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ICD-10-CM and PCS Guidelines Exam – 103 Questions with Solutions
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ICD-10-CM and PCS Guidelines Exam – 103 Questions with Solutions
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ICD-10-CM and PCS GuidelinesExam – 103 Questions with
Solutions
Department of Health and Human Services (DHHS) - -US Federal
Governments department that hold both CMS and NCHS (National Center for
Health Statistics)
-who provides guidelines for coding and reporting using the International
Classification of Diseases? - -Both CMS and NCHS
-what is ICD-10-CM? - -A morbidity classification published by the United
States for classifying diagnoses and reason for visits in all health care
settings.
Based on ICD-10, the statistical classification of diseases published by WHO
-the 4 organizations that make up the Cooperating Parties for the ICD-10-CM
- -the American Hospital Association (AHA)
the American Health Information Management Association (AHIMA), CMS,
and NCHS.
-What are the guidelines for ICD-10-CM? - -A set of rules, instructions
provided within the ICD-10-CM itself. The instructions and conventions of the
classification take precedence over guidelines.
The guidelines are based on coding and sequencing instructions in the
Tabular List and Alphabetic Index of the ICD-10-CM, BUT PROVIDE
ADDITIONAL INSTRUCTION.
-Adherence to these guidelines when assigning ICD-10-CM diagnosis codes
is required under which act? - -The Health Insurance Portability and
Accountability Act(HIPAA)
-A joint effort between the healthcare provider and the coder is essential to
achieve what? - -complete and accurate documentation, code assignment,
and reporting of diagnoses and procedures.
-"encounter" - -term used for all settings, including hospital admissions.
-"provider" - -used throughout the guidelines to mean physician or any
qualified health care practitioner who is legally accountable for establishing
the patients diagnosis.
, -Section I of the ICD-10-CM: Conventions, General Coding Guidelines, and
Chapter Specific Guidelines - -Includes the structure and conventions of the
classification and general guidelines that apply to the entire classification,
and chapter-specific guidelines that correspond to the chapters as they are
arranged in the classification.
All conventions, general guidelines and chapter specific guidelines are
applicable to all healthcare settings unless otherwise indicated.
-What do the conventions and instructions of the classification take
precedence over? - -The guidelines
-Section II: Selection of Principal Diagnosis - -includes guidelines for
selection of principal diagnosis for non-outpatient settings.
The circumstances of inpatient admission always govern the selection of
principal diagnosis.
-where is the principal diagnosis defined? - -in the Uniform Hospital
Discharge Data Set (UHDDS), as "that condition established after study to be
chiefly responsible for occasioning the admission of the patient to the
hospital for care"
-where can the inpatient data elements and their definitions be found? - -in
the July 31, 1985, Federal Register (Vol. 50, No 147), pp. 31038-40.
Since that time the application of the UHDDS definitions has been expanded
to include all non-outpatient settings (acute care, short term, long term care,
and psychiatric hospitals; home health agencies; rehab facilities; nursing
homes, ect) and all levels of hospice services
-what takes precedence over the official coding guidelines of the ICD-10-CM
while determining principal diagnosis, coding conventions? - -the Tabular
List and Alphabetic Index
-the principal diagnosis - -the chiefly responsible reason for the admission
of the patient.
-Section II, A :Codes for symptoms, signs and ill-defined conditions - -Codes
for symptoms, signs, and ill-
defined conditions from Chapter 18 are not to be used as principal diagnosis
when a related definitive diagnosis has been established
-Section II, B : Two or more interrelated conditions, each potentially meeting
the definition for principal diagnosis - -When there are two or more
, interrelated conditions (such as diseases in the same ICD-10-CM chapter or
manifestations characteristically associated with a certain disease)
potentially meeting the definition of principal diagnosis, either condition may
be
sequenced first, unless the circumstances of the admission, the therapy
provided, the
Tabular List, or the Alphabetic Index indicate otherwise
-Section II, C : Two or more diagnoses that equally meet the definition for
principal diagnosis - -In the unusual instance when two or more diagnoses
equally meet the criteria for principal diagnosis as determined by the
circumstances of admission, diagnostic workup and/or therapy provided, and
the Alphabetic Index, Tabular List, or another coding guidelines does not
provide sequencing direction, any one of the diagnoses may be sequenced
first.
-Section II, D : Two or more comparative or contrasting conditions - -In
those rare instances when two or more contrasting or comparative diagnoses
are
documented as "either/or" (or similar terminology), they are coded as if the
diagnoses were confirmed and the diagnoses are sequenced according to
the circumstances of the admission. If no further determination can be made
as to which diagnosis should be principal, either diagnosis may be
sequenced first
-Section II E, a symptom followed by contrasting/comparative diagnoses - -
Guideline has been deleted effective Oct 1, 2014
-Section II F, original treatment plan not carried out - -Sequence as the
principal diagnosis the condition, which after study occasioned the admission
to the hospital, even though treatment may not have been carried out due to
unforseen circumstances.
-Section II G, complications of surgery and other medical care - -When the
admission is for treatment of a complication resulting from surgery or other
medical care, the complication code is sequenced as the principal diagnosis.
If the complication is classified to the T80-T88 series and the code lacks the
necessary specificity in describing the complication, an additional code for
the specific complication should be assigned
-Section II H, uncertain Diagnosis
Note:
This guideline is applicable only to inpatient admissions to short-term, acute,
long-term care and psychiatric hospitals - -If the diagnosis documented at
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