Clinical Classification Systems and Coding Flashcards
7 cards from real RHIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Clinical Classification Systems and Coding flashcards as text
ICD-10-PCS codes differ from ICD-10-CM codes in that they are used to classify what?
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.
A Present on Admission (POA) indicator of 'N' means the condition was:
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.
In the MS-DRG system, a Major Complication or Comorbidity (MCC) does what compared to a CC?
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.
When should a coder initiate a physician query?
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.
Which outpatient coding guideline states that uncertain diagnoses (e.g., 'possible,' 'probable') should NOT be coded?
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.
The Alphabetic Index in ICD-10-CM serves what primary function?
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.
Ambulatory Payment Classifications (APCs) are used under which Medicare payment system?
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.