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
Which HCPCS Level II code category is used to report drugs administered in a physician office or outpatient setting?
Answer: J codes (Drugs Administered Other Than Oral Method)
HCPCS Level II J codes are used to identify injectable drugs and other medications that cannot be self-administered, often in outpatient or office settings.
What is the primary purpose of the 'present on admission' (POA) indicator?
Answer: To distinguish conditions that existed at admission from hospital-acquired conditions
The POA indicator tells payers whether a diagnosis was present when the patient was admitted, which affects reimbursement for hospital-acquired conditions.
A coder reviews a record where the physician documents 'probable pneumonia.' For an inpatient claim, how should this be coded?
Answer: Code pneumonia as if confirmed per inpatient guidelines
Inpatient coding guidelines allow coding of conditions documented as 'probable,' 'suspected,' or 'likely' as if confirmed, unlike outpatient guidelines.
Which section of the ICD-10-PCS code set would be used to code a total knee replacement performed during an inpatient stay?
Answer: Medical and Surgical (Section 0)
Section 0 (Medical and Surgical) of ICD-10-PCS covers all surgical and invasive procedures including orthopedic replacements performed on inpatients.
A charge capture audit reveals that charges for a specific lab panel are being missed routinely. The best corrective action is to:
Answer: Update the charge capture workflow and CDM to ensure the panel triggers automatically
The root cause of missed charges is typically a process or system issue; updating workflows and CDM triggers prevents future revenue leakage.
What is 'charge lag' in the context of revenue cycle management?
Answer: The time gap between when a service is rendered and when the charge is entered into the billing system
Charge lag refers to the delay between service delivery and charge entry, which can affect cash flow, billing timeliness, and compliance with timely filing limits.
When a surgeon performs a procedure and encounters a separate, unrelated condition requiring additional work, which modifier may be used to report the additional procedure?
Answer: -79 (Unrelated Procedure During Postoperative Period)
Modifier -79 is used when an unrelated procedure is performed during the postoperative period of another surgery, indicating it is a separate billable service.