What fourth character default code must be assigned in category Y98 Radiology procedures found in the OPCS-4.7 Tabular List, Volume I if the number of body areas or time is not specified?

 

                          

  1. What fourth character default code must be assigned in category Y98 Radiology procedures found in the OPCS-4.7 Tabular List, Volume I if the number of body areas or time is not specified? [1 Mark]

 

.1

 

 

  1. What category from OPCS-4.7 Tabular List, Volume I must be assigned in addition to certain procedures on the spine (V22 – V68)? Either the category title or code is acceptable. [1 Mark]

 

V55 or Levels of Spine

 

 

  1. The requirement to use fifth characters appears in which three ICD-10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full titles are acceptable. [3 Marks]

 

Chapter IX – Diseases of the circulatory system

Chapter XIII – Diseases of the musculoskeletal system and connective tissue Chapter XIX – Injury, poisoning and certain other consequences of external causes

 

 

  1. Give two examples of the five types of punctuation that appear in the ICD-10 4th Edition Tabular List, Volume 1. [2 Marks]

 

Brace  I or  } Square Brackets  [  ] Colon  :

Point dash  .-

Parentheses  (  )

 

 

  1. The chapters of ICD-10 4th Edition Tabular List, Volume 1 are divided into three different types:

 

  1. Chapter VII Diseases of the eye and adnexa is an example of which group of chapters?

 

‘Body system’ chapters

 

  1. Chapter XX External causes of morbidity and mortality is an example of which group of chapters?

 

‘Other’ chapters

 

  • Chapter II Neoplasms is an example of which group of chapters?

 

‘Special group’ chapters

 

 

  1. How do synonyms appear in ICD-10 4th Edition Tabular List, Volume 1? [1 Mark]

 

Square brackets [ ] are used to enclose synonyms.

 

 

 

  1. Briefly describe the sequencing rules found in the National Clinical Coding Standards OPCS-4 reference book for coding multiple deliveries. [3 Marks]

 

When coding multiple deliveries each different type of delivery must be recorded with the most serious being sequenced first.

Where all methods of delivery are identical, only one code is required.

 

 

  1. What do the four characters following the letter M and before the solidus / represent within a morphology code? [1 Mark]

 

The histological (cell) type.

 

 

  1. What does the term regimen/regime describe when associated with chemotherapy? [5 Marks]

 

  • regimen describes in full the name, drugs, doses, route and time of delivery of a specified systemic anticancer therapy.

 

 

  1. What is the rule for coding a patient described as having chronic kidney disease (CKD) stages 4 or 5 with renal failure? [2 Marks]

 

Whether renal failure is documented in the medical record or not it must not be coded in addition with the exception of acute renal failure.

 

  1. Within OPCS-4.7 Alphabetical Index, Volume II what do the abbreviations

TVT and PEG stand for? [2 Marks]

 

TVT – Trans Vaginal Tape

 

PEG – Percutaneous Endoscopic Gastrostomy

 

 

  1. State two of the three different reasons why ‘Instructional Notes’ appear throughout the ICD-10 Tabular List, Volume 1. [2 Marks]

 

Describes the general content of the succeeding categories

Gives instruction regarding the use of categories

Provides fifth character sub-classifications

 

  1. Explain the meaning of the phrase “are for use with” found in the ICD-10 Tabular List, Volume 1. [1 Mark]

 

Where the phrase “are for use with” is seen, this instruction is mandatory and the codes referred to must be used

 

 

  1. Name both ways in which reactions to drug/medication can be classified within ICD-10 Tabular List, Volume 1. [2 Marks]

 

Poisoning (improper use)

Adverse effect (proper use)

 

  1. What are the coding rules associated with the birth episode of a premature infant who has low birth weight? [4 Marks]

If both the birth weight and gestational age are available when assigning codes from category P07 both can be coded, the ICD-10 code that classifies the birth weight must be sequenced before the code for the gestational age.

  • code from Z38 must be coded on the baby’s birth episode; if a morbid condition is present which has been treated or investigated then the morbid condition must be sequenced first, followed by the Z38 in the first secondary position.

 

  1. Within OPCS-4.7 Tabular List, Volume I there are three circumstances when the use of .8 and .9 is not List two of them. [2 Marks]

 

Extended categories

High Cost Drugs categories

Y97 or Radiology with contrast

 

  1. Myocardial/Cardiac perfusion scans are carried out in two phases. Name the two [2 Marks]

 

Stress test

Rest test

 

  1. Sites marked with the cross hatch symbol (#) within the Neoplasm Table should be classified to malignant neoplasm of skin of that site if the histological type is one of two types. Name the two histological types. [2 Marks]

 

Squamous Cell Carcinoma and Epidermoid Carcinoma

 

 

  1. The National Clinical Coding Standards OPCS-4 reference book contains three types of Standard. Name two of the three types of Standard. [2 Marks]

 

General coding standards

Chapter standards

Coding standards

 

 

  1. For what time period must parenteral nutrition have been given to a patient before it can be coded? [1 Mark]

 

More than 14 days

 

 

 

 

 

       

  1. How is the Neoplasm Table organised in the ICD-10 Alphabetical Index, Volume 3? [8 Marks]

 

The Neoplasm Table is organised by anatomical site with five columns which identify the behaviour of the neoplasms.

The anatomical sites appear as modifiers to the lead term ‘neoplasm’ and are arranged alphabetically down the left hand side of the page.

 

The five column headings for the nature/behaviour of the neoplasms reading from left to right are as follows:            Malignant primary

Malignant secondary

In situ

Benign

Uncertain and unknown behaviour

 

  1. When the site of a primary malignancy and secondary malignancy are both present what is the coding rule that determines which one will be sequenced first? [2 Marks]

 

The code for the primary site always precedes the code for the secondary site unless the stated reason for admission is the management/treatment of the secondary malignancy.

 

 

 

 

 

 

  • When a diagnosis contains two qualifying adjectives that have different code numbers, for example ‘transitional cell epidermoid carcinoma’ what is the principle for assigning the morphology code? [1 Mark]

 

In such circumstances, the higher number should be used, as they are usually more specific. For example, ‘transitional cell carcinoma NOS’ is M8120/3 and ‘epidermoid carcinoma NOS’ is M8070/3, therefore the M8120/3 would be assigned.

 

 

  1. What are the rules for coding human immunodeficiency virus [HIV] disease resulting in a malignant neoplasm? [2 Marks]

 

Both the HIV and the neoplasm must be coded, with the HIV disease being sequenced first.

 

 

  1. When coding a metastatic malignant neoplasm diagnosis that mentions only one site and includes a morphological type that when indexed takes the coder to a different body site/system to that of the site mentioned in the statement, what is the coding standard? [2 Marks]

 

It must be coded as a primary malignant neoplasm of an unspecified site for the morphological type with metastases (secondary) of the site mentioned in the diagnostic statement.

 

 

  1. Name the three neoplastic blood disorders within ICD-10 Tabular List, Volume 1 of which anaemia is a natural symptom and is therefore not to be recorded as an additional code. [3 Marks]

 

Leukaemia

Myeloma

Myelodysplasia

 

 

 

OR

 

 

             

Question D1 Part B: [Answer all parts of this question i, and ii]

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

  1. Name in full the three sections that are found within ICD-10 Alphabetical

Index, Volume 3, and describe in bullet point the content of each section. [14 Marks]

 

Section 1 Alphabetical index to diseases and nature of injury

Content: o Is an alphabetical index of diseases, injuries, signs, symptoms,  syndromes, pathological conditions

  • Factors influencing health status and contact with health services o Morphology of neoplasms

 

            Section 2 Index of external causes of injury              Content: o Contains all the terms classifiable to Chapter XX except drugs and other chemical substances

  • This index describes the circumstances under which an accident or act of violence occurred

 

 Section 3 Table of drugs and chemicals 

Content:

o The table contains an extensive, but not exhaustive, list of
  drugs, alcohols, petroleum products, industrial solvents, corrosives, metals, gases, noxious plants, household cleaning products, pesticides and other toxic agents
o The circumstance, whether this a poisoning (with additional detail of whether this was accidental, intentional self-harm or undetermined intent) or adverse effects
   

 

  1. Describe the function and standard associated with ‘Use’ Notes and where they are found within ICD-10 Tabular List, Volume 1 (Actual codes and titles not required). [4 Marks]

 

The ‘Use’ note is a specific instruction to use an additional code in order to describe a condition more completely and just like other types of notes, can be found at chapter, block and three character category and fourth character subcategory levels. The ‘Use’ Note is never optional and must always be adhered to where the information is available.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

             

 

Section D[2] – OPCS-4 Theory [15% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D2 Part A: [Answer all parts of this question i, ii, iii, iv and v]

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation are for use in an outpatient setting, or if a patient has been solely admitted for the procedure/intervention. There are eight diagnostic imaging procedures that are exceptions to this rule. List three of these exceptions (actual codes not required). [3 Marks]

 

Magnetic Resonance Imaging (MRI)

Computed Tomography (CT)

Implantation of electrocardiography loop recorder

Removal of electrocardiography loop recorder

Transthoracic echocardiography (TTE)

Transoesophageal echocardiography (TOE)  Intravascular echocardiography  Epicardial echocardiography.

