Multiple Choice Questions

Which of the following is the correct code for type 2 diabetes mellitus with diabetic neuropathy?

a) E11.9

b) E11.40

c) E11.21

d) E11.42

Answer: d) E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy)

Rationale: For diabetes with complications, the specific manifestation must be coded. E11.42 is used for diabetic neuropathy.

A patient presents with hyperthyroidism and thyroid storm. What is the correct ICD-10-CM code?

a) E05.00 E05.01: Thyrotoxicosis with thyroid storm

This code covers hyperthyroidism with an acute, life-threatening complication known as a

b) E05.90 thyroid storm.

c) E05.01 A thyroid storm is a severe manifestation of thyrotoxicosis characterized by fever,

tachycardia, and altered mental status.

d) E05.10 Since the thyroid storm is a more severe condition, it is coded over simple
hyperthyroidism.

Answer: c) E05.01 (Thyrotoxicosis with thyroid storm)

Rationale: Thyrotoxicosis (hyperthyroidism) with a life-threatening thyroid storm is coded as E05.01.

Which code should be assigned for a patient diagnosed with Cushing’s syndrome due to long-term steroid use?

a) E24.0

b) E24.2
c) E27.0

d) T38.0X5A

Answer: b) E24.2 (Drug-induced Cushing’s syndrome) + T38.0X5A (Adverse effect of glucocorticoids, initial encounter)

Rationale: When Cushing’s syndrome is caused by medication, both the syndrome and adverse effect codes are needed.

A patient with end-stage renal disease (ESRD) due to type 1 diabetes mellitus is being seen for dialysis. What is the correct code s

a) E10.22, N18.6, Z99.2 Coding Guidance:

Code E10.22 is listed first to capture the underlying cause (diabetes with
b) N18.6, E10.22 kidney disease).

N18.6 is added to specify ESRD.

c) E10.9, N18.6, Z99.2
Z99.2 is used to show the patient’s dependence on dialysis.
d) E10.22, N18.9
This sequence accurately describes the patient's condition, its cause, and the
ongoing treatment.

Answer: a) E10.22 (Type 1 diabetes with chronic kidney disease), N18.6 (ESRD), Z99.2 (Dialysis status)

Rationale: The diabetic complication is coded first, followed by the stage of kidney disease and the dialysis status.

A patient is admitted with severe hypoglycemia due to excessive insulin use. What is the correct coding?

a) E16.2 T38.3X1A - Poisoning by insulin and oral hypoglycemic

[antidiabetic] drugs, accidental (unintentional), initial encounter
b) E11.649
This code indicates the accidental overuse or incorrect
administration of insulin leading to hypoglycemia.
c) E16.1, T38.3X1A
If intentional or due to self-harm, a different 7th character would
be used.
d) E10.649

Answer: c) E16.1 (Other hypoglycemia, not diabetes-related), T38.3X1A (Poisoning by insulin, accidental, initial encounter)
 True.

For a patient with both type 2 diabetes and hypertension, each condition should be coded separately unless a causal relationship is explicitly
documented by the provider.
Rationale: When hypoglycemia is caused by excessive insulin use, it is coded as an adverse drug reaction.
Explanation:
In ICD-10-CM, the guideline states that conditions should only be linked if the documentation clearly indicates a relationship (e.g., "diabetic
hypertension").
If the provider does not document a direct link, you would code type 2 diabetes (E11.9) and hypertension (I10) separately.
However, if a relationship is stated (e.g., "hypertensive nephropathy due to diabetes"), a combination code would be used.
True/False Questions

For a patient with both type 2 diabetes and hypertension, each should be coded separately unless a causal relationship is stated.
TRUE
For a patient with both type 2 diabetes and hypertension, each condition should be coded separately unless a causal relationship is explicitly documented by the provider.
Answer: True (There is no assumed linkage between diabetes and hypertension in ICD-10-CM.)
Explanation:
In ICD-10-CM, the guideline states that conditions should only be linked if the documentation clearly indicates a relationship (e.g., "diabetic hypertension").

If the provider does not document a direct link, you would code type 2 diabetes (E11.9) and hypertension (I10) separately.

However, if a relationship is stated (e.g., "hypertensive nephropathy due to diabetes"), a combination code would be used.

Obesity due to excess caloric intake should be coded as E66.09.

Answer: False (The correct code is E66.0 - Obesity due to excess calories.)

E11.22 is used for type 2 diabetes mellitus with chronic kidney disease, but the stage of CKD must be coded separately.

Answer: True (The stage of CKD (N18.x) must also be documented and coded.)

If a patient has hyperparathyroidism due to chronic kidney disease, the CKD should be coded first.

