CMRT Coding & Classification Systems Flashcards

Which coding system is used in the US to code inpatient hospital diagnoses and procedures for reimbursement under Medicare?

Answer: ICD-10-CM/PCS

ICD-10-CM is used for diagnosis coding while ICD-10-PCS is used for inpatient procedure coding under Medicare's MS-DRG system.

What does CPT stand for, and who maintains it?

Answer: Current Procedural Terminology, maintained by the AMA

CPT (Current Procedural Terminology) is a medical code set maintained by the American Medical Association used for physician services.

In ICD-10-CM, what does a 7th character extension typically indicate?

Answer: Encounter type such as initial, subsequent, or sequela

The 7th character in ICD-10-CM codes for injuries and certain other conditions specifies whether it is the initial encounter, subsequent encounter, or sequela.

Which classification system is used to group inpatient hospital cases into categories for Medicare reimbursement?

Answer: MS-DRG (Medicare Severity Diagnosis Related Groups)

MS-DRGs group inpatient cases with similar diagnoses and procedures into payment categories under Medicare's Inpatient Prospective Payment System.

What is the correct sequencing principle for coding diagnoses in the inpatient setting?

Answer: Principal diagnosis is the condition established after study to be chiefly responsible for the admission

The Uniform Hospital Discharge Data Set (UHDDS) defines principal diagnosis as the condition established after study to be chiefly responsible for the hospital admission.

Which coding guideline requires coders to code to the highest level of specificity in ICD-10-CM?

Answer: Code to the highest degree of certainty and specificity supported by documentation

ICD-10-CM guidelines require coders to assign the most specific code available that is supported by physician documentation.