Top Missed CPC Exam Concepts – Quick Study

25 vocabulary-style flashcards that summarize high-yield ICD-10-CM guidelines and coding tips for the CPC exam.

AIDS/HIV Coding

Always verify a confirmed HIV diagnosis; once confirmed, report B20 for life and sequence any HIV-related conditions after B20.

B20

ICD-10-CM code for confirmed HIV disease, used permanently even if the patient later becomes asymptomatic.

Z20.6

Code indicating exposure to HIV when infection has not been confirmed.

Borderline Diagnosis Coding

Treat a borderline condition as confirmed unless ICD-10-CM provides a specific borderline code; query the provider if uncertainty remains.

Specific Borderline Codes

Distinct codes exist for borderline diabetes, hypertension, osteopenia, obstructed labor pelvis, and personality disorder per the Alphabetic Index.

COPD (Chronic Obstructive Pulmonary Disease)

Differentiate uncomplicated COPD (J44.9) from COPD with exacerbation (J44.1) or infection (J44.0); if both exacerbation and infection are present, code both.

J44.9

ICD-10-CM code for COPD without exacerbation or lower respiratory infection.

J44.1

ICD-10-CM code for COPD with acute exacerbation.

J44.0

ICD-10-CM code for COPD with lower respiratory infection.

Asthma Type with COPD

When a specific asthma type is documented with COPD, assign an additional asthma code; do not report J45.909 (unspecified asthma) merely to satisfy the guideline.

Delivery Coding

Select codes based on outcome and delivery type (vaginal vs C-section) and include any documented complications such as preeclampsia or fetal distress.

Postpartum Complication Coding

Complications occurring after delivery are coded from postpartum chapters and sequenced after the delivery codes.

Diabetes Mellitus Coding

Code diabetes by type (Type 1 or Type 2) and list every documented complication supported by the record.

Combination Diabetes Codes

Use single combination codes (e.g., E11.65 for Type 2 DM with hyperglycemia) when they fully describe both diabetes and the complication.

“With” Convention (Diabetes)

Conditions listed under the word “with” in the Diabetes index are presumed linked to diabetes unless the provider explicitly states otherwise.

Fracture Coding Specifics

Document laterality, whether the fracture is open or closed, and the encounter type (initial, subsequent, sequela).

7th Character Extensions (A, D, S)

Added to injury codes to indicate initial encounter (A), subsequent encounter (D), or sequela (S).

Pathologic Fracture Codes

M80–M84 codes for fractures due to underlying disease; differentiate these from traumatic fractures in the S-code section.

Essential vs Complicated Hypertension

I10 covers essential hypertension, while I11–I13 provide combination codes for hypertension with heart and/or chronic kidney disease.

Late Effect (Sequela) Coding

Report the current residual condition first, followed by the sequela (cause) code that carries the 7th character S when required.

7th Character “S”

Identifies a sequela phase for injury codes and is applied to codes describing both the residual condition and the original injury when appropriate.

STEMI vs NSTEMI

Distinguish ST-elevation myocardial infarction from non-ST-elevation MI to select the correct subclassification within I21.

Acute vs Old Myocardial Infarction Codes

Use I21 codes for MIs occurring within the preceding 4 weeks; assign I25.2 for healed or old MIs that are no longer acute.

“Rule Out” Coding Guidelines

Outpatient coders report symptoms rather than unconfirmed diagnoses, whereas inpatient facility coding may assign probable or likely diagnoses as confirmed.

Sepsis Coding Order

First code the underlying infection, then the sepsis code (A41-); use R65.2- codes for severe sepsis or septic shock and add separate organ-dysfunction codes if not included.