Download CCDS EXAM QUESTIONS WITH 100% CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity!
CCDS EXAM QUESTIONS WITH 100%
CORRECT ANSWERS
World Healh Organization (WHO) - Answer Who publishes the ICD-10 code set What is ICD-10 used for in the US? - Answer Classify morbidity data from IP and OP records, physician offices, and National Canter for a health Statistics surveys, reimbursement purposes, and greater specificity of diagnoses. Who updates and approves the ICD-10 code sets? - Answer AHA, AHIMA, CMS, and NCHS Who publishes coding clinic? - Answer AHA (American Hospital Association) Which act requires all providers to use the same code sets, healthcare transactions, and identifiers? - Answer HIPAA HIPAA requires which code sets to report clinical information? - Answer CPT, HCPCS, ICD-10-CM, National Drug Codes How many characters long is an ICD 10 CM code? - Answer 3- When assigning a code, which hierarchy is followed? - Answer 1. Coding guidelines
- Alphabetic Index
- Tabular List
Can coding clinic supersede Official guidelines, alphabetic index, or tabular list? - Answer No Does CMS endorse coding clinic? - Answer Yes What is coding advice in coding clinic based on? - Answer The statistical classification scene of ICD-10- CM and definitions specified in UHDDS. How long are subcategories in ICD-10-CM? - Answer Four or 5 characters What does an ICD-10-PCS code need to reflect? - Answer The procedure performed and the physician's intent or objective for the procedure. What does a whipple procedure consist of? - Answer Pancreaticoduodenectomy What does the first character in a PCS code describe? - Answer General category or section of the procedure being described (medical, surgical, ancillary) What does the second character in a PCS code describe? - Answer Body system or region within the body that is the focus of the procedure What does the third character in a PCS code describe? - Answer Root operation or the intent of the procedure What does the fourth character of a PCS code describe? - Answer Body part, or specific part of the body system on which the procedure is performed. What does the fifth character of a PCS code describe? - Answer Approach or technique used to reach the site of the procedure How many approaches are there in ICD-10-PCS? - Answer Seven
Data elements and definitions associated with the UHDDS are found in what resource? - Answer Federal register 1985 If a threatened condition is documented and you cannot find it in the code book index, what code do you assign? - Answer A code for the existing underlying condition and not the condition described as impending or threatened If a condition is bilateral but there is no bilateral code, what do you assign? - Answer A code for both left and right. Guidance that states hospitals should ensure complete and accurate coding that results in correct reporting of patient conditions, assignment of appropriate MS-DRG, and ultimately maximum reimbursement comes from where? - Answer Federal Register 1985 If a patient presents with multiple conditions, what guideline do you follow and where does it come from? - Answer Any of the presenting conditions can be principal diagnosis - UHDDS Which organization provides direction that hospitals should ensure complete and accurate coding that results in correct reporting of patient conditions, assignment of appropriate MS-DRG, and ultimately maximum reimbursement for care provided to the patient? - Answer The Federal Register Surgical complication codes require - Answer Documentation that links the condition to the previous event Timeframe required for coding surgical complications - Answer No timeframe needed HIV can be coded in these situations - Answer Provider documents patient is HIV positive WITH SYMPTOMS or has an HIV related illness Zika virus - Answer Cannot be coded if it is suspected. MUST be confirmed.
Neoplasm guideline for anemia due to chemo - Answer Anemia due to chemo is PDX if they are admitted for blood transfusions without any other care Neoplasm guideline for admission for dehydration due to chemo - Answer If patient is treated with IV fluids and antiemetics without treatment for breast cancer, then dehydration is PDX and neoplasm is secondary. Which diabetic codes fall under the "with" guideline? - Answer Stage 1 blood pressure range - Answer 130-139 systolic, 80-89 diastolic Stage 2 hypertension range - Answer At least 140 systolic, at least 90 diastoloc Hypertensive crisis range - Answer Over 180 systolic, over 120 diastolic Fourth universal definition of myocardial infarction was released by which organization - Answer The Joint European Society of Cardiology Which nonclinicians' documentation can be used for BMI, NIH, GCS, and pressure ulcer stages? - Answer Nurses, dietitians (BMI), EMT (NIH, GCS). When a patient takes a drug properly but suffers a toxic or adverse effect, what do you sequence as principal? - Answer The manifestation (ex: bradycardia due to digitalis toxicity). Which government agency administers Medicare and Medicaid - Answer CMS When does the new IPPS rule come out, and how often is it updated? - Answer Annually on October 1st Reimbursement to hospitals for Medicare patients comes from which part of IPPS - Answer Part A How does IPPS pay hospitals? - Answer Per discharge basis
How often are base rates recalculated? - Answer Annually What variables can influence the recalculation of a hospital's base rate? - Answer Operating expenses, capital expenses, property-related costs What is a disproportionate share hospital adjustment? - Answer An additional payment to hospitals for providing care to a higher percentage of low-income patients What is an indirect education adjustment? - Answer An additional payment for each case that an approved teaching hospital does What is an indirect medical education adjustment based on? - Answer Ration of residents-to-beds under IPPS for operating costs, and the ratio of residents-to-average daily census under IPPS for capital costs. What is an outlier payment? - Answer An increase in payment for patients who consume a considerable amount of facility resources and have extended LOS CMS also provides an additional payment for what? - Answer Technologies that meet the new technology add on payment criteria APR-DRGs stand for what? - Answer All patient refined diagnostic related groups Final reimbursement is NOT calculated based on these two factors - Answer Amount of time patient spends in the hospital; amount of resources used in the patient's care. What was the first DRG classification? - Answer CMS DRGs UHDDS stands for what? - Answer Uniform hospital discharge data set
Secondary diagnoses should be reported when they affect patient care in regard to one or more of the following - Answer Clinical evaluation, therapeutic treatment, diagnostic procedures, extended the length of hospital stay, increased nursing care and monitoring. DRG assignment can impact these "less visible" factors - Answer Physician profiles, quality scores, LOS, SOI, ROM Factors that affect DRG assignment - Answer Principal diagnosis, secondary diagnosis, procedure, discharge status, gender, birth weight for neonate What makes up Case Mix Index? - Answer An average of the relative weights of the DRGs in a specified patient population over a set time frame Which organization prompted implementation of POA indicators? - Answer IOM - institute of medicine When were POAs implemented? - Answer 2007 by CMS What are "never events"? - Answer A list of 29 serious reportable events grouped into 7 categories Never events are gripes into 7 categories which are labeled these three terms? - Answer Unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability) and usually preventable The most common medical reimbursement violation - Answer Failure to comply with medical necessity requirements The social security act requires what from CMS? - Answer Protect the Medicare trust fund against inappropriate payments that pose the greatest risk to the trust fund and take corrective actions in response to any inappropriate payments. What are MACs and what do they do? - Answer Medicare Administrative Contractors. They perform clinical review of medical records to ensure that payment is made only for services that need Medicare coverage, coding, and medical necessity requirements.
According to Medicare's conditions of participation - Answer The hospital must have in effect a utilization management plan that provided for review of services furnished by the institution by members of the medical staff to patients entitled to benefits under the Medicare and Medicaid programs. What are RAs and when/how did they start? - Answer Recovery Audit program. 2003 under the Medicare Prescription Drug Improvement and Modernization Act What do RAs do? - Answer Identify and correct improper payments through post payment review of medical records. Common Public report cards - Answer Leapfrog, US News and World Report, Hospital Compare, Physician compare Where does info on Physician Compare come from? - Answer Provider enrollment, chain, and overshoot system (PECOS) and other sources. What 7 measures is CMS required to include for public reporting? - Answer 1. Measures collected under the Physician Quality Reporting System
- An assessment of patient health outcomes and functional status of patients
- An assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
- An assessment of efficiency
- An assessment of patient experience and patient caregiver, and family engagement
- An assessment of safety, effectiveness, and timeliness of care
- Other information as determined appropriate The Institute for Healthcare Improvement's "Triple Aim" approach calls for what three goals? - Answer 1. Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
What is the O/E mortality rate, and what does a high rate mean? - Answer Observed to expected mortality rate. Higher rates mean higher than expected deaths. Lower means fewer patients expired than expected. Which four quality metrics are influenced by accurate documentation? - Answer Hospital value-based purchasing HAC reduction program Hospital are admissions Reduction program 30 day mortality measures When was HVBP program initiated and by who? - Answer 2013 by CMS What is the purpose of HVBP program? - Answer To reward Acute care hospitals with incentive payments when meeting quality of care standards. What five things does HVBP program encourage hospitals to do? - Answer 1 Eliminate or reduce adverse events
- Adopt evidence-based standards and protocols that create the best outcomes for the most patients
- Changing hospital processes to make patients' care experiences better
- Increasing care transparency for consumers
- Recognizing hospitals that give high-quality care at a lower cost to Medicare Hospitals are gauged on these six measures of outcomes - Answer Mortality and complications HAIs Patient safety Patient experience Process Efficiency and cost reduction What is the Deficit Reduction Act, when was it passed, and who passed it? - Answer Authorized CMS to adjust Medicare IPPS hospital payments to encourage prevention of HACs and HACRP
Which conditions are included in HHRP? - Answer AMI, COPD, HeRt Failure, Pneumonia, CABG surgery, Elective primary total hip arthroplasty and/or total knee arthroplasty Definition of readmission - Answer Admission to acute care hospital within 30 days of a discharge from the same or another acute care hospital Exclusions of readmissions - Answer Patients who leave AMA, patients older than 65 Purpose of HHRP - Answer To improve quality and lower costs for Medicare patients, and to make sure hospitals are fully prepared and safe for continued care at home or in a lower-acuity setting. 30 day mortality measures include which medical conditions/surgical procedures? - Answer COPD, AMI, HF, Pneumonia, Stroke, and CABG patients Which factors does the 30 day mortality measure include? - Answer Patients who were enrolled in Medicare for 12 months prior to their hospital admission then readmitted within 30 days after their original admission, patients who are 65 and older. How is the 30 day mortality measure calculated for a facility? - Answer A facility's performance category is estimated from a comparison to the National 30 day observed unplanned readmission rate How does CDI role in HACs and PSIs help patient care? - Answer If the data is not captured and available, then improvements in patient care or delivery of care process cannot occur Definition of a provider per coding guidelines - Answer Physician or any qualified healthcare practitioner legally responsible for establishing the patient's diagnosis Which organizations have resources that describe how and when queries are used? - Answer AHIMA, AHA (Coding clinic), and ACDIS Which cooperating parties can approve updates and rules for ICD-10? - Answer AHA and AHIMA
What did CMS say about queries, where, and when? - Answer Memorandum to QIOs (quality improvement organizations) in 2001. It states that the use of the physician query form is permissible to the extent it provides clarification and is consistent with other medical record documentation. Which clinical indicators should be included in a query? - Answer Risk factors that may preclude the patient to a higher SOI, signs and symptoms that info are a more severe or specific diagnosis, and treatment of the diagnosis in question When communicating the reason for a query to a physician, CDI should discuss... - Answer The overall quality and integrity of the medical record When communicating the reason for a query, the CDI should NOT discuss... - Answer Quality reporting, financial effects, physician scores. These should be left for general/larger education efforts, not the query process. Queries should include the following - Answer Patient identifier Admission date Account number Name and contact info of person sending the query Clinical indicators that support the query Statement or question of the issue Response options/opportunities/instructions for the physician What is the preferred method of posting a question to a provider? - Answer Multiple choice queries Verbal queries require which elements? - Answer Summary of question, possible responses, dialogue with provider, and ensuing result
Name all of the auditors and agencies involved in eliminating fraud - Answer 1. The Hospital Payment Monitoring Program
- Recovery auditors (RA)
- Medicare Administrative Contractors
- Medicaid Integrity Contractors
- The Payment Error Prevention Program
- The program for evaluating Payment Patterns Electronic Report (PEPPER)
- Zone Program Integrity Contractors
- Unified Program Integrity Contractors What do PEPPER reports provide? - Answer Medicare data statistics for discharged at risk for improper payments Which CMS contractor generates PEPPER reports? - Answer TMF Health Quality Institute What does each PEPPER report contain? - Answer Statistics for the most recent 12 federal fiscal quarters for each area at risk for improper payments (target areas) How do PEPPER reports assist a facility's compliance efforts? - Answer Identifies circumstances where the facility is an outlier When are CDI allowed to communicate financial and quality outcomes to physician groups? - Answer When the info is retrospective, anonymous, and aims to demonstrate core documentation improvement tenets A CDI provider education program should have which elements? - Answer A communication and education plan that includes all healthcare providers, and offers information regarding documentation issues, coding information, and reporting of metrics that demonstrate program success. Topics for provider education meetings can include - Answer Specific documentation that correctly describes patient conditions, metrics with success stories or action plans specific to the audience
- documentation coding guideline changes
- case examples, including cases that were denied MDC 1 - Answer Diseases and disorders of the nervous system Three types of cerebral edema - Answer Cytotoxic Vasogenic Interstitial Cytotoxic Edema - Answer Results from swelling of the cellular elements due to substrate and energy failure and affects both gray and white matter Vasogenic Edema - Answer Increased vascular permeability; predominantly affects white matter Interstitial edema - Answer Consequence of impaired absorption or obstruction of CSF, resulting in acute hydrocephalus Treatment for cerebral edema - Answer Osmotherapy which includes Mannitol, corticosteroids such as Decadron, hypoventilation What does mannitol do? - Answer Facilitates removal of excess water from the brain What does decadron do? - Answer Reduces capillary permeability What does hypoventilation do? - Answer Reduces intracranial pressure Surgical treatment for cerebral edema - Answer Ventriculostomy, removal of underlying tumor, decompression craniotomy
Treatment for hepatic encephalopathy - Answer Lactulose Low protein diet Treatment for hypertensive encephalopathy - Answer Antihypertensives Treatment for hypoxic encephalopathy - Answer Provide oxygen Treatment for metabolic or septic encephalopathy - Answer Antibiotics TPN, PEG Improved diet Chemotherapy, radiation Reduction of pressure Treatment for Toxic encephalopathy - Answer Removal of toxic agent Hydration Causes of metabolic/septic encephalopathy - Answer Infection metabolic or mitochondrial dysfunction Poor nutrition Tumors Increased nontraumatic intracranial pressure Seizures CVA MDC 4 - Answer Diseases and disorders of the respiratory system What can a PE be made of? - Answer Fat, air, blood clot, or tumor cells
Time frame that distinguishes acute from chronic PE - Answer No time frame. It is based on provider documentation. VQ scans for PEs - Answer Are less sensitive to microemboli and often result in false negatives Most accurate imaging needed for PEs - Answer Pulmonary arteriogram Risk factors for PEs - Answer Surgery Long periods of inactivity Injury to veins Pregnancy Estrogen therapy Heart disease Obesity Stroke Deep vein thrombosis A-fib Signs symptoms of PEs - Answer Restlessness SOB Anxiety Tachycardia Pleuritic Chest pain Light-headedness Fainting Seizures (hypoxia-related) Cyanosis Hemoptysis Pink foamy sputum
