Question 1

The ____ is the middle layer of the heart composed of cardiac muscle.

Accepted Answer

The myocardium is the middle layer of the heart and is responsible for the heart's muscular contractions that pump blood throughout the body.

Question 2

A patient is admitted with chest pain and is ruled in for an NSTEMI. The patient has a history of a CABG and PTCA with stent placement. Patient is taking medications for hypertension, CAD, and CHF.

Accepted Answer

The correct coding for an NSTEMI with a history of CABG and PTCA with stent placement, along with hypertension, CAD, and CHF, is I21.4 (NSTEMI), I11.0 (Hypertensive heart disease with heart failure), I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris), I50.9 (Heart failure, unspecified), Z95.1 (Presence of aortocoronary bypass graft), and Z95.5 (Presence of coronary angioplasty implant and graft).

Question 3

Patient comes into the ER after fainting at work. The physician determines that the fainting was caused by hypertensive urgency.

Accepted Answer

D

Question 4

Patient with alcoholic cirrhosis of the liver with bleeding esophageal varices was admitted to the hospital. There was no evidence of withdrawal symptoms due to patient's alcohol dependence.

Accepted Answer

The answer of Patient with alcoholic cirrhosis of the liver...

Question 5

Molly has a blood pressure of 150/100 mm Hg. She would be classified as having ____ by her clinician.

Accepted Answer

A blood pressure reading of 150/100 mm Hg is higher than the normal range, indicating hypertension.

Question 6

Diseases of the circulatory system in ICD-10-CM are coded from ____.

Accepted Answer

Diseases of the circulatory system are coded from I00-I99 in ICD-10-CM.

Question 7

All of the following are tests performed to determine whether a myocardial infarction has occurred EXCEPT ____.

Accepted Answer

While CPK, EKG, ECG, and troponin level tests are all used to diagnose a myocardial infarction, urinalysis is not typically used for this purpose. Urinalysis is more commonly used to evaluate kidney function and screen for urinary tract infections.

Question 8

Patient comes to the hospital with chest pain and shortness of breath. A diagnostic left heart cath is performed. The cardiologist documents the diagnosis as primary pulmonary hypertension.

Accepted Answer

I27.0 is the correct ICD-10 code for primary pulmonary hypertension. 4A023N7 is the correct ICD-10-PCS code for the diagnostic left heart catheterization.

Question 9

Patient comes to the hospital for repair of an abdominal aortic aneurysm. The repair is performed by implantation of stent graft in the abdominal aorta via percutaneous approach.

Accepted Answer

The answer of Patient comes to the hospital for repair...

Question 10

Patient was admitted with acute on chronic systolic and diastolic congestive heart failure.

Accepted Answer

The answer of Patient was admitted with acute on chronic...

Question 11

The patient was admitted with left-sided hemiparesis due to a cerebrovascular accident. The patient has a history of previous CVA with residual facial droop.

Accepted Answer

I63.9 - unspecified cerebrovascular disease
G81.94 - hemiplegia and hemiparesis following unspecified cerebrovascular disease
I69.392 - sequelae of cerebral infarction, other specified cerebrovascular disease (previous CVA with residual facial droop)

Question 12

Patient was admitted to have a drug-eluting stent inserted into the left anterior descending coronary artery (LAD) for coronary atherosclerosis. The LAD had 100% chronic occlusion. Procedure was performed percutaneously.

Accepted Answer

- I25.10 for coronary atherosclerosis 
- I25.82 for chronic total occlusion of the coronary artery 
- 027034Z for percutaneous insertion of stent in LAD

Question 13

Patient is admitted with CHF and known hypertensive heart disease.

Accepted Answer

The correct coding sequence is I11.0, I50.9. I11.0 represents hypertensive heart disease, which is the primary condition, and I50.9 represents congestive heart failure (CHF) as a secondary condition. The sequencing is important because the heart failure is considered to be a consequence of the hypertensive heart disease, thus the hypertensive heart disease code should be listed first.

Question 14

Patient was admitted for treatment of gangrenous cellulitis of the left lower leg.

Accepted Answer

The answer of Patient was admitted for treatment of gangrenous...

Question 15

Patient presents with left carotid artery thrombosis with infarct and current right hemiparesis. Patient has residual aphasia from a previous stroke.

Accepted Answer

I63.032 is the code for cerebral infarction due to thrombosis of left carotid artery, which matches the current diagnosis. G81.91 is for hemiparesis affecting right dominant side, which matches the current symptom of right hemiparesis. I69.320 is for aphasia following cerebral infarction, which matches the residual symptom from a previous stroke.

Question 16

Patient is admitted through the ER, presenting with acute chest pain. The patient has a history of COPD and pneumonia as well as type 2 DM with neuropathy. He has a history of hypertension and gout for which he takes meds for both conditions. He is currently smoking about one pack of cigarettes per day. After study, it is determined that patient has had an acute anterolateral wall STEMI. He is taken to the cath lab for a PTCA with the insertion of a drug-eluting stent of the LAD.

Accepted Answer

The correct coding sequence starts with I21.09 for the acute anterolateral wall STEMI, followed by other existing conditions such as hypertension (I10), tobacco use (F17.210), gout (M10.9), COPD (J44.9), type 2 diabetes with neuropathy (E11.40), and the procedure code for PTCA with the insertion of a drug-eluting stent of the LAD (027034Z).

Question 17

Patient is admitted with chest pain and rules in for an anterolateral STEMI. There is a family history of CAD.

Accepted Answer

The answer of Patient is admitted with chest pain and...

Question 18

Patient is admitted through the ER with atrial fibrillation and a history of COPD. She is taken to the EPS lab for EPS mapping and percutaneous radiofrequency ablation of the AV node.

Accepted Answer

The answer of Patient is admitted through the ER with...

Question 19

Patient is admitted with syncope. After tests are performed, it is determined that the patient has sick sinus syndrome.

Accepted Answer

Sick sinus syndrome is specifically coded as I49.5, which directly corresponds to the condition without needing an additional code for syncope.

Question 20

A patient is admitted with facial droop, right-sided hemiparesis, and nystagmus. Testing reveals occlusion of the left carotid artery with cerebral infarct. The patient has uncontrolled hypertension and atrial fibrillation, which is treated with Coumadin. Before discharge, the patient's nystagmus and facial droop have resolved. The patient is discharged to rehab for continued therapy for right-sided hemiparesis.

Accepted Answer

- I63.232: occlusion and stenosis of left carotid artery with cerebral infarction
- G81.91: hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (since the patient has right-sided hemiparesis)
- H55.00: nystagmus (unspecified)
- R29.810: facial asymmetry due to non-dominant side cerebral infarction (since the patient had resolved facial droop on the non-dominant side)
- I10: uncontrolled hypertension
- I48.91: atrial fibrillation
- Z79.01: long-term (current) use of anticoagulants (Coumadin)

Quiz 16: Diseases of the Circulatory System