Term
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Definition
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Term
| New onset seizures, head CT = occipital mass. MD states poss. brain tumor and pt is tx'd for further w/u. Pdx? |
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Definition
| Neoplasm of occipital region |
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Term
| Hospital's base rate or blended rate is: |
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Definition
| Calculated annually, dependent on indirect costs for grad med Edu and new tech, adjusted based on number of low-income pts cared for. **UPDATE EXPAND** |
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Term
| Final MS-DRG assigned to pt's med rec should: |
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Definition
| reflect SOI and resource consumption of care |
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Term
| Pt with SOB, dyspnea, receives tx for ARF in ED which resolves. Admitted w/ pneumonia. Pdx best reflecting SOI is: |
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Definition
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Term
| PNA, CKD 1, anemia, COPD. Receives IVABx, inhalers, O2, IVFs, and iron tabs. Based on coding guidelines for Sdx's what should be coded? |
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Definition
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Term
Example of reportable HAC to CMS:
**REVISE REVIEW** |
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Definition
| Fractured metatarsal; what doesn't is fat embolism, IV infiltration and PNA |
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Term
Example of doc meeting POA criteria;
**REVIEW REVISE** |
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Definition
| Diagnosis listed as possible in H&P |
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Term
| Admitted with abdominal pain and CKD 2 H&P states probable colon CA. On day 2, PN = AKI, tx'd IVFs. DS = possible Mets colon CA and AKI. Pdx? |
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Definition
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Term
Accurate documentation should include:
**REVIEW REVISE** |
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Definition
| identification of pt's SOI, conditions that are POA and medical necessity |
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Term
| Pt w/ h/o metastatic lung ca, admitted with anemia 2/2 chemo, tx is 2u of PRBCs. Pdx? |
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Definition
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Term
| From ED w/ rectal bleed, 2/2 coumadin toxicity, has recent increase in dosage d/t low PT/PTT. Also has h/o COPD, CHF. What is the Pdx? |
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Definition
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Term
| Pt c/o fever, chills, knee pain. Admitted for knee prosthesis removal 2/2 infxn. Elevated WBC and lactic acid, Bands 10%. Pdx? |
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Definition
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Term
| Admitted w/LE pain, documentation reflects cellulitis 2/2 septic joint, X-ray shows possible osteomyelitis. Pdx? |
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Definition
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Term
| Which guideline provides direction for a correct assignment of Pdx? **REVISE** |
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Definition
| Sign & symptom code should only be used of no definitive dx is determined |
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Term
| Admitted w/ HTN, HF and CKD, correct code assignment would (separate codes or combo?): |
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Definition
| identify the most appropriate combo code |
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Term
| Admitted w/COPD exac., ARF, and AKI. Appropriate sequencing would be based on: **REVISE** |
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Definition
| guidelines stating any Dx can be sequenced as Pdx if each condition meets the criteria for Pdx, and coding guidelines indicating chapter-specific guidelines |
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Term
| Chapter specific guidelines provide direction for coding HIV Disease include: |
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Definition
| B20 should only be assigned in confirmed cases, B20 qualifies as an MCC if sequenced as SDx, and coding is specific to the reason for admission |
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Term
| Sequencing for UTI, PNA and Sepsis: |
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Definition
| Systemic infxn is always sequenced as Pdx |
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Term
| Admitted w back pain, documented as 2/2 mets colon ca. Pt gets bone scan, D docs new bone mets of spine. On cx ordered and radiation Rx received. Pt refuses, receives pain control and is DC'd. Pdx? |
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Definition
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Term
| When coding a med rec that includes DM and its manifestations, remember that specificity of coding for DM is dependent upon: |
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Definition
| Doc of type 1 or 2, and doc of any manifestations |
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Term
| Late effect of a condition is defined as: |
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Definition
| Condition that remains/develops after conclusion of the acute phase of an illness/injury (no time limit) |
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Term
| Admitted from NH with PNA, RN notes sacral decub PU 3. MD doesn't indicate PU but ET cx is ordered and WVAC placed: |
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Definition
| Ulcer would not be coded as the DM has not given its etiology or location |
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Term
| Purpose of a concurrent query is to: |
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Definition
| ensure each med rec accurately reflects SOI and resource consumption, proved MDs with necessary info so they can better understand coding guidelines, assist in accurate coding of dx's being tx'd and monitored, and decrease the number of retro queries |
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Term
