ICD-10-CM R-SERIES ADVANCED CLINICAL QUESTION BANK

(R00–R99 ONLY)

1. Patient presents to the emergency department with profound dizziness and a resting pulse rate of 42 beats
per minute. Serial ECGs show sinus bradycardia but are negative for acute ischemic changes, and the
cardiologist's consultation concludes with a primary focus on the slow heart rate pending a Holter monitor
study to rule out a complete heart block -

2. During a routine sports physical, an adolescent is noted to have a grade 2/6 systolic crescendo-
decrescendo sound heard best at the left upper sternal border. An echocardiogram is ordered to rule out
hypertrophic cardiomyopathy, leaving the provider to document the uncharacterized heart sound for the
current encounter -

3. An adult patient arrives at the urgent care clinic complaining of a mild headache, with triage vitals
revealing a blood pressure of 165/95 mmHg. The provider notes the transiently high reading but explicitly
states that the patient does not have a formal diagnosis of hypertension and advises strict outpatient
follow-up -

4. A patient with a heavy smoking history evaluates in the pulmonary clinic complaining of a persistent
cough that produces explicitly blood-tinged sputum for the past three weeks. A high-resolution CT scan of
the chest is immediately ordered to definitively rule out bronchogenic carcinoma, focusing the coding
purely on the coughing up of blood -

5. A patient is referred to an allergist for a frustrating, persistent, dry, hacking cough that has lasted
completely uninterrupted for over 12 weeks. Comprehensive workups including spirometry, chest X-rays,
and methacholine challenge tests all return strictly negative, leading the provider to code the unyielding
symptom as a chronic cough -

6. An elderly patient complains of severe shortness of breath that exclusively occurs when lying flat in bed,
requiring them to sleep propped up on three pillows. The attending physician admits the patient for a
comprehensive cardiac workup to rule out congestive heart failure, strictly focusing the admission
diagnosis on the positional dyspnea -

7. A young adult without any prior history of atopy or reactive airway disease presents with audible, high-
pitched whistling sounds during expiration. The urgent care provider administers a nebulizer treatment to
relieve the airway noise but explicitly notes that a definitive diagnosis of asthma cannot yet be established
-

8. A patient presents with sharp, stabbing chest pain that is profoundly exacerbated by taking a deep breath
or coughing, completely lacking any radiation to the arms or jaw. A spiral CT angiogram is ordered to rule
out a pulmonary embolism, making the pleuritic chest pain the only definitive finding for the encounter -

9. A postoperative patient in the surgical recovery unit suddenly exhibits a sustained drop in pulse oximetry
readings to 86% on room air, accompanied by mild restlessness. Arterial blood gas analysis confirms low
 oxygen tension, prompting immediate supplemental oxygen therapy for the isolated low blood oxygen
condition without a confirmed pulmonary diagnosis -

10. A patient is brought to the trauma bay via EMS receiving active bag-mask ventilation after experiencing a
sudden, complete cessation of spontaneous breathing at home. The critical care team successfully
intubates the patient, documenting the primary admitting event strictly as a respiratory arrest pending
further toxicological and neurological investigation -

11. A middle-aged female presents to the emergency department complaining of excruciating, colicky pain
strictly localized to the right upper quadrant of the abdomen, radiating to the right scapula. An abdominal
ultrasound is ordered immediately to evaluate for suspected acute cholecystitis, restricting the principal
diagnosis to the specific localized abdominal pain -

12. An elderly patient evaluates for a three-day history of progressively worsening, severe, and constant
aching pain situated completely in the left lower quadrant of the abdomen. The provider schedules a stat
CT scan of the abdomen and pelvis with contrast to definitively rule out acute diverticulitis -

13. A pediatric patient is brought to the clinic after experiencing sudden, forceful expulsion of gastric
contents that shoots several feet across the room, distinctly without any preceding nausea or retching. The
pediatrician urgently refers the child for neuroimaging to rule out increased intracranial pressure, coding
the isolated forceful vomiting -

