CDIP ALL QUESTIONS AND ANSWERS SET A+
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the denial rate for DRG 682?
a.0 percent
b.25 percent
c.50 percent
d.100 percent - ✔✔d The denial rate for DRG 682 is 100%: (10/10)* 100 = 100%
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the denial rate for DRG 637?
a.0 percent
b.25 percent
c.50 percent
d.100 percent - ✔✔b The denial impact of DRG 637 is 25%: (5/20)*100 = 25%
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the financial impact for DRG 682?:
a.$11,414.40
b.$18,232.80
c.$6,818.40
d.$5,230.00 - ✔✔c The financial impact for DRG 682 is
$6818.40:($1200*1.5194*10=18232.80) - ($1200*0.9512*10=1141440)= $6818.40
, ✔✔Using the admission criteria provided, determine if the following patient meets the
severity of illness and intensity of service criteria for admission.
Severity of IllnessIntensity of ServicePersistent feverInpatient-approved
surgery/procedure within 24 hours of admissionActive bleedingIntravenous medications
or fluid replacementWound dehiscenceVital signs every 2 hours or more often
Sue presents with vaginal bleeding. An ultrasound showed a missed abortion, so she is
being admitted to the outpatient surgery suite for a D&C.
a.The patient does not meet both severity of illness and intensity of service criteria.
b.The patient meets both severity of illness and intensity of service criteria.
c.The patient meets intensity of service criteria but not severity of illness.
d.The patient meets severity of illness criteria but not intensity of service. - ✔✔d The
patient meets the severity of illness with the vaginal bleeding but does not meet
intensity of service because the surgery is not being performed as an inpatient. She
would not meet the admission criteria provided (Shaw and Elliott 2012, 113, 120).
✔✔SURGICAL HIERARCHY
MDC 03 Diseases & Disorders of the Ear, Nose, Mouth & Throat
129-130 Major Head and Neck Procedures
131-132 Cranial/Facial Procedures
133-134 Other Ear, Nose, Mouth and Throat Procedures
135-136 Sinus and Mastoid Procedures
137-138 Mouth Procedures
Based on the surgical hierarchy above, a patient that has which procedure in the
example is lowest in the hierarchy
a.Major Head and Neck Procedures
b.Sinus and Mastoid Procedures
c.Cranial/Facial Procedures
d.None of the above - ✔✔b Sinus and Mastoid Procedures are the lowest in the
hierarchy. Since patients can have multiple procedures related to their principal
diagnosis during a particular hospital stay, and a patient can be assigned to only one
surgical class, the surgical classes in each MDC are defined in a hierarchical order.
Patients with multiple procedures are assigned to the highest surgical class in the
hierarchy to which one of the procedures is assigned (CMS 2016a).
✔✔SURGICAL HIERARCHY
MDC 03 Diseases & Disorders of the Ear, Nose, Mouth & Throat
129-130 Major Head and Neck Procedures
131-132 Cranial/Facial Procedures
133-134 Other Ear, Nose, Mouth and Throat Procedures
135-136 Sinus and Mastoid Procedures
137-138 Mouth Procedures
Based on the surgical hierarchy above, a patient that has which procedure in the
example is highest in the hierarchy
a.Major Head and Neck Procedures
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the denial rate for DRG 682?
a.0 percent
b.25 percent
c.50 percent
d.100 percent - ✔✔d The denial rate for DRG 682 is 100%: (10/10)* 100 = 100%
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the denial rate for DRG 637?
a.0 percent
b.25 percent
c.50 percent
d.100 percent - ✔✔b The denial impact of DRG 637 is 25%: (5/20)*100 = 25%
✔✔Billed DRGDRG Wt.Revised DRGDRG Wt.Total Agree with denialTotal
Denials682RENAL FAILURE W MCC1.5194683RENAL FAILURE W
CC0.95121010637DIABETES W MCC1.3944638DIABETES W CC0.8261520
What is the financial impact for DRG 682?:
a.$11,414.40
b.$18,232.80
c.$6,818.40
d.$5,230.00 - ✔✔c The financial impact for DRG 682 is
$6818.40:($1200*1.5194*10=18232.80) - ($1200*0.9512*10=1141440)= $6818.40
, ✔✔Using the admission criteria provided, determine if the following patient meets the
severity of illness and intensity of service criteria for admission.
Severity of IllnessIntensity of ServicePersistent feverInpatient-approved
surgery/procedure within 24 hours of admissionActive bleedingIntravenous medications
or fluid replacementWound dehiscenceVital signs every 2 hours or more often
Sue presents with vaginal bleeding. An ultrasound showed a missed abortion, so she is
being admitted to the outpatient surgery suite for a D&C.
a.The patient does not meet both severity of illness and intensity of service criteria.
b.The patient meets both severity of illness and intensity of service criteria.
c.The patient meets intensity of service criteria but not severity of illness.
d.The patient meets severity of illness criteria but not intensity of service. - ✔✔d The
patient meets the severity of illness with the vaginal bleeding but does not meet
intensity of service because the surgery is not being performed as an inpatient. She
would not meet the admission criteria provided (Shaw and Elliott 2012, 113, 120).
✔✔SURGICAL HIERARCHY
MDC 03 Diseases & Disorders of the Ear, Nose, Mouth & Throat
129-130 Major Head and Neck Procedures
131-132 Cranial/Facial Procedures
133-134 Other Ear, Nose, Mouth and Throat Procedures
135-136 Sinus and Mastoid Procedures
137-138 Mouth Procedures
Based on the surgical hierarchy above, a patient that has which procedure in the
example is lowest in the hierarchy
a.Major Head and Neck Procedures
b.Sinus and Mastoid Procedures
c.Cranial/Facial Procedures
d.None of the above - ✔✔b Sinus and Mastoid Procedures are the lowest in the
hierarchy. Since patients can have multiple procedures related to their principal
diagnosis during a particular hospital stay, and a patient can be assigned to only one
surgical class, the surgical classes in each MDC are defined in a hierarchical order.
Patients with multiple procedures are assigned to the highest surgical class in the
hierarchy to which one of the procedures is assigned (CMS 2016a).
✔✔SURGICAL HIERARCHY
MDC 03 Diseases & Disorders of the Ear, Nose, Mouth & Throat
129-130 Major Head and Neck Procedures
131-132 Cranial/Facial Procedures
133-134 Other Ear, Nose, Mouth and Throat Procedures
135-136 Sinus and Mastoid Procedures
137-138 Mouth Procedures
Based on the surgical hierarchy above, a patient that has which procedure in the
example is highest in the hierarchy
a.Major Head and Neck Procedures
