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CCA Exam |300+ Questions Solved 100% Correct| Verified Soltions/Answers
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CCA Exam |300+ Questions Solved 100% Correct| Verified Soltions/Answers
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CCA Exam |300+ Questions Solved 100%Correct| Verified Soltions/Answers
What is the definition of "other diagnoses"? [according to the UHDDS-Uniform Hospital
Discharge Data Set - ✔✔For reporting purposes "other diagnoses" is interpreted as
ADDITIONAL CONDITIONS that affect patient care in terms of requiring: clinical evaluation or
therapeutic treatement or diagnostic procedures or extends the length of stay or increases
nursing care and monitoring.
What is the UHDDS? - ✔✔Uniform Hospital Discharge Data Set is a minimum set of items
based on standard definitions to provide consistent data for multiple users. UHDDS is required
for reporting Medicare and Medicaid patients and many other health care payers also use most
of the UHDDS for the uniform billing system.
What are the required data items of UHDDS? - ✔✔1- Principal Diagnosis
2- Other Diagnoses that have a significance for the specific hospital episode
3- All significant procedures
4- Age, Sex, Race of patient
5- Expected Payer
5- Hospital's Identification
Patient in the ER for chest pain. Evaluation reveals suspicion of GERD [gastroesophageal reflux
disease]. Final diagnosis was "Rule out chest pain versus GERD". What is correct ICD-9-CM
code? - ✔✔786.50, Chest pain NOS: The condition should be coded to the highest degree of
certainty - such as the sign or symptom the patient exhibits. In the outpatient setting, the
condition [here-GERD] in the statement should NOT BE CODED AS IF it existed. Signs,
symptoms, abnormal test results, or other reasons for the outpatient visit are used when a
physician qualifies a diagnostic statement as "rule out" or other similar terms indicating
uncertainty.
A skin lesion is removed from a patient's cheek in the dermatologist's office. Physician
documents "skin lesion" in the health record. Before billing the pathology report returns with a
,diagnosis of basal cell carcinoma. What actions should the coder take for this claim submission?
- ✔✔Code: Basal Cell Carcinoma: In the OUTPATIENT setting, when diagnostic tests have
been interpreted by the physician and the final report is available at the time of coding, code
any CONFIRMED or DEFINITIVE diagnosis(es) that are documented in the record. Do NOT code
related signs and symptoms as addtional diagnoses. ******NOTE this differs from the coding
practive in the hospital inpatient setting regarding abnormal findings on test results. *********
Epidural given during labor. Subsequently determined the patient would require a C-section for
cephalopelvic disproportion [baby's head too large for mother's pelvis] because of obstructed
labor [failure of the fetus to descend through the birth canal]. What it the correct ICD-9-CM
diagnostic and the CPT anesthesia codes? - ✔✔NEED TO LOOK UP THIS ANSWER
Physician correctly prescribes Coumadin [anticoagulant-blood thinner]. Patient takes the
Coumadin as prescribed but develops hematuria [blood in the urine] as a result of taking the
medication. What the correct way to code this case? - ✔✔Hematuria; adverse reaction to
Coumadin. An adverse effect can occur when everything is done correctly. Adverse effects can
occur in situations where medications are administered properly and prescribed correctly in
both therapeutic and diagnostic procedures. The first listed diagnosis is the MANIFESTATION or
the nature of the adverse drug effect - in this case HEMATURIA. Locate the drug in the
SUBSTANCE colum of the Table of Drugs and Chemicals in the Alphabetic Index to Diseases.
Select the E Code for the drug from the Therapeutic Use column of the Table of Drugs and
Chemicals. Use of the E Code is MANDATORY when coding adverse effects.
What is the procedure for locating a DRUG? - ✔✔Locate the drug in the SUBSTANCE colum
of the Table of Drugs and Chemicals in the Alphabetic Index to Diseases. Select the E Code for
the drug from the Therapeutic Use column of the Table of Drugs and Chemicals. Use of the E
Code is MANDATORY when coding adverse effects.
Briefly describe MS-DRG - ✔✔MS-DRG (Medical-Severity-Diagnosis-Related Group). It is
system to classsify hospital cases in groups. DRG's are used to determine how much Medicare
pays the hospital for each "product" [i.e. "appendectomy"] since patients within each group are
clinically similar and are expected to use the same level of hospital resources. Each DRG was a
payment weight assigned to it based on the average resources used to treat Medicare patients
in that DRG. Payment weights are affected by geographic location (cost of living), number of
low income patietns in that location, whether the facility is a teaching facility, and if the case is
an outlier case (a particularly costly case). Claim information is gathered: ICD diagnoses,
,procedures, age, sex, discharge status, and the presence of complication or comorbidities.
