According to UHDDS, the principal diagnosis is defined as the condition established after study to be chiefly responsible for what?
Coding Concepts
Question · Easy
CDI queries: 1v1v1
Short
Two-Midnight Rule
IPPS & Regulations
Flashcard
A secondary diagnosis classified as a major complication or comorbidity (MCC) generally has what effect on MS-DRG assignment compared with a CC?
Section 1886(d) of the Social Security Act sets forth this Medicare arrangement for the operating costs of acute-care hospital stays under Part A.
Medicare payment rules
Guess the Term
Introduction & Exam Overview
1.1 Current Exam Facts
Study guide
Cheat sheet
Which POA indicator means the provider is unable to clinically determine whether the condition was present at the time of inpatient admission?
Question · Medium
Read the clue and guess the term in 6 tries.
Game
MS-DRG payment logic
Per the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice, a query is considered leading when it does what?
Query Process
Broad payment class whose relative weight reflects average resources; the Medicare severity form is one variant.
In the 3M APR-DRG methodology, the subclasses for Severity of Illness (SOI) and Risk of Mortality (ROM) each range across how many levels?
Quality Reimbursement
CC vs. MCC
Acute respiratory failure is generally supported when arterial blood gas shows which of the following?
Clinical Knowledge
Annual review that samples Medicare fee-for-service claims to estimate how often they were paid improperly.
1.2 Eligibility Pathways and the 2,000-Hour Year
Under the Sepsis-3 consensus definition, sepsis is defined as suspected or confirmed infection plus what?
Swap tiles to line up three of the same term.
Term Match
Case Mix Index (CMI)
A CDI specialist reviews a chart before the patient is discharged and queries the physician while care is ongoing. This type of query is best described as:
Condition coded with the code for its underlying systemic infection, or A41.9 when the infection type or causal organism is not specified.
Clinical indicators
Which document is the authoritative coding rulebook that coders and CDI staff must follow for ICD-10-CM code assignment and sequencing?
Regulatory Compliance
Medicare contractor: Recovery Auditor (RA)
For Medicare's Hospital-Acquired Condition (HAC) payment provision, a selected condition coded with a POA indicator of 'N' will generally:
Condition defined by a creatinine rise of at least 0.3 mg/dL within 48 hours or urine output below 0.5 mL/kg/h for 6 hours.
1.3 Allowed Resources and Test-Day Rules
Which of the following is an appropriate trigger for a compliant query?
Flip two cards at a time to find matching terms.
Term Pairs
IPPS annual update
The Medicare Severity DRG (MS-DRG) system is the inpatient prospective payment classification used under which payment system?
Umbrella term whose two main types are emphysema and bronchitis in which the airway lining is constantly irritated and inflamed.
A query that lists clinical indicators and then asks the provider to select from options including the suspected diagnosis, clinically supported alternatives, 'unable to determine', and an open-ended 'other, please specify' is an example of a:
Sepsis-2 vs. Sepsis-3
Clinical Indicators
Which of the following best describes a comorbidity in the context of secondary diagnosis reporting?
One of 25 broad areas, most matching a single organ system, that form the first step in building the inpatient payment groups.
1.4 Recertification, Fees, and How This Guide Maps the Eight Domains
To report a condition as a secondary diagnosis under UHDDS, it must require at least one of which group of elements?
Find five hidden terms in a grid of letters.
Term Search
KDIGO AKI Stage 1
In a typical CDI workflow, the primary goal of the initial concurrent record review is to:
Cdi Process
Communication tool used to clarify documentation so diagnosis, procedure, or service codes are accurate.
Record clarification
Under the False Claims Act, knowingly submitting claims based on documentation that does not support the codes billed can expose a hospital to:
Acute hypoxemic respiratory failure
A CDI program reports that providers concurred with the clarification presented in 85 percent of the queries they answered. This figure is the program's:
Metrics Denials
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