Wiki E/M Coding Course rationale and correct answer do not match....

[grepay]

E/M Coding Course Question:
Question 1
SUBJECTIVE: The patient has no known allergies. She is diabetic since 2002. She takes 81 mg of aspirin daily. Medication list is noted. The patient is here for annual diabetic foot check. She does have diabetic shoes. She denies cigarette use or tobacco use.

OBJECTIVE: On examination, she has elongated thickened toenails 1 through 5 bilaterally, mycotic appearing. Finding is consistent with fungal toenails. We discussed diabetic foot care do's and don'ts. She has intact sensation with 128 cycles per second tuning fork at the level of great toe. She has intact sensation with 5.07 monofilament plantar foot. No foot ulceration is seen. DP and PT pulses are palpable.

IMPRESSION:
1.Onychomycosis
2.Diabetes mellitus.

PLAN: I reduced toenails 1 through 5 manually and with electric grinder. I will see her back for followup in 10-12 weeks

What diagnoses would be reported?

A. E11.9, B35.1
B. E11.40, B35.1
C. B35.1, E11.9
D. B35.1, E11.621

The rationale for this question states Onychomycosis is sequenced first; However, that shows as incorrect when graded. When E11.9 is sequenced first followed by B35.1, the answer shows as correct. What is the correct sequencing for this question.

 

[tkermode]

C. B35.1, e11.9

 

[thomas7331]

ICD-10 guidelines say that for outpatient services "list first the ICD-10 code for the diagnosis, condition,, problem, or other reason for encounter/visit shown in the medical records to be chiefly responsible for the services provided." Since the documentation states that "the patient is here for annual diabetic foot check", reporting E11.9 first would be the most correct answer. The onychomycosis is documented as an additional finding on exam and not the reason for the encounter.