Which of the following is included in the DRG system calculation?
- Labor costs
- Nonlabor costs
- Both labor and nonlabor costs
- Neither labor nor nonlabor costs
The DRG system includes both labor and nonlabor costs.
Which of the following is one of the factors in DRG assignment?
- Admitting diagnosis
- Principal diagnosis
- Present on admission status
- Type of physician
The principal diagnosis is one of the factors in DRG assignment.
Principal Diagnosis: The condition that is the primary, or main, reason for the encounter.
Which of the following parts of Medicare is paid under the DRG system?
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
Medicare Part A pays under the DRG system.
Inpatient Facility: An establishment that provides acute care services to individuals who stay overnight on the premises.
Who typically assigns the DRG for the patient's case?
- The coder
- The physician
- The coding supervisor
- The DRG grouper
The DRG grouper assigns the DRG for each patient's case based on the codes the coder assigns.
Sign: Objective evidence of a disease or condition.
Which of the following is a special software program?
- IPPS
- POA
- DRG grouper
- HAC
The DRG grouper is a special software program.
Diagnosis-Related Group (DRG): An episodic-care payment system basing reimbursement to hospitals for inpatient services upon standards of care for specific diagnoses grouped by their similar usage of resources for procedures, services, and treatments.
What does the abbreviation DRG stand for?
- Disease-related groups
- Diagnosis-related groups
- Disease resources and groups
- Diagnosis resources and groups
DRG stands for diagnosis-related groups.
Diagnosis-Related Group (DRG): An episodic-care payment system basing reimbursement to hospitals for inpatient services upon standards of care for specific diagnoses grouped by their similar usage of resources for procedures, services, and treatments.
What does the abbreviation IPPS stand for?
- Inpatient patient payment system
- Inpatient prospective payment system
- In-hospital prospective payment system
- In-hospital patient payment system
The abbreviation IPPS stands for inpatient prospective payment system.
Inpatient Facility: An establishment that provides acute care services to individuals who stay overnight on the premises.
Which of the following will determine how much an acute care facility will be paid?
- Medicare reimbursement
- Medicaid reimbursement
- IPPS
- OPPS
The IPPS determines how much an acute care facility will be paid.
Acute: Severe; serious.
In inpatient coding, which of the following are you permitted to code?
- Rule out
- Probable
- Suspected
- All of these
An inpatient coder can code a condition that is documented as rule out, probable, or suspected.
Other Specified: Additional information that the physician specified and isn’t included in any other code description.
In outpatient coding, which of the following are you permitted to code?
- Rule out
- Probable
- Suspected
- None of these
An outpatient coder cannot code a condition that is documented as rule out, probable, or suspected.
Not Elsewhere Classifiable (NEC): Specifics that are not described in any other code in the book; also known as not elsewhere classified.
Sally Sumpter was brought in today for LLQ abdominal pain. She was admitted to the medical floor and Dr. Jones was called in to examine her. After examination, Dr. Jones determines that Sally has acute cholecystitis. What is the correct code assignment?
- R10.32, K81.0
- R10.12, K81.9
- K81.0
- K81.9
K81.0 is the correct code for acute cholecystitis. Abdominal pain is not coded because it is a sign/symptom of cholecystitis. K81.0: Index>cholecystitis>acute.
Acute: Severe; serious.
Jamie Jupson was brought in today with a severe headache. An MRI was ordered, and it was determined that Jamie has a glioblastoma in her frontal lobe. What is the correct code assignment?
- C71.1
- R51, C71.1
- G97.1, C71.2
- R51, C71.2
The correct code for a frontal lobe glioblastoma is C71.1. C71.1: Index>neoplasm table>frontal>lobe, brain>malignant, primary. Index>glioblastoma refers you to the neoplasm table by site.
Sign: Objective evidence of a disease or condition.
What is the correct code for a patient who was discharged to a nursing home today after a three-day hospital stay due to dementia?
- F03.90
- F03.91
- F10.27
- F10.97
The correct code for a patient with dementia is F03.90. F03.90: Index>dementia.
Diagnosis: A physician’s determination of a patient’s condition, illness, or injury.
Mary Matthews was found to have a breast lump during a mammogram last month. She is admitted today for a breast biopsy of her left breast. The pathology report returns with infiltrating papillary breast carcinoma of the left breast. Mary's mother had breast cancer in her fifties. What is the correct code assignment?
- D05.12
- D05.12, Z80.3
- C50.312
- C50.912, Z80.3
The correct code for infiltrating papillary breast carcinoma of the left breast is D05.12, and the family history of breast cancer is coded Z80.3. D05.12: Index>neoplasm table>breast>Ca in situ. Z80.3: Index>history>family>malignant neoplasm>breast.
Carcinoma: A malignant neoplasm or cancerous tumor.