Medical Coding Quiz For Neoplasms (C00-d49)

1.

Three months ago. the patient was given a diagnosis of small cell lung carcinoma with metastasis to the liver. The patient's primary neoplasm is lung carcinoma; the secondary neoplasm is located in the liver. The patient underwent now for open wedge resection for liver metastasis.
- A.
  
  C34.90, C78.7, 0FB00ZX
- B.
  
  C34.80, C78.7, 0FC00ZZ
- C.
  
  C78.7, C34.90, 0FB00ZZ
- D.
  
  C78.89, C34.90, 0FC00ZX
Correct Answer
C. C78.7, C34.90, 0FB00ZZ

Explanation
Treatment of secondary site
When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.

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2.

Anemia due to metastatic bone cancer. The patient has a history of primary breast cancer, which was treated with mastectomy 4 years ago. The patient was admitted for transfusion of packed red blood cells (percutaneous peripheral vein):
- A.
  
  D64.9, C79.52, Z85.3, 30233N1
- B.
  
  D63.8, C79.51, Z85.3, Z90.10, 30233G0
- C.
  
  D63.0, C79.51, Z85.3, 30233N0
- D.
  
  C79.51, D63.0, Z85.3, Z90.10, 30233N1
Correct Answer
D. C79.51, D63.0, Z85.3, Z90.10, 30233N1

Explanation
Anemia associated with malignancy
When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

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3.

Aplastic anemia due to radiation. The patient is being treated for cancer of the brain. The patient was transfused with 2 units of packed red blood cells (percutaneous peripheral vein):
- A.
  
  C71.9, D64.9, T45.1X5A, 30233R1
- B.
  
  D61.2, C71.9, Y84.2, 30233N1
- C.
  
  D61.2, C71.9, T66.XXXA, 30233P1
- D.
  
  C71.9, D64.9, Y84.7, 30233Q1
Correct Answer
B. D61.2, C71.9, Y84.2, 30233N1

Explanation
Anemia associated with chemotherapy, immunotherapy and radiation therapy
When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, the anemia code is sequenced first followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5, Adverse effect of antineoplastic and immunosuppressive drugs).
When the admission/encounter is for management of an anemia associated with an adverse effect of radiotherapy, the anemia code should be sequenced first, followed by the appropriate neoplasm code and code Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure

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4.

The patient had a melanoma removed from his back 4 years ago. The patient is currently being treated for metastatic melanoma of the right lung:
- A.
  
  C43.59, C78.01
- B.
  
  Z85.828, C78.01
- C.
  
  C43.58, C78.02
- D.
  
  C78.01, Z85.820
Correct Answer
D. C78.01, Z85.820

Explanation
Primary malignancy previously excised
When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of primary and secondary malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the Z85 code used as a secondary code.

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5.

The patient was admitted for chemotherapy (percutaneous central vein) treatment of acute lymphocytic leukemia (ALL):
- A.
  
  Z51.11, C91.00, 3E04305
- B.
  
  C91.01, Z51.12, 3E04305
- C.
  
  Z51.10, C91.00, 3E04305
- D.
  
  C91.02, Z51.11, 3E04305
Correct Answer
A. Z51.11, C91.00, 3E04305

Explanation
Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy
If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence.
The malignancy for which the therapy is being administered should be assigned as a secondary diagnosis.

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6.

The patient was admitted for chemotherapy (percutaneous peripheral artery) for lymphoma. Because of nausea and severe vomiting due to the chemotherapy, the patient was also treated for dehydration with IV fluids:
- A.
  
  Z51.10, C85.90, E86.0, R11.2, T45.1x4A, 3E05005
- B.
  
  Z51.11, C85.90, E86.0, T45.1x5A, R11.2, 3E05305
- C.
  
  Z51.12, C85.98, E86.0, T45.0X1A, 3E053GC
- D.
  
  Z51.0, C85.90, E86.0, T45.1x5A, R11.2, 3E05305
Correct Answer
B. Z51.11, C85.90, E86.0, T45.1x5A, R11.2, 3E05305

Explanation
Patient admitted for radiation therapy, chemotherapy or immunotherapy and develops complications
When a patient is admitted for the purpose of radiotherapy, immunotherapy or chemotherapy and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy followed by any codes for the complications.

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7.

Patient is in her second trimester and was found to have follicular thyroid cancer:
- A.
  
  O9A.119, Z3A.00, C73
- B.
  
  O9A.112, Z3A.00, C75.9
- C.
  
  O9A.113, Z3A.02, C73
- D.
  
  O9A.112, Z3A.00, C73
Correct Answer
D. O9A.112, Z3A.00, C73

Explanation
Malignant neoplasm in a pregnant patient
When a pregnant woman has a malignant neoplasm, a code from subcategory 09A.1-, Malignant neoplasm complicating pregnancy, childbirth, and the puerperium, should be sequenced first, followed by the appropriate code from Chapter 2 to indicate the type of neoplasm.

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8.

Patient developed an abdominal wall wound infection following surgery for colon cancer. Cellulitis was present. Cultures were negative. The patient is scheduled to begin chemo next week:
- A.
  
  C18.9, T81.3xxS, L03.90, Y83.2
- B.
  
  T81.719A, L03.818, C18.9, Y83.2
- C.
  
  T81.3xxA, L03.90, C18.9, Y83.2
- D.
  
  T81.4xxA, L03.311, C18.9, Y83.2
Correct Answer
D. T81.4xxA, L03.311, C18.9, Y83.2

Explanation
Complication from surgical procedure for treatment of a neoplasm
When an encounter is for treatment of a complication resulting from a surgical procedure performed for the treatment of the neoplasm, designate the complication as the principal/first-listed diagnosis. See guideline regarding the coding of a current malignancy versus personal history to determine if the code for the neoplasm should also be assigned

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9.

Patient was diagnosed with hepatocellular carcinoma. Patient had a liver transplant 2 years ago:
- A.
  
  T86.43, B25.9, C22.7, Y83.0
- B.
  
  C22.0, T86.29, C80.2, Y83.0
- C.
  
  T86.49, C80.2, C22.0. Y83.0.
- D.
  
  C22.0, T86.49, C80.2, Y83.0
Correct Answer
C. T86.49, C80.2, C22.0. Y83.0.

Explanation
Malignant neoplasm associated with transplanted organ
A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign first the appropriate code from category T86.-, Complications of transplanted organs and tissue, followed by code C80.2, Malignant neoplasm associated with transplanted organ. Use an additional code for the specific malignancy.

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10.

Patient was admitted for control of back pain due to vertebral metastasis. Patient has a history of prostate cancer. After pain medications were adjusted and pain was controlled, he was discharged:
- A.
  
  G89.28, C79.51, Z85.46
- B.
  
  C49.6, G89.3, Z85.46
- C.
  
  Z85.46, G89.4, C79.52
- D.
  
  G89.3, C79.51, Z85.46
Correct Answer
D. G89.3, C79.51, Z85.46

Explanation
If a patient is admitted for pain management or pain control, the G89..3 code is assigned as the principal diagnosis, and the malignancy code(s) is assigned as a secondary code(s).

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Medical Coding Quiz For Neoplasms (C00-d49)

Three months ago. the patient was given a diagnosis of small cell lung carcinoma with metastasis to the liver. The patient's primary neoplasm is lung carcinoma; the secondary neoplasm is located in the liver. The patient underwent now for open wedge resection for liver metastasis.

Anemia due to metastatic bone cancer. The patient has a history of primary breast cancer, which was treated with mastectomy 4 years ago. The patient was admitted for transfusion of packed red blood cells (percutaneous peripheral vein):

Aplastic anemia due to radiation. The patient is being treated for cancer of the brain. The patient was transfused with 2 units of packed red blood cells (percutaneous peripheral vein):

The patient had a melanoma removed from his back 4 years ago. The patient is currently being treated for metastatic melanoma of the right lung:

The patient was admitted for chemotherapy (percutaneous central vein) treatment of acute lymphocytic leukemia (ALL):

The patient was admitted for chemotherapy (percutaneous peripheral artery) for lymphoma. Because of nausea and severe vomiting due to the chemotherapy, the patient was also treated for dehydration with IV fluids:

Patient is in her second trimester and was found to have follicular thyroid cancer:

Patient developed an abdominal wall wound infection following surgery for colon cancer. Cellulitis was present. Cultures were negative. The patient is scheduled to begin chemo next week:

Patient was diagnosed with hepatocellular carcinoma. Patient had a liver transplant 2 years ago:

Patient was admitted for control of back pain due to vertebral metastasis. Patient has a history of prostate cancer. After pain medications were adjusted and pain was controlled, he was discharged: