1
Q
What does ICD stand for?
A
international classification disease
2
Q
How many characters are in the ICD-10-CM code structure?
A
3-7
3
Q
What is the first character of an ICD-10-CM code?
A
alphabetic
4
Q
What is the second character of an ICD-10-CM code?
A
numeric
5
Q
What are characters 3-7 in an ICD-10-CM code?
A
alphabetic or numeric
6
Q
What is the Alphabetic Index?
A
alphabetic listing of terms and their corresponding codes
7
Q
What two things does the Alphabetic Index include?
A
disease and injuries & external causes of injuries
8
Q
What is the Tabular List?
A
numerical list of the codes divided by chapters
9
Q
How many chapters are in the Tabular List?
A
22
10
Q
To what site are malignant neoplasms of ectopic tissue coded?
A
they are coded to the site of origin mentioned in the documentation
11
Q
What type of diabetes should be coded if the documentation does not state the type of diabetes?
A
type 2 diabetes mellitus
12
Q
How would you code a congenital malformation that has been corrected?
A
with a personal history code which is used to identify the history of congenital malformation
13
Q
What are the four reporting options of POA (present-on-admission) ?
A
Y, N, U, W
14
Q
What does the ‘Y’ reporting option of POA mean?
A
yes; present at the time of inpatient admission
15
Q
What does the ‘N’ reporting option of POA mean?
A
no; not present at the time of inpatient admission
16
Q
What does the ‘U’ reporting option of POA mean?
A
unknown; documentation is insufficient to determine if condition is present on admission
17
Q
What does the ‘W’ reporting option of POA mean?
A
Clinically undetermined; provider is unable to clinically determine whether condition was present on admission or not
18
Q
True or False? ICD-10-CM includes combination codes.
A
true
19
Q
True or False? The seventh character of an ICD-10-CM code is always a letter.
A
true
20
Q
True or False? ICD-10-CM contains codes that specify laterality.
A
true
21
Q
True or False? For every code where ICD-10-CM provides codes for laterality, bilateral is listed as an option.
A
false
22
Q
True or False? In ICD-10-CM, the term “with” is sequenced immediately following the main term (not in alphabetical order).
A
true
23
Q
What is the purpose of the “X” in subcategory O45.8?
A
to preserve the meaning of the sixth character
24
Q
What punctuation indicates synonyms, alternative wordings, or explanatory phrases in the Tabular List?
A
Bracket
25
What type of note is included under subcategory O99.31?
Use additional code for manifestation
26
What parenthetical terms in the diagnosis statement have no effect on the selection of the codes listed for that main tremor sub term?
Nonessential modifiers
27
What is used when a code has less than six characters and a seventh character is required?
Placeholder characters
28
What are used in the Tabular List to enclose synonyms, abbreviations, alternative wordings, or explanatory phrases?
Brackets
29
What is used in the Tabular List after an incomplete term that needs one or more additional terms in order to be assigned to a particular code?
colons
30
What note indicates that the conditions listed after it cannot ever be used at the same time as the code above the note?
Excludes1
31
What convention indicates that two codes are applied when both conditions are present?
Excludes2
32
What means “not elsewhere specified”?
NEC
33
True or False? The UB-04 claim is used by hospitals for both inpatient and outpatient claims reporting when paper claim forms are allowed.
true
34
True or False? All diagnosis codes require a POA indicator?
false
35
According to UHDDS definitions, what is the preexisting condition that, because of its presence with a specific principal diagnosis, will likely cause an increase in the hospital length of stay for the patient?
comorbidity
36
what do you do if no bilateral code is provided and the condition is bilateral?
assign separate codes for both the left and right side
37
what punctuation is used in the Tabular List to enclose synonyms, abbreviations, alternative wording, or explanatory phrases?
square brackets
38
what punctuation is used in the Alphabetic Index to identify manifestation codes?
slanted brackets
39
what punctuation encloses supplementary words or explanatory information that may or may not be present in the statement of a diagnosis?
parenthesis
40
what punctuation is used in the Tabular List after an incomplete term that needs one or more additional terms in order to be assigned to a particular code?
colon
41
what does UHDDS stand for?
uniform hospital discharge data set
42
For inpatient claims, UB-04 form provides room for how many codes?
22
43
For outpatient claims, UB-04 form provides room for how many codes?
24
44
the payment system for the operating costs of acute care hospital inpatient based on prospective rates of the cost of care is called ____?
IPPS
45
what are medical cases are organized into?
DRGs
46
What does CMS stand for?
Centers for Medicare & Medicaid Services
47
What does QIO stand for?
Quality Improvement Organizations
48
What does MACs stand for?
Medicare administrative contractors
49
What does CERT stand for?
comprehensive error rate testing program
50
What is the condition that is produced by another illness or an injury and remains after the acute phase of the illness or injury?
sequela
51
If two procedures appear to be principal, which one should be assigned as the principal procedure?
the one most related to the principal diagnosis
52
What represents the average resources required to care for cases in that particular DRG relative to the national average of resources used to treat all Medicare cases?
