Solution Manual for Pearson's Comprehensive Medical Coding, 2nd Edition

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PEARSON’S COMPREHENSIVE MEDICAL CODING: A PATH TO SUCCESS 2/E
TEXTBOOK ANSWER KEY
CHAPTERS 1-24
The words in parentheses ( ) following a code provide the Index entries for the Main Term and
subterms of one coding path. Selections for additional characters in the Tabular List are listed
after the subterms. Index entries vary among publishers.
To access the navigation pane in Word, press Ctrl-F, then click on the left hand tab.
CHAPTER 1: YOUR CODING CAREER
CODING PRACTICE
Exercise 1.1 What Is Coding?
1. Coding is the process of accurately assigning codes to verbal descriptions of patients’
conditions and the healthcare services provided to treat those conditions.
2. Diagnosis codes describe patient illnesses, diseases, conditions, injuries, or other reason for
seeking healthcare services. Procedure codes describe the services healthcare professionals
provide to patients.
3. Abstract - determine which elements of the visit require codes
Assign – determine the codes that describe the patient’s condition and services
Arrange – sequence the codes in proper order
Exercise 1.2 Understanding Patient Encounters
1. after an encounter is completed
2. diagnosis, treatment plan, documentation

3. history, physical examination, testing
Exercise 1.3 Certification
1. Certification is a voluntary achievement which documents that a coder has attained a certain
level of proficiency by passing a rigorous examination.
2. CPC - Certified Professional Coder (physician office coding)
COC - Certified Outpatient Coder
CPC-P - Certified Professional Coder-Payer
3. CCS – Certified Coding Specialist (hospital inpatient and outpatient coding)
CCS-P – Certified Coding Specialist-Physician
CCA – Certified Coding Associate
Exercise 1.4 Coding Careers
1. Student answers will vary, so any item from Table 1-3 is acceptable.
2. Student answers will vary and should include the concept that payment for services from
insurance companies is based a high degree of accuracy and productivity.
3. 30 to 40 words per minute (wpm) or 9,000 to 12,000 keystrokes per hour (ksph)
4. Coders must be able to identify medical terms, a skill which includes breaking down
unfamiliar words into a prefix, root, and suffix to define the meaning. It is not possible to code
accurately without knowing the definition of medical terms used in clinical documentation.
CONCEPT QUIZ
Completion
1. Diagnosis
2. abstract, assign, arrange (answers must be in this order)
3. outpatient

2. low income families
3. group, self-insured, individual
Exercise 2.2 Documentation
1. establishing the medical need for services
2. Student answers will vary and should include three of the following: improve a patient’s
condition, evidence-based practice, rendered by appropriate provider, least restrictive setting.
3. The medical record is the comprehensive collection of all information on a patient at a
particular facility. Progress notes are the record of a specific patient encounter.
Exercise 2.3 Life Cycle Of An Insurance Claim
1. It is the time when providers begin collecting insurance information.
2. The computer automatically determines which procedure codes are covered and how much the
insurance company is obligated to pay, and then triggers the payment.
3. Student answers will vary and should include three of the following: Characters in a code are
mistyped, creating an invalid code.
Codes have too many or too few characters.
Diagnosis does not match the procedure.
Codes are sequenced incorrectly.
Additional codes required by the Guidelines or Instructional Notes are missing.
Patient age or gender does not match the diagnosis or procedure.
The services described in one code are included (bundled) into another reported code.
A CPT procedure code requires a modifier in order to be paid.

Exercise 2.4 Reimbursement Methods
1. Negotiated fee schedule is a fee schedule in which the payer specifies the percentage of the
provider’s fee schedule it considers to be acceptable.
2. Prospective payment system is a reimbursement method in which payment is made based on a
predetermined, fixed amount per case.
3.Capitation is a prospective payment method in which physicians are paid a fixed amount per
month for each member assigned to them, regardless of whether that person requests services.
Exercise 2.5 Healthcare Claims
1. Version 5010A1 is the current version of the electronic standards for healthcare transactions.
2. CMS-1500 is used to bill physician services.
3. 837P is the electronic format used to bill physician services.
4. UB-04 or CMS-1450 is the claim form used to bill inpatient hospital services
5. 837I is the electronic format used to bill inpatient hospital services.
Exercise 2.6 Federal Compliance
1. When providers are overpaid they are legally obligated to report the overpayment to
Medicare, to refund the money, and may even have to pay interest on it.
2. Overcoding is coding for a more complex diagnosis or procedure than is documented
3. False Claims Act (FCA)
Exercise 2.7 Health Information Technology
1. Any five of the following are acceptable:
Code first
Diagnosis-procedure mismatch
Invalid characters (I and O in PCS)

