KODE Health Facility Inpatient Level II Coding Assessment

Instructions

• Enter your name and email address below. Use the same email address as your KODE Health account.
• Review each clinical scenario on the following pages. Assume the discharge disposition is 'home' for each encounter.
• Enter the primary and secondary ICD-10-CM codes and all ICD-10-PCS codes that apply. You will be graded on the quality and completeness of your code assignments.
  • DO code long-term use of medications, history of chemotherapy, history of radiation, and any other relevant medical and surgical history.
  • DO NOT code external cause codes.
  • DO NOT indicate POA status for diagnosis codes.
  • MS-DRG codes are not required.
• You will have 2 hours to complete the assessment. At the end of 2 hours, your assessment will be automatically submitted.
• You may only take the assessment once.

You may reference your own medical coding resources or KODE's electronic codebook, Kodex, in a separate window. 

 

Confidential. Any reproduction or distribution is strictly prohibited.

This 80 y.o. female with history of COPD and bronchiectasis on home oxygen (O2), chronic persistent atrial fibrillation on warfarin, and moderate pulmonary hypertension (PH) due to chronic lung disease was admitted with symptomatic ventricular tachycardia (VT).  She had been at her usual baseline, but in the early afternoon developed new persistent chest discomfort she attributed to indigestion.  Symptoms persisted, as well as some dyspnea, and the patient decided to present.  In the ED, she was found to have a heart rate of 190 and was normotensive.  She was sedated and underwent emergent cardioversion.  She converted to atrial fibrillation. Pt was then admitted to ICU and started on amiodarone drip.

Cardiology consult noted chronic congestive heart failure (CHF) with left ventricular ejection fraction of 15-20%, maintained with daily p.o. Lasix and daily ACE inhibitor for LV systolic dysfunction.

She was taken to the Cardiac IR lab for cardiac resynchronization therapy (CRT) defibrillator placement.  An incision was made into the pectoral fascia; a pocket was then fashioned for the pulse generator below the subcutaneous tissue.  Axillary venous access was obtained.  A ventricular lead was secured in the right ventricular apex and the atrial lead into the right atrial appendage under fluoroscopic guidance.  Then the coronary sinus (CS) lead for the left ventricle was advanced over a coronary wire into a lateral CS branch and was sutured to the pre-pectoral fascia/pectoral muscle.

Discharge diagnoses:  VT, chronic persistent atrial fibrillation, COPD, systolic CHF, pulmonary hypertension.

This 23 y.o. Hispanic male was admitted through the ED after his arm was caught in a packaging machine.  He was found to have an open fracture of the right ulna proximal shaft and a closed fracture of the right radial shaft, with a closed radial head dislocation.

He was taken to the OR and examined under fluoroscopy.  The radial head dislocation had spontaneously reduced.  A longitudinal incision was then created over the ulna.  The ulna was reduced and an 8-hole LC-DCP plate was selected and contoured to the medial face of the ulna and affixed with screws.  Then a longitudinal incision was created over the proximal radius.  A locking plate was applied to the bone and screws placed, achieving good compression and reduction of the fracture.

This is a 40 y.o. female with right breast cancer (upper inner quadrant) s/p lumpectomy, undergoing chemotherapy currently, who presented complaining of cough, fever, and lethargy.  She was noted to have pancytopenia from chemotherapy, oral mucositis, and hypotension.

Patient was diagnosed with septic shock.  Chest x-ray and CT chest revealed RML pneumonia.  Blood cultures were negative, but respiratory pathogen panel showed para influenza. Treatment included peripheral IV administration of vasopressors, Cefepime, Vancomycin, and Azithromycin. Patient was transitioned to oral Levaquin to complete 7 days of antibiotics upon discharge.

Grade III oral mucositis due to chemotherapy improved during inpatient stay. Pancytopenia due to chemo was monitored.

Final discharge diagnoses: Sepsis due to parainfluenza with pneumonia, septic shock, mucositis, and pancytopenia due to chemotherapy, breast cancer s/p lumpectomy.

A 55 y.o. female with congestive heart failure (CHF), end stage renal disease (ESRD) due to diabetes mellitus (DM) and hypertension (HTN) s/p cadaver renal transplant (CRT) on Tacrolimus for immunosuppression presented to outside hospital (OSH) w/ acute dyspnea and productive cough with fever.  After admission at OSH, the patient’s oxygen (O2) requirements increased, she became lethargic and an RRT was called with concern for sepsis.  The patient was started on BIPAP due to O2 sats in the 90’s and transferred to KODE Hospital as a direct admit to ICU.

Upon admission to the ICU, she was intubated for acute respiratory failure with hypoxia.  CT chest showed bilateral infiltrates and she was started on azithromycin and cefepime.  Creatine was 2.4, baseline 1.7.  She was seen by Nephrology for acute kidney injury and longstanding CKD stage 3 of transplanted kidney.

Bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial forceps tissue biopsy were performed on the left upper lung lobe, which revealed early low-grade papillary carcinoma (CA).

She continued to need respiratory support and was maintained on the ventilator for 3 days when she was successfully weaned.

Discharge diagnoses:  pneumonia likely gram-negative, left upper lobe papillary CA, mediastinal lymphadenopathy, acute hypoxic respiratory failure, acute kidney injury, CKD, immunodeficiency due to Tacrolimus.