RHIT Medical Coding Principles 4 — Questions and Answers
Question 1: A patient is admitted for hip fracture repair and is found to have hypertension managed with medication. How is the hypertension coded?
- It is not coded because it is not the reason for admission
- It is coded as an additional diagnosis because it affects patient management (Correct answer)
- It is coded as the principal diagnosis
- It is coded only if it causes a complication
Correct answer: It is coded as an additional diagnosis because it affects patient management
Conditions that coexist at the time of admission and affect patient care or management should be coded as additional diagnoses.
Question 2: In CPT surgery coding, what does the global surgical package include?
- Only the operative procedure itself
- Pre-operative, intraoperative, and post-operative care within a defined period (Correct answer)
- Anesthesia services and follow-up labs
- All services billed during the hospital stay
Correct answer: Pre-operative, intraoperative, and post-operative care within a defined period
The global surgical package bundles pre-op evaluation, the surgery, and routine post-op care into a single fee.
Question 3: Which ICD-10-CM code category is used to report the external cause of an injury (e.g., fall from a ladder)?
- Z codes
- V–Y codes (Correct answer)
- S codes
- T codes
Correct answer: V–Y codes
ICD-10-CM chapters V–Y (V00–Y99) contain external cause codes describing how, where, and under what circumstances injuries occurred.
Question 4: What CPT modifier indicates that a service or procedure was distinct or independent from other services performed on the same day?
- -25
- -51
- -59 (Correct answer)
- -76
Correct answer: -59
Modifier -59 identifies procedures not normally reported together but appropriate under specific circumstances on the same date.
Question 5: In MS-DRG assignment under the IPPS, what effect does a major complication or comorbidity (MCC) have?
- It has no effect on DRG assignment
- It typically shifts the case to a higher-weighted DRG with greater reimbursement (Correct answer)
- It always reduces the DRG weight
- It converts the stay to a per diem payment
Correct answer: It typically shifts the case to a higher-weighted DRG with greater reimbursement
MCCs indicate a higher severity of illness and generally move a case to a higher-weight DRG, increasing reimbursement.
Question 6: A patient is seen for a laceration repair of the scalp (2.6 cm). Which CPT code range applies?
- 12001–12007 (Simple repair)
- 12011–12018 (Simple repair, face/neck/scalp) (Correct answer)
- 12031–12037 (Intermediate repair, scalp)
- 13100–13160 (Complex repair)
Correct answer: 12011–12018 (Simple repair, face/neck/scalp)
Simple lacerations of the scalp, neck, axillae, external genitalia, trunk, or extremities under specific sizes use codes 12001–12007; scalp is included in this group.
Question 7: What is the correct sequencing when coding sepsis with an associated localized infection?
- Code the localized infection first, then sepsis
- Code the sepsis first, followed by the code for the localized infection (Correct answer)
- Code only the sepsis
- Code only the localized infection
Correct answer: Code the sepsis first, followed by the code for the localized infection
Per ICD-10-CM sepsis guidelines, the sepsis code is sequenced first, then the code for the associated localized infection.
RHIT Medical Coding Principles 4
A patient is admitted for hip fracture repair and is found to have hypertension managed with medication.
How is the hypertension coded?