Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers, Exams of Nursing

Download Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers and more Exams Nursing in PDF only on Docsity! Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers> Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are similar in that they are both: a. Determined by HCPCS codes b. Focused on hospital outpatients c. Focused on hospital inpatients d. Prospective payment systems - Correct answerd. Prospective payment systems ** Both are types of prospective payment systems (Casto and Forrestal 2015, 6). A patient is treated for esophageal varices with hemorrhage due to cirrhosis. The diagnostic codes that would be assigned are: I85.01 Esophageal varices with bleeding I85.11 Secondary esophageal varices with bleeding K74.60 Unspecified cirrhosis of liver - Correct answerd. K74.60, I85.11 K74.60: Unspecified cirrhosis of liver I85.11:Secondary esophageal varices with bleeding **The patient has cirrhosis of the liver with resulting bleeding esophageal varices. Cirrhosis of liver is sequenced first followed by the code for the bleeding esophageal varices (HHS 2017, Section I.A.13, 11). Assign the code(s) for bronchoscopy with bilateral transbronchial biopsy for each lobe of each lung. 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) 31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe −50 Bilateral procedure - Correct answer Assign the code(s) for endoscopic sinusotomy with bilateral anterior ethmoidectomy. 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) −50 Bilateral procedurea. Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers a. 31254 b. 31254-50 c. 31254, 31254 d. 31231 - Correct answerb. 31254-50 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) −50 Bilateral procedurea. ** A code for the anterior ethmoidectomy is assigned and to denote the bilateral procedure, a modifier of -50 is added (CPT Assistant Winter 1993, 23; Jan. 1997, 4; Sept. 1997, 10; Oct. 1997, 5; Dec. 2001, 6; May 2003, 5). The sinusotomy is not coded separately, as it is a diagnostic procedure. The most common language used for both data definition language and data manipulation language is: a. Unified modeling language b. JAVA c. Perl d. Structured query language - Correct answerd. Structured query language ** Structured query language (SQL) is used commonly for data language and data definitions (Sharp 2016, 184). An ethmoidectomy removes infected tissue and bone in the ethmoid sinuses that blocks natural drainage. The surgeon views your ethmoid sinuses with an endoscope, a thin flexible tube with a very small camera and light at the end of it. - Correct answer Documentation from the nursing or other allied health professionals' notes can be used to establish which of the following diagnoses: a. Body mass index (BMI) b. Malnutrition c. Aspiration pneumonia d. Fatigue - Correct answera. Body mass index (BMI) ** The physician must establish the diagnosis—obesity or morbid obesity—and the additional information can be pulled from ancillary documentation to establish the correct code assignment for body mass index (BMI) (Leon-Chisen 2017, 168). A 55-year-old patient has hypertensive heart disease with congestive heart failure. What code would be assigned? a. I15.8, Other secondary hypertension b. I11.0, Hypertensive heart disease with heart failure and I50.9, Heart failure, unspecified Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers **It is important to understand the time frame for assigning a status code specifying that a condition is present on admission (Leon-Chisen 2017, 571-574). A patient was admitted after a fall down the steps. The patient was unconscious for approximately 45 minutes and was admitted to the emergency department (ED) within 3 hours of the fall. A CT scan was performed within an hour of admission to the ED. A cerebral contusion was diagnosed by the ED physician based on the findings in the CT scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)? R40.0 Somnolence S02.91XA Unspecified fracture of skull, initial encounter for closed fracture S06.331A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter S06.332A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter W10.9XXA Fall (on) (from) unspecified stairs and steps, initial encounter a. S02.91XA, W10.9XXA b. R40.0 c. S06.331A, W10.9XXA d. S06.332A, W10.9XXA - Correct answerd. S06.332A:Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter. W10.9XXA: Fall (on) (from) unspecified stairs and steps, initial encounter **The code for the injury to the brain also includes the time of unconsciousness. The external cause code is provided here as part of the review; however, no external cause codes are used on the exam except those for poisonings and adverse effects of drugs (Leon-Chisen 2017, 487-488). Medicare reimbursement depends on all of the following, except: a. The correct designation of the principal