Solutions.
CPT defines a separate procedure as - Correct answer Procedure considered an
integral part of a more major service
No combination code available - Correct answer Use 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? -
Correct answer Body Mass Index (BMI)
POA Indicator - Y - Correct answer Y-Yes, present at the time of inpatient admission
POA Indicator - N - Correct answer N-No, not present at the time of inpatient admission
POA Indicator - U - Correct answer U-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 - Correct answer W-Clinically undetermined, provider is unable to
clinically determine whether condition was present on admission or not
POA Indicator - E - Correct answer E-Exempt, unreported/not used, some facilities will
leave these blank, others will use the letter "E"
Present on Admission Indicator (POA) - Correct answer A 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: - Correct answer Identify
incomplete and incorrect claims
Medicare's identification of medically necessary services is outlined in: - Correct answer
Local Coverage Determinations (LCDs)
Medically unlikely edits are used to identify: - Correct answer Maximum units of service
for a HCPCS code
National Correct Coding Initiative (NCCI) Edits are released how often? - Correct
answer quarterly
, In 2000, CMS issued the final rule on the outpatient prospective payment system
(OPPS). The final rule: - Correct answer Divided outpatient services into fixed payment
groups
Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are
similar in that they are both: - Correct answer Prospective payment systems
What are APCs? - Correct answer APCs or "Ambulatory Payment Classifications" are
the government's method of paying facilities for outpatient services for the Medicare
program.
How do APCs work? - Correct answer the 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 - Correct answer Inpatient Procedures, not paid under OPPS
APC Status Indicator - N - Correct answer Items and Services Packaged into APC
Rates
APC Status Indicator - S - Correct answer Significant Procedure, Not Discounted When
Multiple
APC Status Indicator - T - Correct answer Significant Procedure, Multiple Reduction
Applies
APC Status Indicator - V - Correct answer Clinic or Emergency Department Visit
APC Status Indicator - X - Correct answer Ancillary Services
APC Status Indicator - Y - Correct answer Non-Implantable Durable Medical Equipment
Medicare exerts control of provider reimbursement through adjustment of this
component of the resource-based relative value scale (RBRVS) - Correct answer
Conversion factor
The process of collecting data elements from a source document is known as: - Correct
answer abstracting
What piece of claims data from hospital an alerts a payer that the patient was
transferred to hospital B? - Correct answer Discharge disposition
Admission source code used to identify a patient admitted to the facility from home: -
Correct answer Non-Healthcare Facility