AAPC-CIC Certified Inpatient Coder - Set 2 - Part 1

Correct Answer: Pharmacological

Medical terms fall into four general categories: anatomical, disease and disorder, diagnostic/procedural, and therapeutic. Pharmacological is not one of them, so it is the option that does not belong to the set. Option a is incorrect because it is a listed category covering terms for specific body areas, movement, and the relation of body parts to each other, such as medial. Option b is incorrect because the four general categories include it for terms about treating or curing diseases; nebulizer is the example given for it. Option d is incorrect because it names a recognized category: terms tied to the process of identifying a disease, condition, or injury, with transrectal ultrasound as an example.

Correct Answer: Right upper quadrant

The right upper quadrant (RUQ) contains the gallbladder, the right lobe of the liver, and parts of the small and large intestines. Right and left refer to the patient's own sides. Option a is incorrect because it holds the stomach, pancreas, spleen, and left lobe of the liver, not the gallbladder. Option c is incorrect because it is described as containing the appendix, right ureter, and right ovary and Fallopian tube, which places the gallbladder elsewhere. Option d is incorrect because its listed contents are the left ureter, left ovary and Fallopian tube, and parts of the intestines, with no gallbladder.

Correct Answer: Hospital-acquired MRSA

Hospital-acquired MRSA (HA-MRSA) is a staph infection resistant to common antibiotics, diagnosed in people who acquired it in the hospital or other health care setting while being treated for another condition. Option b is incorrect because it describes a swollen area within body tissue containing pus, which is a lesion type rather than a resistant staph infection acquired in a health care setting. Option c is incorrect because it is diagnosed in individuals outside a hospital setting, often after close skin-to-skin contact with another person who has the infection, which does not fit this facility-acquired case. Option d is incorrect because it is a contagious bacterial infection forming pustules and yellow, crusty sores, typically found in children, and it is not defined by antibiotic resistance.

Correct Answer: Ventilator-associated pneumonia

Ventilator-associated pneumonia is the category defined as pneumonia diagnosed in someone who has been on a ventilator. The other categories are distinguished by aspiration, community setting, or health care setting stay. Option a is incorrect because it covers pneumonia diagnosed during or following a stay in a health care setting, a broader category than ventilator use. Option b is incorrect because it occurs when food or liquid is breathed into the airways or lungs instead of being swallowed, not from ventilator use. Option d is incorrect because it describes pneumonia diagnosed in someone in the community, outside a hospital, so it does not fit a patient on a ventilator.

Correct Answer: estimated glomerular filtration rate

Because people make different amounts of creatinine, a formula is used to calculate the estimated GFR (eGFR), which shows how well the nephrons are filtering creatinine. Lower than normal levels indicate kidney disease. Option a is incorrect because this is a urine test that finds bacteria that may indicate a urinary tract infection and lists antibiotics for treatment. Option b is incorrect because it measures urea, a waste product from the liver's breakdown of protein, and gives information about kidney and liver function rather than nephron filtration of creatinine. Option c is incorrect because all urinary output over one day is gathered and analyzed, so no blood sample or calculation formula is involved.

Correct Answer: Gestational diabetes

Gestational diabetes is high blood sugar that develops during pregnancy in a woman not previously diagnosed with diabetes. Blood sugars typically return to normal after pregnancy, though later risk of type 2 diabetes mellitus is increased. Option a is incorrect because it describes severe, persistent vomiting during pregnancy that causes dehydration and weight loss, not elevated blood sugar. Option b is incorrect because this is a blood clot forming in a deep vein, most commonly in the legs, and has no link to glucose levels. Option d is incorrect because it is high blood pressure in pregnancy with signs such as edema and protein in the urine, so blood sugar is not its defining feature.

