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
A patient is admitted with acute respiratory failure and pneumonia. The physician documents acute respiratory failure as the condition requiring the most intensive management. Per UHDDS and ICD-10-CM guidelines, what is the principal diagnosis?
Answer: Acute respiratory failure, because it required the most resources
When the attending physician identifies the condition requiring the most intensive management, that condition is selected as the principal diagnosis per UHDDS guidelines.
Which CMS program specifically audits hospital inpatient coding accuracy on a post-payment basis and can demand repayment of improper Medicare payments?
Answer: Recovery Audit Contractor (RAC) program
Recovery Audit Contractors review Medicare claims after payment and issue demand letters for overpayments identified through improper coding.
ICD-10-CM guideline Section I.C.19 covers coding for injuries. When multiple injuries are present, what guides principal diagnosis selection?
Answer: The most serious injury, as determined by the provider, guides sequencing
When multiple injuries are present, the most serious injury as determined by the provider is sequenced as the principal diagnosis.
A hospital receives a Targeted Probe and Educate (TPE) review notice from its MAC. What is the primary purpose of this review process?
Answer: To educate providers on proper billing and reduce error rates before enforcement
TPE is an educational process in which MACs review a sample of claims, provide feedback, and offer education to help providers correct errors before stronger action is taken.
Per ICD-10-CM Official Guidelines, which of the following correctly describes coding for pressure ulcers with multiple stages documented at the same site over the course of an inpatient stay?
Answer: Code the highest stage documented during the stay
When a pressure ulcer progresses during admission, ICD-10-CM guidelines direct assignment of the code for the highest stage documented during the stay.
The Cooperating Parties for ICD-10-CM/PCS include all of the following EXCEPT:
Answer: American Medical Association (AMA)
The four Cooperating Parties are AHIMA, AHA, NCHS, and CMS; the AMA maintains CPT, not ICD-10-CM/PCS.
Under ICD-10-CM guidelines, when a patient is admitted for chemotherapy and develops a complication during the inpatient stay, what is the correct principal diagnosis?
Answer: Encounter for antineoplastic chemotherapy (Z51.11)
ICD-10-CM guidelines specify that when admission is for chemotherapy, Z51.11 is sequenced as principal regardless of complications that arise during the stay.