CCDS Official Coding Guidelines and Regulatory Compliance 4

Question 1

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?

Accepted Answer

The postoperative complication itself

Answer

The postoperative complication is coded as the principal diagnosis when the patient is admitted specifically to treat that complication.

Question 2

Which federal regulation requires hospitals to report inpatient data using the Uniform Hospital Discharge Data Set (UHDDS) definitions?

Accepted Answer

Medicare Inpatient Prospective Payment System final rule

Answer

The CMS IPPS final rule incorporates UHDDS definitions and mandates their use for Medicare inpatient reporting.

Question 3

According to ICD-10-CM guidelines, how should 'probable' diagnoses be coded in the outpatient/physician office setting?

Accepted Answer

Code only the signs and symptoms, not the probable diagnosis

Answer

In outpatient settings, uncertain diagnoses (probable, suspected, rule-out) are coded to the highest degree of certainty — typically signs and symptoms.

Question 4

The National Coverage Determinations (NCDs) issued by CMS are binding on which entities?

Accepted Answer

All Medicare contractors and providers nationwide

Answer

NCDs apply uniformly to all Medicare contractors and providers across the country, unlike Local Coverage Determinations which are contractor-specific.

Question 5

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?

Accepted Answer

Always sequence B20 (HIV disease) as the principal diagnosis

Answer

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.

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS Official Coding Guidelines and Regulatory Compliance 4