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation require the assignment of a possible two additional ‘Y’ code(s). What extra information do these ‘Y’ codes provide? [4 Marks]

 

They require a code from category Y97 Radiology with contrast (if used,) and Y98 Radiology procedures. The Y98 codes identify the number of body areas examined, or the duration of the procedure. The Y97 code identifies contrast usage.

 

iii. What are the standards for coding diagnostic imaging procedures using body system chapter codes in OPCS-4.7 Tabular List, Volume I? [4 Marks]

 

When a specific code classifying a diagnostic imaging procedure is available in a body system chapter (Chapters A-T and V-W), it must be used in preference to the codes within categories U01-U21 and U34-U37.

 

 

The standard to only code diagnostic imaging procedures in an outpatient setting or if the patient has been solely admitted for the purpose of the procedure/intervention only applies to diagnostic imaging procedure codes in Chapter U and categories R36-R43.

 

Additional codes from categories Y97 Radiology with contrast and Y98 Radiology procedures must not be assigned with body system chapter imaging codes.

 

 

  1. Nuclear medicine imaging procedures in the OPCS-4.7 Tabular List, Volume I range U01-U21 and U34-U37 are only for use in an outpatient setting, or if a patient is admitted solely for the purpose of a nuclear medicine imaging procedure. There are four exceptions to this standard, name two of them. [2 Marks]

 

Positron emission tomography (PET)

Single photon emission computed tomography (SPECT)

Positron emission tomography with computed tomography (PET/CT)

Single photon emission computed tomography with computed tomography

(SPECT/CT)

 

 

  1. What two OPCS-4.7 Tabular List, Volume I categories can be added to nuclear medicine imaging procedures? Either the category title or code is acceptable. [2 Marks]

 

Y93 or Gallium-67 imaging

Y94 or Radiopharmaceutical imaging

 

 

OR

 

Question D2 Part B: [Answer all parts of this question i, ii, iii, iv, v and vi]

 

  1. Describe the coding rules pertaining to OPCS-4.7 Tabular List, Volume I category M47 Catheterisation of the bladder, including trial without catheter (TWOC) No OPCS-4.7 codes are required. [6 Marks]

 

A code for unspecified urethral catheterisation of bladder (M47.9) must not be assigned when the catheterisation is performed routinely as part of, or following, a procedure, or when catheterisation is performed to keep the patient comfortable during the admission.

 

A code for unspecified urethral catheterisation of bladder (M47.9) must be assigned when it is documented in the medical record that a patient has developed urinary retention which has been treated with catheterisation.

 

A successful trial without catheter (TWOC) must be coded to removal of urethral catheter from bladder only.

 

If the TWOC fails and a catheter is reinserted both the removal and reinsertion of the catheter must be coded.

 

  1. What type of rupture must an artificial rupture of membranes (R14) be coded to in OPCS-4.7 Tabular List, Volume I? [1 Mark]

 

Artificial rupture of membranes (ARM) must be coded to (R14.1) Forewater rupture of membranes.

 

 

  • What is the coding standard in OPCS-4.7 Tabular List, Volume I for a patient that receives rehabilitation assessment (X60) and rehabilitation delivery (U50U54) within the same admission? [1 Mark]

 

Only the code describing the rehabilitation delivery (U50-U54) is required, as it is assumed the assessment would have been carried out before the rehabilitation commenced.

 

  1. Describe the standards around the coding of preparation for radiotherapy in OPCS-4.7 Tabular List, Volume I. [3 Marks]

 

Preparation for radiotherapy must only be assigned once to cover all planning for each preparation regardless of the number of sessions required for completion of the preparation process.

 

Must be assigned on the first attendance/episode for delivery of radiotherapy.

 

Must be sequenced before the delivery codes.

 

 

  1. Describe the sequencing rules when assigning codes from OPCS-4.7 Tabular

List, Volume I categories Y53 Approach to organ under image control and Y78 Arteriotomy approach to organ under image control. [3 Marks]

 

These codes must only be assigned in a secondary position immediately after the code for the intervention and before the relevant site and laterality codes (Z).

 

 

  1. Which fourth character in OPCS-4.7 Tabular List, Volume I must be assigned when a procedure involves image control but the method of image control is not known? [1 Mark]

 

.9 Unspecified                                                      Section D[3] – Clinical Terms [10% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D3 Part A: [Answer all parts of this question i, ii and iii]

 

  1. SNOMED-CT is a clinical terminology. What does SNOMED-CT stand for? [1 Mark]

 

Systematized Nomenclature of Medicine – Clinical Terms

 

  1. Explain briefly what a clinical terminology is. [6 Marks]

 

A clinical terminology is a structured collection of descriptive terms for use in clinical practice. These terms describe the care and treatment of patients and cover areas like diagnoses, symptoms, surgical procedures, treatments and medicines as well as terms used for healthcare administration.

 

 

  • Name the link mechanism between SNOMED-CT and the ICD-10 and OPCS4.7 classifications that are essential to support the derivation of statistical data from clinical data. [1 Mark]

 

Cross mapping

 

 

 

OR

 

             

Question D3 Part B: [Answer this question]

 

Give 8 benefits of using SNOMED-CT and electronic patient records (EPR) in the NHS. [8 Marks]

 

  1. Controlled vocabulary – less chance of misunderstandings between clinicians.

 

  1. Consistent terminology across all care domains.

 

  1. Precise recording of clinical information.

 

  1. SNOMED-CT is a developing international standard – multilingual/ cultural support.

 

  1. EPR reduces storage costs.

 

  1. EPR can be accessed in many places at the same time.

 

  1. EPR is quickly transferred.

 

  1. EPR is legible as it is not dependant on hand-written notes.

 

  1. More efficient search for patient records.

 

  1. Point of care decision support.

 

  1. Monitoring adverse reactions to treatment.

 

  1. Automatic identification of patient risk factors.

 

  1. Monitor response to treatment.

 

  1. Large populations of consistent data for medical research.

 

This list is not exhaustive

 

 

 

 

 

 

 

             

Section D[4] – Miscellaneous Section [5% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D4 Part A: [Answer all parts of this question i and ii]

 

  1. Give the definition of Clinical Coding, including why it is carried out. [6 Marks]

 

Clinical coding is the translation or written medical terminology that describes a patient’s complaint, problem, diagnosis, treatment or other reason for seeking medical attention into codes that can then be easily tabulated, aggregated and sorted for statistical analysis in an efficient and meaningful manner.

 

  1. Name four uses to which clinical coded data is put.

 

Clinical audit

Epidemiology

Study of aetiology

Health care planning

Casemix

Speciality needs

Staffing levels

Patient admission and clinic schedules

 

This list is not exhaustive

 

 

 

 

OR

            

Question D4 Part B: [Answer all parts of this question i, ii and iii]

 

  1. Within OPCS-4.7 Tabular List, Volume I, which unique fourth-digit identifier is assigned to all ‘conversion from’ codes and in which position are all

‘conversion from’ codes recorded? [3 Marks]

 

The unique identifier is ‘0’.

“Conversion from” codes are always recorded in a subsidiary position to the “conversion to” code.

 

  1. List the four levels of complexity that form part of axis of the OPCS-4.7 classification. [4 Marks]

 

Major

Intermediate

Minor

Non-operative procedures

 

 

iii.        Describe the General Coding Standard (GCS7) relating to the coding of resection and reconstruction procedures. [3 marks]

 

Where the resection and reconstruction have been performed together the codes that classify the resection must be assigned before the codes that classify the reconstruction.

 

            

SECTION E – Anatomy & Physiology (including Medical Terminology)

[35% of the marks]

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[1] – Anatomy & Physiology

 

Answer ALL 15 questions in this Section, writing your answers in the spaces provided.

