CCS EXAM STUDY QUESTIONS WITH
CORRECT ANSWERS
malicious software - Correct Answers -backdoor
A female patient is diagnosed with congestive heart failure. Which of the following will
increase the MS-DRG weight if present on admission?
Atrial fibrillation
Stage III pressure ulcer
Blood loss anemia
Coronary artery disease - Correct Answers -Stage III pressure ulcer
MS-DRG 291 (weight = 01.5010) for congestive heart failure with stage III pressure
ulcer would optimize the MS-DRG. MS-DRG 293 (weight = 0. 6756) is assigned for
congestive heart failure alone, with atrial fibrillation, with blood loss anemia, and with
coronary artery disease all remain the same (Medicare Grouper Version 29-10/11)
A 70-year-old patient was admitted with pneumonia. The history and physical
documented that the patient has a history of diabetes, hypertension, and migraine
headache about 10 years ago without recurrence. The patient was administered IV
antibiotics, metformin, and Altace during the hospitalization. Which conditions would be
reported at the time of discharge? - Correct Answers -Pneumonia, diabetes, and
hypertension
A patient is admitted for chest pain. The patient was stabilized and discharged. In a
subsequent admission, the patient was admitted as an outpatient for a left heart
catheterization, coronary arteriography using two catheters and left ventricular
angiography. The patient was found to have arteriosclerotic heart disease. The patient
has no history of cardiac surgery. The appropriate sequencing of ICD-9 and CPT codes
for the outpatient catheterization would be:
411.1-Intermediate coronary syndrome (unstable angina)
413.9- Other and unspecified angina pectoris
,414.00-Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01-Coronary atherosclerosis of native coronary artery
786.50-Chest pain, unspecified
93452-Left heart catheterization including intraprocedural injection(s) for left
ventriculography, imaging supervision and interpretation, when performed
93453-Combined right and left heart - Correct Answers -414.01, 93458
Code 414.01 is assigned to show coronary artery disease in a native coronary artery
and is used when a patient has coronary artery disease and no history of coronary
bypass graft (CABG) surgery (Schraffenberger 2012, 190-192). Code 93458 includes
intraprocedural injection(s) for left ventricular/left atrial angiography, imaging
supervision, and interpretation when performed (AMA CPT Professional Edition 2013,
Cardiac Catheterization Guidelines, 500-503).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse
colon would be coded as a - Correct Answers -colonoscopy
A chest x-ray done to evaluate a chronic cough revealed a asymptomatic compression
fracture of a lumbar vertebrae. No further evaluation was undertaken. The coder should:
Not assign a code for an acute condition but assign a code for chronic compression
fracture
Assign a code for pathologic lumbar compression fracture
Assign a code for acute traumatic vertebral fracture
Not assign a code for this condition - Correct Answers -Not assign a code for this
condition
Do not assign a code for this condition because this is a frequent condition in the
elderly, is asymptomatic, and there is no documentation of treating the condition so it
should not be coded (Brown 2012, 33).
A patient is admitted with hypotension due to dobutamine taken, administered, and
prescribed correctly. How should this be coded? - Correct Answers -Code 458.2,
Iatrogenic hypotension, should be assigned to describe this condition. This code should
be assigned when hypotension develops as a result of any type of medical care. Assign
code E941.2, Sympathomimetics (adrenergics), to indicate that it is an adverse effect of
the drug
,MS-DRG assignment is based on information that includes - Correct Answers -
Diagnoses (principal and secondary); Surgical procedures (principal and secondary;
Discharge disposition or status; Presence of major or other complications and
comorbidities (MCC or CC as secondary diagnosis)
The cancer registry can be used to - Correct Answers -undertake studies in addition to
reporting cases to a central registry
According to Medicare requirements, a history and physical must: - Correct Answers -
Be completed for each patient no more than 30 days before or 24 hours after admission
or registration, but prior to surgery
Multiple Ts - Correct Answers -Multiple surgical procedures with payment status
indicator T performed during the same operative session are discounted. The highest
weighted procedure is fully reimbursed and all procedures with payment status indicator
T are reimbursed at 50%.
