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

APC assignment under OPPS is driven primarily by the HCPCS/CPT procedure code submitted on the outpatient claim, grouping clinically similar services with similar resource use.

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

ICD-10-CM provides combination codes for diabetes with associated complications; a single code captures both the type 2 diabetes and the diabetic nephropathy.

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

The CC/MCC exclusion list prevents double-counting by identifying pairs where a secondary condition cannot serve as a CC or MCC because it is too closely related to the principal diagnosis.

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

Medical necessity requires that the diagnosis code(s) support the clinical appropriateness of the procedure performed; a mismatch between diagnosis and procedure leads to medical necessity denials.

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

ICD-10-CM uses V, W, X, and Y code categories to capture external causes of injury and morbidity, including mechanism, intent, and place of occurrence.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Coding and Reimbursement 3