CDIP Coding and Reimbursement 2

Question 1

Which MS-DRG grouping methodology assigns patients to categories based on their principal diagnosis, procedures, and comorbidities?

Accepted Answer

MS-DRG

Answer

APR-DRG

Answer

APC

Answer

RBRVS

Question 2

A patient is admitted with acute respiratory failure as the principal diagnosis, with pneumonia documented as the underlying cause. How should these conditions be sequenced?

Accepted Answer

Acute respiratory failure as principal, pneumonia as secondary

Answer

Pneumonia as principal, respiratory failure as secondary

Answer

Both coded equally with no sequencing requirement

Answer

Only the most severe condition is coded

Question 3

What is the purpose of the Medicare Code Editor (MCE) in the claims adjudication process?

Accepted Answer

It detects errors and inconsistencies in coded claims before payment

Answer

It calculates the DRG weight for reimbursement

Answer

It validates CPT codes for outpatient services

Answer

It assigns APCs to outpatient claims

Question 4

Under the IPPS, what is the impact of a major complication or comorbidity (MCC) compared to no MCC/CC on DRG assignment?

Accepted Answer

MCC typically results in a higher-weighted DRG, increasing reimbursement

Answer

MCC designation has no effect on DRG assignment

Answer

MCC lowers the DRG weight due to increased resource use

Answer

MCC only affects outpatient APC assignment

Question 5

A coder queries the physician about a condition described as 'possible CHF' in the discharge summary. Under inpatient coding guidelines, how should this be coded?

Accepted Answer

Code CHF as if confirmed, per inpatient uncertain diagnosis guidelines

Answer

Code only the signs and symptoms, not the uncertain diagnosis

Answer

Query the physician to confirm before coding anything

Answer

Leave the condition uncoded until a definitive diagnosis is documented

Question 6

Which ICD-10-PCS root operation is used when a physician removes a gallbladder laparoscopically without replacing it?

Accepted Answer

Resection

Answer

Destruction

Answer

Excision

Answer

Extraction

Question 7

What does the 'present on admission' (POA) indicator affect in the Medicare inpatient reimbursement system?

Accepted Answer

Hospital-acquired condition payment adjustments

Answer

DRG relative weight calculation

Answer

Length of stay outlier payments

Answer

Wage index adjustments