CCDS Principal Procedure Selection and MS-DRG 4

Question 1

A patient undergoes coronary artery bypass grafting (CABG) and simultaneous mitral valve repair. Which procedure is designated as the principal procedure for MS-DRG assignment?

Accepted Answer

The procedure most closely related to the principal diagnosis or the most resource-intensive procedure

Answer

The principal procedure is the one most closely related to the principal diagnosis or, when tied, the most resource-intensive procedure performed.

Question 2

Under ICD-10-PCS, which root operation would be coded when a surgeon removes a kidney stone via percutaneous nephrostolithotomy without removing any body part?

Accepted Answer

Extirpation

Answer

Extirpation is the root operation for taking or cutting out solid matter (such as a calculus) from a body part without removing the body part itself.

Question 3

A patient admitted for pneumonia also undergoes diagnostic bronchoscopy with bronchoalveolar lavage. Which procedure is the principal procedure?

Accepted Answer

The procedure directly treating the principal diagnosis (none here, so bronchoscopy by default)

Answer

When no therapeutic procedure is performed, the diagnostic procedure most related to the principal diagnosis is designated the principal procedure.

Question 4

Which MS-DRG grouping logic feature allows a single DRG to shift to a higher-weighted DRG when a qualifying OR procedure is present?

Accepted Answer

OR procedure designation

Answer

OR (operating room) procedure designation triggers MS-DRG logic to route a case to surgical DRGs, which typically carry higher relative weights than medical DRGs.

Question 5

A CDS queries about the approach for a laparoscopic appendectomy converted to open. Which ICD-10-PCS approach character should be reported?

Accepted Answer

Open (0), reflecting the completed approach

Answer

ICD-10-PCS guidelines state that when a laparoscopic procedure is converted to open, the open approach (0) is coded because that is how the procedure was completed.

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS Principal Procedure Selection and MS-DRG 4