1

Patient is admitted for treatment of primary liver cancer.Patient had a liver transplant 2 years ago.Patient has a past medical history of hypertension and COPD and is a former alcoholic,now in remission.Patient has been sober for 10 years.

Accepted Answer

D

Question 2

The patient had an embolic cerebrovascular accident and was documented by the surgeon as being a postoperative complication.The patient initially had been admitted for treatment of coronary artery arteriosclerosis with CABG.The patient is taken to the OR for an open three-vessel aorta to coronary artery using greater saphenous vein.The left greater saphenous vein was harvested via percutaneous endoscopic approach.Cardiopulmonary bypass is performed during the surgery.

Accepted Answer

This combination of codes includes I25.10 for the initial reason for admission (coronary artery arteriosclerosis), I63.40 for the cerebrovascular accident, and I97.820 for the postoperative complication. Y83.2 is the appropriate external cause code for a medical care complication during surgical care, and there are additional procedure codes for the CABG and the harvesting of the greater saphenous vein.

Question 3

There is a time limit for complications to occur.

Accepted Answer

Complications can occur at any time, even long after the initial event or procedure.

Question 4

Patient with a history of a kidney transplant comes to the ER with gastroenteritis.His history is positive for CKD,stage 2,and hypertension.

Accepted Answer

The answer of Patient with a history of a kidney...

Question 5

Patient admitted with an abscess due to Streptococcus of abdominal surgical wound,initial encounter.Cultures were positive for Streptococcus.The abscess of the skin was incised and drained.

Accepted Answer

The answer of Patient admitted with an abscess due to...

Question 6

Leakage of peritoneal dialysis catheter.Patient is on dialysis for end-stage renal disease.Peritoneal catheter was removed (percutaneous removal of infusion device from peritoneal cavity).Patient has a history of hypertension and type 2 diabetes with associated neuropathy.

Accepted Answer

- T85.631A: Leakage of other dialysis catheter, initial encounter - to indicate the reason for the current hospital admission
- I12.0: Hypertensive chronic kidney disease - to indicate patient's hypertension and chronic kidney disease
- N18.6: End stage renal disease - to indicate patient's renal disease
- E11.40: Type 2 diabetes mellitus with diabetic neuropathy, unspecified - to indicate patient's diabetes and neuropathy
- Z99.2: Dependence on renal dialysis - to indicate patient's dependence on dialysis
- Y84.1: Other medical devices associated with adverse incidents - to indicate the reason for the removal of the catheter
- 0WPG33Z: Removal of Other Device from Abdomen, Percutaneous Approach, Diagnostic - to indicate the procedure done to remove the peritoneal catheter.

Question 7

To aspirate means to ____.

Accepted Answer

To aspirate means to inhale a foreign substance, such as food, liquid, or vomit, into the lungs instead of swallowing it into the stomach.

Question 8

Patient with decreased visual acuity due to corneal graft rejection.Admitted for cadaver keratoplasty (external)of the left eye with removal of the previous corneal graft

Accepted Answer

The correct ICD-10-CM code for corneal graft rejection is T86.840. The procedure code for cadaver keratoplasty with removal of the previous graft is 08R9XKZ.

Question 9

Patient presents with pseudoaneurysm right femoral artery due to recent cardiac cath at another facility.

Accepted Answer

I97.89 is used for other postprocedural complications and disorders of the circulatory system, not elsewhere classified, which includes pseudoaneurysm following a procedure. I72.4 specifies the location of the aneurysm in the femoral artery. Y84.0 is for cardiac catheterization as the cause of the abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure.

Question 10

A patient had a partial pancreatectomy for chronic pancreatitis and has now developed postpancreatectomy diabetes mellitus along with diabetic nephrosis.

Accepted Answer

- E89.1 (Postprocedural diabetes mellitus) is appropriate for the patient's postpancreatectomy diabetes mellitus.
- E13.21 (Other specified diabetes mellitus with diabetic nephropathy) is appropriate for the patient's diabetic nephrosis.
- Z90.411 (Acquired absence of pancreas) is appropriate for the patient's partial pancreatectomy.
- Y83.6 (Other specified surgical procedures and medical care) is appropriate for the patient's previous surgical procedure. 
- E08.21 (Diabetes mellitus due to underlying condition with diabetic nephropathy) is not appropriate for this patient, as the underlying condition (partial pancreatectomy) is what caused the postpancreatectomy diabetes mellitus.