 

  1. Which tube like structure connects the pharynx to the stomach? [1 Mark]

 

The oesophagus

 

 

 

  1. Which vessels carry blood away from the heart? [1 Mark]

 

The arteries

 

 

  1. At the aortic bifurcation into which two vessels does the aorta divide? [1 Mark]

 

Common iliac arteries (right and left)

 

 

  1. Name the first portion of the small intestine. [1 Mark]

 

Duodenum

 

 

  1. The breasts are also known as which glands? [1 Mark]

 

Mammary glands

 

 

  1. Urea is the chief nitrogenous constituent of urine and the final product of the metabolism of what substance? [1 Mark]

 

Protein

 

 

  1. What is the name of the neck of the uterus at the point where it joins the vagina? [1 Mark]

 

The cervix

 

 

  1. Into which chambers (spaces) in the brain is cerebrospinal fluid continuously being secreted? [1 Mark]

 

The ventricles (left and right ventricles, and the third and fourth ventricles)

 

 

  1. The bicuspid valve of the heart is also known as which valve? [1 Mark]

 

The mitral valve or the left atrioventricular valve

 

 

  1. How many lobes of the brain are there in a single hemisphere? [1 Mark]

 

4

 

 

  1. Which connective tissue holds bones together at the joints? [1 Mark]

 

Ligaments

 

 

  1. Which two groups of bones make up the skull? [2 Marks]

 

Cranium and facial bones

 

 

  1. Name three glands whose action is indirectly controlled by the secretions from the pituitary gland. [3 Marks]

 

Thyroid, adrenal, gonads (testes/ovaries)

 

 

  1. What is the correct medical name for red blood cells? [1 Mark]

 

Erythrocytes

 

 

  1. What name is the second (II) cranial nerve also known by? [1 Mark]

 

The optic nerve

 

 

 

 

 

 

 

 

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[2] – Medical Terminology

 

Answer ALL 10 questions in this Section, writing your answers in the spaces provided.

 

  1. What does the term dorsal pertain to? [1 Mark]

 

Pertaining to the back or towards the back

 

 

  1. What suffix means letter or drawing and is used in the word for a tracing of the electrical activity of the heart? [1 Mark]

 

-gram

 

 

  1. Circle the four suffixes in the list below: [4 Marks]

sub                     tri                      lysis

enter                   tomy                   oid

spasm                 trans                 cyst

 

 

  1. In terms of body movement describe the act of flexing the arm. [1 Mark]

 

Bending (the limb at the elbow joint)

 

 

  1. What is the meaning of the word ‘extraocular’? [1 Mark]

 

Outside the eye

 

 

  1. If a limb is adducted, in which direction is it moved? [1 Mark]

 

Towards the centre line of the body (axial line or median plane)

 

 

  1. Is the term ‘hemi’ a prefix or a suffix? [1 Mark]

 

A prefix

 

 

 

  1. What is the suffix in the medical term ‘pyloroplasty’ and what does it mean? [3 Marks]

 

Plasty             Plastic repair

 

 

  1. What does the ‘root’ word usually indicate? [1 Mark]

 

Body organ or anatomical part being described

 

 

  1. Why would a blood vessel be described as superficial? [1 Mark]

 

It is close to the surface

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section E[3] Diagrams

 

Precisely label the anatomical structure indicated by each line on the following two diagrams. Write your answers in the boxes below.

 

E 3[a] The Ear [13 Marks]

 

 

 

1 Helix 9 Semi-circular canals
2 Tympanic Membrane (ear drum is acceptable) 10 Acoustic nerve
3 External auditory canal 11 Cochlea
4 Lobule (lobe is acceptable) 12 Vestibule
5 Auricle (Pinna is acceptable) 13 Round window
6 Malleus    
7 Incus    
8 Ossicles (ossicular chain is acceptable)    

 

 

 

E 3[b] Pancreas [9 Marks]

 

 

1 Cystic duct 7 Tail of pancreas
2 Gall bladder 8 Body of pancreas
3 Duodenum 9 Pancreatic duct
4 Head of pancreas    
5 Hepatic ducts    
6 Common bile duct    

 

 

 

 

The National Clinical Coding Examination [UK]

 

30 September 2014

 

Paper 2 Theory

1:30 pm – 4:35 pm

[THREE HOURS]

 

The first 5 minutes will be spent reading through this Examination Paper

 

Instructions to Candidates

 

 Write your Candidate Number at the top of each Answer sheet of paper.

If you do not enter your Candidate Number the work will not be marked. 

 Please make sure you cross out any rough work or any mistakes which you have made.

 You must not use ICD-10 and OPCS-4, dictionaries or any other books or documents for this paper.

 Spelling will be taken into account during the marking process.

 For Section D indicate clearly which question you have answered.

 All papers must be handed in to the Invigilator.

 

This Examination Paper consists of 3 sections: C, D and E.

 

Section C – General Theory Short Questions [20% of the marks]

Answer all questions in this Section in the space provided on the Examination Paper.

 

Section D [45% of the marks]

Answer all questions on the lined paper provided. Use a new sheet of paper for each answer. Write only on one side of the paper.

 

General Theory ICD-10 4th Edition Questions D1 [15% of the marks]

Answer either section D1A or D1B

General Theory OPCS-4 Questions D2 [15% of the marks]

Answer either section D2A or D2B

Clinical Terms Questions D3 [10% of the marks]

Answer either section D3A or D3B

Miscellaneous Questions D4 [5% of the marks] Answer either section D4A or D4B

 

Section E – Anatomy & Physiology (including medical terminology) [35% of the marks]

Answer all questions in this Section in the space provided on the Examination Paper.

 

 

 

ANSWERS

 

marking                            0

 

Section C – General Theory Short Questions [20% of the marks]

 

Answer ALL 20 questions in this Section writing your answers in the spaces provided.

 

  1. What fourth character default code must be assigned in category Y98 Radiology procedures found in the OPCS-4.7 Tabular List, Volume I if the number of body areas or time is not specified? [1 Mark]

 

.1

 

 

  1. What category from OPCS-4.7 Tabular List, Volume I must be assigned in addition to certain procedures on the spine (V22 – V68)? Either the category title or code is acceptable. [1 Mark]

 

V55 or Levels of Spine

 

 

  1. The requirement to use fifth characters appears in which three ICD-10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full titles are acceptable. [3 Marks]

 

Chapter IX – Diseases of the circulatory system

Chapter XIII – Diseases of the musculoskeletal system and connective tissue Chapter XIX – Injury, poisoning and certain other consequences of external causes

 

 

  1. Give two examples of the five types of punctuation that appear in the ICD-10 4th Edition Tabular List, Volume 1. [2 Marks]

 

Brace  I or  } Square Brackets  [  ] Colon  :

Point dash  .-

Parentheses  (  )

 

 

  1. The chapters of ICD-10 4th Edition Tabular List, Volume 1 are divided into three different types:

 

  1. Chapter VII Diseases of the eye and adnexa is an example of which group of chapters?

 

‘Body system’ chapters

 

  1. Chapter XX External causes of morbidity and mortality is an example of which group of chapters?

 

‘Other’ chapters

 

  • Chapter II Neoplasms is an example of which group of chapters?

 

‘Special group’ chapters

 

 

  1. How do synonyms appear in ICD-10 4th Edition Tabular List, Volume 1? [1 Mark]

 

Square brackets [ ] are used to enclose synonyms.

 

 

 

  1. Briefly describe the sequencing rules found in the National Clinical Coding Standards OPCS-4 reference book for coding multiple deliveries. [3 Marks]

 

When coding multiple deliveries each different type of delivery must be recorded with the most serious being sequenced first.

Where all methods of delivery are identical, only one code is required.

 

 

  1. What do the four characters following the letter M and before the solidus / represent within a morphology code? [1 Mark]

 

The histological (cell) type.

 

 

  1. What does the term regimen/regime describe when associated with chemotherapy? [5 Marks]

 

  • regimen describes in full the name, drugs, doses, route and time of delivery of a specified systemic anticancer therapy.

 

 

  1. What is the rule for coding a patient described as having chronic kidney disease (CKD) stages 4 or 5 with renal failure? [2 Marks]

 

Whether renal failure is documented in the medical record or not it must not be coded in addition with the exception of acute renal failure.

