Exam (elaborations)
CCS EXAM PREP-DOMAIN #8/COMPLIANCE – 16 QUESTIONS & ANWERS
CCS EXAM PREP-DOMAIN #8/COMPLIANCE – 16 QUESTIONS & ANWERS
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CCS EXAM PREP-DOMAIN#8/COMPLIANCE – 16 QUESTIONS &
ANWERS
-Be completed for each patient no more than 30 days before or 34 hours
after admission or registration, but prior to surgery - -According to Medicare
requirements, a history and physical must:
-Electronic transactions only - -Under HIPAA Standards for Code Sets, the
sets of codes used to encode the diagnoses and procedures, data elements,
and medical concepts must be used in:
-External cause codes for Cause of Injury, Place of Occurrence, activity and
Status - -A 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 the diagnostic codes?
-Facility specific documentation requirements - -Coding compliance policies
should include:
-Hospital base rate, discharge disposition, adjustment for low-income
patients, approved teaching hospital, and sole community hospital - -The
actual payment the hospital is reimbursed is potentially based on which of
the following?
-I11.0, Hypertensive heart disease with heart failure and I50.9, Heart failure,
unspecified
(There is a cause and effect relationship between the hypertension and the
congestive heart failure. A separate code for the congestive heart failure is
assigned based on the "code also" note) - -A 55 year old patient has
hypertensive heart disease with congestive heart failure. What codes would
be assigned?
-I13.2, Hypertensive heart and chronic kidney disease with heart failure and
with stage 5 chronic kidney disease, or end stage renal disease, I50.9, Heart
failure, unspecified, and N18.6 End stage renal disease. - -A 70 year old
patient has congestive heart failure and hypertension with end-stage renal
disease. What should the codes be?
-Items and services that are reasonable and necessary for the diagnosis or
treatment of an illness or injury (and within the scope of a Medicare benefit
category) - -Medicare medical necessity is defined by which factors?
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