14. A patient complains of a chronic, severe burning sensation rising directly from the epigastrium into the
retrosternal area, occurring strictly after consuming spicy meals. An esophagogastroduodenoscopy is
scheduled to evaluate for suspected gastroesophageal reflux disease, leaving the burning discomfort as the
primary reason for the visit -

15. A stroke survivor presents to the outpatient speech-language pathology clinic complaining of significant
difficulty initiating a swallow, frequently coughing when attempting to consume thin liquids. A modified
barium swallow study is ordered to evaluate the exact mechanism of the suspected oropharyngeal phase
swallowing disorder -

16. A patient evaluates in the gastroenterology clinic reporting a severe, uncomfortable feeling of abdominal
fullness and visible outward swelling of the stomach that progressively worsens throughout the day. The
specialist notes the prominent distension and orders a flat and upright abdominal X-ray to rule out a
partial small bowel obstruction -

17. An older adult patient presents to the primary care provider highly distressed by finding small amounts of
stool consistently soiling their undergarments throughout the day, despite attempting normal bowel
movements. The provider documents the condition as incomplete defecation and fecal smearing, pending
a comprehensive anorectal manometry study -

18. During a routine annual physical, the provider palpates a firm, grossly enlarged liver edge extending 4
centimeters below the right costal margin. Comprehensive metabolic panels and a right upper quadrant
ultrasound are ordered to evaluate the uncharacterized hepatomegaly and rule out underlying hepatic
cirrhosis or malignancy -
19. A patient with an extensive history of chronic alcohol consumption presents with a massively distended,
tight abdomen demonstrating shifting dullness and a positive fluid wave. A diagnostic paracentesis is
performed to analyze the unexplained peritoneal fluid buildup, currently documented strictly as other
ascites pending cytology and fluid culture -

20. A completely asymptomatic 50-year-old patient submits a routine take-home guaiac-based stool test,
which returns with a strong positive result for hidden blood. The primary care provider immediately refers
the patient for a screening colonoscopy to investigate the abnormal fecal finding and definitively rule out
colorectal malignancy -

21. A diabetic patient complains of a complete loss of tactile sensation and temperature perception covering
the entire plantar surface of both feet. A comprehensive neurological examination confirms the cutaneous
numbness, and the provider documents the skin anesthesia pending the results of nerve conduction
velocity testing to confirm peripheral neuropathy -

22. A patient evaluates in the urgent care clinic with a sudden, widespread, violently erythematous, and
intensely pruritic maculopapular exanthem covering the trunk and proximal extremities. The provider
notes the recent initiation of a new antibiotic but cannot definitively confirm a drug hypersensitivity
reaction, diagnosing only a non-specific skin eruption -

23. A young adult presents to the surgical oncology clinic after discovering a painless, firm, and immovable 3
cm mass deeply embedded in the lateral aspect of the neck. An excisional biopsy is scheduled
immediately to definitively rule out Hodgkin's lymphoma, classifying the encounter solely for the
localized lump of the neck -

24. A patient presents to the emergency room with a striking bluish discoloration strictly confined to the lips,
nail beds, and fingertips, accompanied by cold extremities. The attending physician initiates a
comprehensive cardiopulmonary workup to identify the underlying cause of the uncharacterized cyanosis,
withholding any definitive structural or ischemic diagnoses -

25. An elderly patient evaluates in the neurology clinic exhibiting a prominent, unprovoked 'pill-rolling'
motion in the right hand that distinctly worsens when the limb is fully relaxed. The neurologist notes the
resting tremor but strictly avoids diagnosing Parkinson's disease until a DaTscan can definitively confirm
the neurodegenerative pathology -

26. A patient recovering from a severe motor vehicle accident is referred to physical therapy strictly due to
significant unsteadiness on their feet, requiring a wide-based stance and frequent use of a cane to prevent
falls. The therapist explicitly documents the primary impairment as a severe difficulty in walking, not
elsewhere classified -

