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The National Clinical Coding Examination [UK]

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The National Clinical Coding Examination [UK] CONFIDENTIAL The National Clinical Coding Examination [UK] 22 March 2016 Paper 1 Practical - ANSWERS 9:30 am - 12:35 pm [THREE HOURS] Please spend the first 5 minutes reading through the ‘Instructions to Candidates’ This Examination Paper consists of 2 Sections: A and B. Section A – Practical Coding [30% of the Marks] Section A [1] – ICD-10 Questions 1-15 [15% of the Marks]. Section A [2] – OPCS-4 Questions 16-30 [15% of the Marks]. Answer all questions in the spaces provided on the Examination Paper. Section B – Case Studies [70% of the Marks] Case Studies 1-7 [10% of the Marks for each Case Study]. Answer all questions using the Answer Sheets provided. Write only on one side of the Answer Sheets provided. March 2016 Practical Paper Version 1.0 Page 1 National Clinical Coding Qualification (UK) March 2016 Section A [1] 15% Write your candidate number on EVERY page ICD-10 codes are required for the first 15 questions [1 – 15] [OPCS-4 codes are NOT required] Provide appropriate code(s) for the following conditions in the boxes alongside each question. If more than one code is required, please use separate boxes for each code to make sequencing clear, for example, box 1 should contain the primary diagnosis code. [The number of boxes is not necessarily indicative of the codes required]. Question 1 Open fracture of the left humeral shaft, external cause and 1. S42.31 place of incident unknown. [7 Marks] 2. X59.9 3. CODES AND TITLES 4. S42.31 Fracture of shaft of humerus – Open 5. X59.9 Exposure to unspecified factor – Unspecified place 6. Index: Fracture (abduction) (adduction) (avulsion) (comminuted) (compression) (dislocation) (oblique) (separation) T14.2 - humerus S42.3 - - shaft S42.3 Tabular: S42.3 Fracture of shaft of humerus Humerus NOS Upper arm NOS 0 closed 1 open Index: Accident (to) X59.- Tabular: X59 Exposure to unspecified factor [See at the beginning of this chapter for the classification of the place of occurrence and activity] .9 Unspecified place March 2016 Practical Paper Version 1.0 Page 2 National Clinical Coding Qualification (UK) March 2016 Question 2 Admitted for investigation following a high blood pressure 1. R03.0 reading in the A&E Department. During the admission the 2. I24.9 [or patient’s blood pressure returned to a normal range and I21.9] they were discharged. However, it was acknowledged the 3. I50.1 patient had suffered a myocardial infarction three weeks 4. ago. Known left ventricular failure. [8 Marks] 5. 6. CODES AND TITLES R03.0 Elevated blood-pressure reading, without diagnosis of hypertension I24.9 Acute ischaemic heart disease, unspecified [I21.9 Acute myocardial infarction, unspecified also accepted] I50.1 Left ventricular failure Index: Elevated, elevation - blood pressure (see also Hypertension) I10 - - reading (incidental) (isolated) (nonspecific), no diagnosis of hypertension R03.0 Tabular: R03.0 Elevated blood-pressure reading, without diagnosis of hypertension Note: This category is to be used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension has been made, or as an isolated incidental finding. Index: Disease, diseased – see also Syndrome - heart (organic) I51.9 - - ischemic (chronic or with a stated duration of over 4 weeks) I25.9 - - - acute or with a stated duration of 4 weeks or less I24.9 Tabular: I24.9 Acute ischaemic heart disease, unspecified Index: Infarct, infarction (of) myocardium, myocardial (acute or with a stated duration of 4 weeks or less) I21.9 Tabular: March 2016 Practical Paper Version 1.0 Page 3 National Clinical Coding Qualification (UK) March 2016 I21.9 Acute myocardial infarction, unspecified Index: Failure, failed - heart (acute) (sudden) (senile) I50.9 - - left (ventricular) (see also Failure, ventricular, left) I50.1 Or Failure, failed - ventricular (see also Failure, heart) I50.9 - - left I50.1 Tabular: I50.1 Left ventricular failure Question 3 Epidemic winter vomiting disease causing severe 1. A08.1 dehydration. [6 Marks] 2. E86.X 3. CODES AND TITLES 4. A08.1 Acute gastroenteropathy due to Norwalk agent 5. E86.X Volume depletion 6. Index: Disease, diseased – see also Syndrome - winter vomiting (epidemic) A08.1 Or Vomiting (see also Hyperemesis) R11 - winter (epidemic) A08.1 Tabular: A08.1 Acute gastroenteropathy due to Norwalk agent Index: Dehydration E86 Tabular: E86 Volume depletion Question 4 Patient admitted with leakage of cerebrospinal fluid from 1. G96.0 the ear. Known to have bipolar affective disorder. [6 Marks] 2. F31.9 3. 