These elements are used to determine the MS-DRG) MS-DRG assignment goes
through four steps: - Correct Answers -Pre-MDC assignments, MDC determination,
Medical/surgical determination, and refinement
If a patient has an excision of a malignant lesion of the skin, the CPT code is
determined by the body area from which the excision occurs and the - Correct Answers
-Diameter of the lesion as well as the margins excised as described in the operative
report
The operative report should be reviewed for the body part involved with the lesion. The
total size of the excised area, including margins, is needed for accurate coding. The
pathology report typically provides the specimen size rather than the lesion or excised
size. Because the specimen tends to shrink, this is not an accurate measurement
according to the intent of the code assignment
The case-mix index for the information provided above is:
MS-DRG Weight Number of Patients
MS-DRG 193, Simple pneumonia and pleurisy age >17 w/ CC;
WEIGHT 3.0; # of patients 10
MS-DRG 195, Simple pneumonia without MCC or CC
2.0; 10
MS-DRG 192, Chronic obstructive pulmonary disease w/o CC
1.0; 10 - Correct Answers -2.0
The case mix is defined as a methods of grouping patients. MS-DRGs are often used to
determine case mix in hospitals. The case-mix index is the average MS-DRG weight
based on the specific patient group and is determined by multiplying the DRG weights
, by the number of patients and then divided by the total number of patients: 30 + 20 + 10
= = 2.0
75-year-old woman is admitted to the hospital after tripping and falling at home. She
underwent an open reduction with internal fixation of the femur. Which of the following
would be important to capture in addition to diagnostic codes? - Correct Answers -E
codes for Cause of Injury, Place of Occurrence, Activity, and Status
External cause of injury codes are used to provide information about how an injury
occurred, the intent (intentional or unintentional), provide information about where the
injury occurred, and the status of the person at the time the injury occurred. In the case
of a person who seeks care for an injury or other health condition that resulted from an
activity, or when an activity contributed to the injury or health condition, activity codes
are used to describe the activity
During an ambulatory surgery visit for excision of a malignant melanoma of the right
forearm, the attending surgeon listed history of benign breast cyst, history of
hypertension currently on Tenormin, and a current hammer toe. Which conditions are to
be coded? - Correct Answers -Malignant melanoma of forearm, hypertension
Assign codes for malignant melanoma of forearm, hypertension. Code chronic
conditions if they affect the patient's treatment. The hypertension was being treated with
a current medication and for this reason the hypertension is coded
Chronic conditions must be _____ by physician - Correct Answers -This is an example
of a circumstance where the chronic condition must be verified. All secondary conditions
must meet the UHDDS definitions
Determining medical necessity for outpatient services includes all the following - Correct
Answers -Local coverage determinations (LCDs)
National coverage determinations (NCDs)
Diagnoses linked to procedures by claims-processing software tests ensuring that the
procedure is cross-referenced, or linked, correctly to an acceptable diagnosis code for
that service
the fee schedule and the current National Correct Coding Initiatives edits. Other
valuable resources are Medicare's Carrier Manual, Medicare's National Coverage
Determinations Manual, and local coverage determinations (LCDs)
A patient was admitted to the emergency department with chest pain, and was
diagnosed with aborted myocardial infarction with acute myocardial ischemia. There
was no prior cardiac surgery. The cardiac enzymes were normal. The appropriate
coding of the diagnosis for this case is: - Correct Answers -411.81 Acute coronary
occlusion without myocardial infarction
CORRECT ANSWERS
malicious software - Correct Answers -backdoor
A female patient is diagnosed with congestive heart failure. Which of the following will
increase the MS-DRG weight if present on admission?
Atrial fibrillation
Stage III pressure ulcer
Blood loss anemia
Coronary artery disease - Correct Answers -Stage III pressure ulcer
MS-DRG 291 (weight = 01.5010) for congestive heart failure with stage III pressure
ulcer would optimize the MS-DRG. MS-DRG 293 (weight = 0. 6756) is assigned for
congestive heart failure alone, with atrial fibrillation, with blood loss anemia, and with
coronary artery disease all remain the same (Medicare Grouper Version 29-10/11)
A 70-year-old patient was admitted with pneumonia. The history and physical
documented that the patient has a history of diabetes, hypertension, and migraine
headache about 10 years ago without recurrence. The patient was administered IV
antibiotics, metformin, and Altace during the hospitalization. Which conditions would be
reported at the time of discharge? - Correct Answers -Pneumonia, diabetes, and
hypertension
A patient is admitted for chest pain. The patient was stabilized and discharged. In a
subsequent admission, the patient was admitted as an outpatient for a left heart
catheterization, coronary arteriography using two catheters and left ventricular
angiography. The patient was found to have arteriosclerotic heart disease. The patient
has no history of cardiac surgery. The appropriate sequencing of ICD-9 and CPT codes
for the outpatient catheterization would be:
411.1-Intermediate coronary syndrome (unstable angina)
413.9- Other and unspecified angina pectoris
,414.00-Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01-Coronary atherosclerosis of native coronary artery
786.50-Chest pain, unspecified
93452-Left heart catheterization including intraprocedural injection(s) for left
ventriculography, imaging supervision and interpretation, when performed
93453-Combined right and left heart - Correct Answers -414.01, 93458
Code 414.01 is assigned to show coronary artery disease in a native coronary artery
and is used when a patient has coronary artery disease and no history of coronary
bypass graft (CABG) surgery (Schraffenberger 2012, 190-192). Code 93458 includes
intraprocedural injection(s) for left ventricular/left atrial angiography, imaging
supervision, and interpretation when performed (AMA CPT Professional Edition 2013,
Cardiac Catheterization Guidelines, 500-503).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse
colon would be coded as a - Correct Answers -colonoscopy
A chest x-ray done to evaluate a chronic cough revealed a asymptomatic compression
fracture of a lumbar vertebrae. No further evaluation was undertaken. The coder should:
Not assign a code for an acute condition but assign a code for chronic compression
fracture
Assign a code for pathologic lumbar compression fracture
Assign a code for acute traumatic vertebral fracture
Not assign a code for this condition - Correct Answers -Not assign a code for this
condition
Do not assign a code for this condition because this is a frequent condition in the
elderly, is asymptomatic, and there is no documentation of treating the condition so it
should not be coded (Brown 2012, 33).