27. A patient presents to the emergency room displaying profoundly uncoordinated, jerky voluntary
movements of the limbs and a highly dysmetric finger-to-nose test. An urgent MRI of the brain is ordered
to rule out an acute cerebellar infarction or demyelinating plaque, leaving the provider to solely code the
unspecified ataxia -
28. An adolescent is brought to the orthopedic clinic by their parents, who noticed a prominent, visibly
uneven shoulder height and an abnormal forward slouching that fails to correct with voluntary
straightening. Standing spine radiographs are ordered to investigate the uncharacterized abnormal posture
and rule out structural scoliosis -

29. A patient presents to the urgent care clinic complaining of a severe, sharp, burning pain felt exclusively
during the act of urination, completely lacking any suprapubic pain or fever. A clean-catch urine specimen
is sent for microscopic analysis and culture to rule out an infectious etiology, leaving dysuria as the only
confirmed finding -

30. An older adult patient is urgently referred to urology after noticing completely painless, bright red, visibly
blood-tinged urine in the toilet bowl over three consecutive days. A cystoscopy is immediately scheduled
to directly visualize the bladder mucosa and conclusively rule out a transitional cell carcinoma,
documenting only the gross hematuria -

31. A patient evaluates in the urogynecology clinic complaining of unpredictable, involuntary leakage of
urine that occurs without any distinct triggers such as coughing or an overwhelming urge to void. The
provider orders comprehensive urodynamic testing to differentiate between stress, urge, or overflow
mechanisms, diagnosing only unspecified urinary incontinence -

32. An adult male arrives in the emergency department reporting absolute inability to pass urine for the past
14 hours, accompanied by severe lower abdominal distension. A bedside bladder ultrasound reveals 800
mL of trapped urine, and a Foley catheter is placed to relieve the unspecified urinary retention pending a
formal urology consult -

33. A patient complains of the need to urinate up to 20 times a day, severely disrupting their work schedule
and daily life, despite voiding only small volumes each time. An extensive workup completely rules out
diabetes insipidus, urinary tract infections, and prostatic hypertrophy, leading the physician to code the
isolated frequency of micturition -

34. EMS brings an unidentified patient into the trauma bay who is completely unresponsive to all verbal and
painful stimuli, lacking spontaneous eye opening and demonstrating absolutely no motor response. The
critical care team intubates for airway protection, logging the admission explicitly as an unspecified coma
while awaiting toxicology and neuroimaging results -

35. Following a severe concussive injury sustained during a sporting event, a patient repeatedly asks the same
questions about their location and cannot form new memories of the hospital visit. The neurologist
formally documents the dense anterograde memory deficit as other amnesia, pending resolution of the
acute post-concussive syndrome -

36. A patient presents to the clinic complaining of a profound, spinning sensation that makes the room feel as
though it is violently rotating whenever they turn over in bed. The provider performs a Dix-Hallpike
maneuver to evaluate for benign paroxysmal positional vertigo, leaving the primary diagnosis strictly as
dizziness and giddiness -
37. A patient evaluates in the otolaryngology clinic reporting a sudden, complete, and profound loss of the
ability to detect any smells, which subsequently ruined their sense of taste. The specialist orders an MRI
of the anterior cranial fossa to rule out an olfactory groove meningioma, coding the symptom exclusively
as anosmia -

38. A patient with no prior psychiatric history is brought to the emergency room deeply terrified, claiming to
see distinctly formed, non-existent people standing perfectly still in the corners of the room. The
psychiatrist orders a comprehensive drug screen and metabolic panel to investigate the uncharacterized
visual hallucinations before assigning a psychotic disorder -

39. An elderly patient with advanced dementia is brought from a nursing home displaying intense,
uncharacteristic pacing, constant wringing of the hands, and an inability to sit still for more than a few
seconds. The provider thoroughly investigates for occult infection or pain, explicitly documenting the
behavioral change as restlessness and agitation -

40. A patient suddenly loses the ability to verbally communicate, struggling to produce fluent speech despite
fully understanding spoken commands and retaining the ability to write perfectly. A stat CT perfusion
scan is ordered to evaluate for a left middle cerebral artery occlusion, restricting the current coding to
expressive aphasia -

