CCS study set 2023 with complete solutions

What factors of the APR-DRG system allow for capturing the extent of the patient's conditions and expected loss of life while an inpatient? a. Severity of illness and risk of mortality b. Severity of diagnosis and risk of morbidity c. Complications and comorbidities d. Hospital acquired conditions and present on admission - Answer- a. Which of the following heart failure codes is considered an MCC? a. I50.9 Heart failure, unspecified b. I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure c. I50.32 Chronic diastolic (congestive) heart failure d. I50.20 Unspecified systolic (congestive) heart failure - Answer- b. Medically unlikely edits are used to identify: a. Pairs of procedure codes that should not be billed together b. Maximum units of services for a HCPCS code c. Diagnoses that don't meet medical necessity d. Procedure and gender discrepancies - Answer- b. A patient was admitted to the hospital with unstable angina and congestive heart failure. The unstable angina is treated with nitrates, and intravenous Lasix is given to manage the heart failure. What is the appropriate coding action? a. Assign only the code for the congestive heart failure b. Assign the codes for the unstable angina and CHF, sequence either 1st c. Query the physician about which diagnosis to code d. Assign only the code for the unstable angina - Answer- b. A 64 year old female was discharged with the final diagnosis of acute renal failure & hypertension. What coding guidelines applies? a. Use combination code of hypertension & chronic renal failure b. Use separate codes for hypertension & chronic renal failure c. Use separate codes for hypertension & acute renal failure d. Use combination code for hypertension & acute renal failure - Answer- c. If a patient undergoes an open biopsy for a frozen section immediately before the definitive surgery, how should this be coded with ICD-10-PCS codes? a. Definitive surgery only b. Open biopsy only c. Exploratory surgery d. Open biopsy and definitive surgery - Answer- d. Medicare's identification of medically necessary services is outlined in: a. Program transmittals b. Claims processing manual c. Local coverage determinations d. National Correct Coding Intitiative - Answer- c. According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon would be coded as a: a. Proctosigmoidoscopy b. Sigmoidoscopy c. Colonoscopy d. Proctoscopy - Answer- c. National Correct Coding Initiative (NCCI)Edits are released how often? a. Monthly b. Quarterly c. Semi-annually d. Annually - Answer- b. Medical exerts control of provider reimbursement through adjustment of this component of the resource-based relative value scale (RBRVS). a. Conversion Factor b. Geographic adjustment c. Relative value unit d. Practice expense - Answer- a. Carcinoma of multiple overlapping sites of the bladder. Diagnostic cystoscopy and transurethral fulguration of bladder lesions (1.9cm, 6.0cm) was completed. A biopsy was taken of a lesion in the lateral wall. What modifier should be added to the biopsy procedure code? a. 50, bilateral procedure b. 51, multiple procedures c. 59, distinct procedural services d. 99, multiple modifiers - Answer- c. A patient is admitted for a cerebral infarction. Residual effects at discharge include aphasia and dysphagia. The patient developed acute diastolic congestive heart failure while admitted and was treated with Lasix in addition to being given Betapace for his long-standing hypertension. Which condition is considered a major complication comorbidity? a. Cerebral infarction b. Acute diastolic congestive heart failure c. Hypertension d. Dysphagia - Answer- b. Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What conditions should have codes assigned? - Answer- c. O60.14X1, O60.14X2, O30.003, Z3A.30, Z37.2 A code for preterm labor & delivery is assigned for each fetus since both babies were born preterm as noted in Coding Clinic. Additionally, a code from category O30, multiple gestations, must be assigned. When a patient is transferred from an acute-care facility to a skilled nursing facility, what abstracted data element can impact the DRG assignment? a. Admission source b. Patient's blood type c. Discharge dispostion d. Patient's age - Answer- c. A 30 year old patient with acquired immunodeficiency syndrome (AIDS), asymptomatic at this time, is admitted for repair of inguinal hernia. The procedure performed was a right indirect inguinal herniorrhaphy via open approach. What are the correct codes and sequencing for this scenario> - Answer- K40.90, B20, 0YQ50ZZ B20 is sequenced as a secondary diagnosis code because inguinal hernia is a condition unrelated to AIDS. A 34 year old woman delivered a live-born, term baby boy (39 wks) with macrosomia. She had a hemorrhage following a low forceps delivery with episiotomy but prior to expulsion of the placenta. What are the appropriate codes and sequencing for this record? - Answer- O67.9, O36.63X), Z37.0, Z3A.39, 10D07Z3, 0W8NXZZ The patient had a hemorrhage that occurred after delivery but before the expulsion of the placenta. This hemorrhage, by definition, occurred in the 3rd stage of labor. conversion factor - Answer- Medicare method for directly controlling provider reimbursement. It is a constant that is applied across the board for all providers Geographic adjustment factor (GAF) - Answer- Adjustment to the national standardized Medicare fee schedule relative value components used to account for differences in the cost of practicing medicine in different geographic areas of the country Relative Value Unit (RVU) - Answer- Measures of value used in determining Medicare reimbursement formulas, including the difficulty level of the work involved, office overhead expenses, and malpractice risk for the given service or procedure. Practice expense (PE) - Answer- Element of the relative value unit (RVU) that covers the physician's overhead costs, such as employee wages, office rent, supplies, and equipment. There are two types, facility and non-facility A laparoscopic tubal ligation is completed. What is t