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Manifestation codes
Medicare medical necessity
Mutually exclusive diagnoses
Mutually exclusive procedures
Patient age
Patient gender
Seven characters required (PCS)
Unacceptable principal diagnosis
Use additional code
Use additional digit(s)
2. Student answers will vary but should include the concept that coders need to understand
what information they must give the software in order for it to provide accurate feedback. An
untrained user can make coding errors with an encoder, just as they would using the physical
manuals.
3. Student answers will vary but should resemble the following examples:
A physician can view medications prescribed by other providers to avoid duplication or
medication interactions.
An emergency department can access a patient’s medical history to more quickly identify a
problem.
A provider can access imaging studies that may help explain the progression of a patient’s
condition.
4. An encoder requires people to conduct an electronic search for each individual code to be
assigned, whereas CAC automatically generates codes based on documentation.

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5. Student answers will vary but should include the concept that technology elevates coders’
professionalism and enables them to focus on tasks requiring judgment and critical thinking,
while computers assist them with the repetitive tasks.
CONCEPT QUIZ
Completion
1. Part A
2. Medigap
3. TC (Tricare)
4. Family history
5. DRG
6. RA
7. Fraud
8. Abuse
9. OIG
10. compliance
Multiple Choice
1. A
2. B
3. D
4. A
5. A
6. C
7. A

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8. C
9. C
10. B
CHAPTER 3: INTRODUCTION TO ICD-10-CM DIAGNOSIS CODING
CODING PRACTICE
Exercise 3.1 Organization of ICD-10-CM
1. category
2. code
3. block
4. code (Entries that require a seventh character are referred to as codes, not subcategories,
even though they are not complete without the seventh character. Entries that require a
fourth, fifth, or sixth character are called subcategories.)
5. code
6. subcategory
7. category
8. code
9. block
10. subcategory
Exercise 3.2 Conventions: Exclusion Notes
1. Don’t use together (Instructional note at G43.0 states: Excludes1 chronic migraine
without aura (G43.7-))

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2. Don’t use together (Instructional note at D56.1 states: Excludes1sickle-cell beta
thalassemia (D57.4-))
3. OK
4. OK
5. Don’t use together (Instructional note at O04 states: Excludes1 failed attempted
termination of pregnancy (O07.-))
6. Don’t use together (Instructional note at R22.2 states: Excludes1 intra-abdominal or
pelvic mass and lump (R19.0-), intra-abdominal or pelvic swelling (R19.0-))
7. OK
8. OK
9. Don’t use together (Instructional note at S83 states: Excludes1 internal derangement of
knee (M23.-))
10. Don’t use together (Instructional note at T38.0 states: Excludes1: glucocorticoids,
topically used (T49.-))
Exercise 3.3 Conventions: Use Additional Characters, Extensions, and Placeholders
1. Correct
2. Incorrect, should be E66.01
3. Incorrect, should be G43.101
4. Incorrect, should be I48.91
5. Incorrect, should be O31.01X1
6. Correct
7. Incorrect, should be S71.151S
8. Incorrect, should be S84.22XA

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9. Incorrect, should be S72.022K
10. Incorrect, should be T59.6X1D
Exercise 3.4 Locating the Main Term
1. Wound, open, ear
2. Deprivation, water
3. Infection, urinary
4. Chickenpox, see Varicella
5. Fever, blackwater
6. Infection, gallbladder, see Cholecystitis
7. Malaria, quartan, see Malaria, malariae
8. Disease, cerebrovascular
9. Failure, congestive, see Failure, heart, congestive
10. Diabetes, type 1
Exercise 3.5 Abstracting, Assigning, and Arranging Diagnosis Codes
1.
a. Syndrome
b. toxic shock
c. A48.3
d. no
e. Use additional code to identify the organism (B95, B96)
f. Streptococcus A
g. no
h. Includes: diseases generally recognized as communicable or transmissible

