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 MS-DRG relative weight reflects the average resource intensity of cases in that group relative to the overall average Medicare case; higher weights yield higher payments.

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

In ICD-10-PCS, the 6th character specifies the device left in place at the conclusion of a procedure; for a CABG, this character captures the type of graft used.

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

ICD-10-CM guidelines specify that when a patient is admitted for antineoplastic therapy, the encounter code for the therapy (Z51.11) is sequenced as principal diagnosis, with anemia and the malignancy as additional diagnoses.

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

NCCI edits, developed by CMS, identify pairs of CPT/HCPCS codes that should not be reported together because one is considered a component of the other, preventing unbundling.

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

Stage III and IV pressure ulcers that are not present on admission are on the CMS HAC list; facilities are penalized financially when these conditions develop during the inpatient stay.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Coding and Reimbursement 4