Answer: False (Hyperparathyroidism due to CKD is coded with E21.1 (Secondary hyperparathyroidism), followed by the CKD stage

When coding metabolic syndrome, only the single code E88.81 is assigned, even if components like hypertension and diabetes ar

Answer: False (E88.81 is assigned, but additional codes for diabetes, hypertension, or obesity should also be reported.)

Case-Based Questions

A patient with type 1 diabetes presents with ketoacidosis without coma. How should this be coded?

Answer: E10.10 (Type 1 diabetes mellitus with ketoacidosis without coma)

Rationale: Ketoacidosis is a serious complication of diabetes and is classified under E10.1x or E11.1x depending on the type.
A patient has hypothyroidism due to Hashimoto’s thyroiditis. What is the correct code?

Answer: E06.3 (Autoimmune thyroiditis, Hashimoto’s disease)

Rationale: Hashimoto’s thyroiditis is an autoimmune cause of hypothyroidism and has its own code.

A patient with morbid obesity and obstructive sleep apnea is scheduled for gastric bypass surgery. What codes should be assigne

Answer: E66.01 (Morbid obesity due to excess calories), G47.33 (Obstructive sleep apnea)

Rationale: Both conditions must be coded, as they impact the need for surgery.

A patient with uncontrolled type 2 diabetes and diabetic retinopathy is seen for an ophthalmology consult. What is the correct cod

Answer: E11.319 (Type 2 diabetes with unspecified diabetic retinopathy without macular edema)

Rationale: Diabetic complications should be coded using combination codes.

A patient presents with severe dehydration due to hyperosmolar hyperglycemic state (HHS) without ketoacidosis. How should thi

Answer: E11.00 (Type 2 diabetes mellitus with hyperosmolarity without coma)

Rationale: HHS is a life-threatening complication of diabetes and must be coded appropriately.

Multiple Choice Questions

Which of the following is the correct ICD-10-CM code for Type 1 diabetes mellitus with diabetic nephropathy?

a) E10.21

b) E11.21

c) E10.22
d) E11.22

Answer: c) E10.22 (Type 1 diabetes mellitus with diabetic chronic kidney disease)

Rationale: Nephropathy is classified under chronic kidney disease (CKD) in ICD-10-CM. The CKD stage should also be coded sepa

A patient presents with goiter and hyperthyroidism. What is the correct code?

a) E05.90

b) E04.9

c) E05.00

d) E06.3

Answer: c) E05.00 (Thyrotoxicosis with diffuse goiter without crisis or storm)

Rationale: When goiter is associated with hyperthyroidism, a combination code is used.

Which of the following is the correct code for a patient with obesity hypoventilation syndrome?

a) E66.01, G47.33

b) E66.2

c) E66.09

d) E66.2, G47.33

Answer: d) E66.2 (Morbid obesity with hypoventilation), G47.33 (Obstructive sleep apnea)

Rationale: This condition, also known as Pickwickian syndrome, requires a specific code for obesity-related hypoventilation.
A patient presents with primary hyperaldosteronism (Conn’s syndrome). What is the correct ICD-10-CM code?

a) E26.0

b) E26.1

c) E27.2

d) E27.3

Answer: a) E26.0 (Primary hyperaldosteronism)

Rationale: Primary hyperaldosteronism (Conn’s syndrome) is caused by excess aldosterone from the adrenal glands.

A patient is diagnosed with severe protein-calorie malnutrition. What is the correct ICD-10-CM code?

a) E43

b) E44.0

c) E46

d) E42

Answer: a) E43 (Unspecified severe protein-calorie malnutrition)

Rationale: Severe malnutrition is classified as E43, whereas moderate malnutrition is coded as E44.x.

True/False Questions

For patients with secondary diabetes mellitus, the underlying cause should be coded first, followed by the diabetes code.

Answer: True (Secondary diabetes must be linked to the causative condition, such as Cushing’s syndrome or drug-induced hyperg
Diabetes mellitus during pregnancy is coded as E11.9.

Answer: False (Diabetes during pregnancy is coded using O24.x codes, not the standard diabetes mellitus codes.)

E55.9 is used for vitamin D deficiency, unspecified.

Answer: True (E55.9 covers general vitamin D deficiency when no specific type is documented.)

E66.01 should be assigned for a patient diagnosed with class 1 obesity.

Answer: False (E66.01 is for morbid obesity, while E66.9 is used for unspecified obesity.)

If a patient has both type 2 diabetes and obesity, both conditions should be coded separately.

Answer: True (*Obesity (E66.x) should be coded in addition to diabetes (E11.x), unless explicitly linked as the
s. What is the correct code sequence?
hypertension and diabetes are present.
etoacidosis. How should this be coded?
ge should also be coded separately.
rome or drug-induced hyperglycemia.)