| Concurrent queries should be designed to clarify: |
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Definition
| Ambiguous, inconsistent, and incomplete doc; clinical significance of abnormal test results; specificity or degree of severity of condition; conditions that were POA |
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Term
| For a credible clinical query regarding a medical condition for an MD, CDS should incorporate which of the following info into query? |
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Definition
| Risk factors, s/s of condition and treatment |
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Term
| Policies and procs that spell out a concurrent query process are important to: |
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Definition
| Identify situations for when/how a query is formulated |
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Term
| metabolic encephalopathy is |
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Definition
| Tx'd by correcting underlying condition |
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Term
| Admitted with new-onset HA, vision changes, difficulty swallowing, and HTN. Clinically which dx would best explain the sx' |
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Definition
| Cerebral edema 2/2 lesion in brain |
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Term
| Elderly man c h/o COPD and HTN, uses home O2..admitted c/o dyspnea, rapid shallow breaths, O2 sat of 84% on 2L. Non-rebreather applied, gets IV Solumedrol, and breathing Txts. MD docs resp failure d/t COPD and PNA. Pdx? |
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Definition
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Term
| Elderly man c h/o COPD and HTN, uses home O2..admitted c/o dyspnea, rapid shallow breaths, O2 sat of 84% on 2L. Non-re-breather applied, gets IV Solumedrol, and breathing Txts. MD docs resp insufficiency. Which query could have been concurrently sent? |
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Definition
| Whether MD was tx'd acute exac. of COPD and/or ARF, and what type of PNA was being Tx'd. |
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Term
| Pt tx'd with Cefoxitin for PNA, what type is most likely? |
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Definition
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Term
| Fever, SOB, CP, non-prod cough. CXR confirms pleural effusion. Which type is most probably? |
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Definition
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Term
| Clinical indicators of ARF most commonly are: |
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Definition
| Accessory muscle use, work of breathing, and inability to speak more than a few words at a time |
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Term
| h/o CAD, GERD, HTN admitted w CP which was unrelieved w nitro at home. GI cocktail is given in ED w relief, cardiac w/u is negative and pt scheduled for EGD. MD docs atypical CP. A concurrent query: |
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Definition
| Would be needed to specify cause of CP |
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Term
| Admitted with syncope. Typical considerations for underlying cause include: |
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Definition
| DM, Bradycardia, and dehydration |
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Term
| What pt admission includes a reimbursable sx proc, assignment of final MS-DRG will' |
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Definition
| be driven by the surgical hierarchy established by CMS |
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Term
| For concurrent query clarifying for GIB, its important to assist the MD in understanding which coding rule? |
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Definition
| Active bleeding doesn't need to be visualized in an endoscopy, the MD impression can be doc'd and coded. |
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Term
| Admitted with cholelithiasis, scheduled for Lap Chole. CDS notes in Op Report 'Dilation of the Sphincter of Oddi' This is important because it indicates... |
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Definition
| The procedure has to be performed via in incision and will lead to a different MS-DRG |
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Term
| It's important to clarify the type of debridement performed because: |
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Definition
| They should be identified by type and depth |
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Term
| Which is an important indicator of Severe Malnutrition? |
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Definition
| Poor or delayed wound healing |
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Term
| Treatment of AKI may include: |
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Definition
| IVF's, hold diuretics, monitor I/Os, and daily BUN/Creatinine |
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Term
| Aplastic anemia is a condition that: |
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Definition
| is defined as bone marrow failure causing a reduction in WBC's, RBC's and platelets |
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Term
| Admit from SNF w/ foley in place. 100.4 F, 92, 22, 118/76. WBC 18.2. Dx includes UTI d/t foley, PNA and infx'd decub R heel. For what should a concurrent query be posed? |
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Definition
| Sepsis d/t multifactorial infx, stage of PU and type of PNA |
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Term
| Which are important metrics to monitor in evaluating CDI productivity? |
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Definition
| Review rates, query rates and MD response rates |
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Term
| MD has a large number of queries w/ a response rate of 50%, agreement rate is 25%. This indicates: |
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Definition
| The MD may not understand the purpose of the program |
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Term
| Which indicators are not usually included when reporting MD profiles |
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Definition
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Term
