RHIA Clinical Classification Systems and Coding 2 — Questions and Answers
Question 1: ICD-10-PCS codes differ from ICD-10-CM codes in that they are used to classify what?
- Diagnoses for outpatient encounters
- Inpatient procedures performed in a hospital (Correct answer)
- Physician office evaluation and management services
- Durable medical equipment claims
Correct answer: Inpatient procedures performed in a hospital
ICD-10-PCS (Procedure Coding System) is used exclusively to code inpatient procedures performed in hospital settings, while ICD-10-CM is used for diagnoses.
Question 2: A Present on Admission (POA) indicator of 'N' means the condition was:
- Present at the time of inpatient admission
- Not present at the time of inpatient admission (Correct answer)
- Clinically undetermined at admission
- Exempt from POA reporting
Correct answer: Not present at the time of inpatient admission
POA indicator 'N' (No) signifies that the condition was not present at the time of admission and developed during the inpatient stay.
Question 3: In the MS-DRG system, a Major Complication or Comorbidity (MCC) does what compared to a CC?
- Results in lower reimbursement than a CC
- Has less clinical severity than a CC
- Typically results in higher reimbursement than a CC (Correct answer)
- Does not affect DRG assignment
Correct answer: Typically results in higher reimbursement than a CC
MCCs represent the highest severity of illness and resource use among secondary diagnoses, resulting in higher DRG relative weights and reimbursement compared to CCs.
Question 4: When should a coder initiate a physician query?
- Whenever the coder disagrees with the physician's treatment plan
- When clinical indicators suggest a diagnosis that is not documented (Correct answer)
- Only after the patient has been discharged
- When the physician has provided too many diagnoses
Correct answer: When clinical indicators suggest a diagnosis that is not documented
Queries should be generated when clinical indicators in the record support a diagnosis that the physician has not explicitly documented, to ensure complete and accurate coding.
Question 5: Which outpatient coding guideline states that uncertain diagnoses (e.g., 'possible,' 'probable') should NOT be coded?
- Uniform Hospital Discharge Data Set guideline
- UHDDS principal diagnosis rule
- AHIMA outpatient coding guidelines
- ICD-10-CM Official Guidelines for outpatient coding (Correct answer)
Correct answer: ICD-10-CM Official Guidelines for outpatient coding
Per the ICD-10-CM Official Guidelines, outpatient/physician coders should report conditions to the highest degree of certainty and not code uncertain or probable diagnoses.
Question 6: The Alphabetic Index in ICD-10-CM serves what primary function?
- Provides the final, definitive code to report on the claim
- Directs the coder to the appropriate code or range in the Tabular List (Correct answer)
- Lists all valid procedure codes in sequence
- Contains official coding guidelines and conventions
Correct answer: Directs the coder to the appropriate code or range in the Tabular List
The Alphabetic Index is a starting reference tool used to locate potential codes, but the Tabular List must always be consulted to verify the final code selection.
Question 7: Ambulatory Payment Classifications (APCs) are used under which Medicare payment system?
- Inpatient Prospective Payment System (IPPS)
- Hospital Outpatient Prospective Payment System (OPPS) (Correct answer)
- Skilled Nursing Facility PPS
- Home Health PPS
Correct answer: Hospital Outpatient Prospective Payment System (OPPS)
APCs are the basis of payment under the Hospital Outpatient Prospective Payment System (OPPS), grouping outpatient services with similar clinical characteristics and resource use.
RHIA Clinical Classification Systems and Coding 2
ICD-10-PCS codes differ from ICD-10-CM codes in that they are used to classify what?