CCS Testing and Quality Assurance 3

Question 1

A coder assigns a code for acute respiratory failure as the principal diagnosis for a patient admitted with pneumonia. The physician's final diagnosis lists only pneumonia. What should the QA auditor do?

Accepted Answer

Flag it for a physician query to clarify the principal diagnosis

Answer

The QA auditor should initiate a compliant physician query to clarify which condition was chiefly responsible for admission, rather than unilaterally changing codes.

Question 2

Which statistical method is MOST commonly used to determine the appropriate sample size for a coding audit?

Accepted Answer

Random sampling with confidence interval calculation

Answer

Random sampling with confidence interval calculation provides a statistically valid and defensible sample for measuring coding accuracy rates.

Question 3

During an outpatient coding audit, a reviewer finds the first-listed diagnosis is a symptom when the related definitive diagnosis is also documented. What is the error?

Accepted Answer

Violating outpatient coding guideline to code the confirmed diagnosis rather than the symptom

Answer

Outpatient coding guidelines require coders to report the confirmed definitive diagnosis rather than the signs or symptoms when both are documented.

Question 4

A facility implements a CDI (Clinical Documentation Improvement) program primarily to achieve which quality goal?

Accepted Answer

Improve the accuracy and completeness of documentation to support correct code assignment

Answer

CDI programs are designed to improve clinical documentation quality so that coded data accurately reflects the patient's clinical picture and supports appropriate reimbursement.

Question 5

An auditor identifies that a coder billed CPT 99215 with modifier -25 and a separate surgical procedure code on the same date. The documentation supports a significant, separately identifiable E/M service. This coding is:

Accepted Answer

Correct — modifier -25 appropriately identifies a significant separately identifiable E/M service

Answer

Modifier -25 is correctly used to indicate that a significant, separately identifiable E/M service was performed on the same day as a procedure when documentation supports it.

(CCS) Certified Coding Specialist Practice Test

(CCS) Certified Coding Specialist Practice Test

CCS Testing and Quality Assurance 3