| CDS tracking the program for the last yr. notices sudden decrease in MCI for a single month which factors may indicate a reason for the sudden and brief decrease? |
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Definition
| Water damage to an OR and 3-5 orthopedica surgeons attended a national conference |
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Term
| CDS team has query rate of 55& but CMI has had marginal improvement; what is the most likely explanation of this? |
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Definition
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Term
| CMS' recovery audit program (RAC) was designed to: |
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Definition
| identify improper payments in Medicare system |
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Term
| When requesting med recs for reviews, recovers auditors: |
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Definition
| Can request any record from any MDC |
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Term
| In prep for the RAC, a hospital may choose to implement a process of internal record review. Important ones would be: |
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Definition
| Records with only one coded CC |
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Term
| If a Rec auditor identifies a record that had improper payment, the hospital cannot |
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Definition
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Term
| Which types of recs are targets for review by RAC programs |
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Definition
| Recs assigned with a single CC |
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Term
| Based on medical necessity requirements which Pdx is most likely to be denied? |
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Definition
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Term
| Which Dx or Proc is considered a high r/f rec audit review |
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Definition
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Term
| Which post-op complication could potentially impact a facilities PSI-90 score as measured by CMS? |
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Definition
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Term
| When performing analysis of PEPPER outlier data, which strategy should be considered 1st for reducing outliers? |
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Definition
| Identify patterns r/t the significant outliers |
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Term
| CDI identified incorrect doc in med rec. Which is the best method of ensuring accurate and compliant doc in med rec? |
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Definition
| Attempt a face to face conversation with provider to discuss the doc. |
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Term
| How is an observed to expected mortality ratio of >1 interpreted? |
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Definition
| Actual death rate is higher than expected rate |
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Term
| What is the primary purpose for developing written policies and procedures for a CDI program? |
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Definition
| Ensures compliance with professional standards |
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Term
| MD docs an MCC on all cases w/out supporting evidence. This is known as: |
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Definition
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Term
| When sx dx's code to a combination and any part of the condition is not POA the indicator is |
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Definition
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Term
| Which individual DI performance metrics indicates a potential performance issue? |
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Definition
| MD agreement rate of 100% |
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Term
| Which measure captures the most accurate view of pt outcomes? |
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Definition
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Term
| Which external organizations provides publicly reportable data regarding the SOI of individual facilities or MDs? |
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Definition
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Term
| A query has been pending for 3 days, pt scheduled for d/c today? This is the most effective technique for obtaining a timely response? |
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Definition
| Try to meet face to face w/ MD. |
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Term
| CDI is in the process of posting query, MD walks onto unit for rounds. CDI should: |
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Definition
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Term
| CDI is developing an Edu presentation for MDs on how doc affects MD profiles. Which is important to include? |
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Definition
| Query response rates, CMI, and expected vs actual mortality rates |
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Term
| After final coding the coder identifies a DRG discrepancy with CDI. To best understand the CDI should first |
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Definition
| Review final codes and determine if guidelines were broken |
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Term
| Which data points does a CDI need to calculate hospital specific reimbursement to a program? |
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Definition
| Facility blended/base rate |
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Term
| Combo codes such as DM and peripheral neuropathy, HTN and HF, require what in doc. |
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Definition
| Nothing, like is assumed if both dx's are included in med rec |
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Term
| Why should MDs link aggressive, combative, or violent behavior w/ dementia? |
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Definition
| Identifies greater specificity of condition |
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Term
| When should a DI or coder query to identify causative organism of infix process if not in doc? |
