CMRT CMRT Coding & Classification Systems 1 — Questions and Answers
Question 1: Which coding system is used in the US to code inpatient hospital diagnoses and procedures for reimbursement under Medicare?
- ICD-10-CM/PCS (Correct answer)
- CPT
- HCPCS Level II
- CDT
Correct 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.
Question 2: What does CPT stand for, and who maintains it?
- Current Procedural Terminology, maintained by the AMA (Correct answer)
- Clinical Procedure Terms, maintained by CMS
- Certified Provider Taxonomy, maintained by AHIMA
- Common Procedure Terminology, maintained by the AHA
Correct 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.
Question 3: In ICD-10-CM, what does a 7th character extension typically indicate?
- Encounter type such as initial, subsequent, or sequela (Correct answer)
- The body system affected
- The severity of the condition
- The place of service
Correct 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.
Question 4: Which classification system is used to group inpatient hospital cases into categories for Medicare reimbursement?
- MS-DRG (Medicare Severity Diagnosis Related Groups) (Correct answer)
- APC
- RBRVS
- RUGS
Correct 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.
Question 5: What is the correct sequencing principle for coding diagnoses in the inpatient setting?
- Principal diagnosis is the condition established after study to be chiefly responsible for the admission (Correct answer)
- First-listed diagnosis is the most chronic condition
- The admitting diagnosis is always the principal diagnosis
- The most expensive condition is sequenced first
Correct 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.
Question 6: Which coding guideline requires coders to code to the highest level of specificity in ICD-10-CM?
- Code to the highest degree of certainty and specificity supported by documentation (Correct answer)
- Always assign a sign or symptom code when a definitive diagnosis exists
- Use unspecified codes when documentation is unclear
- Assign the admitting diagnosis as the principal diagnosis
Correct 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.
CMRT CMRT Coding & Classification Systems 1
Which coding system is used in the US to code inpatient hospital diagnoses and procedures for reimbursement under Medicare?