AHIMA CCS Exam Prep
CPT defines a separate procedure as - ANSProcedure considered an integral part of a more
major service
No combination code available - ANSUse separate codes for hypertension and acute renal
failure
Documentation from the nursing staff or other allied health professionals' notes can be used to
provide specificity for code assignment for which of the following diagnoses? - ANSBody Mass
Index (BMI)
POA Indicator - Y - ANSY-Yes, present at the time of inpatient admission
POA Indicator - N - ANSN-No, not present at the time of inpatient admission
POA Indicator - U - ANSU-Unknown, documentation is insufficient to determine if condition is
present on admission and you cannot speak to the physician to figure it out
POA Indicator - W - ANSW-Clinically undetermined, provider is unable to clinically determine
whether condition was present on admission or not
POA Indicator - E - ANSE-Exempt, unreported/not used, some facilities will leave these blank,
others will use the letter "E"
Present on Admission Indicator (POA) - ANSA Present On Admission (POA) indicator is
required on all diagnosis codes for the inpatient setting except for admission. The indicator
should be reported for principal diagnosis codes, secondary diagnosis codes, Z-codes, and
External cause injury codes.
The use of the outpatient code editor (OCE) is designed to: - ANSIdentify incomplete and
incorrect claims
Medicare's identification of medically necessary services is outlined in: - ANSLocal Coverage
Determinations (LCDs)
Medically unlikely edits are used to identify: - ANSMaximum units of service for a HCPCS code
National Correct Coding Initiative (NCCI) Edits are released how often? - ANSQuarterly
In 2000, CMS issued the final rule on the outpatient prospective payment system (OPPS). The
final rule: - ANSDivided outpatient services into fixed payment groups
, Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are similar in
that they are both: - ANSProspective payment systems
What are APCs? - ANSAPCs or "Ambulatory Payment Classifications" are the government's
method of paying facilities for outpatient services for the Medicare program.
How do APCs work? - ANSThe payments are calculated by multiplying the APCs relative weight
by the OPPS conversion factor and then there is a minor adjustment for geographic location.
APC Status Indicator - C - ANSInpatient Procedures, not paid under OPPS
APC Status Indicator - N - ANSItems and Services Packaged into APC Rates
APC Status Indicator - S - ANSSignificant Procedure, Not Discounted When Multiple
APC Status Indicator - T - ANSSignificant Procedure, Multiple Reduction Applies
APC Status Indicator - V - ANSClinic or Emergency Department Visit
APC Status Indicator - X - ANSAncillary Services
APC Status Indicator - Y - ANSNon-Implantable Durable Medical Equipment
Medicare exerts control of provider reimbursement through adjustment of this component of the
resource-based relative value scale (RBRVS) - ANSConversion factor
The process of collecting data elements from a source document is known as: - ANSAbstracting
What piece of claims data from hospital A alerts a payer that the patient was transferred to
hospital B? - ANSDischarge disposition
Admission source code used to identify a patient admitted to the facility from home: -
ANSNon-Healthcare Facility
Admission source code used to identify a patient admitted to the facility from hospice care: -
ANSTransfer from hospice
When a patient is transferred from an acute care facility to a skilled nursing home facility, what
abstracted data element can impact the DRG assignment? - ANSDischarge disposition
A complication or comorbidity - ANSHypernatremia - A high concentration of sodium in the
blood. Hypernatremia most often occurs in people who don't drink enough water.
CPT defines a separate procedure as - ANSProcedure considered an integral part of a more
major service
No combination code available - ANSUse separate codes for hypertension and acute renal
failure
Documentation from the nursing staff or other allied health professionals' notes can be used to
provide specificity for code assignment for which of the following diagnoses? - ANSBody Mass
Index (BMI)
POA Indicator - Y - ANSY-Yes, present at the time of inpatient admission
POA Indicator - N - ANSN-No, not present at the time of inpatient admission
POA Indicator - U - ANSU-Unknown, documentation is insufficient to determine if condition is
present on admission and you cannot speak to the physician to figure it out
POA Indicator - W - ANSW-Clinically undetermined, provider is unable to clinically determine
whether condition was present on admission or not
POA Indicator - E - ANSE-Exempt, unreported/not used, some facilities will leave these blank,
others will use the letter "E"
Present on Admission Indicator (POA) - ANSA Present On Admission (POA) indicator is
required on all diagnosis codes for the inpatient setting except for admission. The indicator
should be reported for principal diagnosis codes, secondary diagnosis codes, Z-codes, and
External cause injury codes.
The use of the outpatient code editor (OCE) is designed to: - ANSIdentify incomplete and
incorrect claims
Medicare's identification of medically necessary services is outlined in: - ANSLocal Coverage
Determinations (LCDs)
Medically unlikely edits are used to identify: - ANSMaximum units of service for a HCPCS code
National Correct Coding Initiative (NCCI) Edits are released how often? - ANSQuarterly
In 2000, CMS issued the final rule on the outpatient prospective payment system (OPPS). The
final rule: - ANSDivided outpatient services into fixed payment groups
, Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are similar in
that they are both: - ANSProspective payment systems
What are APCs? - ANSAPCs or "Ambulatory Payment Classifications" are the government's
method of paying facilities for outpatient services for the Medicare program.
How do APCs work? - ANSThe payments are calculated by multiplying the APCs relative weight
by the OPPS conversion factor and then there is a minor adjustment for geographic location.
APC Status Indicator - C - ANSInpatient Procedures, not paid under OPPS
APC Status Indicator - N - ANSItems and Services Packaged into APC Rates
APC Status Indicator - S - ANSSignificant Procedure, Not Discounted When Multiple
APC Status Indicator - T - ANSSignificant Procedure, Multiple Reduction Applies
APC Status Indicator - V - ANSClinic or Emergency Department Visit
APC Status Indicator - X - ANSAncillary Services
APC Status Indicator - Y - ANSNon-Implantable Durable Medical Equipment
Medicare exerts control of provider reimbursement through adjustment of this component of the
resource-based relative value scale (RBRVS) - ANSConversion factor
The process of collecting data elements from a source document is known as: - ANSAbstracting
What piece of claims data from hospital A alerts a payer that the patient was transferred to
hospital B? - ANSDischarge disposition
Admission source code used to identify a patient admitted to the facility from home: -
ANSNon-Healthcare Facility
Admission source code used to identify a patient admitted to the facility from hospice care: -
ANSTransfer from hospice
When a patient is transferred from an acute care facility to a skilled nursing home facility, what
abstracted data element can impact the DRG assignment? - ANSDischarge disposition
A complication or comorbidity - ANSHypernatremia - A high concentration of sodium in the
blood. Hypernatremia most often occurs in people who don't drink enough water.
