Coding and Reimbursement Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Coding and Reimbursement flashcards as text
What does the 'relative weight' (RW) of an MS-DRG represent in the IPPS payment formula?
Answer: The expected resource consumption of that DRG relative to the average Medicare case
The MS-DRG relative weight reflects the average resource intensity of cases in that group relative to the overall average Medicare case; higher weights yield higher payments.
A patient undergoes a coronary artery bypass graft (CABG) using a saphenous vein graft. Which ICD-10-PCS character specifies the device used?
Answer: Device character (6th)
In ICD-10-PCS, the 6th character specifies the device left in place at the conclusion of a procedure; for a CABG, this character captures the type of graft used.
Which coding guideline applies when a patient is admitted for chemotherapy and also receives treatment for anemia caused by the chemotherapy?
Answer: Sequence the encounter for chemotherapy as the principal diagnosis; anemia is secondary
ICD-10-CM guidelines specify that when a patient is admitted for antineoplastic therapy, the encounter code for the therapy (Z51.11) is sequenced as principal diagnosis, with anemia and the malignancy as additional diagnoses.
What is the function of the National Correct Coding Initiative (NCCI) edits in outpatient claims?
Answer: To prevent improper payment for services that should not be billed together
NCCI edits, developed by CMS, identify pairs of CPT/HCPCS codes that should not be reported together because one is considered a component of the other, preventing unbundling.
Which condition would most likely qualify as a hospital-acquired condition (HAC) under the CMS HAC Reduction Program?
Answer: Stage III pressure ulcer that developed after day 2 of hospitalization
Stage III and IV pressure ulcers that are not present on admission are on the CMS HAC list; facilities are penalized financially when these conditions develop during the inpatient stay.
A coder is assigning codes for a patient with sepsis due to a central line-associated bloodstream infection (CLABSI). What is the correct sequencing?
Answer: Sepsis as principal, CLABSI as the underlying infection, followed by the organism
ICD-10-CM sepsis guidelines require sequencing sepsis as principal diagnosis when it meets admission criteria, with secondary codes for the source of infection and causative organism.
In value-based purchasing programs, how does accurate clinical documentation improvement (CDI) directly influence hospital performance scores?
Answer: Accurate CDI captures true patient severity, improving risk-adjusted outcome measures and quality metrics
Accurate CDI ensures that documented diagnoses reflect true patient severity; risk-adjusted mortality and complication rates improve when the denominator correctly reflects case complexity, directly affecting VBP scores.