Chapter 33 — Quiz
24 questions: multiple choice and short answer. The answer key is in the collapsed block at the bottom. All dollar figures are this book's constructed teaching figures.
1. Under IPPS, a hospital's payment for an inpatient Medicare stay is determined primarily by:
- A. The total charges on the UB-04
- B. The number of covered days
- C. The MS-DRG the coded record groups to
- D. The hospital's cost report
2. IPPS became effective for cost reporting periods beginning:
- A. January 1, 1965
- B. October 1, 1983
- C. October 1, 2007
- D. October 1, 2015
3. The principal diagnosis is the condition:
- A. Present on admission that is most severe
- B. Listed first in the ED record
- C. Established after study to be chiefly responsible for occasioning the admission
- D. That consumed the most resources during the stay
4. A patient is admitted for chest pain; the workup establishes an acute myocardial infarction. The principal diagnosis is:
- A. The chest pain, because it occasioned the admission
- B. The infarction, because it was established after study
- C. Either, at the coder's discretion
- D. Whichever produces the higher-weighted DRG
5. A discharge summary documents "probable pulmonary embolism." On the inpatient claim this is:
- A. Not coded; code the symptoms instead
- B. Coded as if established
- C. Coded only with a query response
- D. Coded with POA = U
6. Short answer: name the data set whose definitions govern inpatient reporting, including the principal diagnosis.
7. A record carries one MCC and three CCs among its secondaries. The severity tier is set by:
- A. The sum of all four designations
- B. The MCC alone
- C. The three CCs, because they outnumber the MCC
- D. The average severity of the secondaries
8. Adding a fourth well-documented CC to the record in question 7 changes this claim's payment by:
- A. One tier
- B. The CC's relative weight
- C. Nothing
- D. It depends on the payer
9. The CC and MCC designations are revised:
- A. Quarterly, with the HCPCS update
- B. Annually, in the IPPS final rule
- C. Every October 1, in the ICD-10-CM Guidelines
- D. Only when Congress acts
10. The grouper's steps, in order, are:
- A. MDC → severity split → surgical partition → pre-MDC check
- B. Pre-MDC check → MDC → surgical partition → severity split
- C. Surgical partition → MDC → pre-MDC check → severity split
- D. Severity split → MDC → surgical partition → pre-MDC check
11. Whether a stay takes the surgical partition is decided by:
- A. Whether the patient went to the operating room
- B. The presence of an OR-designated ICD-10-PCS code on the record
- C. The attending physician's specialty
- D. The CPT code on the professional claim
12. At a base rate of \$6,200.00, a DRG with relative weight 0.8003 pays:
- A. \$4,064.10
- B. \$4,961.86
- C. \$6,829.30
- D. \$8,003.00
13. On Account 22-8891, the difference between DRG 190 and DRG 191 — \$1,867.44 — is the value of:
- A. One additional covered day
- B. The documented phrase "acute respiratory failure with hypoxia" rather than "hypoxia"
- C. The pressure ulcer's POA indicator
- D. The wage index adjustment
14. The base rate's labor-related share is adjusted by:
- A. The conversion factor
- B. The cost-to-charge ratio
- C. The hospital's wage index
- D. The case mix index
15. The case mix index is:
- A. The average length of stay across discharges
- B. The average relative weight of a hospital's discharges
- C. The ratio of charges to costs
- D. The share of stays with an MCC
16. Short answer: a hospital's CMI rises with no change in its clinical services. Give the two explanations the number alone cannot distinguish.
17. A condition that develops during an outpatient ED encounter, before the inpatient admission order, is reported with POA:
- A. Y
- B. N
- C. U
- D. W
18. For HAC payment purposes, POA = U is treated like ___ and POA = W is treated like ___:
- A. Y; N
- B. N; Y
- C. N; N
- D. Y; Y
19. A stage 3 pressure ulcer on the HAC list is reported with POA = N on a record whose only other severity-tier condition is an MCC with POA = Y. The effect of the HAC provision on this claim's payment is:
- A. The claim is denied
- B. The stay drops one tier
- C. Nothing — the POA = Y MCC already sets the tier
- D. The ulcer's charges are carved out
20. The payment rules key on the geometric rather than the arithmetic mean length of stay because the geometric mean:
- A. Is always larger
- B. Is resistant to the long-stay outliers that skew the arithmetic mean
- C. Includes transfer cases
- D. Is recalculated more often
21. A DRG pays \$9,300.00 in full with a GMLOS of 5.0 days. A patient is transferred to another acute hospital after 3 days. The transfer payment (per diem, day 1 doubled) is:
- A. \$5,580.00
- B. \$7,440.00
- C. \$9,300.00
- D. \$3,720.00
22. Short answer: state the transfer rule's cap in one sentence.
23. In ICD-10-PCS, the root operation Resection differs from Excision in that Resection is:
- A. Performed through an open approach
- B. The cutting out of all of a body part
- C. Always accompanied by a device character
- D. Limited to the Medical and Surgical section
24. In 0DTJ4ZZ, the character "4" reports:
- A. The body part
- B. The device
- C. The approach — percutaneous endoscopic
- D. The qualifier