Health Information & Data Content Flashcards
7 cards from real CPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Health Information & Data Content flashcards as text
What does 'data granularity' mean in health information management?
Answer: The level of detail at which data elements are defined and collected
Data granularity refers to the degree of detail or precision with which data is captured — for example, recording exact blood pressure values versus just 'normal.'
A pathology report confirming malignancy is received after the patient has been discharged. How should the coder handle this?
Answer: Code the confirmed malignancy based on the pathology report, even though it arrived post-discharge
If a pathology report confirming a diagnosis is received after discharge, the confirmed diagnosis should be coded for the inpatient stay per UHDDS guidelines.
In the context of the Uniform Hospital Discharge Data Set (UHDDS), what is the definition of 'other diagnoses'?
Answer: All conditions that coexist at admission, develop subsequently, or affect the treatment received or the length of stay
UHDDS defines other diagnoses as conditions that affect patient care in terms of requiring clinical evaluation, therapeutic treatment, diagnostic procedures, or extended length of stay.
Which coding guideline applies when a patient is admitted for complications of chemotherapy?
Answer: The complication of chemotherapy is sequenced as the principal diagnosis, not the malignancy
When a patient is admitted for a complication of chemotherapy (such as dehydration or nausea), the complication is sequenced as the principal diagnosis.
Which of the following best describes a 'comorbidity' in inpatient coding?
Answer: A pre-existing condition that, because of its presence with the principal diagnosis, increases the patient's length of stay or intensity of care
A comorbidity is a pre-existing condition that affects patient management and may qualify as a secondary diagnosis when it impacts treatment or length of stay.
What is the function of the 'Table of Drugs and Chemicals' in ICD-10-CM?
Answer: To locate codes for poisonings, adverse effects, and underdosing of drugs and chemicals
The Table of Drugs and Chemicals provides the appropriate ICD-10-CM codes for poisonings, adverse effects, and underdosing by substance and circumstances.
Which document provides the official guidelines for ICD-10-CM code assignment approved by the four cooperating parties?
Answer: ICD-10-CM Official Guidelines for Coding and Reporting
The ICD-10-CM Official Guidelines for Coding and Reporting are approved by CMS, NCHS, AHA, and AHIMA and are the authoritative source for code assignment rules.