CCS Exam Study Questions: High-Yield Practice for
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A female patient is diagnosed with congestive heart failure. Which of the following will increase the
MS-DRG weight if present on admission?
Atrial fibrillation
Stage III pressure ulcer
Blood loss anemia
Coronary artery disease
Stage III pressure ulcer
MS-DRG 291 (weight = 01.5010) for congestive heart failure with stage III pressure ulcer would optimize
the MS-DRG. MS-DRG 293 (weight = 0. 6756) is assigned for congestive heart failure alone, with atrial
fibrillation, with blood loss anemia, and with coronary artery disease all remain the same (Medicare
Grouper Version 29-10/11)
A 70-year-old patient was admitted with pneumonia. The history and physical documented that the
patient has a history of diabetes, hypertension, and migraine headache about 10 years ago without
recurrence. The patient was administered IV antibiotics, metformin, and Altace during the
hospitalization. Which conditions would be reported at the time of discharge?
Pneumonia, diabetes, and hypertension
A patient is admitted for chest pain. The patient was stabilized and discharged. In a subsequent
admission, the patient was admitted as an outpatient for a left heart catheterization, coronary
arteriography using two catheters and left ventricular angiography. The patient was found to have
arteriosclerotic heart disease. The patient has no history of cardiac surgery. The appropriate
sequencing of ICD-9 and CPT codes for the outpatient catheterization would be:
411.1-Intermediate coronary syndrome (unstable angina)
,413.9- Other and unspecified angina pectoris
414.00-Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01-Coronary atherosclerosis of native coronary artery
786.50-Chest pain, unspecified
93452-Left heart catheterization including intraprocedural injection(s) for left ventriculography,
imaging supervision and interpretation, when performed
93453-Combined right and left heart catheterization including intraprocedural injection(s) for left
ventriculography, imaging supervision and interpretation, when performed
93454-Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural
injection(s) for coronary angiography, imaging supervision and interpretation;
93458-with left heart catheterization including intraprocedural injection(s) for left ventriculography,
when performed
414.01, 93458
Code 414.01 is assigned to show coronary artery disease in a native coronary artery and is used when a
patient has coronary artery disease and no history of coronary bypass graft (CABG) surgery
(Schraffenberger 2012, 190-192). Code 93458 includes intraprocedural injection(s) for left
ventricular/left atrial angiography, imaging supervision, and interpretation when performed (AMA CPT
Professional Edition 2013, Cardiac Catheterization Guidelines, 500-503).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon would be
coded as a
colonoscopy
A chest x-ray done to evaluate a chronic cough revealed a asymptomatic compression fracture of a
lumbar vertebrae. No further evaluation was undertaken. The coder should:
Not assign a code for an acute condition but assign a code for chronic compression fracture
Assign a code for pathologic lumbar compression fracture
Assign a code for acute traumatic vertebral fracture
Not assign a code for this condition
Not assign a code for this condition
Do not assign a code for this condition because this is a frequent condition in the elderly, is
,asymptomatic, and there is no documentation of treating the condition so it should not be coded
(Brown 2012, 33).
A patient is admitted with hypotension due to dobutamine taken, administered, and prescribed
correctly. How should this be coded?
Code 458.2, Iatrogenic hypotension, should be assigned to describe this condition. This code should be
assigned when hypotension develops as a result of any type of medical care. Assign code E941.2,
Sympathomimetics (adrenergics), to indicate that it is an adverse effect of the drug
MS-DRG assignment is based on information that includes
Diagnoses (principal and secondary); Surgical procedures (principal and secondary; Discharge disposition
or status; Presence of major or other complications and comorbidities (MCC or CC as secondary
diagnosis)
These elements are used to determine the MS-DRG) MS-DRG assignment goes through four steps:
Pre-MDC assignments, MDC determination, Medical/surgical determination, and refinement
If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body
area from which the excision occurs and the
Diameter of the lesion as well as the margins excised as described in the operative report
The operative report should be reviewed for the body part involved with the lesion. The total size of the
excised area, including margins, is needed for accurate coding. The pathology report typically provides
the specimen size rather than the lesion or excised size. Because the specimen tends to shrink, this is
not an accurate measurement according to the intent of the code assignment
The case-mix index for the information provided above is:
MS-DRG Weight Number of Patients
MS-DRG 193, Simple pneumonia and pleurisy age >17 w/ CC;
WEIGHT 3.0; # of patients 10
MS-DRG 195, Simple pneumonia without MCC or CC
2.0; 10
MS-DRG 192, Chronic obstructive pulmonary disease w/o CC
1.0; 10
2.0
The case mix is defined as a methods of grouping patients. MS-DRGs are often used to determine case
mix in hospitals. The case-mix index is the average MS-DRG weight based on the specific patient group
and is determined by multiplying the DRG weights by the number of patients and then divided by the
total number of patients: 30 + 20 + 10 = = 2.0
, 75-year-old woman is admitted to the hospital after tripping and falling at home. She underwent an
open reduction with internal fixation of the femur. Which of the following would be important to
capture in addition to diagnostic codes?