 

  1. Within OPCS-4.7 Alphabetical Index, Volume II what do the abbreviations

TVT and PEG stand for? [2 Marks]

 

TVT – Trans Vaginal Tape

 

PEG – Percutaneous Endoscopic Gastrostomy

 

 

  1. State two of the three different reasons why ‘Instructional Notes’ appear throughout the ICD-10 Tabular List, Volume 1. [2 Marks]

 

Describes the general content of the succeeding categories

Gives instruction regarding the use of categories

Provides fifth character sub-classifications

 

  1. Explain the meaning of the phrase “are for use with” found in the ICD-10 Tabular List, Volume 1. [1 Mark]

 

Where the phrase “are for use with” is seen, this instruction is mandatory and the codes referred to must be used

 

 

  1. Name both ways in which reactions to drug/medication can be classified within ICD-10 Tabular List, Volume 1. [2 Marks]

 

Poisoning (improper use)

Adverse effect (proper use)

 

  1. What are the coding rules associated with the birth episode of a premature infant who has low birth weight? [4 Marks]

If both the birth weight and gestational age are available when assigning codes from category P07 both can be coded, the ICD-10 code that classifies the birth weight must be sequenced before the code for the gestational age.

  • code from Z38 must be coded on the baby’s birth episode; if a morbid condition is present which has been treated or investigated then the morbid condition must be sequenced first, followed by the Z38 in the first secondary position.

 

  1. Within OPCS-4.7 Tabular List, Volume I there are three circumstances when the use of .8 and .9 is not List two of them. [2 Marks]

 

Extended categories

High Cost Drugs categories

Y97 or Radiology with contrast

 

  1. Myocardial/Cardiac perfusion scans are carried out in two phases. Name the two [2 Marks]

 

Stress test

Rest test

 

  1. Sites marked with the cross hatch symbol (#) within the Neoplasm Table should be classified to malignant neoplasm of skin of that site if the histological type is one of two types. Name the two histological types. [2 Marks]

 

Squamous Cell Carcinoma and Epidermoid Carcinoma

 

 

  1. The National Clinical Coding Standards OPCS-4 reference book contains three types of Standard. Name two of the three types of Standard. [2 Marks]

 

General coding standards

Chapter standards

Coding standards

 

 

  1. For what time period must parenteral nutrition have been given to a patient before it can be coded? [1 Mark]

 

More than 14 days

 

 

 

 

 

 

 

 

 

 

             

Section D – General Theory Questions

 

Please use separate Answer Sheets found at the end of this question paper, to answer your chosen questions in Section D.

 You must use a new Answer Sheet for each question.

 Write on only one side of the Answer Sheet.

 You must write your candidate number in the top right hand corner of each Answer Sheet that you use.

 You must write the question number in the top left hand corner of each Answer Sheet that you use.

 

Section D[1] – ICD-10 Theory [15% of the marks]

 

Answer either Part A or Part B of the following:

 

Please make it clear which question you are answering and label each section accordingly.

 

Question D1 Part A: [Answer all parts of this question, i, ii, iii, iv, v and vi]

 

  1. How is the Neoplasm Table organised in the ICD-10 Alphabetical Index, Volume 3? [8 Marks]

 

The Neoplasm Table is organised by anatomical site with five columns which identify the behaviour of the neoplasms.

The anatomical sites appear as modifiers to the lead term ‘neoplasm’ and are arranged alphabetically down the left hand side of the page.

 

The five column headings for the nature/behaviour of the neoplasms reading from left to right are as follows:            Malignant primary

Malignant secondary

In situ

Benign

Uncertain and unknown behaviour

 

  1. When the site of a primary malignancy and secondary malignancy are both present what is the coding rule that determines which one will be sequenced first? [2 Marks]

 

The code for the primary site always precedes the code for the secondary site unless the stated reason for admission is the management/treatment of the secondary malignancy.

 

 

 

 

 

 

  • When a diagnosis contains two qualifying adjectives that have different code numbers, for example ‘transitional cell epidermoid carcinoma’ what is the principle for assigning the morphology code? [1 Mark]

 

In such circumstances, the higher number should be used, as they are usually more specific. For example, ‘transitional cell carcinoma NOS’ is M8120/3 and ‘epidermoid carcinoma NOS’ is M8070/3, therefore the M8120/3 would be assigned.

 

 

  1. What are the rules for coding human immunodeficiency virus [HIV] disease resulting in a malignant neoplasm? [2 Marks]

 

Both the HIV and the neoplasm must be coded, with the HIV disease being sequenced first.

 

 

  1. When coding a metastatic malignant neoplasm diagnosis that mentions only one site and includes a morphological type that when indexed takes the coder to a different body site/system to that of the site mentioned in the statement, what is the coding standard? [2 Marks]

 

It must be coded as a primary malignant neoplasm of an unspecified site for the morphological type with metastases (secondary) of the site mentioned in the diagnostic statement.

 

 

  1. Name the three neoplastic blood disorders within ICD-10 Tabular List, Volume 1 of which anaemia is a natural symptom and is therefore not to be recorded as an additional code. [3 Marks]

 

Leukaemia

Myeloma

Myelodysplasia

 

 

 

OR

 

 

             

Question D1 Part B: [Answer all parts of this question i, and ii]

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

  1. Name in full the three sections that are found within ICD-10 Alphabetical

Index, Volume 3, and describe in bullet point the content of each section. [14 Marks]

 

Section 1 Alphabetical index to diseases and nature of injury

Content: o Is an alphabetical index of diseases, injuries, signs, symptoms,  syndromes, pathological conditions

  • Factors influencing health status and contact with health services o Morphology of neoplasms

 

            Section 2 Index of external causes of injury              Content: o Contains all the terms classifiable to Chapter XX except drugs and other chemical substances

  • This index describes the circumstances under which an accident or act of violence occurred

 

 Section 3 Table of drugs and chemicals 

Content:

o The table contains an extensive, but not exhaustive, list of
  drugs, alcohols, petroleum products, industrial solvents, corrosives, metals, gases, noxious plants, household cleaning products, pesticides and other toxic agents
o The circumstance, whether this a poisoning (with additional detail of whether this was accidental, intentional self-harm or undetermined intent) or adverse effects
   

 

  1. Describe the function and standard associated with ‘Use’ Notes and where they are found within ICD-10 Tabular List, Volume 1 (Actual codes and titles not required). [4 Marks]

 

The ‘Use’ note is a specific instruction to use an additional code in order to describe a condition more completely and just like other types of notes, can be found at chapter, block and three character category and fourth character subcategory levels. The ‘Use’ Note is never optional and must always be adhered to where the information is available.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

             

 

Section D[2] – OPCS-4 Theory [15% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D2 Part A: [Answer all parts of this question i, ii, iii, iv and v]

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation are for use in an outpatient setting, or if a patient has been solely admitted for the procedure/intervention. There are eight diagnostic imaging procedures that are exceptions to this rule. List three of these exceptions (actual codes not required). [3 Marks]

 

Magnetic Resonance Imaging (MRI)

Computed Tomography (CT)

Implantation of electrocardiography loop recorder

Removal of electrocardiography loop recorder

Transthoracic echocardiography (TTE)

Transoesophageal echocardiography (TOE)  Intravascular echocardiography  Epicardial echocardiography.

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation require the assignment of a possible two additional ‘Y’ code(s). What extra information do these ‘Y’ codes provide? [4 Marks]

 

They require a code from category Y97 Radiology with contrast (if used,) and Y98 Radiology procedures. The Y98 codes identify the number of body areas examined, or the duration of the procedure. The Y97 code identifies contrast usage.

 

iii. What are the standards for coding diagnostic imaging procedures using body system chapter codes in OPCS-4.7 Tabular List, Volume I? [4 Marks]

 

When a specific code classifying a diagnostic imaging procedure is available in a body system chapter (Chapters A-T and V-W), it must be used in preference to the codes within categories U01-U21 and U34-U37.

 

 

The standard to only code diagnostic imaging procedures in an outpatient setting or if the patient has been solely admitted for the purpose of the procedure/intervention only applies to diagnostic imaging procedure codes in Chapter U and categories R36-R43.

 

Additional codes from categories Y97 Radiology with contrast and Y98 Radiology procedures must not be assigned with body system chapter imaging codes.