Examples: Normal Newborn, Psychoses, Major Joint Replacement, Chest Pain, Cesarean
Section, Simple pneumonia, Heart Failure. DRG's were developed to monitor quality of care and
resource use, cost efficiency, and use the indicators to improve quality. Only ONE DRG can be
assigned and reimbursed for a single admission. The payment provided for the DRG is intended
to cover the costs of all hospital services performed during the patient's stay. Under the PPS,
hospitals are paid a set fee for treating patients in a single DRG category, regardless of the
acutal cost of care for the individual.
Patient admitted to the hospital for shortness of breath and congestive heart failure. Patient
subsequently develops respiratory failure. Patient undergoes intubation with ventilator
management. What is the correct sequencing and coding of this case? - ✔✔Congestive Heart
Failure, Respiratory Failure, Ventilator Management, Intubation: Acute Respiratory Failure
[518.81] may be assigned as a principal or secondary diagnosis depending upon the
circumstances of the inpatient admission. {chapter specific coding guidelines provide specific
sequencing direction-obstetrics, poisoning, HIV, newborn}. Respiratory failure may be listed as
a secondary diagnosis. If respiratory failure occurs AFTER admission, it may be listed as a
secondary diagnosis.
Patient admitted to the hospital with abdominal pain. Principal diagnosis is cholecystitis.
Patient has a history of hypertension and diabetes. In the DRG [Diagnosis Related Group]
prospective payment system, which of following determines the MDC [Major Diagnostic
Category] assignment for this patient? a-abdominal pain, b-cholecystitis, c-hypertension, or d-
diabetes - ✔✔Cholecystitis - The principal diagnosis determines the MDC.
Patient is admitted to the hospital with symptoms of a stroke and secondary diagnoses of COPD
and hypertension. Patient was subsequently discharged with a principal diagnosis of cerebral
vascular accident and secondary diagnosis of catheter-associated urinary tract infection, COPD,
and hypertension. Which of the following diagnoses should NOT be tagged as POA? A) catheter-
associated UTI, B) CVA, C) COPD, or D-Hypertension - ✔✔A) Catheter-Associated UTI: POA-
Present on Admission is defined as present at the time the order for inpatient admission occurs.
[All claims involving inpatient admissions to general acute care hospitals or other facilities that
are subject to law or regulation mandating collection of present on admission information.]
Conditions that develop during an outpatient encounter, including the ER Department,
observation, or outpatient surgery, are considered POA. Any condition that occurs after
admission is NOT considered a POA condition.
, Patient returns during a 90-day postoperative period from a ventral hernia repair, now
complaining of eye pain. What modifier would a physician setting use with the E&M [Evaluation
and Management] code? - ✔✔-24: Unrelated evaluation and management service by the
same physician during a postoperative period. NOTE: -79: Unrelated procedure or service by
the same physician during the postoperative period... would NOT be used as the question made
mention of E&M, not service or procedure.
Identify the 2-digit modifier that may be reported to indicate a physician performed the
postoperative management of a patient, but another physician performed the surgical
procedure. - ✔✔-55: postoperative management only {Modifiers are appended to code the
provide more information to alert the payer that payment change is required.
Name the 4 Cooperating Parties for ICD-9-CM - ✔✔1) AHIMA, 2) AHA-American Hospital
Association, 3) CMS-Centers for Medicare and Medicaid, and 4) NCHS-National Center for
Health Statistics
What is a POA Indicator? - ✔✔The POA-Present on Admission Indicator is used to
differentiate between conditions present at the time of admission and conditions that develop
during an inpatient admission. The POA Indicator applies to diagnosis codes for claims involving
inpatient admissions to acute care hospitals and other facilities. POA - developed by the
Cooperating Parties.
What organization is responsible for updating the diagnosis classification (Volumes 1 & 2) for
ICD-9-CM? - ✔✔Volumes 1 & 2 of the ICD-9-CM are updated by NCHS-National Center for
Health Statistics.
What organization is responsible for updating the procedure classification (Volume 3) for ICD-9-
CM? - ✔✔Volume 3 of the ICD-9-CM is updated by CMS-Centers for Medicaid and Medicare.
Which classification level of ICD-9-CM codes is the most specific? - ✔✔The "sub-
classification" level is the most specific level of coding in ICD-9-CM (5-digit codes).
What are the levels of ICD-9-CM codes called? - ✔✔Category>Subcategory (4-digit)>Sub-
classification (5-digit)
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