Free CCDS Principal Procedure Selection and MS-DRG Questions and Answers 1

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 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?

Accepted Answer

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

Answer

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?

Accepted Answer

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

Answer

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?

Accepted Answer

Coronary artery bypass graft (CABG)

Answer

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?

Accepted Answer

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

Answer

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.

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS - Certified Clinical Documentation Specialist Practice Test

Free CCDS Principal Procedure Selection and MS-DRG Questions and Answers 1