Correct Answer: I and II

CAD occurs when atherosclerosis in the coronary arteries obstructs oxygenated blood flow to the heart muscle, and reduced flow to cardiac muscle cells is called ischemia. Statements I and II are therefore accurate. Option b is incorrect because statement III is wrong: the chest pain of CAD is called angina, while a murmur is an abnormal heart sound heard on auscultation. Option c is incorrect because statement IV contradicts the description of CAD as progressive, which if left untreated can cause a myocardial infarction, even though statement II is accurate. Option d is incorrect because both statements are inaccurate, and this pairing leaves out statements I and II, which correctly describe atherosclerotic obstruction and ischemia.

Correct Answer: Memory cells

The adaptive immune response requires exposure to a pathogen, either through direct contact or immunization. Afterward it develops memory cells that recognize the pathogen in the future and quickly mount a defense. Option a is incorrect because they form the first line of defense, such as intact skin and mucous membranes, and do not recognize a pathogen from earlier exposure. Option b is incorrect because histamine is released during the immune response and is a primary cause of allergy and anaphylactic shock symptoms, not of remembered pathogen recognition. Option d is incorrect because a rise in body temperature belongs to the nonspecific innate response, stimulating white blood cells and inhibiting pathogen growth without any recall of past exposure.

Correct Answer: Benign tumor

Benign cells grow and divide in a more controlled manner and remain localized to a certain area. A benign tumor may be surgically removed with no further medical treatment required, which matches the excerpt. Option a is incorrect because cancer means abnormal cells that overgrow and invade and harm tissues; some also disrupt programmed cell death, but nothing here shows invasion or harm. Option b is incorrect because metastasis means cells spread through the blood or lymphatic system to other parts of the body, while this growth stays in one area. Option c is incorrect because malignant cells show uncontrolled growth, divide rapidly and invade normal cells, and they call for prompt, targeted interventions, which does not match this localized, controlled growth.

Correct Answer: Xerostomia

Xerostomia is the term for the condition of a dry mouth. The other terms name inflammation of specific structures of the oral cavity, such as the mouth, tongue, or gums, rather than dryness. Option a is incorrect because it refers to inflammation of the mouth, which is an inflammatory process and not a description of dryness. Option b is incorrect because it names inflammation of the tongue, and the documentation reports no tongue involvement, so it does not describe a dry mouth. Option d is incorrect because it denotes inflammation of the gums; the documentation rules out gum swelling, and the term says nothing about dryness.

Correct Answer: Ataxia

Ataxia is the cerebral palsy movement disorder defined as poor balance and coordination. Cerebral palsy is classified by main movement disorder type: spasticity, dyskinesia, or ataxia, and one or more can occur. Option a is incorrect because is the word meaning weakness or problems with using the muscles; it names the condition broadly and is not one of the movement disorders. Option b is incorrect because describes stiff muscles, a different cerebral palsy movement disorder, and does not refer to impaired balance or coordination. Option c is incorrect because refers to uncontrollable movements, so it names involuntary motion rather than a deficit in balance and coordination.

Correct Answer: Ischemic stroke

An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed, which can result from a blood clot that travelled from another body area and lodged in the brain. Option a is incorrect because this neurological disease is defined by recurrent seizures, so it does not describe a single event from an obstructed vessel. Option c is incorrect because a seizure is a sudden, uncontrolled electrical disturbance in the brain, not an interruption of blood flow caused by a vessel blockage. Option d is incorrect because it involves bleeding into the brain from a damaged vessel, with blood pressing on tissue, rather than a blocked or narrowed vessel.

Correct Answer: Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) treats stones in the kidney and ureter without surgery. High-energy shock waves break stones into pieces as small as grains of sand, which then pass out with the urine. Option b is incorrect because it is a diagnostic test discussed among urinary diagnostic procedures, and it does not break stones into smaller pieces. Option c is incorrect because a stent is a tube placed through the bladder and ureter to let urine flow from kidney to bladder, not to fragment stones. Option d is incorrect because it requires entering the kidney through a small incision in the back with a nephroscope, so it is a surgical stone removal.