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5. A
6. B
7. A
8. A
9. D
10. D
KEEP ON CODING
1. M21.42 (Flat, foot, see Deformity, limb, flat foot, left)
2. Z51.12 (Encounter, immunotherapy for neoplasm)
3. L89.323 (Ulcer, pressure, buttock; Tabular: left, stage 3)
4. F10.20 (Dependence, alcohol)
5. M25.122 (Fistula, joint, elbow; Tabular: left)
6. Z81.1 (History, family, alcohol abuse)
7. Z68.38 (Body, mass index, adult, 38.0-38.9)
8. I10 (Hypertension)
9. I69.391 (Dysphagia, following, cerebrovascular disease, cerebral infarction; Tabular: Use
additional code to identify the type of dysphagia, if known (R13.1-))
R13.10 (Dysphagia; Tabular: Code first, if applicable, dysphagia following cerebrovascular
disease (I69. with final characters -91))
10. R10.824 (Pain, abdominal, rebound, see Tenderness, abdominal, rebound, left lower
quadrant)
11. R29.6 (Repeated falls NEC)
12. C4A.11 (Carcinoma, Merkel cell, eyelid; Tabular: right)

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13. G89.3 (Pain, due to malignancy)
14. E11.9 (Diabetes, type 2)
15. S90.562D (Bite, ankle, superficial, insect; Tabular: left, subsequent encounter)
16. T25.711A (Burn, chemical, see corrosion by site; Corrosion, ankle, right, third degree;
Tabular: initial encounter)
17. Q70.23 (Fused, see Fusion, fused; Fusion, toes; Tabular: bilateral)
18. N30.21 (Cystitis, chronic, with hematuria)
19. B59 (Pneumonia, pneumocystis)
20. D64.9 (Anemia)
21. Z01.83 (Encounter, blood typing)
22. J95.851 (Pneumonia, ventilator associated)
23. B85.0 (Lice, head)
24. O40.2XX3 (Polyhydramnios; Tabular: second trimester, fetus 3)
25. H60.501 (Otitis, externa, acute; Tabular: right)
CODING CHALLENGE
1.
a. shortness of breath
b. Chronic combined systolic and diastolic heart failure; hypertension
2.
a. yes
b. no
c. do not code for symptoms that are integral to the condition diagnosed
d. hypertension

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CHAPTER 4: SYMPTOMS, SIGNS, AND ABNORMAL CLINICAL AND
LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED (R00-R99)
CODING PRACTICE
Exercise 4.1 Symptoms and Signs Refresher
1. dys/pnea difficulty breathing, R06.00
2. noct/uria urination at night, R35.1
3. a/phag/ia unable to swallow, R13.0
4. epi/staxis bleeding from above (nosebleed) , R04.0
5. lymph/adeno/pathy abnormal condition of lymph nodes, R59.1
6. hyper/emesis excessive vomiting, R11.10
7. hyp/ox/emia low oxygen in the blood, R09.02
8. cyan/osis yellow skin, R23.0
9. glycos/uria sugar in urine, R81
10. tachy/card/ia rapid heartbeat, R00.0
Exercise 4.2 Abstracting Symptoms and Signs
1.
a. no
b. abnormal laboratory test
c. abnormal
2.
a. irregular heartbeat, chest pain, and lightheadedness
b. yes

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c. yes
d. none
e. atrial fibrillation
3.
a. no
b. seizures
c. seizures
4.
a. polydipsia, polyuria, difficulty sleeping, hyperglycemia
b. yes, type 2 diabetes
c. yes, sleep apnea
d. no, symptoms and signs
e. polydipsia, polyuria, hyperglycemia
f. difficulty sleeping
g. type 2 diabetes, difficulty sleeping
5.
a. extreme nervousness and irritability
b. uncertain condition the physician wants to confirm or eliminate from the final
assessment
c. no
d. yes, hyperthyroidism
e. nervousness and irritability
6.