diagnosis b. Policies and procedures of the medical staff c. The presence or absence of additional codes that represent complications, comorbidities, or major complications/comorbidities d. Procedures performed - Correct answerb. Policies and procedures of the medical staff **Policies and procedures of the medical staff are not relevant. But the presence or absence of additional codes that represent complications, comorbidities, or major complications/ comorbidities are all important to determine the MS-DRG as part of Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers Medicare Acute Inpatient Prospective Payment System (Leon-Chisen 2017, 566; Rinehart-Thompson 2016a, 240-241). A 35-year-old woman has hypertension with acute renal failure and stage 3 chronic kidney disease. What code would be assigned? a. N17.9, Acute kidney failure, unspecified b. I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease c. I50.9, Heart failure, unspecified d. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease and N18.3, Chronic kidney disease, stage 3 (moderate) - Correct answerd. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease and N18.3, Chronic kidney disease, stage 3 (moderate) **Code the hypertension with stage 3 chronic kidney disease. In this case, both hypertension and chronic kidney disease are documented and a combination code is used. Also the code for the stage 3 chronic kidney disease must be assigned due to the "code also" note. The acute renal failure is identified with a separate code (HHS 2017, Section I.C.9.a., 40; HHS 2017, Section I.C.14.a., 53). A patient is diagnosed with infertility due to endometriosis and undergoes an outpatient laparoscopic laser destruction of pelvic endometriosis. In order to code this encounter accurately, what steps must the coder take? a. Review the operative report to determine what procedure codes to use and also to determine the site or sites of endometriosis so codes with the highest specificity may be assigned, and use infertility as a principal diagnosis. b. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified, and assign a principal diagnosis of infertility. c. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified as principal, and assign a secondary diagnosis of infertility. d. Review the operative report to determine what procedure codes to use and also to deter - Correct answerd. Review the operative report to determine what procedure codes to use and also to determine the site or sites of endometriosis so codes with the highest specificity may be assigned, and use the diagnosis of infertility as a secondary condition. ** There may be endometrial implants throughout the pelvic cavity which may attach to various anatomic structures such as the fallopian tube, ovary, and omentum. These Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers locations should be identified so that the appropriate diagnostic codes can be assigned and the appropriate procedure codes can be assigned based on the destruction of the endometrial implants. Therefore, the Correct answer is to review the operative report to determine what procedure codes to use and determine the site or sites of endometriosis so that codes with the highest specificity may be assigned. Also, use the diagnosis of infertility as a secondary condition (Schraffenberger 2017, 455-457; Leon- Chisen 2017, 272). A patient is admitted to a psychiatric unit of an acute-care facility. The patient experienced the following symptoms almost every day for the last month: loss of interest or pleasure in most or all activities, which is a change from her prior level of functioning. She has also gained 15 lbs, has difficulty falling asleep, feels fatigued, and has difficulty making decisions. What potential diagnosis most closely fits the patient's overall symptoms? a. Insomnia b. Major depression c. Reye's syndrome d. Bipolar disorder - Correct answerb. Major depression The CPT definition of a surgical package contains which of the following? a. The surgical procedure(s) b. Follow-up surgery c. Preoperative tests d. Yearly follow-up visits - Correct answera.The surgical procedure(s) **The surgical package refers to a combination of individual services provided during one surgical operation (Smith 2017, 55). A patient was admitted to the endoscopy unit for a screening colonoscopy. During the colonoscopy, polyps of the colon were found and a polypectomy was performed. What diagnostic codes should be used and how should they be sequenced? Z12.11 Encounter for screening for malignant neoplasm of colon D12.6 Benign neoplasm of colon, unspecified a. Z12.11 b. D12.6 c. Z12.11, D12.6 d. D12.6, Z12.11 - Correct answerc. Z12.11: Encounter for screening for malignant neoplasm of colon D12.6:Benign neoplasm of colon, unspecified Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers 0HQ4XZZ Repair neck skin, external approach 12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2. 