What is coding?

True or False: The conventions and guidelines are the only rules that a coder needs to know. A. False, the coder needs to know the payment policies and eligibility rules for the setting, in addition to the conventions and guidelines. B. False, the coder needs to know the specific coding rules that apply to home health and hospice because the guidelines are different depending on the health care setting. C. True, because home care and hospice coders are not concerned with CPT codes or HCPCS codes. D. True, according to HIPAA, the conventions are the most important, followed by the guidelines.

A. In addition to the conventions and guidelines, which are essentially the same for every health care setting, the coder needs to know the other rules that apply to the setting, such as payment policies and eligibility standards for the benefit.

True or False: The 7th character can be a letter or a number. A. True B. False

A. Some codes like the obstetrics codes and gout have numbers as the 7th character.

Which is most important to a coder? A. The conventions B. The official coding guidelines C. The face to face encounter document D. The chapter specific guidelines

A. The conventions are the general rules for use of the classification independent of the guidelines. The instructions and conventions take precedence over the guidelines. If a convention conflicts with a guideline, always apply the convention, not the guideline.

Which of the following is FALSE regarding ICD-10-CM features? A. The first letter of the code must be uppercase B. The placeholder X is sometimes needed in a code C. First character of all the codes is a letter D. The codes are 3-7 characters in length

A. Alphabetical characters are not case sensitive.

Look at the Excludes 1 note at Z93. What does it mean? A. It means that you cannot code the Z93 code for status of the ostomy at the same time as the attention to the same ostomy. B. It means you can code the Z93 code along with the complication of the same ostomy.

A. An Excludes 1 note usually indicates the code excluded should never be used at the same time as the code above the Excludes 1 notes. You cannot code the attention to code for the ostomy at the same time as the status code or complication code for the same ostomy.

Look at J20. The excludes 1 note for bronchitis NOS means: A. If the physician has specified acute bronchitis, then bronchitis unspecified is not coded. B. Never code bronchitis unspecified since there is a code for acute bronchitis available. C. The coder should choose to code both acute bronchitis and bronchitis to ensure everyone understands the patient has bronchitis.

A. An excludes 1 note is a pure excludes note which means the two conditions cannot be coded at the same time (unless a specific exception applies). In this case, acute bronchitis is the more specific of the two so J20.- is chosen.

Codes for home health claims are entered into: A. OASIS, PoC, and the claim B. PoC, Plan of Discharge, and the claim C. Claim only D. OASIS, PoC, and the Conditions of Participation

A. The diagnosis codes are entered into the OASIS, PoC and the RAP/claim.

The physician documents essential anemia. When you reference anemia in the index, the word 'essential' is in parentheses. What does that mean? A. That word in parentheses is a non-essential modifier. It means that essential anemia is coded the same way as if the physician stated 'anemia.' B. That word in parentheses is an essential modifier and means that the coder needs to look further in the index to find the right code. C. That word in parentheses means to look further in the indentations so as to find the more specific code.

A. Words in parentheses are non-essential modifiers and do not change the code assignment. The code for essential anemia is the same as anemia -D64.9.

What is the default 7th character for injuries in home care and hospice? A. A for aftercare B. D for subsequent care C. S for subsequent recertifications

B. D, subsequent encounter, is used for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase or for long term consequences of the disease.

True or False: Aftercare for fractures will be coded with a Z code. A. True B. False

B. Fractures will be coded as current diagnoses with a 7th character to indicate healing. M1025 will not be used for fractures.

See Z89.43. When there is no code for bilateral, but the condition is bilateral, you should: A. Assign the code for the right side only because it is the default. B. Assign separate codes for the right side and the left side.

B. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

The M1A codes use a 7th character for subsequent care. A. True B. False

B. These gout codes use a 7th character to indicate with or without tophi.

Look at J20. The excludes 2 note for acute bronchitis with chronic obstructive pulmonary disease means: A. The coder needs to choose between J20.- and J44.- B. If the patient has both conditions then both conditions should be coded. C. Always code both conditions because the patient cannot have one without the other. D. Code J44.- because it is the most severe of the two conditions and there is no need to code J20.-

B. Excludes 2 means the condition specified in the excludes 2 note is not the same as the condition in the code and if the patient has both conditions, code both codes.

The Cooperating Parties include the: A. AHIMA, AHA, AAHC, APIC B. AHIMA, WHO, CMS, CDC C. AHIMA, AHA, CMS, NCHS D. AHA, NAHC, AAHC, CDC

C. The cooperating parties are: AHIMA, AHA, CMS, NCHS.

Which of the following may be coded based on clinical documentation? A. Hypertensive heart disease, Body Mass Index, congestive heart failure B. Obesity, Body Mass Index and osteoporosis fractures C. Pressure ulcers, Body Mass Index and severity of non-pressure ulcers D. Pressure ulcer stage, Body Mass Index and severity of non-pressure ulcers.

D. Guidelines state that pressure ulcer stage, the severity of non-pressure ulcers and BMI may be coded based on clinician documentation other than the physician.

Which of the following statements regarding home health coding is false? A. Home health is paid on a per diem basis. B. All diagnoses, related and unrelated to the primary diagnosis, should be coded. C. The primary diagnosis is the diagnosis that contributes to the prognosis of 6 months or less. D. All of the above statements are false.

D. All the statements are true of hospice, but not home health.

Look up K31.5. The list underneath the K31.5 code is called a(n): A. Excludes list B. Essential modifier C. Subentry D. Inclusion list

D. The inclusion list provides examples of diagnoses included in the code.

ICD-9 and ICD-10 were developed by WHO. What is the significance to that? A. We can blame all of our coding problems on them. B. The United States has to pay a fee to the World Court to be able to use the code set. C. The United States has to get permission for changes since the WHO owns the code set. D. There is interoperability since most of the world uses the same code set. E. Both C & D

E. The World Health Organization owns the code set and there is interoperability between nations using the ICD-10 code set.

Which of the following are examples of methods for finding terms in the alphabetical index? A. Think of the noun. B. Skip the alphabetical index and go straight to the tabular list. C. Purchase a cheat sheet so that the coding manual doesn't have to be used. D. Keep a list of terms to look up Z codes because those are hard to find. E. A and D F. All of the above

E. General guidelines require that coders use both the alphabetical index and the tabular list. CMS recommends that all coding be done native, meaning cheat sheets are not a good idea. Z codes do not follow the rule of "Think of the noun"; and a different list of terms is useful for finding those in the index.