E codes for Cause of Injury, Place of Occurrence, Activity, and Status
External cause of injury codes are used to provide information about how an injury occurred, the intent
(intentional or unintentional), provide information about where the injury occurred, and the status of
the person at the time the injury occurred. In the case of a person who seeks care for an injury or other
health condition that resulted from an activity, or when an activity contributed to the injury or health
condition, activity codes are used to describe the activity
During an ambulatory surgery visit for excision of a malignant melanoma of the right forearm, the
attending surgeon listed history of benign breast cyst, history of hypertension currently on Tenormin,
and a current hammer toe. Which conditions are to be coded?
Malignant melanoma of forearm, hypertension
Assign codes for malignant melanoma of forearm, hypertension. Code chronic conditions if they affect
the patient's treatment. The hypertension was being treated with a current medication and for this
reason the hypertension is coded
Chronic conditions must be _____ by physician
This is an example of a circumstance where the chronic condition must be verified. All secondary
conditions must meet the UHDDS definitions
Determining medical necessity for outpatient services includes all the following
Local coverage determinations (LCDs)
National coverage determinations (NCDs)
Diagnoses linked to procedures by claims-processing software tests ensuring that the procedure is cross-
referenced, or linked, correctly to an acceptable diagnosis code for that service
the fee schedule and the current National Correct Coding Initiatives edits. Other valuable resources are
Medicare's Carrier Manual, Medicare's National Coverage Determinations Manual, and local coverage
determinations (LCDs)
A patient was admitted to the emergency department with chest pain, and was diagnosed with
aborted myocardial infarction with acute myocardial ischemia. There was no prior cardiac surgery.
The cardiac enzymes were normal. The appropriate coding of the diagnosis for this case is:
411.81 Acute coronary occlusion without myocardial infarction
Patients with acute ischemic heart disease or acute myocardial ischemia does not always indicate an
infarction. It is often possible to prevent infarction by means of surgery or the use of thrombolytic
Success
malicious software
backdoor
A female patient is diagnosed with congestive heart failure. Which of the following will increase the
MS-DRG weight if present on admission?
Atrial fibrillation
Stage III pressure ulcer
Blood loss anemia
Coronary artery disease
Stage III pressure ulcer
MS-DRG 291 (weight = 01.5010) for congestive heart failure with stage III pressure ulcer would optimize
the MS-DRG. MS-DRG 293 (weight = 0. 6756) is assigned for congestive heart failure alone, with atrial
fibrillation, with blood loss anemia, and with coronary artery disease all remain the same (Medicare
Grouper Version 29-10/11)
A 70-year-old patient was admitted with pneumonia. The history and physical documented that the
patient has a history of diabetes, hypertension, and migraine headache about 10 years ago without
recurrence. The patient was administered IV antibiotics, metformin, and Altace during the
hospitalization. Which conditions would be reported at the time of discharge?
Pneumonia, diabetes, and hypertension
A patient is admitted for chest pain. The patient was stabilized and discharged. In a subsequent
admission, the patient was admitted as an outpatient for a left heart catheterization, coronary
arteriography using two catheters and left ventricular angiography. The patient was found to have
arteriosclerotic heart disease. The patient has no history of cardiac surgery. The appropriate
sequencing of ICD-9 and CPT codes for the outpatient catheterization would be:
411.1-Intermediate coronary syndrome (unstable angina)
,413.9- Other and unspecified angina pectoris
414.00-Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01-Coronary atherosclerosis of native coronary artery
786.50-Chest pain, unspecified
93452-Left heart catheterization including intraprocedural injection(s) for left ventriculography,
imaging supervision and interpretation, when performed
93453-Combined right and left heart catheterization including intraprocedural injection(s) for left
ventriculography, imaging supervision and interpretation, when performed
93454-Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural
injection(s) for coronary angiography, imaging supervision and interpretation;
93458-with left heart catheterization including intraprocedural injection(s) for left ventriculography,
when performed
414.01, 93458
Code 414.01 is assigned to show coronary artery disease in a native coronary artery and is used when a
patient has coronary artery disease and no history of coronary bypass graft (CABG) surgery
(Schraffenberger 2012, 190-192). Code 93458 includes intraprocedural injection(s) for left
ventricular/left atrial angiography, imaging supervision, and interpretation when performed (AMA CPT
Professional Edition 2013, Cardiac Catheterization Guidelines, 500-503).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon would be
coded as a
colonoscopy
A chest x-ray done to evaluate a chronic cough revealed a asymptomatic compression fracture of a
lumbar vertebrae. No further evaluation was undertaken. The coder should:
Not assign a code for an acute condition but assign a code for chronic compression fracture
Assign a code for pathologic lumbar compression fracture
Assign a code for acute traumatic vertebral fracture
Not assign a code for this condition
Not assign a code for this condition
Do not assign a code for this condition because this is a frequent condition in the elderly, is
,asymptomatic, and there is no documentation of treating the condition so it should not be coded
(Brown 2012, 33).