5 cm or less 12042 Repair, intermediate, wounds of neck, hands, feet, and/or external genitalia; 2.6 cm to 7.5 cm a. S11.91XA, 0HQ4XZZ b. S11.92XA, 0HQ4XZZ c. S11.92XA, 12041 d. S11.91XA, 12042 - Correct answerd. S11.91XA :Laceration without foreign body of unspecified part of neck, initial encounter. 12042: Repair, intermediate, wounds of neck, hands, feet, and/or external genitalia; 2.6 cm to 7.5 cm Assign the code(s) for diagnostic left and right cardiac catheterization, left and right coronary arteriogram with low osmolar contrast and fluoroscopic guidance. 4A023N6 Measurement of cardiac sampling and pressure, right heart, percutaneous approach 4A023N7 Measurement of cardiac sampling and pressure, left heart, percutaneous approach 4A023N8 Measurement of cardiac sampling and pressure, bilateral, percutaneous approach B2141ZZ Fluoroscopy of right heart using low osmolar contrast B2151ZZ Fluoroscopy of left heart using low osmolar contrast B2161ZZ Fluoroscopy of right and left heart using low osmolar contrast B2111ZZ Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast a. 4A023N6, 4A023N7 b. 4A023N8, B2111ZZ c. 4A023N6 d. 4A023N7 - Correct answerb. 4A023N8: Measurement of cardiac sampling and pressure, bilateral, percutaneous approach B2111ZZ: Fluoroscopy of Multiple Coronary Arteries using Low Osmolar Contrast **There is a combination code for a left and right cardiac catheterization (4A023N8). Both the diagnostic cardiac catheterization and the cardiac angiography procedures are assigned (Leon- Chisen 2017, 412-414). A patient is admitted with an acute exacerbation of COPD with stage 5 hypertensive kidney disease. What is the correct diagnostic code assignment? Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers I12.0 Hypertensive chronic kidney disease with stage 5 or end-stage renal disease I12.9 Hypertensive chronic kidney disease, stage 1 through stage 4, or unspecified with chronic kidney disease J44.1 Chronic obstructive pulmonary disease with exacerbation J44.9 Chronic obstructive pulmonary disease, unspecified N18.5 Chronic kidney disease, stage 5 a. J44.9, I12.0 b. J44.1, I12.9 c. J44.9, I12.0 d. J44.1, I12.0, N18.5 - Correct answerd. J44.1, I12.0, N18.5 J44.1 Chronic obstructive pulmonary disease with exacerbation. I12.0 Hypertensive chronic kidney disease with stage 5 or end-stage renal disease. N18.5 Chronic kidney disease, stage 5 **Acute exacerbation of COPD is coded as J44.1. The hypertension is present with the chronic renal disease. Because of this, a combination code for hypertension and chronic renal disease is coded. In addition, the stage of the kidney disease is also coded (HHS 2017, Section I.C.14.a, 53). A data map or crosswalk consists of: a. Terms used to describe paths between classifications and vocabularies b. A map of time frames for multiple project completion c. A descriptive list of data names d. Normalized data attributes - Correct answera. Terms used to describe paths between classifications and vocabularies **There are several definitions of mapping and crosswalks but an important one in healthcare is that they are used to describe paths between classifications and terminologies (Palkie 2016, 164-165). The patient was admitted for breast carcinoma in the right breast at two o'clock. This was removed via lumpectomy. The patient was found to have 1 of 7 lymph nodes positive for carcinoma during axillary lymph node dissection. One of the patient's neighbors who is also a coworker at the hospital called the coding department to get the patient's diagnosis because she is a cancer survivor herself. The coder should: a. Discuss the case with the coworker b. Report the incident to hospital security c. Give the caller false information Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers d. Explain that discussing the case would violate the patient's right to privacy - Correct answerd. Explain that discussing the case would violate the patient's right to privacy ** Disclosing information without the patient's written consent violates the patient's right to privacy (Brodnik 2012, 231, 414; Gordon and Gordon 2016a, 615-616). The requirements for documentation and record completion (documents such as history and physicals, discharge summaries, and consultations) as well as penalties for non- adherence must be specified in: a. Hospital rules and regulations b. Conditions of nonparticipation c. Medical staff bylaws d. Nursing staff policies - Correct answerc. Medical staff bylaws **The medical staff bylaws are required by accreditation and regulatory organizations to refer to the timeline required for completion (Malmgren and Solberg 2016, 240; Brinda 2016, 166). A bronchoscopy with biopsy of the left bronchus was completed and revealed adenocarcinoma. What, if any, modifier should be added to the procedure codes? a. -50, Bilateral procedure b. -51, Multiple procedures c. -LT, Left side d. No modifiers should