Outpatient and Inpatient Coding Flashcards
8 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 8 Outpatient and Inpatient Coding flashcards as text
What is the 'two-midnight rule' under Medicare?
Answer: A physician must expect a patient's stay to cross two midnights for inpatient admission to be medically necessary under Medicare
CMS's two-midnight rule states that inpatient admission is appropriate when the treating physician expects the patient to require hospital care spanning at least two midnights.
What is 'observation status' in a hospital, and how does it differ from inpatient admission?
Answer: Observation is an outpatient status billed under Part B; inpatient is Part A for Medicare patients
Observation is an outpatient status billed under Medicare Part B, while inpatient admission is covered under Part A — with different cost-sharing implications for patients.
Which condition code on the UB-04 indicates that the services were provided in a swing bed facility?
Answer: Condition code 44
Condition code 44 is used to indicate that the patient is in observation status (reclassified from inpatient to outpatient). Swing bed hospitals typically use specific codes; 44 pertains to specific notification.
What does UHDDS require regarding the reporting of procedures in the inpatient setting?
Answer: All significant procedures that are surgical in nature, carry an anesthetic risk, or are investigative must be reported
UHDDS requires reporting of all significant procedures — those that are surgical, carry anesthetic risk, require specialized training, or require special facilities.
In ICD-10-PCS, what does the 'approach' character in a code represent?
Answer: The technique used to reach the procedure site
The 'approach' character in ICD-10-PCS describes the technique used to reach the procedure site (e.g., open, percutaneous, endoscopic).
What is a 'transferred DRG' case in Medicare inpatient coding?
Answer: A case where a patient is transferred from one acute hospital to another and may receive a reduced payment
When a Medicare patient is transferred from one acute care hospital to another, the transferring hospital typically receives a reduced (per-diem based) DRG payment.
Which of the following would be coded as a hospital-acquired condition (HAC) under Medicare policy?
Answer: A catheter-associated urinary tract infection that developed during the hospitalization
A catheter-associated UTI (CAUTI) that was NOT present on admission is a CMS-designated HAC that can trigger a payment penalty.
What is a Clinical Documentation Improvement (CDI) specialist's primary role in inpatient coding?
Answer: To query physicians to clarify documentation and capture the full complexity of the patient's condition
CDI specialists review inpatient records concurrently and query physicians to ensure documentation is complete, accurate, and supports the appropriate level of coding.