A patient is admitted with hypotension due to dobutamine taken, administered, and prescribed
correctly. How should this be coded?
Code 458.2, Iatrogenic hypotension, should be assigned to describe this condition. This code should be
assigned when hypotension develops as a result of any type of medical care. Assign code E941.2,
Sympathomimetics (adrenergics), to indicate that it is an adverse effect of the drug
MS-DRG assignment is based on information that includes
Diagnoses (principal and secondary); Surgical procedures (principal and secondary; Discharge disposition
or status; Presence of major or other complications and comorbidities (MCC or CC as secondary
diagnosis)
These elements are used to determine the MS-DRG) MS-DRG assignment goes through four steps:
Pre-MDC assignments, MDC determination, Medical/surgical determination, and refinement
If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body
area from which the excision occurs and the
Diameter of the lesion as well as the margins excised as described in the operative report
The operative report should be reviewed for the body part involved with the lesion. The total size of the
excised area, including margins, is needed for accurate coding. The pathology report typically provides
the specimen size rather than the lesion or excised size. Because the specimen tends to shrink, this is
not an accurate measurement according to the intent of the code assignment
The case-mix index for the information provided above is:
MS-DRG Weight Number of Patients
MS-DRG 193, Simple pneumonia and pleurisy age >17 w/ CC;
WEIGHT 3.0; # of patients 10
MS-DRG 195, Simple pneumonia without MCC or CC
2.0; 10
MS-DRG 192, Chronic obstructive pulmonary disease w/o CC
1.0; 10
2.0
The case mix is defined as a methods of grouping patients. MS-DRGs are often used to determine case
mix in hospitals. The case-mix index is the average MS-DRG weight based on the specific patient group
and is determined by multiplying the DRG weights by the number of patients and then divided by the
total number of patients: 30 + 20 + 10 = = 2.0
, 75-year-old woman is admitted to the hospital after tripping and falling at home. She underwent an
open reduction with internal fixation of the femur. Which of the following would be important to
capture in addition to diagnostic codes?
E codes for Cause of Injury, Place of Occurrence, Activity, and Status
External cause of injury codes are used to provide information about how an injury occurred, the intent
(intentional or unintentional), provide information about where the injury occurred, and the status of
the person at the time the injury occurred. In the case of a person who seeks care for an injury or other
health condition that resulted from an activity, or when an activity contributed to the injury or health
condition, activity codes are used to describe the activity
During an ambulatory surgery visit for excision of a malignant melanoma of the right forearm, the
attending surgeon listed history of benign breast cyst, history of hypertension currently on Tenormin,
and a current hammer toe. Which conditions are to be coded?
Malignant melanoma of forearm, hypertension
Assign codes for malignant melanoma of forearm, hypertension. Code chronic conditions if they affect
the patient's treatment. The hypertension was being treated with a current medication and for this
reason the hypertension is coded
Chronic conditions must be _____ by physician
This is an example of a circumstance where the chronic condition must be verified. All secondary
conditions must meet the UHDDS definitions
Determining medical necessity for outpatient services includes all the following
Local coverage determinations (LCDs)
National coverage determinations (NCDs)
Diagnoses linked to procedures by claims-processing software tests ensuring that the procedure is cross-
referenced, or linked, correctly to an acceptable diagnosis code for that service
the fee schedule and the current National Correct Coding Initiatives edits. Other valuable resources are
Medicare's Carrier Manual, Medicare's National Coverage Determinations Manual, and local coverage
determinations (LCDs)
A patient was admitted to the emergency department with chest pain, and was diagnosed with
aborted myocardial infarction with acute myocardial ischemia. There was no prior cardiac surgery.
The cardiac enzymes were normal. The appropriate coding of the diagnosis for this case is:
411.81 Acute coronary occlusion without myocardial infarction
Patients with acute ischemic heart disease or acute myocardial ischemia does not always indicate an
infarction. It is often possible to prevent infarction by means of surgery or the use of thrombolytic