be reported. - Correct answerd. No modifiers should be reported. Because the lungs are paired organs, it may seem as though modifier -50 would be appropriate. However, a modifier would not be assigned because the bronchus is not a paired organ, and the bronchus is the location of the procedure, not the lungs. Similarly, it might seem as though modifier -LT would be assigned, but again, this would not be assigned as the bronchus is not a paired organ. In order to assign the correct modifier, it is important to note that paired organs include ears, eyes, nostrils, kidneys, lungs, ovaries, and such (CPT Assistant May 2003). Using the following evaluation and management map, which answers represent documentation that should be considered, when assigning an E/M example for hospital acuity points assignment? Evaluation and Management Mapping The following are the points needed to determine the level of CPT code: Level 1 = 1-20 Level 2 = 21-35 Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers completeness of an organization's data is a definition that can be agreed upon by the organization The information provided shows that: a. The payment is higher for patients with DRG 191 b. There are more patients with DRG 191 c. The case-mix index could be increased if more patients in DRG 193 were admitted d. The case mix would not increase if more patients in DRG 193 were admitted - Correct answera. The payment is higher for patients with DRG 191 **The MS-DRG weight is higher than the other MS-DRG weights and therefore the associated MS-DRG pays the most (Castro and Forrestal 2015, 115). The billing department has requested that copies of the final coding summary with associated code meanings for Medicare be printed remotely in the admission department. Currently they request the summaries only when there is an unspecified procedure. Each time the coding supervisor goes to the admission department, the coding summaries have been left on a table near the patient entrance. Of the actions presented here, what would be the best action for the coding supervisor to take? a. Comply with the request. b. Refuse to undertake this without further explanation. c. Ignore the request. d. Explain to the billing department supervisor that leaving the coding summary in public view violates the patient's right to privacy. - Correct answerd. Explain to the billing department supervisor that leaving the coding summary in public view violates the patient's right to privacy. **Health information should not be left in public view Databases utilize data models and data dictionaries. Which of the statements below are true for these two important tools? a. Data models are entities that store individual data; data dictionaries are an alphabetic index of all data values b. Data models are used for relational databases only; data dictionaries are used for objectoriented databases c. Data models provide the conceptual and graphical framework that helps define the entity and its attributes; data dictionaries provide details on each data element d. Data models represent a standard model of a database; data dictionaries provide a listing of all data elements along with their attributes - Correct answerc. Data models Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers provide the conceptual and graphical framework that helps define the entity and its attributes; data dictionaries provide details on each data element **Data models provide a conceptual framework and graphical representation that help in defining data elements. Data dictionaries are documents that explain in detail all data elements and their corresponding attributes. A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm. The x-ray showed fracture of ulna. Patient underwent closed reduction of fracture right proximal ulna. What diagnostic and procedure codes should be assigned? S52.101A Unspecified fracture of upper end of right radius, initial encounter for closed fracture S52.101B Unspecified fracture of upper end of right radius, initial encounter for open fracture S52.001A Unspecified fracture of upper end of right ulna, initial encounter for closed fracture S52.001B Unspecified fracture of upper end of right ulna, initial encounter for open fracture 0PSH0ZZ Reposition right radius, open approach 0PSK0ZZ Reposition right ulna, open approach 24670 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without manipulation 24675 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process - Correct answerd. S52.001A, 24675 S52.001A: Unspecified fracture of upper end of right ulna, initial encounter for closed fracture. 24675: Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); with manipulation **The patient has a fracture of the right proximal ulna and closed reduction is necessary. In the ICD-10-CM codebook, under Fracture, ulna, proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT (AMA CPT Professional Edition 2017, 104). [Note: Since this is an ambulatory surgery center case, CPT codes are assigned, rather than ICD-10-PCS codes.] Authentication of health record entries means to: a. Create facsimiles of documents b. Prove authorship of documents c. Develop documents Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers d. Use a rubber stamp on random sets of documents - Correct answerb. Prove authorship of documents **Authentication is the act of verifying a claim of identity (Brickner 2016, 89). In order to prove authorship of documents they are required to be authenticated by a signature A patient is admitted with hemoptysis. A bronchoscopy with transbronchial biopsy of the lower lobe was undertaken that revealed squamous cell carcinoma of the right lung. Which conditions should be identified as present on admission? C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung P26.9 Unspecified pulmonary hemorrhage originating in the perinatal period R04.2 Hemoptysis a. C34.30 b. R04.2 c. C34.31, R04.2 d. C34.30, P26.9, R04.2 - Correct answerc. C34.31, R04.2 C34.31: Malignant neoplasm of lower lobe, right bronchus or lung R04.2: Hemoptysis **The diagnosis after study (lung cancer) was present on admission as well as the symptom (hemoptysis). Code P26.9 would not be assigned because it is not diagnosed and only applies to the perinatal period (HHS 2017, Appendix I, 109-114). Current Procedural Terminology (CPT) defines a separate procedure as which of the following? a. When performed in conjunction with another service, is considered an integral part of the major service b. Provision of anesthesia c. Joint aspiration is required d. Pre-operative evaluation is not required - Correct answera. When performed in conjunction with another service, is considered an integral part of the major service **When a procedure is designated as a separate procedure in the CPT codebook and it is performed in conjunction with another service, it is considered an integral part of the major service. The CPT code description includes "separate procedure." The intention is not to provide payment for a procedure that is already integral to any given procedure (Smith 2016, 58; AMA CPT Professional Edition 2017, 66). Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers c. K57.33, 45330 d. K92.2, K57.30, 45382 - Correct answerb. K57.31:Diverticulosis of large intestine without perforation or abscess with bleeding 45382:Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma, coagulator) **The bleeding is included in the code for diverticulosis and therefore a second code is not warranted (CPT Assistant 4th Quarter 1990, 20-24). Cystourethroscopy with removal of two lesions of separate locations in the bladder, one is 1.5-cm bladder tumor anterior wall and one is 0.75-cm in the lateral wall. What coding rule applies? a. Two CPT codes should be used with a modifier -59. b. Two CPT codes should be used. c. Code only the CPT code for cystourethroscopy. d. Code only the largest tumor. - Correct answerd. Code only the largest tumor. **Per CPT Assistant, "Codes 52234-52240 should only be reported once, regardless of the number of tumors removed." Only one of the three codes may be reported per session. Select the code based on the largest tumor. Note that 52234 is used when one or more of the tumors is from 0.5 cm to 2.0 cm. Code 52240 is used when one or more of the tumors are larger than 5.0 cm (AMA August 2009, 6). A patient is admitted to the hospital complaining of abdominal pain. Following evaluation, it was determined that the patient had an intestinal obstruction of the left colon due to adhesions from a prior abdominal surgery. The patient underwent an exploratory laparotomy with lysis of adhesions. What conditions should be coded? a. Abdominal pain, abdominal adhesions, abdominal obstruction, laparotomy, lysis of adhesions b. Abdominal adhesions, abdominal obstruction, postoperative complications of the digestive system, laparotomy, lysis of adhesions c. Abdominal adhesions with obstruction, lysis of adhesions d. Abdominal adhesions and abdominal obstruction, postoperative complications of the digestive system, lysis of adhesions - Correct answerc. Abdominal adhesions with obstruction, lysis of adhesions **The patient has abdominal adhesions with obstruction, and lysis of adhesions was performed. The abdominal pain is not coded as it is a symptom (HHS 2017, Section I.B.5, 14; Leon-Chisen 2017, 140-141). Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers Lysis of adhesions - Correct answeris a surgical procedure that removes this soft scar tissue to treat a complication or to prevent a future problem involving two intersecting muscles, tissues, joints, tendons, and/or organs. A patient had a normal pregnancy and delivery at 39 weeks gestation with loose nuchal cord around neck. Delivery was accompanied by an episiotomy with repair with birth of liveborn male infant. Delivery room record states "no evidence of fetal problem." What diagnosis and procedure codes should be assigned? O80 Encounter for full-term uncomplicated delivery O69.81X0 Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified Z3A.39 39 weeks gestation of pregnancy Z37.0 Single live birth 10E0XZZ Delivery of products of conception, external approach 0W8NXZZ Division of female perineum, external approach 0WQNXZZ Repair female perineum, external approach a. O80, Z3A.39, Z37.0, 0W8NXZZ, 0WQNXZZ b. O69.81X0, Z3A.39, Z37.0, 10E0XZZ, 0W8NXZZ c. O69.81X0, 0W8NXZZ, 0WQNXZZ d. O69.81X0, Z3A.39, Z37.0, 10E0XZZ, 0WQNXZZ - Correct answerb. O69.81X0: Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified Z3A.39: 39 weeks gestation of pregnancy Z37.0: Single live birth 10E0XZZ: Delivery of products of conception, external approach 0W8NXZZ: Division of female perineum, external approach **The physician may word the delivery as "normal" but the coder cannot use O80 unless the patient meets the criteria for using it. The patient has a nuchal cord around the baby's neck which precludes the use of O80 (HHS 2017, Section I.C.15.n, 60). If a patient has a principal diagnosis of septicemia, which of the following procedures will increase the MS-DRG assignment the most? a. Bronchoscopy with left bronchus biopsy (0BB74ZX) b. Debridement of toenail (0HBRXZZ) Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers c. Nonexcisional debridement of skin ulcer of perineum with abrasion (0HD9XZZ) d. Respiratory Ventilation, Greater than 96 Consecutive Hours (5A1955Z) - Correct answerd. Respiratory Ventilation, Greater than 96 Consecutive Hours (5A1955Z) **The ventilator management is the procedure that will impact the MS-DRG to provide appropriate reimbursement. The MS-DRG with the highest weight is 870 (Medicare Grouper Version 2017). Respiratory Ventilation, Greater than 96 Consecutive Hours (5A1955Z). Medicare DRG assigned: 0870, SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS DRG weight = 05.8960. InCorrect answer option explanations provided for clarity: a. Bronchoscopy with biopsy (0BB74ZX) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0283 (incorrect) b. Debridement of toenail (0HBRXZZ) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0283 (incorrect) c. Nonexcisional debridement of skin ulcer with abrasion (0HD9XZZ) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0283 (incorrect) When coding benign lipomatous neoplasms of skin, the section noted above directs the coder to: D23- Other benign neoplasms of skin Includes: Benign neoplasm of hair follicles Benign neoplasm of sebaceous glands Benign neoplasm of sweat glands Excludes 1: benign lipomatous neoplasms of skin (D17.0-D17.3) melanocytic nevi (D22.-) a. Use category D23 b. Use a code from D17.0-D17.3 c. Use code E88.2 d. Use category D22 - Correct answerb. Use a code from D17.0-D17.3 **Excludes note 1 directs the coder to D17.0-D17.3 (HHS 2017, I.A.12a, 11). Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers a. Query the physician. b. Assign the codes for the postoperative transplant rejection. c. Assign only the code for the transplant rejection. d. Assign only the code for heart failure. - Correct answera. Query the physician. **When the documentation is not clear regarding a potential complication, it is appropriate to query the physician (HHS 2017, Section II.B., 101; Leon-Chisen 2017, 42-44). The UHDDS definition of principal diagnosis does not apply to the coding of outpatient encounters because: a. There is not enough documentation b. Usually there are multiple reasons for the encounter c. No after study element is involved as continued evaluation cannot occur d. A pre-admission work up is not available - Correct answerc. No after study element is involved as continued evaluation cannot occur **The principal diagnosis requires that the condition after study, which occasioned the patient's admission to the hospital, be assigned as the principal diagnosis. In the outpatient setting, no after study element is involved as continued evaluation cannot occur (Leon-Chisen 2017, 30; HHS 2017, Section IV, 104). UHDDS :Uniforn Hospital Discharge Data Set - Correct answerUniform Hospital Discharge Data Set (UHDDS) Used for reporting inpatient data in acute care, short-term care, and long-term care hospitals. Minimum set of items based on standard definitions to provide consistent data for multiple users. Required for reporting Medicare and Medicaid patients. Assign the code(s) for bilateral epidural lumbar injection of steroids: 62282 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions, with or without other therapeutic substance; epidural, lumbar, sacral [caudal]) 62311 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic,antispasmodic, opioid, steroid, other solution), not including neurolytic substances,including needle or catheter placement, includes contrast for localization whenperformed, epidural or subarachnoid; lumbar or sacral (caudal) −50 Bilateral procedure a. 62282 b. 62311 c. 62311, 62311 Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers d. 62311-50 - Correct answerb. 