CRCR Charge Capture and Coding 2 — Questions and Answers
Question 1: Which coding system is primarily used for reporting inpatient hospital diagnoses in the United States?
- CPT-4
- ICD-10-CM (Correct answer)
- HCPCS Level II
- CDT
Correct answer: ICD-10-CM
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is used to code diagnoses for inpatient and outpatient encounters in the US.
Question 2: A patient is admitted for a hip fracture and also has diabetes mellitus type 2 that is monitored during the stay. How should the diabetes be coded?
- Omit it since it is not the principal diagnosis
- Code it as an additional diagnosis (comorbidity) (Correct answer)
- Code it only if it required insulin during the stay
- List it as the principal diagnosis
Correct answer: Code it as an additional diagnosis (comorbidity)
Conditions that coexist at admission and affect patient care or length of stay are coded as additional diagnoses per UHDDS guidelines.
Question 3: What is the purpose of a charge description master (CDM)?
- To list all payer contracts and reimbursement rates
- To serve as the facility's database linking services to charges and billing codes (Correct answer)
- To document physician credentials for credentialing purposes
- To track patient accounts receivable balances
Correct answer: To serve as the facility's database linking services to charges and billing codes
The CDM (chargemaster) is a comprehensive list of all services, supplies, and procedures with associated charges, revenue codes, and HCPCS/CPT codes.
Question 4: Which entity publishes and maintains CPT codes?
- Centers for Medicare & Medicaid Services (CMS)
- American Medical Association (AMA) (Correct answer)
- World Health Organization (WHO)
- National Uniform Billing Committee (NUBC)
Correct answer: American Medical Association (AMA)
The AMA owns and annually updates the Current Procedural Terminology (CPT) code set used for reporting medical procedures and services.
Question 5: A coder assigns a code for a service that was documented but not ordered by the physician. This is an example of:
- Upcoding
- Unbundling
- Phantom billing (Correct answer)
- Code creep
Correct answer: Phantom billing
Phantom billing (billing for services not rendered or not ordered) is a form of healthcare fraud.
Question 6: What does the modifier -59 indicate when appended to a CPT code?
- The service was performed by a different physician
- The procedure is distinct and separate from other services on the same date (Correct answer)
- The service was reduced due to complications
- The procedure was performed bilaterally
Correct answer: The procedure is distinct and separate from other services on the same date
Modifier -59 indicates a distinct procedural service, showing that a procedure or service was independent from other services performed on the same day.
Question 7: Revenue code 0450 on a UB-04 claim form typically represents which type of service?
- Pharmacy
- Emergency room services (Correct answer)
- Radiology
- Laboratory
Correct answer: Emergency room services
Revenue code 0450 (and its subcategories 0451-0459) represents emergency room services on the UB-04 institutional claim form.
CRCR Charge Capture and Coding 2
Which coding system is primarily used for reporting inpatient hospital diagnoses in the United States?