NATIONAL CENTRE FOR CLASSIFICATION IN HEALTH

ICD-10-AM, ACHI and ACS Tenth Edition

Coding Exercises Workbook

HIMAA – NCCH Conference

Cairns, 2017

NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 1

National Centre for Classification in Health
Faculty of Health Sciences
The University of Sydney
Sydney, Australia

Published by the National Centre for Classification in Health, Faculty of Health Sciences,
The University of Sydney, NSW 1825 Australia.

ICD-10-AM is based upon the International Statistical Classification of Diseases and Related Health
Problems, Tenth Revision (ICD-10) Fifth Edition 2016 © Copyright World Health Organization. All rights
reserved. Modified by permission for Australian Government purposes.
© Copyright Independent Hospital Pricing Authority 2017.

Australian Classification of Health Interventions (ACHI) © Copyright Independent Hospital Pricing Authority
2017.

Australian Coding Standards (ACS) © Independent Hospital Pricing Authority 2017.

© This exercise workbook is copyright of The University of Sydney and may not be replicated without the
written consent of the University, 2017.

OVERVIEW

The material contained in the ICD-10-AM/ACHI/ACS Tenth Edition Coding Exercises Workbook
should be undertaken using ICD-10-AM/ACHI/ACS Tenth Edition (including Errata 1 and 2), before
the NCCH education session of the HIMAA-NCCH Conference 2017.

This workbook includes scenarios designed to provide clinical coders with an additional overview
of areas of major change in Tenth Edition.

Answers will be provided at the NCCH education session of the HIMAA-NCCH Conference 2017.

2 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 1
Scenario:
A 43 year old female was admitted to hospital with confusion and agitation and jerky movements.
The patient was diagnosed with hepatic encephalopathy on a background of alcohol dependence.
She has a history of alcoholic liver failure. She was managed under the neurology team, and the
patient was also reviewed by the Drug and Alcohol service.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 3

 Case Scenario 2
Scenario:
A 62 year old female admitted to hospital with a right foot ulcer due to venous insufficiency. The
patient has no history of diabetes mellitus, peripheral vascular disease or ischaemic heart
disease. Patient is a current smoker. The ulcer was dressed daily and patient was given IV
antibiotics. She was put on oral antibiotics before discharge home.

Codes:
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4 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 3
Scenario:
Patient was admitted for management of his hyperparathyroidism (secondary, of renal origin).
Patient has CKD stage 3.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 5

 Case Scenario 4
Scenario:
24 year old male presented to facility with deterioration in health over the last week. He had
significant weight loss, coughing, and sleepiness.

Patient was reviewed by the dietitian for increased protein intake in regard to his worsening
cachexia. The patient also received palliative care for their neoplasm (Grade 3 anaplastic
astrocytoma of the brainstem Dx 2012). Patient referred to community palliative care services and
patient was discharged home.

Codes:
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6 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 5
Scenario:
Admitted with pelvic pain and increased endometrial thickness.
A hysteroscopy and D&C were performed under GA (ASA 1).
No cause for the pelvic pain was found.
For outpatient follow up.

Histopathology report summary:

Uterine curettings: endometrium in late secretory phase.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 7

 Case Scenario 6
Scenario:
53 year old female with known endocervical polyp for hysteroscopy and polypectomy.
Hx chronic lower back pain.
Hysteroscopy, polypectomy and D&C performed under GA (ASA1).
Postoperatively the patient complained of lower back pain, her regular medication for chronic pain
was increased. Patient was discharged home.

Histopathology report summary:

Uterine curettings: endometrium in mid to late secretory phase.
Endocervical polyp: features consistent with a benign endocervical glandular polyp.

Codes:
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8 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 7
Scenario:
Patient admitted with (L) knee pain on a background of osteoarthritis. The patient was
commenced on pain medication (Panadol osteo) and anti-inflammatories (celebrex). Daily
physiotherapy was undertaken to strengthen the knee structures.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 9

 Case Scenario 8
Scenario:
Patient with type 1 diabetes mellitus is admitted for induction of labour with prostin gel (37/40).
She delivers healthy twin girls, both by normal vaginal (spontaneous vertex) delivery. Assistance
is provided with breast feeding due to insufficient milk supply, and attachment problems.

Codes:
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10 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 9
Scenario:
A breast feeding mother is admitted eight weeks after deliver for treatment of severe bilateral
mastitis (IV antibiotics). She is seen by the lactation consultant for assistance due to attachment
difficulties.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 11

 Case Scenario 10
Scenario:
Patient admitted in labour (39/40). McRoberts manoeuvre performed, followed by vaginal delivery
of healthy infant.

Codes:
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12 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 11
Scenario:
Patient admitted in labour (39/40). Vacuum delivery attempted but failed; followed by vaginal
delivery of healthy infant.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 13

 Case Scenario 12
Scenario:
Patient admitted 12 hours after a planned home delivery, with postpartum haemorrhage. She is
taken to theatre for removal of clots and fragments of placenta via D&C (GA ASA 1), and
discharged the next day.

Codes:
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14 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 13
Scenario:
Same-day admission for a colonoscopy (under sedation) for altered bowel habit and a family
history of bowel cancer. Colonoscopy reported as normal.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 15

 Case Scenario 14
Scenario:
Same-day admission for colonoscopy for "screening" (under sedation ASA 1). Findings included
diverticulosis of the sigmoid colon, a polyp of the rectum (which was snared), and grade II
haemorrhoids.
Histology: hyperplastic rectal polyp.