62311: Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic,antispasmodic, opioid, steroid, other solution), not including neurolytic substances,including needle or catheter placement, includes contrast for localization whenperformed, epidural or subarachnoid; lumbar or sacral (caudal) **Modifier -50 would not be used as this modifier pertains to paired organs only (CPT Assistant Feb. 2000, 4; Nov. 2008, 11; Oct. 2009, 12). A laparoscopic cholecystectomy was performed. What is the correct ICD-10-PCS code? 0FB40ZZ Excision of gallbladder, open approach 0FB44ZZ Excision of gallbladder, percutaneous endoscopic approach 0FT40ZZ Resection of gallbladder, open approach 0FT44ZZ Resection of gallbladder, percutaneous endoscopic approach a. 0FB40ZZ b. 0FT40ZZ c. 0FT44ZZ d. 0FB44ZZ - Correct answerc. 0FT44ZZ :Resection of gallbladder, percutaneous endoscopic approach The gallbladder is a specified body part in ICD-10-PCS, therefore, the correct root operation is Resection. Since it is specified as a laparoscopic cholecystectomy, the approach is percutaneous endoscopic (Leon-Chisen 2017, 250-252). cholecystectomy - Correct answeris the surgical removal of the gallbladder. The operation is done to remove the gallbladder due to gallstones causing pain or infection. Common Symptoms. ectomy - Correct answersuffix meaning the "surgical removal" of something specified: lobectomy, thrombectomy, thyroidectomy. Carcinoma of multiple overlapping sites of the bladder. Diagnostic cystoscopy and transurethral fulguration of bladder lesions (1.9 cm, 6.0 cm) are completed and a skin lesion was also removed from the left thigh. What modifier should be added to the procedure codes? a. -50, Bilateral procedure b. -51, Multiple procedures c. -59, Distinct procedural service d. -99, Multiple modifiers - Correct answerc. -59, Distinct procedural service Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers **The surgery is done on two distinct body systems with two distinct approaches. This warrants the use of -59 (CPT Assistant Sept. 2001). Before an organization can measure the quality of information it produces it must: a. Establish a data quality committee b. Investigate if there are fraudulent processes in current use c. Determine all attributes of poor quality d. Establish data standards within the organization - Correct answerd. Establish data standards within the organization **Data can only be identified as high-quality when they conform to a recognized standard (Sharp and Madlock-Brown 2016, 193). In 2000, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the outpatient prospective payment system (OPPS). This program: a. Identified the payment structure for long-term care b. Divided outpatient services into fixed-payment groups c. Created less opportunity for health information management professionals d. Facilitated greater use of ICD-9-CM procedure codes - Correct answerb. Divided outpatient services into fixed-payment groups **This final rule established APCs by dividing outpatient services into fixed-payment groups (Smith 2017, 261). (OPPS) outpatient prospective payment system - Correct answeroutpatient prospective payment system (OPPS). Assign the code for dilation and curettage for retained products of conception abortion at 11 weeks' gestation. 10A07ZW Abortion of products of conception, laminaria, via natural or artificial opening 10A07ZZ Abortion of products of conception, via natural or artificial opening 10D17ZZ Extraction of products of conception, retained, via natural or artificial opening 10D27ZZ Extraction of products of conception, ectopic, via natural or artificial opening a. 10D17ZZ b. 10A07ZZ c. 10A07ZW d. 10D27ZZ - Correct answera. 10D17ZZ: Extraction of products of conception, retained, via natural or artificial opening Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers **The patient was admitted and treated for the respiratory failure. The other conditions present are also coded (Leon-Chisen 2017, 232-234; HHS 2017, Section I.C.10.b., 48). A quality improvement study showed that newborn codes associated with maternal conditions are not being coded as often as they should. What HIM software could be used to identify the mother's chart so it can be reviewed at the time the newborn record is coded? a. Birth certificate registry or master patient index b. Transcription registry or correspondence registry c. Quality improvement or operative registry d. Pathology or laboratory information - Correct answera. Birth certificate registry or master patient index **Several data sources can assist the process of improving data quality in this scenario (Sharp and Madlock-Brown 2016, 194-199). The case-mix index for the information provided above is: a. 0.679 b. 0.89 c. 1.5 d. 0.75 - Correct answerc. 