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A patient presents for a routine cardiovascular examination. The provider documents, “Diabetes without complications.” This patient also has stage 3 chronic kidney disease (CKD). When the provi...
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A patient presented for an annual wellness visit. The provider documented, “Diabetes mellitus without complications.” This patient also has dermatitis. When the provider documents DM without co...
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A patient with positive blood cultures for Candida glabrata was diagnosed with candida fungemia and treated with intravenous antifungals. There is not a specific index entry to capture this conditi...
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A 20-year-old patient with progressive adolescent idiopathic scoliosis of the thoracic region presented for complex reconstruction due to collapsing spine syndrome. What is the appropriate code ass...
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A 70-year-old patient presented for conversion of hip resurfacing to total hip replacement, along with excision of heterotopic ossification of bone from the muscle of the left leg. The heterotopic ...
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A patient was diagnosed with steroid dependent minimal change disease (MCD) and nephrotic syndrome. What are the correct code assignments for these conditions?
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A patient is diagnosed with acute kidney injury (AKI) with nephrotic hematuria/proteinuria due to minimal change disease (MCD) with acute tubular necrosis (ATN). What are the correct code assignmen...
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A patient presents for the insertion of Prokera® bilaterally due to a diagnosis of keratoconjunctivitis sicca oculus uterque (OU). The Index lists the default code as M35.0, Sjogren syndrome, with...
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A patient presented to the emergency department for left-sided chest pain and scalp laceration due to a fall. The provider documented rib pain due to fall in the final impression. Rib pain indexes ...
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A patient who is status post chemoradiation for Hodgkin’s disease presents with esophageal and gastric outlet obstruction, due to progression of metastatic leiomyosarcoma to the liver, causing ex...
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