A patient is admitted with hypotension due to dobutamine taken, administered, and
prescribed correctly. How should this be coded? - Correct Answers -Code 458.2,
Iatrogenic hypotension, should be assigned to describe this condition. This code should
be assigned when hypotension develops as a result of any type of medical care. Assign
code E941.2, Sympathomimetics (adrenergics), to indicate that it is an adverse effect of
the drug
,MS-DRG assignment is based on information that includes - Correct Answers -
Diagnoses (principal and secondary); Surgical procedures (principal and secondary;
Discharge disposition or status; Presence of major or other complications and
comorbidities (MCC or CC as secondary diagnosis)
The cancer registry can be used to - Correct Answers -undertake studies in addition to
reporting cases to a central registry
According to Medicare requirements, a history and physical must: - Correct Answers -
Be completed for each patient no more than 30 days before or 24 hours after admission
or registration, but prior to surgery
Multiple Ts - Correct Answers -Multiple surgical procedures with payment status
indicator T performed during the same operative session are discounted. The highest
weighted procedure is fully reimbursed and all procedures with payment status indicator
T are reimbursed at 50%.
These elements are used to determine the MS-DRG) MS-DRG assignment goes
through four steps: - Correct Answers -Pre-MDC assignments, MDC determination,
Medical/surgical determination, and refinement
If a patient has an excision of a malignant lesion of the skin, the CPT code is
determined by the body area from which the excision occurs and the - Correct Answers
-Diameter of the lesion as well as the margins excised as described in the operative
report
The operative report should be reviewed for the body part involved with the lesion. The
total size of the excised area, including margins, is needed for accurate coding. The
pathology report typically provides the specimen size rather than the lesion or excised
size. Because the specimen tends to shrink, this is not an accurate measurement
according to the intent of the code assignment
The case-mix index for the information provided above is:
MS-DRG Weight Number of Patients
MS-DRG 193, Simple pneumonia and pleurisy age >17 w/ CC;
WEIGHT 3.0; # of patients 10
MS-DRG 195, Simple pneumonia without MCC or CC
2.0; 10
MS-DRG 192, Chronic obstructive pulmonary disease w/o CC
1.0; 10 - Correct Answers -2.0
The case mix is defined as a methods of grouping patients. MS-DRGs are often used to
determine case mix in hospitals. The case-mix index is the average MS-DRG weight
based on the specific patient group and is determined by multiplying the DRG weights
, by the number of patients and then divided by the total number of patients: 30 + 20 + 10
= = 2.0
75-year-old woman is admitted to the hospital after tripping and falling at home. She
underwent an open reduction with internal fixation of the femur. Which of the following
would be important to capture in addition to diagnostic codes? - Correct Answers -E
codes for Cause of Injury, Place of Occurrence, Activity, and Status
External cause of injury codes are used to provide information about how an injury
occurred, the intent (intentional or unintentional), provide information about where the
injury occurred, and the status of the person at the time the injury occurred. In the case
of a person who seeks care for an injury or other health condition that resulted from an
activity, or when an activity contributed to the injury or health condition, activity codes
are used to describe the activity
During an ambulatory surgery visit for excision of a malignant melanoma of the right
forearm, the attending surgeon listed history of benign breast cyst, history of
hypertension currently on Tenormin, and a current hammer toe. Which conditions are to
be coded? - Correct Answers -Malignant melanoma of forearm, hypertension
Assign codes for malignant melanoma of forearm, hypertension. Code chronic
conditions if they affect the patient's treatment. The hypertension was being treated with
a current medication and for this reason the hypertension is coded
Chronic conditions must be _____ by physician - Correct Answers -This is an example
of a circumstance where the chronic condition must be verified. All secondary conditions
must meet the UHDDS definitions
Determining medical necessity for outpatient services includes all the following - Correct
Answers -Local coverage determinations (LCDs)
National coverage determinations (NCDs)
Diagnoses linked to procedures by claims-processing software tests ensuring that the
procedure is cross-referenced, or linked, correctly to an acceptable diagnosis code for
that service
the fee schedule and the current National Correct Coding Initiatives edits. Other
valuable resources are Medicare's Carrier Manual, Medicare's National Coverage
Determinations Manual, and local coverage determinations (LCDs)
A patient was admitted to the emergency department with chest pain, and was
diagnosed with aborted myocardial infarction with acute myocardial ischemia. There
was no prior cardiac surgery. The cardiac enzymes were normal. The appropriate
coding of the diagnosis for this case is: - Correct Answers -411.81 Acute coronary
occlusion without myocardial infarction
