CCS EXAM PREPARATION, DOMAIN 3: PROVIDER QUERIES QUESTIONS AND CORRECT VERIFIED ANSWERS

CCS EXAM PREPARATION, DOMAIN 3:
PROVIDER QUERIES QUESTIONS AND
CORRECT VERIFIED ANSWERS
TheA2mostA2challengingA2typeA2ofA2providerA2queryA2isA2issuedA2for:
A.A2DeterminingA2causeA2andA2effect
B.A2EstablishingA2clinicalA2validation
C.A2ResolvingA2documentationA2conflict
D.A2ClarifyingA2acuityA2orA2specificityA2-A2Ans--A2B.A2EstablishingA2clinicalA2validation

TheA2mostA2challengingA2queryA2typeA2isA2forA2clinicalA2validationA2andA2mayA2bestA2beA2a
ddressedA2byA2clinicalA2documentationA2specialistsA2(AHIMAA22019c).

AA2patientA2wasA2admittedA2withA2TypeA21A2diabetesA2withA2proliferativeA2diabeticA2retinop
athyA2toA2haveA2surgeryA2forA2tractionA2retinalA2detachmentA2forA2macularA2edema.A2Whic
hA2ofA2theA2followingA2questionsA2wouldA2makeA2aA2compliantA2queryA2forA2thisA2patient?

A.A2WasA2theA2procedureA2performedA2onA2theA2leftA2orA2rightA2eyeA2orA2bilateralA2eyes?
B.A2IsA2theA2retinopathyA2aA2complication?
C.A2WillA2youA2documentA2useA2ofA2insulinA2forA2thisA2patient?
D.A2IsA2thereA2aA2comorbidA2conditionA2thatA2canA2beA2documentedA2toA2increaseA2theA2re
imbursement?A2-A2Ans--
A2A.A2WasA2theA2procedureA2performedA2onA2theA2leftA2orA2rightA2eyeA2orA2bilateralA2eyes?


QueriesA2cannotA2beA2leading,A2includeA2impactA2onA2reimbursement,A2orA2directA2aA2phy
sicianA2toA2includeA2aA2specificA2diagnosis.A2Therefore,A2clarificationA2ofA2whichA2eyeA2the
A2procedureA2isA2onA2isA2theA2onlyA2compliantA2queryA2questionA2(AHIMAA22019c).


AA2patientA2hasA2findingsA2suggestiveA2ofA2chronicA2obstructiveA2pulmonaryA2diseaseA2(C
OPD)A2onA2chestA2x-ray.A2TheA2attendingA2physicianA2mentionsA2theA2x-
rayA2findingA2inA2oneA2progressA2noteA2butA2noA2medication,A2treatment,A2orA2furtherA2eval
uationA2isA2provided.A2TheA2codingA2professionalA2should:
A.A2QueryA2theA2attendingA2physicianA2regardingA2theA2x-rayA2finding.
B.A2CodeA2theA2conditionA2becauseA2theA2documentationA2reflectsA2it.
C.A2QuestionA2theA2radiologistA2regardingA2whetherA2toA2codeA2thisA2condition.
D.A2UseA2aA2codeA2fromA2abnormalA2findingsA2toA2reflectA2theA2condition.A2-A2Ans--
A2A.A2QueryA2theA2attendingA2physicianA2regardingA2theA2x-rayA2finding.


AA256-year-oldA2womanA2isA2admittedA2toA2anA2acute-
careA2facilityA2fromA2aA2skilledA2nursingA2facility.A2TheA2patientA2hasA2multipleA2sclerosisA2
andA2hypertension.A2DuringA2theA2courseA2ofA2hospitalization,A2aA2decubitusA2ulcerA2isA2fo
undA2andA2debridedA2atA2theA2bedsideA2byA2aA2physician.A2ThereA2isA2noA2typedA2operativ
eA2reportA2andA2noA2pathologyA2report.A2TheA2codingA2professionalA2should:

, A.A2UseA2anA2excisionalA2debridementA2codeA2asA2theseA2chartsA2areA2rarelyA2reviewedA2t
oA2verifyA2theA2excisionalA2debridement.
B.A2CodeA2withA2aA2non-excisionalA2debridementA2procedureA2code.
C.A2QueryA2theA2healthcareA2providerA2whoA2performedA2theA2procedureA2toA2determineA2
ifA2theA2debridementA2wasA2excisional.
D.A2EliminateA2theA2procedureA2codeA2allA2together.A2-A2Ans--
A2C.A2QueryA2theA2healthcareA2providerA2whoA2performedA2theA2procedureA2toA2determine
A2ifA2theA2debridementA2wasA2excisional.


ExcisionalA2debridementA2canA2beA2performedA2inA2theA2operatingA2room,A2theA2emergen
cyA2department,A2orA2atA2theA2bedside.A2CodingA2professionalsA2areA2encouragedA2toA2wo
rkA2withA2theA2physicianA2andA2otherA2healthcareA2providersA2toA2ensureA2thatA2theA2docu
mentationA2inA2theA2healthA2recordA2isA2veryA2specificA2regardingA2theA2typeA2ofA2debride
mentA2performed.A2IfA2thereA2isA2anyA2questionA2asA2toA2whetherA2theA2debridementA2isA2e
xcisionalA2orA2non-
excisional,A2theA2providerA2shouldA2beA2queriedA2forA2clarificationA2(SchraffenbergerA2and
A2PalkieA22022,A2426-A2427).


WhenA2creatingA2compliantA2queriesA2codingA2professionalsA2should:
A.A2QueryA2onceA2withoutA2furtherA2followA2up
B.A2QueryA2multipleA2timesA2untilA2theA2desiredA2diagnosisA2isA2provided
C.A2QueryA2onceA2withA2additionalA2followA2upA2ifA2necessary
D.A2QueryA2unlimitedA2timesA2untilA2everyA2discrepancyA2isA2resolvedA2-A2Ans--
A2C.A2QueryA2onceA2withA2additionalA2followA2upA2ifA2necessaryA2


AHIMA'sA2GuidelinesA2forA2AchievingA2aA2CompliantA2QueryA2PracticeA2instructA2thatA2ad
ditionalA2queriesA2mayA2beA2necessaryA2basedA2onA2theA2informationA2providedA2inA2theA2
firstA2queryA2response.A2ItA2isA2permissibleA2toA2issueA2anotherA2queryA2inA2thatA2circumst
anceA2(AHIMAA22019c).

WhenA2anA2inpatientA2hasA2hadA2multipleA2testsA2toA2evaluateA2anA2abnormalA2findingA2bu
tA2noA2definitiveA2diagnosisA2hasA2beenA2documented,A2theA2codingA2professionalA2should
:
A.A2AssignA2aA2codeA2forA2theA2abnormalA2findingA2withoutA2confirmingA2withA2theA2physici
an
B.A2NotA2assignA2anyA2codeA2forA2theA2abnormalA2finding
C.A2AssignA2aA2diagnosisA2codeA2basedA2onA2theA2codingA2professional'sA2judgment
D.A2QueryA2theA2physicianA2regardingA2whetherA2aA2diagnosisA2shouldA2beA2assignedA2or
A2notA2-A2Ans--
A2D.A2QueryA2theA2physicianA2regardingA2whetherA2aA2diagnosisA2shouldA2beA2assignedA2
orA2not

QueryA2theA2physicianA2regardingA2whetherA2aA2diagnosisA2shouldA2beA2assignedA2orA2no
t.A2ItA2isA2notA2withinA2theA2codingA2professional'sA2scopeA2ofA2practiceA2toA2diagnoseA2aA2
conditionA2(CMSA22021a,A2SectionA2III,A2104-105).