CCDS EXAM
A patient has documented ESRD and is placed in the ICU for "fluid
overload". He receives dialysis daily and is a candidate for a kidney
transplant. There is a match, and the patient is transferred to another
hospital for the transplant. The principal diagnosis at the time of
discharge from the first facility is:
A. Fluid overload
B. ESRD
C. Admit for hemodialysis
D. Kidney transplant - ANSWERS-A. Fluid overload
A patient is admitted from a nursing facility with pneumonia, pleural
effusion, encephalopathy, tachypnea, and tachycardia. Two days after
admission, the patient is intubated due to respiratory distress and then
expires. Which of the following query opportunities would most
impact the ROM profile of this case?
A. Aspiration pneumonia
B. Acute CHF
C. COPD exacerbation
D. Acute respiratory failure - ANSWERS-D. Acute respiratory failure
,Conditions that are high cost and/ or high volume and could have
been reasonably prevented through application of evidence-based
clinical guidelines are identified as:
A. Present on admission diagnoses
B. Hospital-acquired conditions
C. Patient safety indicators
D. Hierarchal conditions - ANSWERS-B. Hospital-acquired
conditions
A patient with a history of CKD stage 2 is admitted for renal failure.
The patient receives IV fluids at 100 mL/hr over the course of the
admission and has the following lab results:
........................Adm.....Day1.....Day2.....Day3.....Day4
Creatinine....2.7.........2.5.........2.1............1.9...........1.5
BUN............... 58..........44.........38............27...........25
Which of the following queries would be appropriate for these clinical
indicators?
A. Acute glomerular nephritis
B. Acute kidney injury
C. Acute tubular necrosis
D. Pre-renal azotemia - ANSWERS-C. Acute tubular necrosis
,If the documentation is unclear as to whether a condition is in
remission or resolved, what should a concurrent reviewer do?
A. Query the physician to clarify the record
B. Code the therapy used to treat the condition
C: Use a code for the type of cancer
D. Use a personal history code - ANSWERS-A. Query the physician
to clarify the record
Which of the following elements does NOT affect Medicare
reimbursement?
A. A comorbid condition
B. The patient's length of stay
C. The principal diagnosis
D. A surgical procedure - ANSWERS-B. The patient's length of stay
What must be present in a query to provide context as to why the
query was initiated?
A. Clinical indicators appropriate to the patient
B. Patient identifiers
C. The choice of "unable to determine"
, D. A listing of all the documents - ANSWERS-A. Clinical indicators
appropriate to the patient
Why can coding for neoplasms be difficult?
A. The physician's documented reason for admission may not meet
criteria for reporting as the principal diagnosis due to sequencing
rules in the Official Guidelines for Coding and Reporting
B. Physicians frequently do not provide enough specificity in their
documentation when it comes to neoplasm and cancer treatments
C. The Official Guidelines for Coding and Reporting have changed
multiple times
D. The physician's documentation is not usually specific enough to
determine the type of malignancy - ANSWERS-A. The physician's
documented reason for admission may not meet criteria for reporting
as the principal diagnosis due to sequencing rules in the Official
Guidelines for Coding and Reporting
A patient is admitted from a skilled nurse facility with HCAP. The
wound care nurse documents a pressure ulcer as "stage 3 pressure
ulcer of the left hip." The H&P indicates a wound on the buttock. The
CDI specialist should:
A. Assign the appropriate ICD-10-CM code for stage 3 pressure ulcer
of left hip
B. Query the physician for the etiology and location of the ulcer
C. Query the wound care nurse for present on admission status
A patient has documented ESRD and is placed in the ICU for "fluid
overload". He receives dialysis daily and is a candidate for a kidney
transplant. There is a match, and the patient is transferred to another
hospital for the transplant. The principal diagnosis at the time of
discharge from the first facility is:
A. Fluid overload
B. ESRD
C. Admit for hemodialysis
D. Kidney transplant - ANSWERS-A. Fluid overload
A patient is admitted from a nursing facility with pneumonia, pleural
effusion, encephalopathy, tachypnea, and tachycardia. Two days after
admission, the patient is intubated due to respiratory distress and then
expires. Which of the following query opportunities would most
impact the ROM profile of this case?
A. Aspiration pneumonia
B. Acute CHF
C. COPD exacerbation
D. Acute respiratory failure - ANSWERS-D. Acute respiratory failure
,Conditions that are high cost and/ or high volume and could have
been reasonably prevented through application of evidence-based
clinical guidelines are identified as:
A. Present on admission diagnoses
B. Hospital-acquired conditions
C. Patient safety indicators
D. Hierarchal conditions - ANSWERS-B. Hospital-acquired
conditions
A patient with a history of CKD stage 2 is admitted for renal failure.
The patient receives IV fluids at 100 mL/hr over the course of the
admission and has the following lab results:
........................Adm.....Day1.....Day2.....Day3.....Day4
Creatinine....2.7.........2.5.........2.1............1.9...........1.5
BUN............... 58..........44.........38............27...........25
Which of the following queries would be appropriate for these clinical
indicators?
A. Acute glomerular nephritis
B. Acute kidney injury
C. Acute tubular necrosis
D. Pre-renal azotemia - ANSWERS-C. Acute tubular necrosis
,If the documentation is unclear as to whether a condition is in
remission or resolved, what should a concurrent reviewer do?
A. Query the physician to clarify the record
B. Code the therapy used to treat the condition
C: Use a code for the type of cancer
D. Use a personal history code - ANSWERS-A. Query the physician
to clarify the record
Which of the following elements does NOT affect Medicare
reimbursement?
A. A comorbid condition
B. The patient's length of stay
C. The principal diagnosis
D. A surgical procedure - ANSWERS-B. The patient's length of stay
What must be present in a query to provide context as to why the
query was initiated?
A. Clinical indicators appropriate to the patient
B. Patient identifiers
C. The choice of "unable to determine"
, D. A listing of all the documents - ANSWERS-A. Clinical indicators
appropriate to the patient
Why can coding for neoplasms be difficult?
A. The physician's documented reason for admission may not meet
criteria for reporting as the principal diagnosis due to sequencing
rules in the Official Guidelines for Coding and Reporting
B. Physicians frequently do not provide enough specificity in their
documentation when it comes to neoplasm and cancer treatments
C. The Official Guidelines for Coding and Reporting have changed
multiple times
D. The physician's documentation is not usually specific enough to
determine the type of malignancy - ANSWERS-A. The physician's
documented reason for admission may not meet criteria for reporting
as the principal diagnosis due to sequencing rules in the Official
Guidelines for Coding and Reporting
A patient is admitted from a skilled nurse facility with HCAP. The
wound care nurse documents a pressure ulcer as "stage 3 pressure
ulcer of the left hip." The H&P indicates a wound on the buttock. The
CDI specialist should:
A. Assign the appropriate ICD-10-CM code for stage 3 pressure ulcer
of left hip
B. Query the physician for the etiology and location of the ulcer
C. Query the wound care nurse for present on admission status