 

 

  1. Nuclear medicine imaging procedures in the OPCS-4.7 Tabular List, Volume I range U01-U21 and U34-U37 are only for use in an outpatient setting, or if a patient is admitted solely for the purpose of a nuclear medicine imaging procedure. There are four exceptions to this standard, name two of them. [2 Marks]

 

Positron emission tomography (PET)

Single photon emission computed tomography (SPECT)

Positron emission tomography with computed tomography (PET/CT)

Single photon emission computed tomography with computed tomography

(SPECT/CT)

 

 

  1. What two OPCS-4.7 Tabular List, Volume I categories can be added to nuclear medicine imaging procedures? Either the category title or code is acceptable. [2 Marks]

 

Y93 or Gallium-67 imaging

Y94 or Radiopharmaceutical imaging

 

 

OR

 

Question D2 Part B: [Answer all parts of this question i, ii, iii, iv, v and vi]

 

  1. Describe the coding rules pertaining to OPCS-4.7 Tabular List, Volume I category M47 Catheterisation of the bladder, including trial without catheter (TWOC) No OPCS-4.7 codes are required. [6 Marks]

 

A code for unspecified urethral catheterisation of bladder (M47.9) must not be assigned when the catheterisation is performed routinely as part of, or following, a procedure, or when catheterisation is performed to keep the patient comfortable during the admission.

 

A code for unspecified urethral catheterisation of bladder (M47.9) must be assigned when it is documented in the medical record that a patient has developed urinary retention which has been treated with catheterisation.

 

A successful trial without catheter (TWOC) must be coded to removal of urethral catheter from bladder only.

 

If the TWOC fails and a catheter is reinserted both the removal and reinsertion of the catheter must be coded.

 

  1. What type of rupture must an artificial rupture of membranes (R14) be coded to in OPCS-4.7 Tabular List, Volume I? [1 Mark]

 

Artificial rupture of membranes (ARM) must be coded to (R14.1) Forewater rupture of membranes.

 

 

  • What is the coding standard in OPCS-4.7 Tabular List, Volume I for a patient that receives rehabilitation assessment (X60) and rehabilitation delivery (U50U54) within the same admission? [1 Mark]

 

Only the code describing the rehabilitation delivery (U50-U54) is required, as it is assumed the assessment would have been carried out before the rehabilitation commenced.

 

  1. Describe the standards around the coding of preparation for radiotherapy in OPCS-4.7 Tabular List, Volume I. [3 Marks]

 

Preparation for radiotherapy must only be assigned once to cover all planning for each preparation regardless of the number of sessions required for completion of the preparation process.

 

Must be assigned on the first attendance/episode for delivery of radiotherapy.

 

Must be sequenced before the delivery codes.

 

 

  1. Describe the sequencing rules when assigning codes from OPCS-4.7 Tabular

List, Volume I categories Y53 Approach to organ under image control and Y78 Arteriotomy approach to organ under image control. [3 Marks]

 

These codes must only be assigned in a secondary position immediately after the code for the intervention and before the relevant site and laterality codes (Z).

 

 

  1. Which fourth character in OPCS-4.7 Tabular List, Volume I must be assigned when a procedure involves image control but the method of image control is not known? [1 Mark]

 

.9 Unspecified                                                      Section D[3] – Clinical Terms [10% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D3 Part A: [Answer all parts of this question i, ii and iii]

 

  1. SNOMED-CT is a clinical terminology. What does SNOMED-CT stand for? [1 Mark]

 

Systematized Nomenclature of Medicine – Clinical Terms

 

  1. Explain briefly what a clinical terminology is. [6 Marks]

 

A clinical terminology is a structured collection of descriptive terms for use in clinical practice. These terms describe the care and treatment of patients and cover areas like diagnoses, symptoms, surgical procedures, treatments and medicines as well as terms used for healthcare administration.

 

 

  • Name the link mechanism between SNOMED-CT and the ICD-10 and OPCS4.7 classifications that are essential to support the derivation of statistical data from clinical data. [1 Mark]

 

Cross mapping

 

 

 

OR

 

             

Question D3 Part B: [Answer this question]

 

Give 8 benefits of using SNOMED-CT and electronic patient records (EPR) in the NHS. [8 Marks]

 

  1. Controlled vocabulary – less chance of misunderstandings between clinicians.

 

  1. Consistent terminology across all care domains.

 

  1. Precise recording of clinical information.

 

  1. SNOMED-CT is a developing international standard – multilingual/ cultural support.

 

  1. EPR reduces storage costs.

 

  1. EPR can be accessed in many places at the same time.

 

  1. EPR is quickly transferred.

 

  1. EPR is legible as it is not dependant on hand-written notes.

 

  1. More efficient search for patient records.

 

  1. Point of care decision support.

 

  1. Monitoring adverse reactions to treatment.

 

  1. Automatic identification of patient risk factors.

 

  1. Monitor response to treatment.

 

  1. Large populations of consistent data for medical research.

 

This list is not exhaustive

 

 

 

 

 

 

 

             

Section D[4] – Miscellaneous Section [5% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D4 Part A: [Answer all parts of this question i and ii]

 

  1. Give the definition of Clinical Coding, including why it is carried out. [6 Marks]

 

Clinical coding is the translation or written medical terminology that describes a patient’s complaint, problem, diagnosis, treatment or other reason for seeking medical attention into codes that can then be easily tabulated, aggregated and sorted for statistical analysis in an efficient and meaningful manner.

 

  1. Name four uses to which clinical coded data is put.

 

Clinical audit

Epidemiology

Study of aetiology

Health care planning

Casemix

Speciality needs

Staffing levels

Patient admission and clinic schedules

 

This list is not exhaustive

 

 

 

 

OR

            

Question D4 Part B: [Answer all parts of this question i, ii and iii]

 

  1. Within OPCS-4.7 Tabular List, Volume I, which unique fourth-digit identifier is assigned to all ‘conversion from’ codes and in which position are all

‘conversion from’ codes recorded? [3 Marks]

 

The unique identifier is ‘0’.

“Conversion from” codes are always recorded in a subsidiary position to the “conversion to” code.

 

  1. List the four levels of complexity that form part of axis of the OPCS-4.7 classification. [4 Marks]

 

Major

Intermediate

Minor

Non-operative procedures

 

 

iii.        Describe the General Coding Standard (GCS7) relating to the coding of resection and reconstruction procedures. [3 marks]

 

Where the resection and reconstruction have been performed together the codes that classify the resection must be assigned before the codes that classify the reconstruction.

 

            

SECTION E – Anatomy & Physiology (including Medical Terminology)

[35% of the marks]

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[1] – Anatomy & Physiology

 

Answer ALL 15 questions in this Section, writing your answers in the spaces provided.

 

  1. Which tube like structure connects the pharynx to the stomach? [1 Mark]

 

The oesophagus

 

 

 

  1. Which vessels carry blood away from the heart? [1 Mark]

 

The arteries

 

 

  1. At the aortic bifurcation into which two vessels does the aorta divide? [1 Mark]

 

Common iliac arteries (right and left)

 

 

  1. Name the first portion of the small intestine. [1 Mark]

 

Duodenum

 

 

  1. The breasts are also known as which glands? [1 Mark]

 

Mammary glands

 

 

  1. Urea is the chief nitrogenous constituent of urine and the final product of the metabolism of what substance? [1 Mark]

 

Protein

 

 

  1. What is the name of the neck of the uterus at the point where it joins the vagina? [1 Mark]

 

The cervix

 

 

  1. Into which chambers (spaces) in the brain is cerebrospinal fluid continuously being secreted? [1 Mark]

 

The ventricles (left and right ventricles, and the third and fourth ventricles)

 

 

  1. The bicuspid valve of the heart is also known as which valve? [1 Mark]

 

The mitral valve or the left atrioventricular valve

 

 

  1. How many lobes of the brain are there in a single hemisphere? [1 Mark]

 

4

 

 

  1. Which connective tissue holds bones together at the joints? [1 Mark]

 

Ligaments

 

 

  1. Which two groups of bones make up the skull? [2 Marks]

 

Cranium and facial bones

 

 

  1. Name three glands whose action is indirectly controlled by the secretions from the pituitary gland. [3 Marks]

 

Thyroid, adrenal, gonads (testes/ovaries)

 

 

  1. What is the correct medical name for red blood cells? [1 Mark]

 

Erythrocytes

 

 

  1. What name is the second (II) cranial nerve also known by? [1 Mark]

 

The optic nerve

 

 

 

 

 

 

 

 

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[2] – Medical Terminology

 

Answer ALL 10 questions in this Section, writing your answers in the spaces provided.