Codes:
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16 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 15
Scenario:
Patient who has previously had oesophageal varices detected, now presents for same-day
admission, 12 months later for "follow-up varices". At endoscopy, the varices were found to have
increased in size, and were banded (under sedation).

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 17

 Case Scenario 16
Scenario:
Patient admitted with a positive faecal occult blood test as indication for a same-day colonoscopy
(under sedation). Colonoscopy was normal.

Codes:
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18 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 17
Scenario:
26 year old female with severe endometriosis of the ovaries for laparoscopic diathermy of
endometriosis under GA (ASA 2). Patient had “difficult intubation – Cormack-Lehane (CL) 2b” as
per documentation on the anaesthetic chart. The operation went as planned after multiple
attempts at intubation. No intraoperative complications documented.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 19

 Case Scenario 18
Scenario:
Patient admitted for an investigation of ?stenosis of colonic anastomosis (post hemicolectomy). A
colonoscopy was undertaken (under sedation). A stenotic stricture was noted at the anastomosis
site.

Codes:
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20 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 19
Scenario:
Patient admitted with a subcutaneous haematoma post ORIF of a fractured femur (NOF) at this
hospital. Drainage was undertaken (GA), and the remaining haematoma resolved.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 21

 Case Scenario 20
Scenario:
A 41 year old female admitted with major depression. Patient underwent a course of 23 ECT
treatments consisting of 10 sessions of bilateral stimulation with ultrabrief ECT, and 13 sessions
with bilateral stimulation not specified as ultrabrief, all were performed under GA (ASA 2). The
patient was also seen by a clinical psychologist and 3 cognitive behavioural therapy (CBT)
sessions were attended by the patient.

Codes:
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22 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 21
Scenario:
Patient admitted with a haematoma of the abdominal wall due to his warfarin. The patient’s INR
was monitored during his hospital stay. The haematoma resolved without intervention.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 23

 Case Scenario 22
Scenario:
Patient with known AF (on warfarin) was brought into hospital by ambulance from the medical
centre with palpitations and chest discomfort. An ECG showed the patient was in paroxysmal AF
and was noted to have subtherapeutic INR (1.2). The patient’s warfarin dosage was adjusted and
his INR monitored. He was discharged and referred back to his GP after 2 days.

Codes:
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24 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 23
Scenario:
66 year old male brought in by ambulance with claudication pain in his left leg and a background
of PVD with recurrrent thrombosis, on warfarin. CT angiogram revealed a lower limb venous
thrombosis in the popliteal vein and extending down to the tibial vein. His warfarin dosage was
adjusted. A possible future bypass procedure was discussed with the patient. Plan: INR on Friday
and then follow up with GP.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 25

 Case Scenario 24
Scenario:
A patient was admitted for an elective foramenotomy and facetectomy for neuropathic pain due to
his nerve root compression in spinal stenosis of L5/S1. A foramenotomy and facetectomy was
performed under GA (ASA 2) without complications.

Codes:
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26 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 25
Scenario:
Patient admitted with major depression underwent a course of 5 ECT treatments consisting of 3
sessions of ultrabrief ECT, and 2 sessions with bilateral stimulation (not specified as ultrabrief)
(under GA) within the same episode of care.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 27

 Case Scenario 26
Scenario:
A patient is admitted with SOB. Patient has a history of asthma, and has never smoked. He
revealed that a visitor to is home over the weekend was smoking heavily, and he says this was
when his symptoms started. Patient’s symptoms resolved after being on the nebuliser and he was
discharged home. The final diagnosis was exacerbation of asthma due to cigarette smoke.

Codes:
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28 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 27
Scenario:
61 year old male admitted to hospital with right senile cataract, for removal and insertion of
intraocular lens. Patient has a background of hypertension and is a current smoker. Patient
underwent a right phacoemulsification and IOL insertion under a subtenon block and sedation
(ASA1) and was discharged the next day.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 29

 Case Scenario 28
Scenario:
Patient was admitted for intermittent strabismus of the right eye for botox injection into the right
eye muscles (under LA). Procedure was performed without complications.

Codes:
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30 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 29
Scenario:
64 year old male admitted to ED with chest pain on a history of known CAD, the patient is an
ex-smoker 50+ pack year history.
An urgent coronary angiogram with left heart catheterisation and L ventriculogram performed
under sedation which showed:

triple vessel disease – 90% stenosis LAD, 60% stenosis L circumflex, 70% RC,
FFR measurements done
LAD stent placed to the LAD with good results
Remained well and haemodynamically stable during admission
The patient was discharged home the next day.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 31

 Case Scenario 30
Scenario:
53 year old man presented to the facility with ?CVA with sudden onset of dysphasia and right
sided weakness at approx. 1900 hours. Patient has a medical history of liver disease and Hep C.
CT brain showed left MCA ischaemic infarct due to occlusion of MCA. Patient was thrombolysed
at 21:05 hours on 19/09/2017 via IV infusion and admitted to the stroke unit.

Codes:
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32 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017

 Case Scenario 31
Scenario:
Patient was admitted to hospital after a CT KUB showed a 2mm calculus in the left kidney. The
calculus was fragmented with laser prior to removal via percutaneous nephroscopy, under GA
(ASA 1). The operation was uneventful and the patient was discharged home on the next day.

Codes:
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NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017 33

 Case Scenario 32
Scenario:
A 48 year old female with a polyp in the cervix for excision under GA (ASA 2). The patient
underwent a polypectomy of the cervix via hysteroscopy.The operation went well and no
complications were documented.
Histopathology report revealed patient’s polyp was an adenocarcinoma.

Codes:
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34 NCCH Coding Exercises Workbook for the NCCH-HIMAA Conference 2017