1.5 ***(10 × 2.0) + (10 × 1.5) + (10 × 1.0) / 30 = 1.5 The case mix can be determined by multiplying the relative weight of each MS-DRG by the number of discharges within that MS-DRG. The sum of all the weights is the case mix. Dividing the case mix by the total number of MS-DRGs is the case-mix index (Edgerton 2016, 501; Casto and Forrestal 2015, 115; Horton 2016, 401-402). The patient is discharged with hemiplegia and aphasia associated with a cerebral infarction of the left side of the brain due to cerebral artery stenosis. The patient is right- handed and also has a history of hypertension and compensated congestive heart failure (both conditions currently controlled on medication and treated while in the hospital). What code assignment would be appropriate? G81.90 Hemiplegia, unspecified affecting unspecified side G81.91 Hemiplegia, unspecified affecting right dominant side G81.92 Hemiplegia, unspecified affecting left dominant side I11.0 Hypertensive heart disease with heart failure I50.9 Heart failure, unspecified Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers I63.50 Cerebral Infarction due to unspecified occlusion or stenosis of unspecified cerebral artery I66.9 Occlusion and stenosis of unspecified cerebral artery I69.320 Aphasia following cerebral infarction R47.01 Aphasia a. I63.50, G81.91, R473.01, I50.9, I11.0 b. G81.90 - Correct answera. I63.50, G81.91, R47.01, I50.9, I11.0 I63.50: Cerebral Infarction due to unspecified occlusion or stenosis of unspecified cerebral artery G81.91: Hemiplegia, unspecified affecting right dominant side R47.01: Aphasia I50.9:Heart failure, unspecified I11.0:Hypertensive heart disease with heart failure **The residual effects that the patient has been discharged with are coded in addition to the cerebral infarction. The infarction is on the left side of the brain which affects the right side of the body in this right-handed patient, and is specified as due to cerebral artery stenosis (HHS 2017, Section I.C.6.a., 37; Leon-Chisen 2017, 209). **The infarction is on the left side of the brain which affects the right side of the body in this right-handed patient. A 70-year-old patient has congestive heart failure and hypertension with end-stage renal disease. What codes would be assigned? a. I11.0, Hypertensive heart disease with heart failure b. I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease, I50.9, Heart failure, unspecified, and N18.6 End stage renal disease c. I50.9, Heart failure, unspecified, I12.0, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease, and N18.6, End stage renal disease; d. N18.6, End stage renal disease or N18.5, Chronic kidney disease, stage 5 - Correct answerb. I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease, I50.9, Heart failure, unspecified, and Certified Coding Specialist (CCS) Exam Preparation 83 Verified Questions and Answers N18.6 End stage renal disease **Code the CHF as well as hypertension with end stage kidney disease. In this exercise, both hypertension and chronic kidney disease are documented and for this reason code a combination code. The combination code for hypertensive heart disease is used in this case as a causal relationship between the hypertension and the CHF is presumed. According to the 2017 Guideline I.A.15, a causal relationship is presumed between conditions linked by the term "with" in both the Alphabetic Index and the Tabular List. When looking in the index under Hypertension, the coding professional is ultimately referred to cardiorenal with heart failure with stage 5 or end stage renal disease. In the Tabular List, code also notes indicate to code the type of heart failure and the stage of renal disease (HHS 2017, Section I.C.9.a., 40; HHS 2017, Section I.C.14.a., 53). A patient was admitted to the emergency department for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. List the diagnoses that would be coded in the order of sequence. a. Abdominal pain, infectious gastroenteritis, chronic obstructive pulmonary disease, angina b. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina c. Gastroenteritis, abdominal pain, angina d. Diarrhea, chronic obstructive pulmonary disease, angina - Correct answerb. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina **The abdominal pain and diarrhea are not coded as they are symptoms integral to the diagnosis of infectious gastroenteritis. Review Coding Guideline II.A for additional information on coding of symptoms, signs, and ill-defined conditions (HHS 2017, Section II.A., 100). Assign the code(s) for extraction of extracapsular cataract with simultaneous intraocular lens insertion in the right eye. 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorhexis), or performed on patients in the amblyogenic developmental stage 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1- stage procedure) 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) −51 Multiple procedures