Free CCDS Principal Procedure Selection and MS-DRG Questions and Answers 1 — Questions and Answers
Question 1: According to the UHDDS definition, the principal procedure is one that is performed for:
- The most resource-intensive purpose, regardless of intent.
- Diagnostic purposes to find the underlying problem.
- Definitive treatment of a condition. (Correct answer)
- Prophylactic purposes to prevent a future condition.
Correct answer: Definitive treatment of a condition.
The principal procedure is performed for definitive treatment of the principal diagnosis, rather than for diagnostic or exploratory purposes. A diagnostic procedure is only selected as principal if no therapeutic procedure was performed.
Question 2: A patient is admitted for pneumonia and also undergoes a screening colonoscopy during the stay, which was scheduled prior to admission. Which statement is correct regarding principal procedure selection?
- The colonoscopy is the principal procedure because it is an invasive procedure.
- There is no principal procedure as it was unrelated to the admission's principal diagnosis. (Correct answer)
- The chest X-ray for pneumonia is the principal procedure.
- The most expensive procedure performed is always the principal procedure.
Correct answer: There is no principal procedure as it was unrelated to the admission's principal diagnosis.
The colonoscopy is unrelated to the reason for admission (pneumonia). Therefore, there is no principal procedure for this encounter, and the case will be assigned a medical MS-DRG based on the pneumonia diagnosis.
Question 3: A patient admitted for a GI bleed undergoes an EGD (esophagogastroduodenoscopy) where a bleeding ulcer is identified and cauterized. How does the cauterization affect MS-DRG assignment?
- It has no effect on the MS-DRG.
- It confirms the medical diagnosis but does not change the DRG.
- It qualifies the EGD as an OR procedure, moving the case to a surgical DRG. (Correct answer)
- It lowers the relative weight because the problem was fixed.
Correct answer: It qualifies the EGD as an OR procedure, moving the case to a surgical DRG.
A purely diagnostic EGD is a non-OR procedure. Adding a therapeutic intervention like cautery makes it a significant OR procedure, which shifts the case from a medical MS-DRG (for GI bleed) to a higher-weighted surgical MS-DRG.
Question 4: A patient is admitted for unstable angina. A cardiac catheterization is performed, which is diagnostic. Based on the findings, the patient then undergoes a coronary artery bypass graft (CABG) surgery during the same admission. What is the principal procedure?
- Cardiac catheterization
- Coronary artery bypass graft (CABG) (Correct answer)
- Both are co-principal procedures.
- Neither, as the admission was for a medical condition.
Correct answer: Coronary artery bypass graft (CABG)
When a diagnostic procedure (cardiac catheterization) is followed by a therapeutic procedure (CABG) for the condition found, the therapeutic procedure is designated as the principal procedure. The CABG is the definitive treatment.
Question 5: What is the primary reason the designation of a procedure as 'OR' versus 'Non-OR' is critical for a CDS to recognize?
- It determines the length of the post-operative recovery period.
- It is the primary determinant for assigning a case to a surgical MS-DRG. (Correct answer)
- It is only used for internal hospital quality tracking.
- Non-OR procedures are never coded on the claim.
Correct answer: It is the primary determinant for assigning a case to a surgical MS-DRG.
The assignment of a principal procedure that is on the ICD-10-PCS OR procedure list is a fundamental driver of the MS-DRG logic. It is the main switch that moves an inpatient case from a medical DRG to a surgical DRG, which typically results in higher reimbursement.
Question 6: A patient is admitted for an open femur fracture and undergoes an open reduction internal fixation (ORIF). During the hospital stay, they develop respiratory failure and require an emergency intubation and mechanical ventilation. What is the principal procedure?
- Intubation, because it was life-saving.
- Open reduction internal fixation (ORIF). (Correct answer)
- Mechanical ventilation.
- There are two principal procedures in this case.
Correct answer: Open reduction internal fixation (ORIF).
The ORIF was performed to treat the principal diagnosis (femur fracture), which was the reason for the admission. The intubation was performed to treat a complication that arose later. Therefore, the ORIF is the principal procedure.
Free CCDS Principal Procedure Selection and MS-DRG Questions and Answers 1
According to the UHDDS definition, the principal procedure is one that is performed for: