Question 1

Which classification system is used to track neoplasms?

Accepted Answer

ICD-O (International Classification of Diseases for Oncology) is specifically designed to classify and code neoplasms, including their topography and morphology.

Question 2

The _________ axis of an ICD-O-3 code indicates the site of a neoplasm in the body.

Accepted Answer

The topography axis of an ICD-O-3 (International Classification of Diseases for Oncology, 3rd Edition) code specifies the location or site of the neoplasm in the body, distinguishing it from the morphology axis, which describes the characteristics of the tumor itself.

Question 3

In an ICD-O-3 code, which part is the behavior code, indicating whether a tumor is malignant, benign, in situ, or uncertain?

Accepted Answer

The behavior code in an ICD-O-3 (International Classification of Diseases for Oncology, 3rd Edition) code is indicated by the digit that comes after the slash on the morphology axis. This code helps in identifying the nature of the tumor, such as malignant, benign, in situ, or of uncertain behavior.

Question 4

Which is a requirement for a valid ICD-10-CM code?

Accepted Answer

ICD-10-CM codes begin with a letter character, which is part of their structure to ensure specificity and accuracy in medical diagnosis coding.

Question 5

A character value of X in the Qualifier position of certain ICD-10-PCS codes indicates a(n):

Accepted Answer

The answer of A character value of X in the...

Question 6

In the third character of an ICD-10-PCS code, the main difference between the definitions of the Root Operations excision and resection is:

Accepted Answer

The answer of In the third character of an ICD-10-PCS...

Question 7

Using the figure, which is the ICD-10-PCS code for an endoscopic colonoscopy?

Accepted Answer

The answer of Using the figure, which is the ICD-10-PCS...

Question 8

The auditor was reviewing the hospital bills and noticed that for several cases billed to a commercial payer the DRG assignment, based on the MS-DRG description of the DRG code, did not match the diagnosis/procedure codes. One possible reason for this is:

Accepted Answer

Some commercial payers may use a different DRG system than Medicare, leading to discrepancies in DRG assignments.

Question 9

What is the lowest level of medical complexity represented by CPT E/M codes?

Accepted Answer

Straightforward is considered the lowest level of medical complexity in the context of CPT Evaluation and Management (E/M) codes.

Question 10

Why might a coding manager automatically review and/or revise patients assigned to DRG 469 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC) or DRG 470 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC)?

Accepted Answer

The answer of Why might a coding manager automatically review...

Question 11

It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must:

Accepted Answer

The coder must code and sequence according to the documentation in the medical record, using software as a tool to optimize coding, ensuring accuracy and compliance with coding guidelines and regulations.

Question 12

What software checks ICD-10 codes for age conflicts, such as a newborn jaundice code assigned to a middle-aged man?

Accepted Answer

The Medicare Code Editor (MCE) checks for medical coding inconsistencies, including age conflicts with ICD-10 codes, ensuring that the codes assigned are appropriate for the patient's age, gender, and other demographic details.

Question 13

Where does the grouper search for a comorbidity or complication (CC) or major comorbidity or complication (MCC)?

Accepted Answer

The grouper searches for a comorbidity or complication (CC) or major comorbidity or complication (MCC) within secondary diagnosis codes, as these codes provide information on additional conditions that may affect patient care and resource use during a hospital stay.

Question 14

Why does the presence of a hospital-acquired condition (HAC) result in lower reimbursement?

Accepted Answer

Hospital-acquired conditions (HACs) are considered preventable by Medicare, and thus, their occurrence can lead to lower reimbursement rates for hospitals. This policy aims to incentivize hospitals to implement measures that reduce the risk of these conditions.

Question 15

What trend in the case mix might trigger a CMS audit?

Accepted Answer

An unusually high number of complex cases for a period of time might trigger a CMS audit because it could indicate upcoding or misreporting, aiming to receive higher reimbursements.

Question 16

A coder or group of coders is said to demonstrate ___________ when codes are consistently assigned for similar or identical cases.

Accepted Answer

Reliability in coding refers to the consistency of the coding process, where similar or identical cases are coded in the same way each time, ensuring that the coding is dependable and repeatable.

Question 17

____________ occurs when the coding results in the MS-DRG that most accurately represents the facility's utilization of resources, on the basis of the diagnoses and procedures, and is completely substantiated by documentation.

Accepted Answer

Optimization occurs when the coding results in the MS-DRG that most accurately represents the facility's utilization of resources, based on the diagnoses and procedures, and is fully supported by documentation.

Question 18

Which is the best way for HIM department managers to determine if charts are being coded at the proper volume?

Accepted Answer

The answer of Which is the best way for HIM...

Question 19

How does computer-assisted coding (CAC) work?

Accepted Answer

Computer-assisted coding (CAC) software automatically scans and interprets medical records to assign appropriate codes, enhancing efficiency and accuracy in the coding process.

Question 20

Who audits the coding of Medicare patient records?

Accepted Answer

Quality Improvement Organizations (QIOs) are responsible for auditing the coding of Medicare patient records to ensure accuracy, compliance, and to improve the quality of care for Medicare beneficiaries.

Quiz 5: Coded Data