CDIP DRG Optimization and Case Mix Index 2

Question 1

Which of the following is the CORRECT UHDDS definition of 'principal diagnosis' used in the inpatient acute care setting?

Accepted Answer

The condition established after study to be chiefly responsible for occasioning the admission

Answer

UHDDS defines the principal diagnosis as the condition established after study to be chiefly responsible for occasioning the admission to the hospital; this is a coding and CDI cornerstone.

Question 2

A CDI specialist is reviewing a patient admitted for hip fracture repair who also has Stage 3 chronic kidney disease (CKD). The coder asks whether to include the CKD. Under ICD-10-CM guidelines, the CDI specialist should advise:

Accepted Answer

Include CKD as an additional diagnosis if it was monitored, evaluated, or affected patient management

Answer

ICD-10-CM guidelines instruct coders to report additional diagnoses that affect patient management, require clinical evaluation, or influence treatment—CKD Stage 3 frequently meets these criteria even without dialysis.

Question 3

What is 'DRG creep' in the context of CDI and compliance?

Accepted Answer

The intentional or inadvertent practice of selecting diagnoses or codes to maximize DRG reimbursement beyond what is clinically supported

Answer

DRG creep refers to the practice of gaming code selection to land in a higher-paying DRG without legitimate clinical support, which constitutes fraud if intentional and is a primary concern of OIG audits.

Question 4

A patient is admitted with acute exacerbation of COPD and also develops hospital-acquired pneumonia during the stay. Which diagnosis should be sequenced as principal?

Accepted Answer

The condition established after study as chiefly responsible for the admission, following ICD-10-CM sequencing guidelines

Answer

ICD-10-CM guidelines and UHDDS definitions require sequencing the condition chiefly responsible for the admission after study, not simply defaulting to the admitting diagnosis or highest-paying code.

Question 5

Which of the following BEST describes the role of the geometric mean length of stay (GMLOS) in MS-DRG payment?

Accepted Answer

It is a statistical measure used as a benchmark; cases exceeding it may qualify for outlier payments

Answer

GMLOS is a statistical benchmark; cases with extraordinarily high costs relative to the GMLOS may qualify for outlier payments from Medicare, which partially offset the hospital's additional expenses.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP DRG Optimization and Case Mix Index 2