41. A patient is admitted to the infectious disease service after experiencing daily, spiking temperatures up to
103°F for over three weeks, entirely lacking any localizing signs or symptoms. Extensive cultures,
autoimmune panels, and whole-body imaging return strictly negative, leading the provider to diagnose a
fever of unspecified origin -

42. A patient presents with a severe, throbbing, bilateral cephalalgia that is not accompanied by photophobia,
phonophobia, aura, or nausea. The provider prescribes NSAIDs and advises rest, explicitly noting that the
criteria for a migraine or tension-type pathology are not met, establishing a diagnosis of an unspecified
headache -

43. A patient complains of an overwhelming, generalized lack of physical strength, finding it incredibly
difficult to simply lift their arms or climb a single flight of stairs. The physician orders a comprehensive
metabolic panel and a thyroid cascade to evaluate the profound weakness, withholding any definitive
myopathic or systemic diagnosis -

44. A teenager suddenly collapses to the floor, completely losing consciousness for roughly 20 seconds while
standing in a hot, crowded auditorium, before rapidly and spontaneously recovering full orientation. An
ECG is performed to rule out a prolonged QT interval, focusing the emergency encounter strictly on the
episode of syncope and collapse -

45. A young adult is rushed to the emergency department after experiencing a sudden, unprovoked episode of
tonic-clonic jerking movements accompanied by a loss of bowel control. The provider initiates
anticonvulsant therapy and orders an EEG, strictly classifying the event as unspecified convulsions prior
to confirming an epilepsy diagnosis -
46. During a routine dental exam, the provider notices multiple firm, non-tender, significantly swollen
glandular masses restricted entirely to the anterior cervical chain on the right side of the neck. The patient
is referred to an otolaryngologist to evaluate the localized enlarged lymph nodes and decisively rule out
an occult squamous cell carcinoma -

47. A pregnant patient evaluates in the obstetric triage unit with sudden, profound, and highly asymmetric
swelling completely restricted to the left lower extremity, from the ankle to the mid-thigh. A stat venous
Doppler ultrasound is ordered to absolutely rule out a deep vein thrombosis, coding the finding strictly as
localized edema -

48. A previously healthy patient presents to the primary care clinic highly alarmed after inadvertently
dropping over 25 pounds in the span of two months without making any changes to diet or exercise. The
provider initiates a massive workup to rule out hidden malignancies or hyperthyroidism, diagnosing the
condition entirely as abnormal weight loss -

49. An asymptomatic patient undergoes routine annual blood work, which reveals a fasting plasma glucose
level of 115 mg/dL. The provider explicitly notes that the patient absolutely does not meet the diagnostic
criteria for diabetes mellitus, instead documenting the isolated laboratory anomaly as other abnormal
glucose -

50. A patient presenting with vague, non-specific chest discomfort undergoes a battery of tests in the
emergency room, resulting in a markedly elevated quantitative D-dimer assay. A subsequent CT
pulmonary angiogram is completely negative for an embolism, leaving the physician to discharge the
patient with a diagnosis of other specified abnormal findings of blood chemistry -

ANSWER KEY

1. R00.1 2. R01.1 3. R03.0 4. R04.2 5. R05.3

6. R06.01 7. R06.2 8. R07.1 9. R09.02 10. R09.2
11. R10.11 12. R10.32 13. R11.12 14. R12 15. R13.12
16. R14.0 17. R15.2 18. R16.0 19. R18.8 20. R19.5
21. R20.0 22. R21 23. R22.1 24. R23.0 25. R25.1
26. R26.2 27. R27.0 28. R29.3 29. R30.0 30. R31.0
31. R32 32. R33.9 33. R35.0 34. R40.20 35. R41.3
36. R42 37. R43.0 38. R44.1 39. R45.1 40. R47.01
41. R50.9 42. R51.9 43. R53.1 44. R55 45. R56.9
46. R59.0 47. R60.0 48. R63.4 49. R73.09 50. R79.89