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a. epigastric pain
b. no
c. acute pancreatitis or cholangitis
Exercise 4.3 Assigning Codes for Symptoms and Signs
1. R94.5 (Abnormal, function studies, liver)
2. I48.91 (Fibrillation, atrial)
3. R56.9 (Seizures)
Exercise 4.4 Arranging Codes for Symptoms and Signs
1. E11.9 (Diabetes, type 2)
G47.9 (Sleep, disorder or disturbance)
2. R45.0 (Nervousness)
R45.4 (Irritability)
3. K85.90 (Pancreatitis, acute)
K83.0 (Cholangitis)
CONCEPT QUIZ
Completion
1. symptom
2. integral
3. uncertain
4. clinical
5. sign
6. related
7. uncertain

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9. R06.02 (Shortness, breath)
10. K85.90 (Pancreatitis. Instructional note at R65.10: Code first underlying condition.
R65.10 (Syndrome, systemic inflammatory response (SIRS))
11. R61 (Sweating, excessive)
12. R62.0 (Late, walker)
13. R19.4 (Change, bowel habit)
14. R01.1 (Murmur)
15. R40.2123 (Coma, with, opening of eyes, in response to, pain)
R40.2233 (Coma, with, verbal response, inappropriate words)
R40.2343 (Coma, with, motor response, flexion with withdrawal)
R40.2423 (Glasgow coma scale, total score, 9-12)
16. R78.2 (Findings, in blood, cocaine)
17. R41.81 (Decline, cognitive, age associated)
18. R39.198 (Urine, stream intermittent)
19. R49.0 (Hoarseness)
20. R79.81 (Abnormal, blood-gas level)
21. R09.2 (Arrest, respiratory)
22. R26.81 (Unsteadiness on feet)
23. R93.2 (Abnormal, scan, liver)
24. R62.51 (Failure, gain, weight)
25. R56.00 (Seizure, febrile)
CODING CHALLENGE
1. R92.0 (Abnormal mammogram, microcalcifications)

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2. R91.8 (Abnormal, diagnostic imaging, lung)
3. R75 (HIV, laboratory evidence or Test, HIV, nonconclusive)
4. R06.7 (Sneezing)
R09.89 (Scratchy throat)
R09.82 (Drip, postnasal)
5. M51.16 (Hernia, intervertebral disc, see Displacement, intervertebral disc, lumbar
region, with sciatica)
6. R87.614 (Abnormal, Papanicolaou (smear), cervix, with cytologic evidence of
malignancy)
7. E88.81 (Resistance, insulin)
8. R51 (Headache, daily chronic)
9. I50.9 (Failure, heart, congestive)
10. E55.9 (Deficiency, vitamin, D)
CHAPTER 5: NEOPLASMS (C00-D49)
CODING PRACTICE
Exercise 5.1 Neoplasm Refresher
1. osteo/sarc/oma malignant neoplasm of bone and connective tissue
2. leio/my/oma neoplasm of smooth muscle
3. lip/oma neoplasm of fatty tissue
4. lipo/sarc/oma malignant neoplasm of fatty tissue
5. aden/oma neoplasm of a gland
6. adeno/carcin/oma cancerous neoplasm of a gland

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7. oste/oma neoplasm of bone
8. melan/oma neoplasm of pigmented cells
9. neuro/blast/oma neoplasm of immature nerve cells
10. lymph/oma neoplasm of lymph glands
Exercise 5.2 Abstracting Diagnoses for Neoplasms
1.
a. right breast, lower outer quadrant
b. yes, brain
c. no
d. chemotherapy
2.
a. a therapeutic procedure blocking the flow of blood
b. benign tumor of smooth muscle
c. uterus
d. benign
3.
a. fundus of the stomach
b. the top portion of the curve, the upper part of the stomach next to the cardia
c. no
d. no
e. review results of biopsy and CT scan
4.
a. left thigh

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b.no
c. none
d. surgery to remove tumor
e. femur
5.
a. classical lymphocyte depleted Hodgkin lymphoma
b. no
c. anemia
d. anemia
6.
a. squamous cell carcinoma of the lung
b. yes, brain stem
c. brain stem
d. targeted delivery of stereotactic (using 3-D coordinates) radiation to the tumor
Exercise 5.3 Assigning Codes for Neoplasms
1. D25.1 (Leiomyoma, uterus, intramural)
2. C40.22 (Osteosarcoma, see Table of Neoplasms, bone, femur, malignant primary,
Tabular List: left)
3. C16.1 (Adenocarcinoma, see also Neoplasm, Malignant, by site; Table of Neoplasms,
stomach, fundus, malignant primary)
Exercise 5.4 Arranging Codes for Neoplasms
1. Z51.11 (Chemotherapy, neoplasm)
C50.511 (Table of Neoplasms, breast, lower outer quadrant, malignant primary,

