Coding and Reimbursement Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Coding and Reimbursement flashcards as text
Under the Outpatient Prospective Payment System (OPPS), what determines the Ambulatory Payment Classification (APC) assigned to a service?
Answer: HCPCS/CPT code for the service performed
APC assignment under OPPS is driven primarily by the HCPCS/CPT procedure code submitted on the outpatient claim, grouping clinically similar services with similar resource use.
A physician documents 'Type 2 diabetes with diabetic nephropathy.' Which ICD-10-CM guideline applies to coding this combination?
Answer: Use a combination code that captures both conditions in a single code
ICD-10-CM provides combination codes for diabetes with associated complications; a single code captures both the type 2 diabetes and the diabetic nephropathy.
What is the significance of the 'CC/MCC exclusion list' in MS-DRG grouping?
Answer: It identifies secondary diagnoses that cannot act as CC/MCC when the principal diagnosis is a related condition
The CC/MCC exclusion list prevents double-counting by identifying pairs where a secondary condition cannot serve as a CC or MCC because it is too closely related to the principal diagnosis.
A hospital receives a claim denial because a procedure code is not supported by the documented diagnosis. This is an example of which type of coding error?
Answer: Medical necessity failure
Medical necessity requires that the diagnosis code(s) support the clinical appropriateness of the procedure performed; a mismatch between diagnosis and procedure leads to medical necessity denials.
Which ICD-10-CM code category is used to capture external causes of morbidity, such as the mechanism and place of a patient's injury?
Answer: V, W, X, Y codes
ICD-10-CM uses V, W, X, and Y code categories to capture external causes of injury and morbidity, including mechanism, intent, and place of occurrence.
Under ICD-10-PCS, which approach value is used when a procedure is performed entirely through a natural or artificial opening?
Answer: Via Natural or Artificial Opening
ICD-10-PCS approach value '7' (Via Natural or Artificial Opening) is used when instruments are introduced through a natural body opening or an artificially created one, such as a cystoscopy via the urethra.
What is 'charge capture' in the context of hospital revenue cycle management?
Answer: The process of recording all billable services rendered to generate an accurate claim
Charge capture is the process by which all services, supplies, and procedures provided to a patient are recorded so they can be billed accurately, forming the foundation of claim generation.