3. Correct coding practice is to select the code with the greater number of characters available.
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1 Final Exam Part I: Chapters 1 6, Understanding the Fundamentals 1. ICD-10 codes are issued by the World Health Organization (WHO), and updates are published by the Centers for Medicare & Medicaid Services (CMS) on a biannual basis. 2. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all providers and payers of healthcare services use standard forms and codes for all claims. 3. Correct coding practice is to select the code with the greater number of characters available. 4. For an ICD-10 code, to locate congestive heart failure, you would look under heart. 5. The convention "Excludes 1" means that two codes may never be used in the same encounter. 6. The abbreviation NOS means not otherwise stated. 7. [ ] Slanted brackets are used in the Index to Diseases to indicate a mandatory additional code that must be coded after the first code. 8. Italic print symbolizes that two codes must be used to properly identify diagnosis and manifestation.
2 9. Manifestation codes may be listed as primary diagnosis. 10. Instructional terms ( see or see also ) must be followed to locate the correct code. Part II: Chapter 7 13, Long Term Care Specifics 1. Reimbursement in long-term care facilities is based on the appropriate ICD-10 code assignment. 2. Residents are guaranteed 100 days of coverage under Medicare Part A when their diagnosis indicates a skilled service. 3. The MDS 3.0 collects active diagnoses, specifically those that affect resident s care. 4. If all diagnoses are coded upon admission to the facility, it is not necessary to review and update codes during the resident s stay. 5. Upcoding is defined as misuse of assigning codes to a claim to obtain more money than is allowed by law. 6. Unbundling of charges and services is considered fraud. 7. The hospital s principal diagnosis is always the reason long-term care is needed. 8. Once coded, the primary diagnoses code never changes. 9. Centers for Medicare & Medicaid Services (CMS) requires completion of five MDS 3.0 assessments within 100 days. 10. Under the requirement, the skilled nursing facility must include all charges for services received during the Part A stay, except for certain exclusions.
3 Final Exam Answer Key Part I: Chapters 1 6, Understanding the Fundamentals of ICD-10-CM Coding 1. True, Chapter 1 2. True, Chapter 2 3. True, Chapter 3 4. False, Chapter 4 5. True, Chapter 5 6. False, Chapter 5 7. True, Chapter 5 8. True, Chapter 5 9. False, Chapter True, Chapter 6 Part II: Chapter 7 13, Long Term Care Specifics 1. False 2. False 3. True 4. False 5. True 6. True 7. False 8. False 9. True 10. True
4 Part III Chapters Diagnostic Statement Correct Answer Pulmonary tuberculosis, A15.0 infiltrative Sepsis due to methicillinresistant Staphylococcus A41.02 aureus (MRSA) Chronic gonococcal cystitis A54.01 Pneumocystis carinii B20, B59 AIDS Diabetes mellitus, type 1 E10.21 Diabetic nephrosis Chronic kidney disease, stage E10.22, N18.4 IV due to type 1 diabetes Hereditary thrombocytopenia D69.42 Sarcoidosis of lung and D86.2 lymph nodes Parkinson's disease G20 Alzheimer's disease with G30.9, F05 delirium Chronic bronchitis with J44.1 decompensated COPD Emphysema with chronic J44.9 obstructive bronchitis Pneumonia, bacterial, left J15.9 upper lobe Congestive heart failure with I50.9 pleural effusion Infected tracheostomy due to J95.02, L02.11, B95.8 staphylococcal abscess of the neck Urinary tract infection due to B37.49 candidiasis Chronic cystitis with N30.21 hematuria Benign prostatic hypertrophy N40.1, N13.8 with urinary obstruction Cystocele with incomplete N81.2, N39.3 uterine prolapse and stress incontinence
5 Infection of gastrostomy with K94.22, L02.211, B95.1 abscess of abdominal wall due to Streptococcus B Morbid obesity E66.01 Gangrenous diabetic ulcer of E11.621, E11.52, L right foot due to peripheral circulatory disorder Pilonidal fistula with abscess L05.02 Abdominal aortic aneurysm I71.4 Acute myocardial infarction, I21.09 anterior wall Congestive heart failure due I11.0, I50.9 to hypertensive heart disease Hemiplegia on right I (dominant) side due to old cerebral thrombosis Multiple myeloma C90.00 Chronic lymphocytic C91.11 leukemia (B-cell), in remission
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Supplementary materials for:
Supplementary materials for: Cecil E, Bottle A, Sharland M, Saxena S. Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions.