CRCR Charge Capture and Coding 3

Question 1

When coding outpatient services, which diagnosis should be sequenced first when a definitive diagnosis has not been established?

Accepted Answer

The sign, symptom, or finding that prompted the visit

Answer

Per outpatient coding guidelines, when no definitive diagnosis is confirmed, the sign, symptom, or condition chiefly responsible for the visit is coded first.

Question 2

Which of the following best describes 'unbundling' in medical coding?

Accepted Answer

Billing separately for components of a procedure that should be reported as one comprehensive code

Answer

Unbundling is the practice of using multiple procedure codes for services that should be reported under a single, more comprehensive code, inflating reimbursement.

Question 3

Under the MS-DRG system, what primarily determines the DRG assignment for an inpatient stay?

Accepted Answer

The principal diagnosis, secondary diagnoses, procedures, age, sex, and discharge status

Answer

MS-DRG grouping uses the principal diagnosis, CC/MCC conditions, procedures, age, sex, and discharge disposition to classify patients into a reimbursement group.

Question 4

A hospital bills Medicare for a higher-complexity E/M service than what the documentation supports. This is known as:

Accepted Answer

Upcoding

Answer

Upcoding means billing for a more expensive or higher-level service than what was actually documented or provided, which is a form of fraud.

Question 5

What is the function of NCCI (National Correct Coding Initiative) edits?

Accepted Answer

To prevent inappropriate payment of procedure codes that should not be billed together

Answer

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.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Charge Capture and Coding 3