Certified Medical Coding Specialist Research & Evidence-Based Practice 4 — Questions and Answers
Question 1: A coder is reviewing a study that concludes a new documentation improvement program increased MS-DRG weight by 0.15. To determine if this is clinically meaningful, the coder should evaluate:
- The p-value only
- Both statistical significance and effect size (clinical significance) (Correct answer)
- The sample size alone
- The journal impact factor
Correct answer: Both statistical significance and effect size (clinical significance)
A result can be statistically significant but clinically trivial; both significance and effect size must be considered to judge practical importance.
Question 2: Which ICD-10-CM Official Guideline section governs the selection of the principal diagnosis for inpatient hospital admissions?
- Section I — Conventions and General Coding Guidelines
- Section II — Selection of Principal Diagnosis (Correct answer)
- Section III — Reporting Additional Diagnoses
- Section IV — Outpatient Guidelines
Correct answer: Section II — Selection of Principal Diagnosis
Section II of the ICD-10-CM Official Guidelines specifically addresses the rules for selecting the principal diagnosis for inpatient admissions.
Question 3: A prospective coding audit collects data on new patient encounters as they occur. Compared to retrospective audits, prospective audits are more useful for:
- Analyzing historical trends over many years
- Providing real-time feedback to prevent future errors (Correct answer)
- Using larger, pre-existing datasets
- Reducing data collection costs
Correct answer: Providing real-time feedback to prevent future errors
Prospective audits capture data as events occur, allowing immediate corrective feedback before claims are submitted.
Question 4: A coder reads a study where the confidence interval for a coding accuracy improvement is 95% CI [−0.02, 0.18]. What does this interval crossing zero suggest?
- The improvement is clinically significant
- The result is not statistically significant at the 0.05 level (Correct answer)
- The sample size was too large
- The intervention worsened coding accuracy
Correct answer: The result is not statistically significant at the 0.05 level
When a 95% confidence interval for a difference includes zero, it indicates the result is not statistically significant at the 0.05 alpha level.
Question 5: A facility wants to benchmark its CC/MCC capture rate against national averages. Which publicly available database would be MOST appropriate for this comparison?
- UHDDS facility-specific reports
- CMS MedPAR data (Correct answer)
- AAFP coding guidelines
- OIG Work Plan summaries
Correct answer: CMS MedPAR data
CMS MedPAR (Medicare Provider Analysis and Review) data contains national inpatient statistics including DRG distributions used for benchmarking.
Question 6: In a coding accuracy study, sensitivity is defined as the ability of a coding review process to:
- Correctly identify all non-errors as non-errors
- Correctly identify all true coding errors as errors (Correct answer)
- Minimize the number of false positives flagged
- Measure inter-rater agreement between coders
Correct answer: Correctly identify all true coding errors as errors
Sensitivity (true positive rate) measures how well a process identifies all actual errors among all cases that truly contain errors.
Question 7: A coder discovers that a 2019 AHA Coding Clinic edition conflicts with a 2023 edition on the same coding scenario. Which guidance should be followed?
- The 2019 edition, as original guidance supersedes revisions
- The 2023 edition, as more recent guidance supersedes older guidance (Correct answer)
- Either edition, as both are equally valid
- Neither — only CMS transmittals apply
Correct answer: The 2023 edition, as more recent guidance supersedes older guidance
More recent AHA Coding Clinic guidance supersedes older guidance on the same topic, as it reflects updated official interpretation.
Certified Medical Coding Specialist Research & Evidence-Based Practice 4
A coder is reviewing a study that concludes a new documentation improvement program increased MS-DRG weight by 0.15.
To determine if this is clinically meaningful, the coder should evaluate: