Data Quality ✔️✔️Ensuring the accuracy and completeness of an organization's data
Information Management ✔️✔️Supports decision making
According to Medicare requirements, a history and physical must: ✔️✔️Be completed for each
patient no more than 30 days before or 24 hours after admission or registration, but prior to
surgery
Revenue Code ✔️✔️Revenue codes are 4-digit numbers that are used on hospital bills to tell
the insurance companies either where the patient was when they received treatment, or what type
of item a patient might have received as a patient. A medical claim will not be paid if this is
missing from a bill. The revenue code tells an insurance company whether the procedure was
performed in the emergency room, operating room or another department.
PSI ✔️✔️The Patient Safety Indicators (PSIs) provide information on potentially avoidable
safety events that represent opportunities for improvement in the delivery of care. More
specifically, they focus on potential in-hospital complications and adverse events following
surgeries, procedures, and childbirth.
,The UHDDS definition of principal diagnosis does not apply to the coding of outpatient
encounters because ✔️✔️Short duration of the evaluation does not allow enough time to make
an "after study" determination
The UHDDS definition of principal diagnosis does not apply in the: ✔️✔️Provider Office
(Outpatient Services)
UHDDS - Uniform Hospital Discharge Data Set ✔️✔️A defined set of data that give a
minimum description of a hospital episode or admission; recommended upon discharge for all
hospital stays reimbursed under Medicare and Medicaid.
APC Codes (Ambulatory Payment Classifications) ✔️✔️APCs or Ambulatory Payment
Classifications are the United States government's method of paying for facility outpatient
services for the Medicare (United States) program. APCs are an outpatient prospective payment
system applicable only to hospitals.
MS-DRGs - Medicare Severity Diagnosis Related Groups ✔️✔️Defined by a particular set of
patient attributes which include principal diagnosis, specific secondary diagnoses, procedures,
sex and discharge status.
What is difference between a DRG and a MS-DRG? ✔️✔️Medicare Severity-Diagnosis
Related Groups (MS-DRG) is a severity-based system. So the patient might have five CCs, but
, will only be assigned to the DRG based on one CC. In contrast to MS-DRGs, full severity-
adjusted systems do not just look at one diagnosis.
All Patients Refined Diagnosis Related Groups (APR DRG) ✔️✔️a classification system that
classifies patients according to their reason of admission, severity of illness and risk of mortality.
All APR DRGs have 4 severity levels.
All Patient DRGs (AP-DRGs) ✔️✔️an expansion of the basic DRGs to be more representative
of Non-Medicare populations such as pediatric patients. The All Patient Refined DRGs (APR-
DRG) incorporate severity of illness subclasses into the AP-DRGs.
Prolonged Pregnancy ✔️✔️42 weeks +
Cardiac Lead - use of a guide wire ✔️✔️percutaneous approach
CPT - an endoscopy that is undertaken to the level of the midtransverse colon
✔️✔️colonoscopy
A patient admitted with pneumococcal pneumonia and severe pneumococcal sepsis
✔️✔️Assign codes for sepsis, pneumonia and severe sepsis
Code three codes
A code for the systemic infection is sequenced first followed by the code for the localized
infection and a code from category R65.2