CCS EXAM LATEST 2023-2024 REAL EXAM 200 QUESTIONS
AND CORRECT ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+
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? – ANSWER- 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 – ANSWER- 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 – ANSWER- 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 – ANSWER- 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? – ANSWER- 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 – ANSWERDiagnoses (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: – ANSWER- 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 – ANSWERDiameter 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 – ANSWER- 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 MSDRG 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 = 60 / 30 = 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? –
ANSWER- 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? – ANSWER- 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 – ANSWER- 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 –
ANSWER- 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: – ANSWER- 411.81 Acute
coronary occlusion without myocardial infarction