CCDS Official Coding Guidelines and Regulatory Compliance 2

Question 1

Under ICD-10-CM Official Guidelines, the 'Excludes1' note indicates:

Accepted Answer

The two conditions cannot occur simultaneously and cannot be coded together

Answer

The excluded code may be used together with the code it is excluded from

Answer

The excluded code should always be sequenced before the primary code

Answer

The condition is included in the code and should not be coded separately

Question 2

Which federal agency is responsible for maintaining and updating the ICD-10-CM code set?

Accepted Answer

CMS and the National Center for Health Statistics (NCHS)

Answer

The American Hospital Association (AHA)

Answer

The American Health Information Management Association (AHIMA)

Answer

The Department of Veterans Affairs (VA)

Question 3

A hospital's internal audit reveals that coders have been assigning a CC-designated secondary diagnosis code that is not clinically supported by physician documentation but is mentioned in nursing notes. This practice violates which standard?

Accepted Answer

ICD-10-CM coding guideline requiring physician documentation to support diagnoses

Answer

UHDDS reporting requirements for secondary diagnoses

Answer

CMS MS-DRG Grouper calculation methodology

Answer

The Joint Commission medical record completion standards

Question 4

Which OIG program provides annual guidance on high-risk healthcare compliance areas including CDI and coding?

Accepted Answer

OIG Work Plan and annual compliance program guidance

Answer

Medicare Administrative Contractor (MAC) Local Coverage Determinations

Answer

Recovery Audit Contractor (RAC) denial trend reports

Answer

CMS PEPPER reports

Question 5

Under the Cooperating Parties coding guidelines, which organization provides the official publication for ICD-10-CM/PCS coding advice?

Accepted Answer

AHA Coding Clinic for ICD-10-CM/PCS

Answer

ACDIS (Association of Clinical Documentation Integrity Specialists)

Answer

CMS Medicare Claims Processing Manual

Answer

AHIMA Standards of Ethical Coding

Question 6

A PEPPER report shows a hospital is a statistical outlier for 'one-day stays.' What does this indicate from a CDI compliance perspective?

Accepted Answer

The hospital may have admissions that do not meet inpatient criteria and should review medical necessity documentation

Answer

The hospital is efficiently discharging patients, reflecting strong care quality

Answer

One-day stays are a sign of appropriate CDI query activity

Answer

PEPPER outlier status requires immediate self-disclosure to the OIG