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Tabular List: right )
C79.31 (Table of Neoplasms, brain, overlapping lesion, malignant secondary)
2. C79.31 (Table of Neoplasms, brain, stem, malignant secondary)
C34.90 (Table of Neoplasms, lung, malignant primary)
3. C81.30 (Lymphoma, Hodgkin, classical, lymphocyte depleted, unspecified site)
D63.0 (Anemia, in, neoplastic disease)
CONCEPT QUIZ
Completion
1. topography
2. histology
3. metastasis or secondary neoplasm
4. staging
5. adjuvant
6. chemotherapy
7. CA in situ
8. overlapping
9. grading
10. malignant
Multiple Choice
1. C
2. B
3. D
4. B

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5. B
6. B
7. D
8. D
9. A
10. D
KEEP ON CODING
1. D02.0 (Table of Neoplasms, vocal cords, false, CA in situ)
2. D10.30 (Table of Neoplasms, mouth benign)
3. D3A.093 (Tumor, carcinoid, benign, kidney)
4. C45.7 (Mesothelioma, site classification, lung)
5. C79.31 (Table of Neoplasms, brain, parietal lobe, malignant secondary)
6. D12.6 (Polyp, colon, adenomatous)
7. D35.1 (Adenoma, chief cell)
8. B20 (Human, immunodeficiency virus disease)
C46.4 (Kaposi’s, sarcoma, stomach)
9. C44.612 (Table of Neoplasms, skin, hand, malignant primary, Tabular List: right)
10. C43.59 (Melanoma, skin, abdominal wall)
11. C50.011 (Table of Neoplasms, breast, nipple, female, Tabular List: right)
12. C82.45 (Lymphoma, follicular, grade, IIIb, inguinal region)
13. C95.02 (Leukemia, unspecified cell type, acute, in relapse)
14. C43.62 (Melanoma, skin, forearm, Tabular List: left)
15. D06.7 (Table of Neoplasms, cervix, stump, CA in situ)

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16. Z80.3 (History, family, malignant neoplasm, breast)
17. Z85.841 (History, personal, malignant neoplasm, brain)
18. C34.82 (Table of Neoplasms, lung, overlapping lesion, malignant primary, Tabular
List: left)
19. Z51.11 (Chemotherapy, neoplasm)
C56.9 (Table of Neoplasms, ovary, malignant primary, unspecified)
20. C25.1 (Table of Neoplasms, pancreas, body, malignant primary)
21. C79.51 (Table of Neoplasms, rib, malignant, secondary)
22. C69.92 (Table of Neoplasms, intraocular, malignant primary, Tabular List: left)
D63.0 (Anemia, in, neoplastic disease)
23. C78.7 (Table of Neoplasms, liver, malignant secondary)
C80.1 (Table of Neoplasms, unknown site or unspecified, malignant primary)
24. D39.2 (Hydatidiform mole, malignant)
25. C07 (Table of Neoplasms, parotid, malignant primary)
C79.51 (Table of Neoplasms, bone, spine, malignant secondary)
CODING CHALLENGE
1. C90.01 (Myeloma, in remission)
2. D11.0 (Table of Neoplasms, salivary gland, parotid, benign)
3. D01.0 (Table of Neoplasms, intestine, large, colon, sigmoid, in situ)
4. C43.39 (Melanoma, skin, forehead)
5. D04.5 (Table of Neoplasms, skin, breast, in situ)
6. Z51.0 (Radiation, therapy, encounter for)

