CDIP Coding and Reimbursement 3

Question 1

Under the Outpatient Prospective Payment System (OPPS), what determines the Ambulatory Payment Classification (APC) assigned to a service?

Accepted Answer

HCPCS/CPT code for the service performed

Answer

Principal diagnosis and length of visit

Answer

Patient's insurance type and discharge status

Answer

Number of diagnoses coded on the claim

Question 2

A physician documents 'Type 2 diabetes with diabetic nephropathy.' Which ICD-10-CM guideline applies to coding this combination?

Accepted Answer

Use a combination code that captures both conditions in a single code

Answer

Code only the diabetes; nephropathy is assumed unrelated

Answer

Code nephropathy as the principal diagnosis with diabetes secondary

Answer

Code separately with an 'and' convention linking both codes

Question 3

What is the significance of the 'CC/MCC exclusion list' in MS-DRG grouping?

Accepted Answer

It identifies secondary diagnoses that cannot act as CC/MCC when the principal diagnosis is a related condition

Answer

It lists diagnoses that are never reported as secondary codes

Answer

It excludes certain procedures from DRG calculation

Answer

It defines which codes qualify for POA exemption

Question 4

A hospital receives a claim denial because a procedure code is not supported by the documented diagnosis. This is an example of which type of coding error?

Accepted Answer

Medical necessity failure

Answer

Upcoding

Answer

Unbundling

Answer

Duplicate billing

Question 5

Which ICD-10-CM code category is used to capture external causes of morbidity, such as the mechanism and place of a patient's injury?

Accepted Answer

V, W, X, Y codes

Answer

Z codes

Answer

S and T codes

Answer

E codes (legacy ICD-9)

Question 6

Under ICD-10-PCS, which approach value is used when a procedure is performed entirely through a natural or artificial opening?

Accepted Answer

Via Natural or Artificial Opening

Answer

Open

Answer

Percutaneous

Answer

External

Question 7

What is 'charge capture' in the context of hospital revenue cycle management?

Accepted Answer

The process of recording all billable services rendered to generate an accurate claim

Answer

The process of collecting payment from patients at discharge

Answer

The method for calculating DRG relative weights

Answer

The auditing of claims after submission to payers