CCS MS-DRGs, APCs & Edits Practice Questions
MS-DRGs, APCs & Edits makes up 5 of every 50 questions on a Tigertest CCS practice test. Here are 10 of the 20 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCS Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. A secondary diagnosis on the CC list does not count as a CC for a case when it appears on the:
- A.OCE edit list for the claim
- B.PDx's CC exclusion list
- C.MCE unacceptable PDx list
- D.POA exempt code list
Answer: B. Each CC and MCC has an exclusion list of principal diagnoses closely related to it. When the principal diagnosis is on that list, the secondary diagnosis does not act as a CC or MCC.
2. An MS-DRG family with a three-way split divides cases by:
- A.Surgical or medical
- B.Length of stay
- C.Age, sex, or both
- D.MCC, CC, or neither
Answer: D. MS-DRGs can split into three levels: with MCC, with CC, and without CC or MCC. Some families split two ways or not at all.
3. Cases such as heart transplants and tracheostomy with long ventilation group to:
- A.Pre-MDC MS-DRGs
- B.Unrelated OR DRGs
- C.MDC of the PDx
- D.Ungroupable DRGs
Answer: A. Pre-MDC MS-DRGs are assigned by procedure, before the principal diagnosis is used to choose an MDC, because their resource use is very high whatever the diagnosis.
4. MS-DRGs 981 to 983 group cases in which:
- A.The patient was transferred out
- B.The stay lasted over 30 days
- C.OR work is outside the PDx's MDC
- D.No principal diagnosis is coded
Answer: C. These DRGs capture cases with an operating room procedure unrelated to the MDC of the principal diagnosis, which is often a sign to check sequencing.
5. APR-DRGs add which two subclasses, each with four levels?
- A.Acuity and length of stay
- B.Age group and patient sex
- C.Severity and mortality risk
- D.Cost and charge level
Answer: C. APR-DRGs assign a severity of illness and a risk of mortality subclass, each from 1 (minor) to 4 (extreme), to every base APR-DRG.
6. NCCI edits pairing procedures that cannot reasonably be done at one session were formerly known as:
- A.Mutually exclusive edits
- B.Medically unlikely edits
- C.Add-on code pairing edits
- D.Column two code edits
Answer: A. NCCI once separated column one/column two edits from mutually exclusive edits. Both are now procedure-to-procedure edits.
7. NCCI edits for hospital outpatient claims are applied through the:
- A.Chargemaster
- B.MCE
- C.MS-DRG grouper
- D.I/OCE
Answer: D. The I/OCE applies NCCI edits and other outpatient edits to OPPS claims. The Medicare Code Editor checks inpatient claims.
8. An MUE with adjudication indicator 2 is:
- A.A per-month total limit
- B.A per-day absolute limit
- C.A per-claim-line limit
- D.A per-day clinical limit
Answer: B. MUE adjudication indicator 1 is a claim line edit, 2 is a date-of-service edit based on policy that units above it cannot be paid even on appeal, and 3 is a date-of-service edit based on clinical benchmarks.
9. Which abstracted field can trigger the Medicare post-acute care transfer policy?
- A.Admitting diagnosis
- B.Discharge status
- C.Admission type
- D.Attending physician
Answer: B. The patient discharge status code shows a discharge to a SNF, home health or other post-acute setting, which for qualifying DRGs can reduce payment. A wrong status code changes payment.
10. On the UB-04, the field that shows where the patient came from before admission is the:
- A.Discharge status
- B.Admitting diagnosis
- C.Type of admission
- D.Point of origin
Answer: D. The point of origin for admission or visit code reports the source, such as a physician referral, another hospital or a clinic. The type of admission shows emergency, urgent or elective.
Practice all 20 ms-drgs, apcs & edits questions, and the rest of the 200-question bank, in the free CCS training sets. Questions you miss come back until you have mastered them.
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