CDIP Coding and Reimbursement 4

Question 1

What does the 'relative weight' (RW) of an MS-DRG represent in the IPPS payment formula?

Accepted Answer

The expected resource consumption of that DRG relative to the average Medicare case

Answer

The average length of stay for that DRG

Answer

The maximum allowable reimbursement for that DRG

Answer

The number of MCC codes associated with the DRG

Question 2

A patient undergoes a coronary artery bypass graft (CABG) using a saphenous vein graft. Which ICD-10-PCS character specifies the device used?

Accepted Answer

Device character (6th)

Answer

Section character (1st)

Answer

Root operation character (3rd)

Answer

Qualifier character (7th)

Question 3

Which coding guideline applies when a patient is admitted for chemotherapy and also receives treatment for anemia caused by the chemotherapy?

Accepted Answer

Sequence the encounter for chemotherapy as the principal diagnosis; anemia is secondary

Answer

Sequence the anemia as principal diagnosis because it required active treatment

Answer

Code only the malignancy; chemotherapy and anemia are bundled

Answer

Sequence whichever condition required more resources as principal

Question 4

What is the function of the National Correct Coding Initiative (NCCI) edits in outpatient claims?

Accepted Answer

To prevent improper payment for services that should not be billed together

Answer

To assign APCs to outpatient procedures

Answer

To validate diagnosis codes against ICD-10-CM tabular guidelines

Answer

To audit inpatient DRG assignments post-payment

Question 5

Which condition would most likely qualify as a hospital-acquired condition (HAC) under the CMS HAC Reduction Program?

Accepted Answer

Stage III pressure ulcer that developed after day 2 of hospitalization

Answer

Pneumonia documented as present on admission

Answer

Pre-existing deep vein thrombosis managed during the stay

Answer

Chronic kidney disease exacerbated during hospitalization

Question 6

A coder is assigning codes for a patient with sepsis due to a central line-associated bloodstream infection (CLABSI). What is the correct sequencing?

Accepted Answer

Sepsis as principal, CLABSI as the underlying infection, followed by the organism

Answer

CLABSI as principal, sepsis as secondary

Answer

Code only the sepsis with the organism; CLABSI is not separately reported

Answer

Code only the device complication code; sepsis is bundled

Question 7

In value-based purchasing programs, how does accurate clinical documentation improvement (CDI) directly influence hospital performance scores?

Accepted Answer

Accurate CDI captures true patient severity, improving risk-adjusted outcome measures and quality metrics

Answer

CDI reduces the average length of stay, improving throughput metrics only

Answer

CDI affects only financial reimbursement and has no impact on quality scoring

Answer

CDI scores are calculated separately from VBP measures and do not interact