 

  1. What does the term dorsal pertain to? [1 Mark]

 

Pertaining to the back or towards the back

 

 

  1. What suffix means letter or drawing and is used in the word for a tracing of the electrical activity of the heart? [1 Mark]

 

-gram

 

 

  1. Circle the four suffixes in the list below: [4 Marks]

sub                     tri                      lysis

enter                   tomy                   oid

spasm                 trans                 cyst

 

 

  1. In terms of body movement describe the act of flexing the arm. [1 Mark]

 

Bending (the limb at the elbow joint)

 

 

  1. What is the meaning of the word ‘extraocular’? [1 Mark]

 

Outside the eye

 

 

  1. If a limb is adducted, in which direction is it moved? [1 Mark]

 

Towards the centre line of the body (axial line or median plane)

 

 

  1. Is the term ‘hemi’ a prefix or a suffix? [1 Mark]

 

A prefix

 

 

 

  1. What is the suffix in the medical term ‘pyloroplasty’ and what does it mean? [3 Marks]

 

Plasty             Plastic repair

 

 

  1. What does the ‘root’ word usually indicate? [1 Mark]

 

Body organ or anatomical part being described

 

 

  1. Why would a blood vessel be described as superficial? [1 Mark]

 

It is close to the surface

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section E[3] Diagrams

 

Precisely label the anatomical structure indicated by each line on the following two diagrams. Write your answers in the boxes below.

 

E 3[a] The Ear [13 Marks]

 

 

 

1 Helix 9 Semi-circular canals
2 Tympanic Membrane (ear drum is acceptable) 10 Acoustic nerve
3 External auditory canal 11 Cochlea
4 Lobule (lobe is acceptable) 12 Vestibule
5 Auricle (Pinna is acceptable) 13 Round window
6 Malleus    
7 Incus    
8 Ossicles (ossicular chain is acceptable)    

 

 

 

E 3[b] Pancreas [9 Marks]

 

 

1 Cystic duct 7 Tail of pancreas
2 Gall bladder 8 Body of pancreas
3 Duodenum 9 Pancreatic duct
4 Head of pancreas    
5 Hepatic ducts    
6 Common bile duct    

 

 

 

 

The National Clinical Coding Examination [UK]

 

30 September 2014

 

Paper 2 Theory

1:30 pm – 4:35 pm

[THREE HOURS]

 

The first 5 minutes will be spent reading through this Examination Paper

 

Instructions to Candidates

 

 Write your Candidate Number at the top of each Answer sheet of paper.

If you do not enter your Candidate Number the work will not be marked. 

 Please make sure you cross out any rough work or any mistakes which you have made.

 You must not use ICD-10 and OPCS-4, dictionaries or any other books or documents for this paper.

 Spelling will be taken into account during the marking process.

 For Section D indicate clearly which question you have answered.

 All papers must be handed in to the Invigilator.

 

This Examination Paper consists of 3 sections: C, D and E.

 

Section C – General Theory Short Questions [20% of the marks]

Answer all questions in this Section in the space provided on the Examination Paper.

 

Section D [45% of the marks]

Answer all questions on the lined paper provided. Use a new sheet of paper for each answer. Write only on one side of the paper.

 

General Theory ICD-10 4th Edition Questions D1 [15% of the marks]

Answer either section D1A or D1B

General Theory OPCS-4 Questions D2 [15% of the marks]

Answer either section D2A or D2B

Clinical Terms Questions D3 [10% of the marks]

Answer either section D3A or D3B

Miscellaneous Questions D4 [5% of the marks] Answer either section D4A or D4B

 

Section E – Anatomy & Physiology (including medical terminology) [35% of the marks]

Answer all questions in this Section in the space provided on the Examination Paper.

 

 

 

ANSWERS

 

marking                            0

 

Section C – General Theory Short Questions [20% of the marks]

 

Answer ALL 20 questions in this Section writing your answers in the spaces provided.

 

  1. What fourth character default code must be assigned in category Y98 Radiology procedures found in the OPCS-4.7 Tabular List, Volume I if the number of body areas or time is not specified? [1 Mark]

 

.1

 

 

  1. What category from OPCS-4.7 Tabular List, Volume I must be assigned in addition to certain procedures on the spine (V22 – V68)? Either the category title or code is acceptable. [1 Mark]

 

V55 or Levels of Spine

 

 

  1. The requirement to use fifth characters appears in which three ICD-10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full titles are acceptable. [3 Marks]

 

Chapter IX – Diseases of the circulatory system

Chapter XIII – Diseases of the musculoskeletal system and connective tissue Chapter XIX – Injury, poisoning and certain other consequences of external causes

 

 

  1. Give two examples of the five types of punctuation that appear in the ICD-10 4th Edition Tabular List, Volume 1. [2 Marks]

 

Brace  I or  } Square Brackets  [  ] Colon  :

Point dash  .-

Parentheses  (  )

 

 

  1. The chapters of ICD-10 4th Edition Tabular List, Volume 1 are divided into three different types:

 

  1. Chapter VII Diseases of the eye and adnexa is an example of which group of chapters?

 

‘Body system’ chapters

 

  1. Chapter XX External causes of morbidity and mortality is an example of which group of chapters?

 

‘Other’ chapters

 

  • Chapter II Neoplasms is an example of which group of chapters?

 

‘Special group’ chapters

 

 

  1. How do synonyms appear in ICD-10 4th Edition Tabular List, Volume 1? [1 Mark]

 

Square brackets [ ] are used to enclose synonyms.

 

 

 

  1. Briefly describe the sequencing rules found in the National Clinical Coding Standards OPCS-4 reference book for coding multiple deliveries. [3 Marks]

 

When coding multiple deliveries each different type of delivery must be recorded with the most serious being sequenced first.

Where all methods of delivery are identical, only one code is required.

 

 

  1. What do the four characters following the letter M and before the solidus / represent within a morphology code? [1 Mark]

 

The histological (cell) type.

 

 

  1. What does the term regimen/regime describe when associated with chemotherapy? [5 Marks]

 

  • regimen describes in full the name, drugs, doses, route and time of delivery of a specified systemic anticancer therapy.

 

 

  1. What is the rule for coding a patient described as having chronic kidney disease (CKD) stages 4 or 5 with renal failure? [2 Marks]

 

Whether renal failure is documented in the medical record or not it must not be coded in addition with the exception of acute renal failure.

 

  1. Within OPCS-4.7 Alphabetical Index, Volume II what do the abbreviations

TVT and PEG stand for? [2 Marks]

 

TVT – Trans Vaginal Tape

 

PEG – Percutaneous Endoscopic Gastrostomy

 

 

  1. State two of the three different reasons why ‘Instructional Notes’ appear throughout the ICD-10 Tabular List, Volume 1. [2 Marks]

 

Describes the general content of the succeeding categories

Gives instruction regarding the use of categories

Provides fifth character sub-classifications

 

  1. Explain the meaning of the phrase “are for use with” found in the ICD-10 Tabular List, Volume 1. [1 Mark]

 

Where the phrase “are for use with” is seen, this instruction is mandatory and the codes referred to must be used

 

 

  1. Name both ways in which reactions to drug/medication can be classified within ICD-10 Tabular List, Volume 1. [2 Marks]

 

Poisoning (improper use)

Adverse effect (proper use)

 

  1. What are the coding rules associated with the birth episode of a premature infant who has low birth weight? [4 Marks]

If both the birth weight and gestational age are available when assigning codes from category P07 both can be coded, the ICD-10 code that classifies the birth weight must be sequenced before the code for the gestational age.

  • code from Z38 must be coded on the baby’s birth episode; if a morbid condition is present which has been treated or investigated then the morbid condition must be sequenced first, followed by the Z38 in the first secondary position.

 

  1. Within OPCS-4.7 Tabular List, Volume I there are three circumstances when the use of .8 and .9 is not List two of them. [2 Marks]

 

Extended categories

High Cost Drugs categories

Y97 or Radiology with contrast

 

  1. Myocardial/Cardiac perfusion scans are carried out in two phases. Name the two [2 Marks]

 

Stress test

Rest test

 

  1. Sites marked with the cross hatch symbol (#) within the Neoplasm Table should be classified to malignant neoplasm of skin of that site if the histological type is one of two types. Name the two histological types. [2 Marks]

 

Squamous Cell Carcinoma and Epidermoid Carcinoma

 

 

  1. The National Clinical Coding Standards OPCS-4 reference book contains three types of Standard. Name two of the three types of Standard. [2 Marks]

 

General coding standards

Chapter standards

Coding standards

 

 

  1. For what time period must parenteral nutrition have been given to a patient before it can be coded? [1 Mark]

 

More than 14 days

 

 

 

 

 

 

 

 

 

 

             

Section D – General Theory Questions

 

Please use separate Answer Sheets found at the end of this question paper, to answer your chosen questions in Section D.

