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

The UHDDS (Uniform Hospital Discharge Data Set) defines the principal diagnosis and guides inpatient diagnosis code selection.

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

POA means the condition existed at the time the patient was admitted, not one that developed during the hospital stay.

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

DRGs are a patient classification system used by Medicare to determine inpatient hospital reimbursement, grouping patients with similar diagnoses and expected resource use.

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

In inpatient coding, 'probable,' 'suspected,' and 'likely' diagnoses may be coded as confirmed. In outpatient coding, only confirmed diagnoses or signs/symptoms are coded.

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

MCCs (Major Complications and Comorbidities) are more severe conditions that significantly increase resource use and result in higher DRG payment; CCs have a moderate effect.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS Outpatient and Inpatient Coding