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C78.01 (Table of Neoplasms, lung, malignant secondary, Tabular List: right)
C80.1 (Table of Neoplasms, [first row] malignant primary)
7. D13.7 (Islet cell tumor, pancreas)
8. Z12.11 (Screening, colonoscopy)
Z85.038 (History, personal, malignant neoplasm, colon, NEC)
9. C25.9 (Table of Neoplasms, pancreas, malignant primary)
C79.9 (Table of Neoplasms, [first row] malignant secondary
10. E87.1 (Hyponatremia or Dehydration, hypotonic)
C56.1 (Table of Neoplasms, ovary, malignant primary, Tabular List: right)
C56.2 (Table of Neoplasms, ovary, malignant primary, Tabular List: left)
C79.9 (Table of Neoplasms, [first row] malignant secondary)
CHAPTER 6: FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH
HEALTH SERVICES (Z00-Z99)
CODING PRACTICE
Exercise 6.1 Introduction to Z Codes
1. Student answers will vary and may include any of the following:
aftercare
counseling
follow up
immunizations
observation
obstetrics

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routine or administrative examinations (pre-employment, annual check-up)
screening examinations (colonoscopy, mammogram).
2. a. OGCR I.C.21.c.1)
b. OGCR I.C.21. c.3)
c. OGCR I.C.21. c.7)
d. OGCR I.C.21. c.13)
3. a. Screening
b. Donor
c. Non-specific
d. History
Exercise 6.2. Abstracting for Z Codes
1. a. annual medical examination
b. no
2. a. Supervision of normal second pregnancy, third trimester
b. no
3. a. adjustment of cardiac pacemaker
b. no
4. a. normal mammogram, both breasts
b. no
c. personal history of breast cancer
5.a. 6-month follow up for malignant neoplasm of prostate
b. no
c. malignant neoplasm of prostate

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d. personal history
e. prostate
6. a. angina pectoris
b. no
c. tobacco use
Exercise 6.3. Assigning Z Codes
1. Z00.00 (Examination, annual)
2. Z34.83 (Pregnancy, supervision of, normal, specified NEC, third trimester)
Z3A.34 (Pregnancy, weeks of gestation, 34 weeks)
3. Z45.018 (Fitting and adjustment of, pacemaker)
Exercise 6.4. Arranging Z Codes
1. Z12.31 (Screening, neoplasm, breast, routine mammogram)
Z85.3 (History, personal, malignant neoplasm, breast)
2. Z08 (Examination, following, treatment (for), malignant neoplasm)
Z90.79 (Absence, prostate)
Z85.46 (History, personal, malignant neoplasm, prostate)
3. I20.0 (Angina, unstable)
Z72.0 (Tobacco, use)
CONCEPT QUIZ
Completion
1. Screening
2. Personal history
3. Observation

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4. Counseling
5. Routine and administrative examinations
6. Aftercare
7. Family history
8. Miscellaneous
9. Follow-up
10. Obstetrical and reproductive
Multiple Choice
1. D
2. B
3. A
4. C
5. A
6. B
7. D
8. A
9. D
10. C
KEEP ON CODING
1. Z32.02 (Encounter, pregnancy, test, result negative)
2. Z67.30 (Blood, type, AB, Rh positive)
3. Z01.20 (Examination, dental)
4. Z53.20 (Canceled procedure, because of, patient’s decision)

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5. Z94.1 (Transplant, heart)
6. Z99.2 (Dialysis, renal, status
7. Z45.819 (Encounter, removal, breast implant)
8. Z53.31 (Procedure, converted, laparoscopic to open)
9. Z83.3 (History, family, diabetes mellitus)
10. Z87.891 (History, personal, tobacco dependence)
11. Z02.81 (Encounter, administrative, examination for, paternity testing)
12. O09.92 (Pregnancy, supervision, high risk, 2nd trimester)
Z3A.20 (Pregnancy, weeks of gestation, 20)
13. Z38.00 (Newborn, born in hospital)
14. Z72.3 (Lack of, physical exercise)
15. Z79.1 (Long-term, anti-inflammatory, non-steroidal)
16. Z91.013 (Allergy, food, status, seafood)
17. Z98.2 (Presence, CSF shunt)
18. Z78.1 (Status, physical restraint)
19. Z66 (DNR)
20. Z59.0 (Homelessness)
21. Z33.1 (State, pregnant, incidental)
22. Z87.442 (History, personal, kidney stones)
23. Z14.1 (Carrier, genetic, cystic fibrosis)
24. Z91.412 (History, personal, neglect, adult)
25. Z00.121 (Examination, child, abnormal findings)

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