Outpatient and Inpatient Coding Flashcards

Under UHDDS guidelines, how many diagnoses may be reported as 'other diagnoses' (additional diagnoses) on an inpatient claim?

Answer: As many as meet the reporting criteria

UHDDS guidelines allow reporting of all additional diagnoses that meet specified criteria — there is no fixed maximum number.

What does ICD-10-PCS stand for, and where is it used?

Answer: ICD-10 Procedure Coding System, used for inpatient hospital procedures

ICD-10-PCS is the ICD-10 Procedure Coding System used exclusively for inpatient hospital procedure coding.

Which of the following is the claim form used for inpatient hospital billing?

Answer: UB-04 (CMS-1450)

The UB-04 (also called CMS-1450) is the standard institutional claim form used by hospitals for inpatient billing.

What is a 'complication of care' in ICD-10-CM coding?

Answer: A condition arising as a result of medical or surgical management, coded from the T80-T88 category

Complications of care are specific conditions arising from medical or surgical treatment, coded from categories T80-T88 in ICD-10-CM.

In ICD-10-CM, which POA indicator is assigned when the condition could not be determined as present on admission or not?

Answer: U (Unknown)

POA indicator 'U' is used when documentation is insufficient to determine if a condition was present at the time of admission.

What is 'DRG creep' or 'upcoding' in inpatient billing?

Answer: The inappropriate practice of assigning higher-paying diagnosis codes not supported by documentation

DRG creep refers to the fraudulent assignment of codes for more complex diagnoses to increase reimbursement without adequate documentation support.

Which revenue code on the UB-04 indicates medical/surgical room and board — private?

Answer: Revenue code 011x

Revenue code 011x (0110-0119) identifies accommodation charges for private room medical/surgical care.

When a patient is admitted through the emergency department for a condition that differs from the final principal diagnosis, which condition is coded as principal?

Answer: The condition established after study to be chiefly responsible for the admission

The principal diagnosis is determined after all study — it is the condition established as chiefly responsible for the admission, even if it differs from the initial ED presentation.