Official Coding Guidelines and Regulatory Compliance Flashcards
7 cards from real CCDS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Official Coding Guidelines and Regulatory Compliance flashcards as text
Under ICD-10-CM Official Guidelines, when a patient is admitted for a complication of a previous surgery performed at another facility, what is the principal diagnosis?
Answer: The postoperative complication itself
The postoperative complication is coded as the principal diagnosis when the patient is admitted specifically to treat that complication.
Which federal regulation requires hospitals to report inpatient data using the Uniform Hospital Discharge Data Set (UHDDS) definitions?
Answer: Medicare Inpatient Prospective Payment System final rule
The CMS IPPS final rule incorporates UHDDS definitions and mandates their use for Medicare inpatient reporting.
According to ICD-10-CM guidelines, how should 'probable' diagnoses be coded in the outpatient/physician office setting?
Answer: Code only the signs and symptoms, not the probable diagnosis
In outpatient settings, uncertain diagnoses (probable, suspected, rule-out) are coded to the highest degree of certainty — typically signs and symptoms.
The National Coverage Determinations (NCDs) issued by CMS are binding on which entities?
Answer: All Medicare contractors and providers nationwide
NCDs apply uniformly to all Medicare contractors and providers across the country, unlike Local Coverage Determinations which are contractor-specific.
When coding a patient with HIV disease who is admitted for an unrelated condition (e.g., a broken leg), what is the correct sequencing per ICD-10-CM guidelines?
Answer: Always sequence B20 (HIV disease) as the principal diagnosis
ICD-10-CM guidelines instruct that B20 is always sequenced as the principal diagnosis when a patient with HIV is admitted, regardless of the reason for admission.
Under the Outpatient Code Editor (OCE), which edit would cause a claim to be returned to a provider for correction?
Answer: A diagnosis code not acceptable as a first-listed code on an outpatient claim
The OCE flags diagnosis codes designated as 'unacceptable principal diagnosis' (e.g., manifestation codes), triggering a return-to-provider edit.
The ICD-10-CM guideline for 'code also' notes instructs the coder to:
Answer: Assign the 'code also' code only if the condition is documented as present
'Code also' notes indicate that a second code may be needed if the underlying condition is documented; if not documented, only the primary code is assigned.