Outpatient and Inpatient Coding Flashcards
8 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 8 Outpatient and Inpatient Coding flashcards as text
What guidelines govern the selection of the principal diagnosis in inpatient coding?
Answer: UHDDS (Uniform Hospital Discharge Data Set) definitions
The UHDDS (Uniform Hospital Discharge Data Set) defines the principal diagnosis and guides inpatient diagnosis code selection.
What does 'present on admission' (POA) indicate?
Answer: A condition that was present at the time the order for inpatient admission occurred
POA means the condition existed at the time the patient was admitted, not one that developed during the hospital stay.
In the inpatient setting, what is a Diagnosis Related Group (DRG)?
Answer: A classification of inpatient diagnoses into groups that predict similar resource use for Medicare payment
DRGs are a patient classification system used by Medicare to determine inpatient hospital reimbursement, grouping patients with similar diagnoses and expected resource use.
What is the key coding difference between inpatient and outpatient settings for uncertain diagnoses?
Answer: Inpatient allows coding uncertain diagnoses as if confirmed; outpatient requires coding only signs and symptoms
In inpatient coding, 'probable,' 'suspected,' and 'likely' diagnoses may be coded as confirmed. In outpatient coding, only confirmed diagnoses or signs/symptoms are coded.
In MS-DRG assignment, what is the difference between a CC and an MCC?
Answer: CCs are complications/comorbidities that moderately affect resource use; MCCs severely affect resource use and result in higher payment
MCCs (Major Complications and Comorbidities) are more severe conditions that significantly increase resource use and result in higher DRG payment; CCs have a moderate effect.
What is the Ambulatory Payment Classification (APC) system used for?
Answer: Outpatient hospital reimbursement under Medicare's Outpatient Prospective Payment System (OPPS)
APCs are the classification and payment system CMS uses for outpatient hospital services under the Outpatient Prospective Payment System (OPPS).
What is the 'principal procedure' in inpatient coding?
Answer: The procedure performed for definitive treatment of the principal diagnosis or for complications of the principal diagnosis
The principal procedure is the one performed for definitive treatment of the principal diagnosis, not necessarily the most complex or the first one performed.
In outpatient coding under OPPS, what is a 'packaged service'?
Answer: A service whose payment is included in the APC payment for the primary service
Packaged services are those whose costs are considered bundled into the APC payment for the primary or adjunctive service and are not paid separately.