CCDS Principal Procedure Selection and MS-DRG 2

Question 1

Under ICD-10-PCS guidelines, which procedure is defined as the 'principal procedure' for DRG grouping purposes?

Accepted Answer

The procedure most related to the principal diagnosis and most resource-intensive

Answer

The first procedure listed in the operative report

Answer

The procedure with the highest ICD-10-PCS relative weight

Answer

The procedure performed by the attending physician, regardless of complexity

Question 2

A patient is admitted with acute appendicitis and undergoes a laparoscopic appendectomy. A second procedure (colonoscopy for incidental polyp removal) is also performed. Which procedure should be designated as principal?

Accepted Answer

Laparoscopic appendectomy, as it directly treats the principal diagnosis

Answer

Colonoscopy, as it is a more complex endoscopic procedure

Answer

Both procedures have equal claim to principal designation

Answer

The procedure performed first in the operating suite

Question 3

Which of the following changes to a case would MOST likely result in a shift from a medical MS-DRG to a surgical MS-DRG?

Accepted Answer

Documenting a therapeutic surgical procedure performed during the admission

Answer

Adding an MCC-level secondary diagnosis

Answer

Changing the principal diagnosis to a more specific code

Answer

Documenting additional days of mechanical ventilation

Question 4

In the MS-DRG system, what is the significance of a 'Major Diagnostic Category' (MDC)?

Accepted Answer

It groups cases by organ system or etiology and is the first-level classification before DRG assignment

Answer

It determines the maximum number of secondary diagnoses allowed per claim

Answer

It is used to calculate the hospital's total CMI across all service lines

Answer

It determines whether a case receives the CC or MCC version of the DRG

Question 5

A patient undergoes hip replacement surgery and develops a pulmonary embolism (PE) on post-operative day 2. Which DRG consideration is MOST important?

Accepted Answer

Whether PE documentation triggers a HAC payment adjustment for DVT/PE after orthopedic surgery

Answer

Whether PE is classified as a CC or MCC affecting the orthopedic DRG

Answer

Whether the PE shifts the case from an orthopedic MDC to a respiratory MDC

Answer

Whether the PE should be coded as the principal diagnosis instead of the hip replacement

Question 6

Which of the following ICD-10-PCS sections is used to code procedures on peripheral veins?

Accepted Answer

Section 0 - Medical and Surgical

Answer

Section 2 - Placement

Answer

Section 3 - Administration

Answer

Section 5 - Extracorporeal or Systemic Assistance