CCA Weak Spot

Outpatient coding: Do you code “probable,” “suspected,” or “rule out” diagnoses as confirmed?

No. Code the symptoms, signs, or reason for the visit instead.

Outpatient provider documents “probable pneumonia.” What do you code?

Code symptoms such as cough, fever, shortness of breath, etc., not pneumonia.

What does ICD-10-CM assume between hypertension and CKD?

A causal relationship. Code hypertensive chronic kidney disease.

Hypertension with CKD stage 3 needs what codes?

A hypertensive CKD code plus a CKD stage code.

ICD-10-PCS Excision means what?

Cutting out or removing part of a body part.

ICD-10-PCS Resection means what?

Cutting out or removing all of a body part.

ICD-10-PCS Release means what?

Freeing a body part from an abnormal constraint, such as adhesions.

A surgeon removes the entire gallbladder. What PCS root operation is used?

Resection, because the whole body part was removed.

A surgeon removes part of the colon. What PCS root operation is used?

Excision, because only part of the body part was removed.

A surgeon frees intestinal adhesions and removes nothing. What PCS root operation is used?

Release.

MS-DRGs are mainly used for what?

Inpatient hospital payment.

APCs are mainly used for what?

Outpatient hospital payment.

Memory trick for MS-DRG?

DRG = admitted and staying = inpatient.

Memory trick for APC?

APC = appointment/outpatient.

CPT codes report what?

Procedures and professional services.

HCPCS Level II codes report what?

Supplies, drugs, durable medical equipment, ambulance, and some services not found in CPT.

A wheelchair is usually coded with what code set?

HCPCS Level II.

A vaccine product is usually reported with what?

CPT/HCPCS.

ICD-10-CM tells what part of the claim?

Why the patient was seen, meaning the diagnosis or reason for the encounter.

CPT/HCPCS tells what part of the claim?

What was done, given, or supplied.

HIPAA protects what?

Patient health information.

The HIPAA minimum necessary rule means what?

Share only the information needed to complete the task.

Fraud means what?

Intentional deception for improper gain.

Abuse means what?

Improper practices that may cause unnecessary costs or improper payment, not always intentional.

Billing for a service that was never performed on purpose is what?

Fraud.

Unbundling means what?

Reporting separate codes for services that should be reported together.

Upcoding means what?

Coding a higher-level service than the documentation supports.

What should a coder do if documentation is unclear?

Query the provider according to policy.

A compliant provider query should be what?

Clear, concise, and non-leading.

The principal diagnosis is what?

The condition established after study to be chiefly responsible for the inpatient admission.

Is the principal diagnosis always the first diagnosis listed by the doctor?

No.

Is the principal diagnosis always the most expensive condition?

No.

How do you find the principal diagnosis?

Ask: After study, what condition was mainly responsible for the admission?

Patient admitted for acute appendicitis and has appendectomy. Principal diagnosis?

Acute appendicitis.

Modifier -59 means what?

Distinct Procedural Service.

Modifier -25 means what?

Significant, separately identifiable E/M service on the same day as another procedure.

Modifier -LT means what?

Left side.

Modifier -RT means what?

Right side.

Modifier -TC means what?

Technical component.

Two distinct procedures during the same operative session may need what modifier?

-59.

Modifier -50 means what?

Bilateral procedure.

ICD-10-PCS Inspection means what?

Visually or manually exploring a body part.

A diagnostic bronchoscopy usually uses what PCS root operation?

Inspection.

Medical necessity means what?

The service is reasonable and necessary for diagnosis or treatment.

A claim may be denied when what does not support medical necessity?

The diagnosis.

The chargemaster is what?

A list of hospital charges for services, supplies, and procedures.

The legal health record is what?

The official business record used for legal purposes.

Good clinical documentation should be what?

Complete, accurate, timely, and legible.

Accuracy is an example of what?

A data quality characteristic.

A secondary diagnosis should be coded when it does what?

Requires evaluation, treatment, monitoring, nursing care, or affects length of stay.

A coder should assign codes based on what?

Provider documentation and official coding guidelines.

Acute streptococcal pharyngitis codes to what?

J02.0.

Type 1 diabetes codes usually start with what category?

E10.

Type 2 diabetes codes usually start with what category?

E11.

Chest X-ray codes are found in what CPT section?

Radiology.

Durable medical equipment is usually coded with what?

HCPCS Level II.