CRCR Charge Capture and Coding 4 — Questions and Answers
Question 1: Which HCPCS Level II code category is used to report drugs administered in a physician office or outpatient setting?
- A codes (Transportation/Medical Supplies)
- J codes (Drugs Administered Other Than Oral Method) (Correct answer)
- E codes (Durable Medical Equipment)
- G codes (Procedures/Professional Services)
Correct 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.
Question 2: What is the primary purpose of the 'present on admission' (POA) indicator?
- To identify elective vs. emergency admissions
- To distinguish conditions that existed at admission from hospital-acquired conditions (Correct answer)
- To flag cases requiring Medicare Secondary Payer review
- To indicate the patient's functional status at discharge
Correct 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.
Question 3: A coder reviews a record where the physician documents 'probable pneumonia.' For an inpatient claim, how should this be coded?
- Code the sign/symptom (cough, fever) only
- Code pneumonia as if confirmed per inpatient guidelines (Correct answer)
- Leave the diagnosis blank until confirmed
- Query the physician before coding any diagnosis
Correct 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.
Question 4: Which section of the ICD-10-PCS code set would be used to code a total knee replacement performed during an inpatient stay?
- Medical and Surgical (Section 0) (Correct answer)
- Imaging (Section B)
- Rehabilitation (Section F)
- Measurement and Monitoring (Section 4)
Correct 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.
Question 5: A charge capture audit reveals that charges for a specific lab panel are being missed routinely. The best corrective action is to:
- Retroactively bill all missed charges for the past three years
- Update the charge capture workflow and CDM to ensure the panel triggers automatically (Correct answer)
- Terminate the staff responsible for the missed charges
- Ignore the issue since it involves a small dollar amount
Correct 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.
Question 6: What is 'charge lag' in the context of revenue cycle management?
- A delay in posting payments from insurance companies
- The time gap between when a service is rendered and when the charge is entered into the billing system (Correct answer)
- A lag in patient eligibility verification
- Delayed denial management responses
Correct 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.
Question 7: 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?
- -51 (Multiple Procedures)
- -22 (Increased Procedural Services)
- -78 (Unplanned Return to Operating Room)
- -79 (Unrelated Procedure During Postoperative Period) (Correct answer)
Correct 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.
CRCR Charge Capture and Coding 4
Which HCPCS Level II code category is used to report drugs administered in a physician office or outpatient setting?