 You must use a new Answer Sheet for each question.

 Write on only one side of the Answer Sheet.

 You must write your candidate number in the top right hand corner of each Answer Sheet that you use.

 You must write the question number in the top left hand corner of each Answer Sheet that you use.

 

Section D[1] – ICD-10 Theory [15% of the marks]

 

Answer either Part A or Part B of the following:

 

Please make it clear which question you are answering and label each section accordingly.

 

Question D1 Part A: [Answer all parts of this question, i, ii, iii, iv, v and vi]

 

  1. How is the Neoplasm Table organised in the ICD-10 Alphabetical Index, Volume 3? [8 Marks]

 

The Neoplasm Table is organised by anatomical site with five columns which identify the behaviour of the neoplasms.

The anatomical sites appear as modifiers to the lead term ‘neoplasm’ and are arranged alphabetically down the left hand side of the page.

 

The five column headings for the nature/behaviour of the neoplasms reading from left to right are as follows:            Malignant primary

Malignant secondary

In situ

Benign

Uncertain and unknown behaviour

 

  1. When the site of a primary malignancy and secondary malignancy are both present what is the coding rule that determines which one will be sequenced first? [2 Marks]

 

The code for the primary site always precedes the code for the secondary site unless the stated reason for admission is the management/treatment of the secondary malignancy.

 

 

 

 

 

 

  • When a diagnosis contains two qualifying adjectives that have different code numbers, for example ‘transitional cell epidermoid carcinoma’ what is the principle for assigning the morphology code? [1 Mark]

 

In such circumstances, the higher number should be used, as they are usually more specific. For example, ‘transitional cell carcinoma NOS’ is M8120/3 and ‘epidermoid carcinoma NOS’ is M8070/3, therefore the M8120/3 would be assigned.

 

 

  1. What are the rules for coding human immunodeficiency virus [HIV] disease resulting in a malignant neoplasm? [2 Marks]

 

Both the HIV and the neoplasm must be coded, with the HIV disease being sequenced first.

 

 

  1. When coding a metastatic malignant neoplasm diagnosis that mentions only one site and includes a morphological type that when indexed takes the coder to a different body site/system to that of the site mentioned in the statement, what is the coding standard? [2 Marks]

 

It must be coded as a primary malignant neoplasm of an unspecified site for the morphological type with metastases (secondary) of the site mentioned in the diagnostic statement.

 

 

  1. Name the three neoplastic blood disorders within ICD-10 Tabular List, Volume 1 of which anaemia is a natural symptom and is therefore not to be recorded as an additional code. [3 Marks]

 

Leukaemia

Myeloma

Myelodysplasia

 

 

 

OR

 

 

             

Question D1 Part B: [Answer all parts of this question i, and ii]

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

  1. Name in full the three sections that are found within ICD-10 Alphabetical

Index, Volume 3, and describe in bullet point the content of each section. [14 Marks]

 

Section 1 Alphabetical index to diseases and nature of injury

Content: o Is an alphabetical index of diseases, injuries, signs, symptoms,  syndromes, pathological conditions

  • Factors influencing health status and contact with health services o Morphology of neoplasms

 

            Section 2 Index of external causes of injury              Content: o Contains all the terms classifiable to Chapter XX except drugs and other chemical substances

  • This index describes the circumstances under which an accident or act of violence occurred

 

 Section 3 Table of drugs and chemicals 

Content:

o The table contains an extensive, but not exhaustive, list of
  drugs, alcohols, petroleum products, industrial solvents, corrosives, metals, gases, noxious plants, household cleaning products, pesticides and other toxic agents
o The circumstance, whether this a poisoning (with additional detail of whether this was accidental, intentional self-harm or undetermined intent) or adverse effects
   

 

  1. Describe the function and standard associated with ‘Use’ Notes and where they are found within ICD-10 Tabular List, Volume 1 (Actual codes and titles not required). [4 Marks]

 

The ‘Use’ note is a specific instruction to use an additional code in order to describe a condition more completely and just like other types of notes, can be found at chapter, block and three character category and fourth character subcategory levels. The ‘Use’ Note is never optional and must always be adhered to where the information is available.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

             

 

Section D[2] – OPCS-4 Theory [15% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D2 Part A: [Answer all parts of this question i, ii, iii, iv and v]

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation are for use in an outpatient setting, or if a patient has been solely admitted for the procedure/intervention. There are eight diagnostic imaging procedures that are exceptions to this rule. List three of these exceptions (actual codes not required). [3 Marks]

 

Magnetic Resonance Imaging (MRI)

Computed Tomography (CT)

Implantation of electrocardiography loop recorder

Removal of electrocardiography loop recorder

Transthoracic echocardiography (TTE)

Transoesophageal echocardiography (TOE)  Intravascular echocardiography  Epicardial echocardiography.

 

  1. The majority of codes within OPCS-4.7 Tabular List, Volume I categories

U01-U21 and U35-37 from Chapter U Operations on Diagnostic Imaging, Testing and Rehabilitation require the assignment of a possible two additional ‘Y’ code(s). What extra information do these ‘Y’ codes provide? [4 Marks]

 

They require a code from category Y97 Radiology with contrast (if used,) and Y98 Radiology procedures. The Y98 codes identify the number of body areas examined, or the duration of the procedure. The Y97 code identifies contrast usage.

 

iii. What are the standards for coding diagnostic imaging procedures using body system chapter codes in OPCS-4.7 Tabular List, Volume I? [4 Marks]

 

When a specific code classifying a diagnostic imaging procedure is available in a body system chapter (Chapters A-T and V-W), it must be used in preference to the codes within categories U01-U21 and U34-U37.

 

 

The standard to only code diagnostic imaging procedures in an outpatient setting or if the patient has been solely admitted for the purpose of the procedure/intervention only applies to diagnostic imaging procedure codes in Chapter U and categories R36-R43.

 

Additional codes from categories Y97 Radiology with contrast and Y98 Radiology procedures must not be assigned with body system chapter imaging codes.

 

 

  1. Nuclear medicine imaging procedures in the OPCS-4.7 Tabular List, Volume I range U01-U21 and U34-U37 are only for use in an outpatient setting, or if a patient is admitted solely for the purpose of a nuclear medicine imaging procedure. There are four exceptions to this standard, name two of them. [2 Marks]

 

Positron emission tomography (PET)

Single photon emission computed tomography (SPECT)

Positron emission tomography with computed tomography (PET/CT)

Single photon emission computed tomography with computed tomography

(SPECT/CT)

 

 

  1. What two OPCS-4.7 Tabular List, Volume I categories can be added to nuclear medicine imaging procedures? Either the category title or code is acceptable. [2 Marks]

 

Y93 or Gallium-67 imaging

Y94 or Radiopharmaceutical imaging

 

 

OR

 

Question D2 Part B: [Answer all parts of this question i, ii, iii, iv, v and vi]

 

  1. Describe the coding rules pertaining to OPCS-4.7 Tabular List, Volume I category M47 Catheterisation of the bladder, including trial without catheter (TWOC) No OPCS-4.7 codes are required. [6 Marks]

 

A code for unspecified urethral catheterisation of bladder (M47.9) must not be assigned when the catheterisation is performed routinely as part of, or following, a procedure, or when catheterisation is performed to keep the patient comfortable during the admission.

 

A code for unspecified urethral catheterisation of bladder (M47.9) must be assigned when it is documented in the medical record that a patient has developed urinary retention which has been treated with catheterisation.

 

A successful trial without catheter (TWOC) must be coded to removal of urethral catheter from bladder only.

 

If the TWOC fails and a catheter is reinserted both the removal and reinsertion of the catheter must be coded.

 

  1. What type of rupture must an artificial rupture of membranes (R14) be coded to in OPCS-4.7 Tabular List, Volume I? [1 Mark]

 

Artificial rupture of membranes (ARM) must be coded to (R14.1) Forewater rupture of membranes.

 

 

  • What is the coding standard in OPCS-4.7 Tabular List, Volume I for a patient that receives rehabilitation assessment (X60) and rehabilitation delivery (U50U54) within the same admission? [1 Mark]

 

Only the code describing the rehabilitation delivery (U50-U54) is required, as it is assumed the assessment would have been carried out before the rehabilitation commenced.

 

  1. Describe the standards around the coding of preparation for radiotherapy in OPCS-4.7 Tabular List, Volume I. [3 Marks]

 

Preparation for radiotherapy must only be assigned once to cover all planning for each preparation regardless of the number of sessions required for completion of the preparation process.