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Definition
| Should query for any infix process |
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Term
| Which best describes how to report DM w/ manifestations? |
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Definition
| Assign as many codes as needed to report all conditions |
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Term
| A dx is indicated in the H&P and ruled out in the DS should be |
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Definition
| Disregarded as a possible code |
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Term
| Which are important metrics to monitor when evaluating CDI productivity? |
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Definition
| Review rates and MD response rates |
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Term
| Pt w/ acute osteomyelitis is DC'd to HH w/ 6wks of IV tx. 3 wks after d/c pt admitted with AKI probably 2/2 IV Vanco. CDI should |
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Definition
| Assign AKI as Pdx (not complication) |
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Term
| 69yo w/ ESRD admitted w s/s of sepsis. 102.5, 122, 24, 90/58, WBC 22, Bands 11%, Neuts 78. MD docs infx'd vas-cath and cath is removed. CDI should: |
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Definition
| Query for sepsis d/t the infx'd cath as Pdx. |
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Term
| During review of final coding summary of a case reviewed by CDI, the CDS manager notices coder has coded and ICD-10 code for a dx that doesn't seem to be supported in doc by MD. CDS manager should: |
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Definition
| Contact cover and discuss record to determine next steps. |
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Term
| Pt is a direct admit to tele bed from MD's office w/ dx of dig toxicity. EKG = Brady w/ HR 48. CDS should: |
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Definition
| Query for bradycardia as Pdx |
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Term
| Pt admitted w bacteremia. To maintain being compliant w coding guidelines CDS should: |
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Definition
| Review med rec for other indications pt may be septic and if present, query MD for clarification |
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Term
| h/o COPD< admitted w AKI. On 2nd night, severe SOB w/ sats in 60s. RR called, pt is intubated, remains on vent for 4 days then extubated and DC'd. Which best described the impact of vent on final DRG? |
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Definition
| Doesn't change DRG as Pdx is AKI. |
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Term
| Policies and procedures that indicate process for a concurrent query process are important to: |
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Definition
| Identify conditions for when/how a query will be formulated |
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Term
| Advantage of concurrent CDI rec reviews includes: |
|
Definition
| Ability to communicate doc needs to providers prior to d/c |
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Term
| Which is least important metric to monitor when evaluating CDS productivity? |
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Definition
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Term
| MD has a large number of queries w/ response rate of 100% and agreement rate of 75%. Indicated: |
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Definition
| MD has engaged w/ CDI program |
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Term
| Pt has ESRD, put in ICU for fluid overload. Receives daily HD, candidate for kidney tx. There is a match and pt is tx'd for tx. Pdx at d/c is |
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Definition
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Term
| Pt admit from NH w/ PNA, eural eff, enceph, tachypnea/cardia. 2 days after admission pt intubated d/t resp distree and then expires. Which query would most impact the ROM profile |
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Definition
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Term
| Conditions that are high dose and/or high volume and could have bee reasonably prevented through application of Evidence-Based Clinical guidelines are identified as: |
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Definition
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Term
| Pt w/ h/o CKD 2 admitted for renail failure, gets IVFs, labs=creat/bun 2.7/25 on day 4. Which query is appropriate? |
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Definition
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Term
| If doc is unclear as to whether a Dx is in remission or resolved what should a concurrent reviewer do? |
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Definition
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Term
| Which element does not affect medicare reimbursement? |
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Definition
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Term
| What must be prsent in a query to provide context as to why query was inititated? |
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Definition
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Term
| Why can coding for neoplasms be difficult? |
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Definition
| MD's doc'd reason for admittion may not meet criterial as PDx d/t sequencing rules in Official Gudelines for Coding and Reporting |
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Term
| Admitted from SNF w/ HCAP, ET nurse docs PU as stage 3 on L hip. H&P indicates wound on buttock. CDI should |
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Definition
| Query MD for etio and location of ulcer |
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Term
| Which is an example of doc meeting POA criteria? |
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Definition
| Listed as 'possible' in H&P |
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Term
| Advantage of having a CDI w/ a clinical background includes: |
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Definition
| Ability to clarify dx as they are being discussed and evaluated in pt's plan of care |
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