Correct Answer: Half-life

Half-life is the rate at which 50% of a drug is eliminated from the body, and liver disease can prolong it when the liver no longer metabolizes the medication effectively, extending the therapeutic effect. Option a is incorrect because this describes inactivation of swallowed drugs by the intestines and liver before circulation, not the time needed for the body to eliminate half of a drug. Option b is incorrect because this is the Phase II reaction that couples a drug molecule with another molecule; it is a metabolic step, not a measure of elimination rate. Option c is incorrect because this is a Phase I change turning an inactive drug into an active form; it does not measure how quickly half of a drug leaves the body.

Correct Answer: The conventions and instructions of the classification

The guidelines state that the conventions and instructions of the classification take precedence over guidelines. The guidelines are built on the Tabular List and Alphabetic Index instructions and only provide additional instruction. Option b is incorrect because documentation supports accurate code assignment and is reviewed for the reason for the encounter, yet it is not an authority that outranks the classification. Option c is incorrect because approval by the Cooperating Parties makes the guidelines official, but it does not place them above the conventions and instructions within the classification. Option d is incorrect because the guidelines accompany and complement the classification and are based on its instructions, so the classification's own instructions rank above them.

Correct Answer: The "other specified" code

In the Alphabetic Index, NEC means "not elsewhere classifiable" and represents "other specified." When no specific code exists for the condition, the Index directs the coder to the "other specified" code in the Tabular List. Option a is incorrect because unspecified is the meaning of NOS, "not otherwise specified"; NEC does not stand for that term in either the Alphabetic Index or Tabular List. Option b is incorrect because the placeholder X fills empty characters so a code is valid; it has nothing to do with the meaning of NEC. Option d is incorrect because categories and subcategories are not permissible for reporting purposes, since only complete codes with any applicable 7th character are reported.

Correct Answer: Code both, sequencing the acute code first

When the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, ICD-10-CM guidelines direct coding both and sequencing the acute (subacute) code first. Option a is incorrect because the guideline directs that both codes be reported when separate subentries exist, so dropping the acute code leaves the condition incompletely described. Option c is incorrect because a query is reserved for unclear documentation, such as the relationship between a condition and care; here the guideline already gives a clear instruction. Option d is incorrect because the guideline places the acute (subacute) code ahead of the chronic code, so reversing the sequence contradicts the stated order.

Correct Answer: NOS

The ICD-10-CM abbreviations guideline states that NOS, "Not otherwise specified," is the equivalent of unspecified. This holds for the abbreviation in the Alphabetic Index and in the Tabular List alike. Option a is incorrect because it is an applicable character that must be last in the data field for certain categories, and it carries no meaning of unspecified. Option b is incorrect because it is a character that allows for future expansion and fills empty characters ahead of a required 7th character, not an abbreviation. Option c is incorrect because it represents "other specified," the entry used when a specific code is not available for a condition, which is a different meaning from unspecified.

Correct Answer: A condition assigned to that code

Inclusion terms are the conditions for which a code is to be used. Under an 'other specified' code, the terms are a list of the various conditions assigned to that code, rather than synonyms of the title. Option b is incorrect because sequencing direction is not given by a 'code also' note, and inclusion terms are conditions for the code, not instructions about order. Option c is incorrect because excluded conditions appear under Excludes notes, which mean the codes are independent of each other, not under inclusion terms that name conditions for the code. Option d is incorrect because an Includes note under a three-character code title defines or gives examples of the category; inclusion terms sit under individual codes instead.

Correct Answer: Listed after the underlying condition code

Under the etiology/manifestation convention, "in diseases classified elsewhere" codes must be used with an underlying condition code and listed after it. They are never permitted as first listed or principal diagnosis. Option a is incorrect because codes with this title are never permitted as first listed or principal diagnosis, even when the manifestation prompted the admission. Option b is incorrect because these codes must be used in conjunction with an underlying condition code, so they cannot stand alone. Option c is incorrect because the convention fixes the order, with the etiology code first and the manifestation second, as shown by the notes and brackets.