4. CODES AND TITLES 5. March 2016 Practical Paper Version 1.0 Page 4 National Clinical Coding Qualification (UK) March 2016 G96.0 Cerebrospinal fluid leak 6. F31.9 Bipolar affective disorder, unspecified Index: Leak, leakage - cerebrospinal fluid G96.0 Tabular: G96.0 Cerebrospinal fluid leak Excl.: from spinal puncture Index: Disorder (of) – see also Disease - affective (mood) (see also Disorder, mood) F39 - - bipolar (see also Disorder, bipolar, affective) F31.9 Or Disorder (of) – see also Disease - bipolar F31.9 - - affective F31.9 Tabular: F31.9 Bipolar affective disorder, unspecified Question 5 Diabetes mellitus due to malnutrition. Severe ketoacidosis, 1. E12.0 patient in hypoglycaemic coma. [6 Marks] 2. E16.2 3. CODES AND TITLES 4. E12.0 Malnutrition-related diabetes mellitus with coma 5. E16.2 Hypoglycaemia, unspecified 6. Index: Diabetes, diabetic (mellitus) (controlled) (familial) (severe) E14.- - malnutrition-related (insulin- or non-insulin-dependent) E12.- Tabular: E12 Malnutrition-related diabetes mellitus [See before E10 for subdivisions] .0 With coma Index: Hypoglycaemia (spontaneous) E16.2 Tabular: March 2016 Practical Paper Version 1.0 Page 5 National Clinical Coding Qualification (UK) March 2016 E16.2 Hypoglycaemia, unspecified Question 6 Admitted for treatment of mucinous adenocarcinoma of the 1. C44.1 canthus. Also known to have acinar adenocarcinoma of the 2. M8480/3 prostate. [12 Marks] 3. C61.X 4. M8550/3 CODES AND TITLES 5. C44.1 Other malignant neoplasms of skin - Skin of eyelid, 6. including canthus M8480/3 Mucinous adenocarcinoma C61.X Malignant neoplasm of prostate M8550/3 Acinar cell carcinoma Index: Adenocarcinoma (M8140/3) – see also Neoplasm, malignant - mucinous (M8480/3) Malignant Primary Neoplasm, neoplastic - canthus (eye) (inner) (outer) C44.1 Tabular: C44.1 Skin of eyelid, including canthus Index: Adenocarcinoma (M8140/3) – see also Neoplasm, malignant - acinar (M8550/3) Malignant Primary Neoplasm, neoplastic - prostate (gland) C61 Tabular: C61 Malignant neoplasm of prostate Question 7 Bilateral Barton’s fractures of the forearms and fractured 1. T02.40 nose following a fall from a skateboard at a sports centre. 2. S02.20 [11 Marks] 3. W02.3 4. CODES AND TITLES 5. March 2016 Practical Paper Version 1.0 Page 6 National Clinical Coding Qualification (UK) March 2016 T02.40 Fractures involving multiple regions of both upper 6. limbs – closed S02.20 Fracture of nasal bones – closed W02.3 Fall involving ice-skates, skis, roller-skates or skateboards – Sports and athletics area Index: Fracture (abduction) (adduction) (avulsion) (comminuted) (compression) (dislocation) (oblique) (separation) T14.2 - multiple T02.9 - - arm - - - meaning upper limb – see Fracture, multiple, limb, upper Fracture (abduction) (adduction) (avulsion) (comminuted) (compression) (dislocation) (oblique) (separation) T14.2 - multiple T02.9 - - limb - - - upper (one) T02.2 - - - - with - - - - - other upper limb T02.4 Or Fracture (abduction) (adduction) (avulsion) (comminuted) (compression) (dislocation) (oblique) (separation) T14.2 - limb - - upper T10 - - - both T02.4 Tabular: T02.4 Fractures involving multiple regions of both upper limbs Fractures of sites classifiable to S42.-, S52.-, S62.- and T10 specifies as bilateral 0 closed 1 open Index: Fracture (abduction) (adduction) (avulsion) (comminuted) (compression) (dislocation) (oblique) (separation) T14.2 - nose, nasal (bone) (septum) S02.2 Tabular: S02.2 Fracture of nasal bones 0 closed 1 open External Causes of Injury Index: March 2016 Practical Paper Version 1.0 Page 7 National Clinical Coding Qualification (UK) March 2016 Fall, falling (accidental) W19 - involving - - skateboard(s) W02 Tabular: W02 Fall involving ice-skates, skis, roller-skates or skateboards .3 Sports and athletics area Question 8 Patient with carotid artery plaque admitted for 1. I65.2 endarterectomy. Registered blind due to amaurosis fugax. 2. G45.3 [6 Marks] 3. 4. CODES AND TITLES 5. I65.2 Occlusion and stenosis of carotid artery 6. G45.3 Amaurosis fugax Index: Plaque(s) - artery, arterial – see Arteriosclerosis Arteriosclerosis, arteriosclerotic (diffuse) (disease) (general) (obliterans) (senile) (with calcification) I70.9 - carotid artery I65.2 Tabular: I65.2 Occlusion and stenosis of carotid artery Index: Amaurosis (acquired) (congenital) (see also Blindness) H54.0 - fugax G45.3 Tabular: G45.3 Amaurosis fugax Question 9 Avulsed brachial plexus nerve due to birth injury. Patient is 1. P14.3 43 years old. [3 Marks] 2. 3. CODES AND TITLES 4. P14.3 Other brachial plexus birth injuries 5. 6. March 2016 Practical Paper Version 1.0 Page 8 National Clinical Coding Qualification (UK) March 2016 Index: Avulsion (traumatic) T14.7 - nerve (root) see Injury, nerve Injury (see also specified injury type) T14.9 - birth (see also Birth injury) P15.9 Birth - injury P15.9 - - nerve - - - brachial plexus P14.3 Tabular: P14.3 Other brachial plexus birth injuries Question 10 Myasthenia syndrome due to Type II diabetes mellitus. [7 1. E11.4D Marks] 2. G73.0A
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