CBCS Outpatient and Inpatient Coding

Question 1

What guidelines govern the selection of the principal diagnosis in inpatient coding?

Accepted Answer

UHDDS (Uniform Hospital Discharge Data Set) definitions

Answer

ICD-10-CM Outpatient Guidelines

Answer

CMS-1450 claim form instructions

Answer

CPT surgery section guidelines

Question 2

What does 'present on admission' (POA) indicate?

Accepted Answer

A condition that was present at the time the order for inpatient admission occurred

Answer

A condition that was diagnosed after the patient was admitted

Answer

A complication that developed during surgery

Answer

A condition documented only in the discharge summary

Question 3

In the inpatient setting, what is a Diagnosis Related Group (DRG)?

Accepted Answer

A classification of inpatient diagnoses into groups that predict similar resource use for Medicare payment

Answer

A system that classifies outpatient procedures for reimbursement

Answer

A coding guideline for grouping multiple diagnoses on a claim

Answer

A quality measure used by hospitals for accreditation

Question 4

What is the key coding difference between inpatient and outpatient settings for uncertain diagnoses?

Accepted Answer

Inpatient allows coding uncertain diagnoses as if confirmed; outpatient requires coding only signs and symptoms

Answer

Both settings prohibit coding uncertain diagnoses

Answer

Outpatient allows coding uncertain diagnoses; inpatient does not

Answer

Both settings allow coding uncertain diagnoses with a modifier

Question 5

In MS-DRG assignment, what is the difference between a CC and an MCC?

Accepted Answer

CCs are complications/comorbidities that moderately affect resource use; MCCs severely affect resource use and result in higher payment

Answer

CC means the condition was the primary diagnosis; MCC means it was a secondary diagnosis

Answer

CC refers to surgical complications; MCC refers to medical complications

Answer

CCs require additional documentation; MCCs do not

Question 6

What is the Ambulatory Payment Classification (APC) system used for?

Accepted Answer

Outpatient hospital reimbursement under Medicare's Outpatient Prospective Payment System (OPPS)

Answer

Inpatient hospital reimbursement under Medicare

Answer

Physician office visit reimbursement

Answer

Long-term care facility reimbursement

Question 7

What is the 'principal procedure' in inpatient coding?

Accepted Answer

The procedure performed for definitive treatment of the principal diagnosis or for complications of the principal diagnosis

Answer

The most complex surgical procedure performed during the hospitalization

Answer

The first procedure performed after admission

Answer

The procedure with the highest relative weight in the DRG grouper

Question 8

In outpatient coding under OPPS, what is a 'packaged service'?

Accepted Answer

A service whose payment is included in the APC payment for the primary service

Answer

A bundled payment for a group of unrelated services

Answer

A service that requires separate billing under its own APC

Answer

A service covered only under the inpatient benefit