 

Must be assigned on the first attendance/episode for delivery of radiotherapy.

 

Must be sequenced before the delivery codes.

 

 

  1. Describe the sequencing rules when assigning codes from OPCS-4.7 Tabular

List, Volume I categories Y53 Approach to organ under image control and Y78 Arteriotomy approach to organ under image control. [3 Marks]

 

These codes must only be assigned in a secondary position immediately after the code for the intervention and before the relevant site and laterality codes (Z).

 

 

  1. Which fourth character in OPCS-4.7 Tabular List, Volume I must be assigned when a procedure involves image control but the method of image control is not known? [1 Mark]

 

.9 Unspecified                                                      Section D[3] – Clinical Terms [10% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D3 Part A: [Answer all parts of this question i, ii and iii]

 

  1. SNOMED-CT is a clinical terminology. What does SNOMED-CT stand for? [1 Mark]

 

Systematized Nomenclature of Medicine – Clinical Terms

 

  1. Explain briefly what a clinical terminology is. [6 Marks]

 

A clinical terminology is a structured collection of descriptive terms for use in clinical practice. These terms describe the care and treatment of patients and cover areas like diagnoses, symptoms, surgical procedures, treatments and medicines as well as terms used for healthcare administration.

 

 

  • Name the link mechanism between SNOMED-CT and the ICD-10 and OPCS4.7 classifications that are essential to support the derivation of statistical data from clinical data. [1 Mark]

 

Cross mapping

 

 

 

OR

 

             

Question D3 Part B: [Answer this question]

 

Give 8 benefits of using SNOMED-CT and electronic patient records (EPR) in the NHS. [8 Marks]

 

  1. Controlled vocabulary – less chance of misunderstandings between clinicians.

 

  1. Consistent terminology across all care domains.

 

  1. Precise recording of clinical information.

 

  1. SNOMED-CT is a developing international standard – multilingual/ cultural support.

 

  1. EPR reduces storage costs.

 

  1. EPR can be accessed in many places at the same time.

 

  1. EPR is quickly transferred.

 

  1. EPR is legible as it is not dependant on hand-written notes.

 

  1. More efficient search for patient records.

 

  1. Point of care decision support.

 

  1. Monitoring adverse reactions to treatment.

 

  1. Automatic identification of patient risk factors.

 

  1. Monitor response to treatment.

 

  1. Large populations of consistent data for medical research.

 

This list is not exhaustive

 

 

 

 

 

 

 

             

Section D[4] – Miscellaneous Section [5% of the marks]

 

Answer either Part A or Part B of the following:

 

Please use a separate Answer Sheet making it clear which question you are answering and label each section accordingly.

 

Question D4 Part A: [Answer all parts of this question i and ii]

 

  1. Give the definition of Clinical Coding, including why it is carried out. [6 Marks]

 

Clinical coding is the translation or written medical terminology that describes a patient’s complaint, problem, diagnosis, treatment or other reason for seeking medical attention into codes that can then be easily tabulated, aggregated and sorted for statistical analysis in an efficient and meaningful manner.

 

  1. Name four uses to which clinical coded data is put.

 

Clinical audit

Epidemiology

Study of aetiology

Health care planning

Casemix

Speciality needs

Staffing levels

Patient admission and clinic schedules

 

This list is not exhaustive

 

 

 

 

OR

            

Question D4 Part B: [Answer all parts of this question i, ii and iii]

 

  1. Within OPCS-4.7 Tabular List, Volume I, which unique fourth-digit identifier is assigned to all ‘conversion from’ codes and in which position are all

‘conversion from’ codes recorded? [3 Marks]

 

The unique identifier is ‘0’.

“Conversion from” codes are always recorded in a subsidiary position to the “conversion to” code.

 

  1. List the four levels of complexity that form part of axis of the OPCS-4.7 classification. [4 Marks]

 

Major

Intermediate

Minor

Non-operative procedures

 

 

iii.        Describe the General Coding Standard (GCS7) relating to the coding of resection and reconstruction procedures. [3 marks]

 

Where the resection and reconstruction have been performed together the codes that classify the resection must be assigned before the codes that classify the reconstruction.

 

            

SECTION E – Anatomy & Physiology (including Medical Terminology)

[35% of the marks]

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[1] – Anatomy & Physiology

 

Answer ALL 15 questions in this Section, writing your answers in the spaces provided.

 

  1. Which tube like structure connects the pharynx to the stomach? [1 Mark]

 

The oesophagus

 

 

 

  1. Which vessels carry blood away from the heart? [1 Mark]

 

The arteries

 

 

  1. At the aortic bifurcation into which two vessels does the aorta divide? [1 Mark]

 

Common iliac arteries (right and left)

 

 

  1. Name the first portion of the small intestine. [1 Mark]

 

Duodenum

 

 

  1. The breasts are also known as which glands? [1 Mark]

 

Mammary glands

 

 

  1. Urea is the chief nitrogenous constituent of urine and the final product of the metabolism of what substance? [1 Mark]

 

Protein

 

 

  1. What is the name of the neck of the uterus at the point where it joins the vagina? [1 Mark]

 

The cervix

 

 

  1. Into which chambers (spaces) in the brain is cerebrospinal fluid continuously being secreted? [1 Mark]

 

The ventricles (left and right ventricles, and the third and fourth ventricles)

 

 

  1. The bicuspid valve of the heart is also known as which valve? [1 Mark]

 

The mitral valve or the left atrioventricular valve

 

 

  1. How many lobes of the brain are there in a single hemisphere? [1 Mark]

 

4

 

 

  1. Which connective tissue holds bones together at the joints? [1 Mark]

 

Ligaments

 

 

  1. Which two groups of bones make up the skull? [2 Marks]

 

Cranium and facial bones

 

 

  1. Name three glands whose action is indirectly controlled by the secretions from the pituitary gland. [3 Marks]

 

Thyroid, adrenal, gonads (testes/ovaries)

 

 

  1. What is the correct medical name for red blood cells? [1 Mark]

 

Erythrocytes

 

 

  1. What name is the second (II) cranial nerve also known by? [1 Mark]

 

The optic nerve

 

 

 

 

 

 

 

 

 

Please be aware that spelling will be taken into account during the marking process.

 

Section E[2] – Medical Terminology

 

Answer ALL 10 questions in this Section, writing your answers in the spaces provided.

 

  1. What does the term dorsal pertain to? [1 Mark]

 

Pertaining to the back or towards the back

 

 

  1. What suffix means letter or drawing and is used in the word for a tracing of the electrical activity of the heart? [1 Mark]

 

-gram

 

 

  1. Circle the four suffixes in the list below: [4 Marks]

sub                     tri                      lysis

enter                   tomy                   oid

spasm                 trans                 cyst

 

 

  1. In terms of body movement describe the act of flexing the arm. [1 Mark]

 

Bending (the limb at the elbow joint)

 

 

  1. What is the meaning of the word ‘extraocular’? [1 Mark]

 

Outside the eye

 

 

  1. If a limb is adducted, in which direction is it moved? [1 Mark]

 

Towards the centre line of the body (axial line or median plane)

 

 

  1. Is the term ‘hemi’ a prefix or a suffix? [1 Mark]

 

A prefix

 

 

 

  1. What is the suffix in the medical term ‘pyloroplasty’ and what does it mean? [3 Marks]

 

Plasty             Plastic repair

 

 

  1. What does the ‘root’ word usually indicate? [1 Mark]

 

Body organ or anatomical part being described

 

 

  1. Why would a blood vessel be described as superficial? [1 Mark]

 

It is close to the surface

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section E[3] Diagrams

 

Precisely label the anatomical structure indicated by each line on the following two diagrams. Write your answers in the boxes below.

 

E 3[a] The Ear [13 Marks]

 

 

 

1 Helix 9 Semi-circular canals
2 Tympanic Membrane (ear drum is acceptable) 10 Acoustic nerve
3 External auditory canal 11 Cochlea
4 Lobule (lobe is acceptable) 12 Vestibule
5 Auricle (Pinna is acceptable) 13 Round window
6 Malleus    
7 Incus    
8 Ossicles (ossicular chain is acceptable)    

 

 

 

E 3[b] Pancreas [9 Marks]

 

 

1 Cystic duct 7 Tail of pancreas
2 Gall bladder 8 Body of pancreas
3 Duodenum 9 Pancreatic duct
4 Head of pancreas    
5 Hepatic ducts    
6 Common bile duct    

 

 

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