Question 11

A patient had a kidney transplant 2 years ago but developed ESRD again due to transplant failure.The patient has been on dialysis for the past year.The patient is now complaining of SOB and edema and is admitted for fluid overload and hemodialysis.Dialysis is performed multiple times during this stay.

Accepted Answer

The answer of A patient had a kidney transplant 2...

Question 12

During a posterior lumbar fusion at L4-L5 for spinal stenosis,the surgeon accidentally nicks the dura.The fusion was performed via an open posterior approach with fusion of the posterior column using morselized allograft.Patient has a history of asthma for which he takes meds prn.

Accepted Answer

The surgical complication of dural nick during a posterior lumbar fusion procedure should be coded with G97.41, which is the code for "Dural tear following a procedure, not elsewhere classified". The diagnosis code for spinal stenosis, which was the indication for the surgery, is not provided in the options. However, code M48.06 can be used for spinal stenosis of the lumbar region. The asthma of the patient is mentioned in the history but not as a current condition, therefore it would not be coded. The Y codes are used as external cause codes and are not applicable to the diagnosis. The code for the procedure would be 0SG00K1, which is "fusion of lumbar vertebral joint with interbody fusion device, posterior approach". Therefore, the correct answer is B.

Question 13

The term dehiscence means ____.

Accepted Answer

Dehiscence refers to the separation of the edges or layers of a surgical wound. It can occur when the wound site is under strain, leading to the wound opening up. It is a complication that requires prompt medical attention to prevent infection and further tissue damage.

Question 14

Patient was admitted for an open TAH (removal of uterus and cervix)due to symptomatic fibroids.The physician documented in the operative report that a complication had occurred in which the bladder was accidentally lacerated during the procedure and was repaired with suture.

Accepted Answer

D25.9 represents the symptomatic fibroids, the reason for the surgery. N99.71 is the code for accidental laceration of a pelvic organ during a procedure, which in this case is the bladder. 0UT90ZZ is the code for the total removal of the uterus, open approach. 0UTC0ZZ is for the total removal of the cervix, open approach. 0TQB0ZZ is the code for the repair of the bladder, open approach.

Question 15

A patient is admitted with a urinary tract infection (UTI)resulting from E.coli.The patient has an indwelling Foley catheter following recent radical prostatectomy for prostate cancer.The coder queries the physician regarding the relationship of the UTI and the Foley,and the physician documents that the UTI is caused by the Foley.The patient is morbidly obese with type 2 diabetes,controlled with insulin.The patient is still under active treatment for the cancer.

Accepted Answer

- N39.0: urinary tract infection
- E66.01: morbid obesity
- E11.9: type 2 diabetes mellitus without complications
- C61: malignancy of prostate
- Z79.4: long-term (current) use of insulin
- Y84.6: presence of urinary catheter

B96.20 (urinary tract infection, unspecified site, Escherichia coli [E.coli] as the cause) is added to indicate that the UTI is caused by E.coli. T83.511A (infection and inflammatory reaction due to indwelling urinary catheter, initial encounter) is added to indicate the relationship between the UTI and the Foley catheter.

Question 16

Complications affect only certain body systems.

Accepted Answer

Complications can affect multiple body systems and can have far-reaching effects on overall health.

Question 17

Patient had an outpatient surgical procedure this morning and was discharged in stable condition.Patient returns because of inability to void.A Foley catheter is inserted.
Diagnosis: Postoperative urinary retention.

Accepted Answer

The answer of Patient had an outpatient surgical procedure this...

Question 18

Patient had an outpatient ERCP for extraction of a common bile duct stone.The patient developed acute abdominal pain and was admitted to rule out post ERCP pancreatitis.
Impression: Post ERCP pancreatitis.

Accepted Answer

The correct codes are K91.89 (Other postprocedural complications and disorders of digestive system), K80.50 (Calculus of bile duct without cholangitis or cholecystitis, without obstruction), K85.90 (Acute pancreatitis, unspecified), Y83.8 (Other surgical procedures), and 0FC98ZZ (Endoscopic extraction of common bile duct). These codes accurately represent the patient's condition and the procedures performed.

Question 19

Patient was hospitalized 1 month prior to this admission.During that admit,she was diagnosed with COPD and placed on a ventilator for 2 days.She is admitted today with pneumonia.

Accepted Answer

The patient is admitted with pneumonia (J18.9) and has a history of COPD (J44.9). There is no indication of a complication of the ventilator from the previous admission, so J95.851 is not applicable.

Question 20

Codes under subcategory T86 are used ____.

Accepted Answer

Codes under subcategory T86 are used for both complications and rejection of transplanted organs.

Quiz 26: Complications of Surgical and Medical Care