Charge Capture and Coding Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Charge Capture and Coding flashcards as text
When coding outpatient services, which diagnosis should be sequenced first when a definitive diagnosis has not been established?
Answer: The sign, symptom, or finding that prompted the visit
Per outpatient coding guidelines, when no definitive diagnosis is confirmed, the sign, symptom, or condition chiefly responsible for the visit is coded first.
Which of the following best describes 'unbundling' in medical coding?
Answer: Billing separately for components of a procedure that should be reported as one comprehensive code
Unbundling is the practice of using multiple procedure codes for services that should be reported under a single, more comprehensive code, inflating reimbursement.
Under the MS-DRG system, what primarily determines the DRG assignment for an inpatient stay?
Answer: The principal diagnosis, secondary diagnoses, procedures, age, sex, and discharge status
MS-DRG grouping uses the principal diagnosis, CC/MCC conditions, procedures, age, sex, and discharge disposition to classify patients into a reimbursement group.
A hospital bills Medicare for a higher-complexity E/M service than what the documentation supports. This is known as:
Answer: Upcoding
Upcoding means billing for a more expensive or higher-level service than what was actually documented or provided, which is a form of fraud.
What is the function of NCCI (National Correct Coding Initiative) edits?
Answer: To prevent inappropriate payment of procedure codes that should not be billed together
NCCI edits are CMS-developed code pair edits that identify procedure code combinations that should not be billed together for the same patient on the same date.
Which of the following is an example of a Major Complication or Comorbidity (MCC) under the MS-DRG system?
Answer: Acute respiratory failure
Acute respiratory failure is classified as an MCC because it significantly increases hospital resource consumption and affects DRG assignment and reimbursement.
A patient is treated for cellulitis of the right lower leg. The ICD-10-CM code should specify:
Answer: The specific site and laterality of the cellulitis
ICD-10-CM requires coding to the highest level of specificity, including the anatomical site and laterality when documented.