Relative rate
53
What reflects the sickest patient with the highest level of severity who requires a significant amount of resources to treat both the principal diagnosis and the additional conditions of the patient?
MS-DRG with MCC
54
what does the CMS do?
contracts with part A & B Medicare and DME to perform review of claims data to identify atypical billing patterns
55
What is the QIO?
a non-profit private organizations staffed by physicians, nurses, and other healthcare professionals trained to review healthcare services and help medicare beneficiaries receive quality health care
56
What are the MACs?
a private insurance companies that are responsible for Medicare claims
57
What does the CERT do?
review a sample of claims for the purpose of producing a national medicare fee-for-service payment error rate
58
How many levels of appeals are in the RAC process?
5
59
What is the intent of the two types of Excludes Notes that appear in the Tabular List of ICD-10-CM?
Excludes 1: ‘not coded here’
Excludes 2: ‘not included here’
60
According to Guideline IV.H, can uncertain diagnosis be assigned codes for outpatient visits?
no
61
What is the name of the program that functions to detect and correct improper payments in the traditional Medicare fee-for-service programs?
RACs
62
What are post-acute-care settings?
Healthcare settings where patients receive services after discharge from hospitals
63
What is the first step in locating a code in ICD-10-CM?
Locate the main term and applicable subterms in the Alphabetic Index
64
A _____ is defined as an additional diagnosis that describes a condition arising after the beginning of hospital observation and treatment and then modifying the course of the patient’s illness or the medical care required.
Complication
65
A patient is seen in the outpatient surgery department for a cardiac catheterization for treatment of CAD. Following surgery, the patient experienced respiratory distress as a complication of the surgery and was admitted to the hospital. What code is assigned as the principal diagnosis for the hospital inpatient admission?
Postoperative complication
66
A hospital’s payment rate is based on which of the following factors?
Type of hospital, designation of the hospital, and wage index for the geographic area where the hospital is located
67
What is one factor that an MS-DRG assignment is not based on?
Length of stay
68
Accurate ICD-10-CM diagnosis coding is essential to establish the ___ of a particular service.
Medical necessity
69
True or False? The ICD-10-CM official coding guidelines for inpatient and outpatient are exactly the same.
false
70
True or False? For an inpatient, if the diagnosis documented at the time of discharge is “probable pneumonia”, it is coded as “pneumonia.
true
71
True or False? For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, it is appropriate to code any confirmed or definitive diagnosis(es) documented in the interpretation.
true
72
Which punctuation is used in the Tabular List to enclose synonyms, abbreviations, alternative wording, or explanatory phrase?
Square brackets [ ]
73
Which punctuation is used in the Alphabetic Index to identify manifestation codes?
Slanted brackets
74
Which punctuation encloses supplementary words or explanatory information that may or may not be present in the statement of a diagnosis?
Parenthesis ( )
75
Which punctuation is used in the Tabular List after an incomplete term that needs one or more additional terms in order to be assigned to a particular code?
Colon :
76
POA stands for ____ ?
Present on admission
77
What 4 things do the main terms represent in ICD-10-CM?
Disease
Condition
Nouns
Adjectives
78
A term or a series of terms that appear in parentheses following a main term or sub-term is known as ___?
nonessential modifiers
79
What is a name, as in a drug or disease, based on or derived from the name of a person?
eponym
80
What note appears in ICD-10-CM, meaning that two codes may be required to fully describe a condition?
Code also
81
What is the code that is listed to a main term in the Alphabetic Index called?
default code
82
What does it mean when NEC appears in the Alphabetic Index?
it will direct the coder to the Tabular List showing an "other specified" codes description
83
What type of codes are available when the documentation of the condition identified by the provider in the health record does not provide enough information to assign a more specific code?
NOS
84
What does NOS stand for?
not otherwise specified
85
What are lists of medical diagnoses under some codes in the Tabular List?
Inclusion terms
86
What type of inclusion terms that appear immediately under a three-character code title to further define, or give examples of, the content of the category?
Includes not
87
What are the coding conventions that require two codes for situations when one disease produces another condition?
Etiology and manifestation
88
What is the first disease considered in the coding convention?
Etiology
89
What is the second condition that a disease produces in the coding convention called?
Manifestation
90
The coding convention used in ICD-10-CM that directs the coder as to which condition is coded first is known as ____?
code first
91
With a condition that requires two codes to completely describe the condition, ICD-10-CM will remind the coder to ______ to fully describe it.
use additional code
92
What note indicates that this code may be assigned as a first-listed or principal diagnosis when the causal condition is unknown or not applicable?
code, if applicable, a causal condition first
93
Two codes are required for coding ____ conditions.
sequela
94
When coding sequela conditions, the first code is the ______
condition that exists at present or the sequela
95
When coding sequela conditions, the second code is the ____
original condition identified as the cause of the present condition.
ICD-10-CM
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