FREE CCDS Principal Procedure Selection and MS-DRG Questions and Answers

Question 1

According to the UHDDS definition, the principal procedure is one that is performed for:

Accepted Answer

Definitive treatment of a condition.

Answer

The most resource-intensive purpose, regardless of intent.

Answer

Diagnostic purposes to find the underlying problem.

Answer

Prophylactic purposes to prevent a future condition.

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?

Accepted Answer

There is no principal procedure as it was unrelated to the admission's principal diagnosis.

Answer

The colonoscopy is the principal procedure because it is an invasive procedure.

Answer

The chest X-ray for pneumonia is the principal procedure.

Answer

The most expensive procedure performed is always the principal procedure.

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?

Accepted Answer

It qualifies the EGD as an OR procedure, moving the case to a surgical DRG.

Answer

It has no effect on the MS-DRG.

Answer

It confirms the medical diagnosis but does not change the DRG.

Answer

It lowers the relative weight because the problem was fixed.

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?

Accepted Answer

Coronary artery bypass graft (CABG)

Answer

Cardiac catheterization

Answer

Both are co-principal procedures.

Answer

Neither, as the admission was for a medical condition.

Question 5

What is the primary reason the designation of a procedure as 'OR' versus 'Non-OR' is critical for a CDS to recognize?

Accepted Answer

It is the primary determinant for assigning a case to a surgical MS-DRG.

Answer

It determines the length of the post-operative recovery period.

Answer

It is only used for internal hospital quality tracking.

Answer

Non-OR procedures are never coded on the claim.

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?

Accepted Answer

Open reduction internal fixation (ORIF).

Answer

Intubation, because it was life-saving.

Answer

Mechanical ventilation.

Answer

There are two principal procedures in this case.