1. CKHS CDI Jeopardy Final Jeopardy $100 $100 $100 $100 $100 $200 $200
I KNOW
IT!
IPPS
2019
MS-DRG
AHA CC
ICD-10 CM
Guidelines
$100
$100
$100
$100
$100
$200
$200
$200
$200
$200
$300
$300
$300
$300
$300
$400
$400
$400
$400
$400
$500
$500
$500
$500
$500
Final Jeopardy

2. 1 - $100
Which condition is defined as: bone marrow failure causing a reduction in white blood cells, red blood cells, and platelets?
A. Acute blood loss anemia
B. Aplastic anemia
C. Pernicious anemia
D. Sickle cell anemia

3. 1 - $200
Based on the H & P and ED documentation the patient was admitted with a fever T102.1 F, shortness of breath, chest pain, and a nonproductive cough. The chest x-ray confirms a pleural effusion, which type of effusion is most suspicious for this patient?
A. Malignant
B. Transudative
C. Exudative
D. Serosanguinous

4. 1 - $300
Which microorganism commonly causes exacerbations in patient with COPD?
A. Haemaphilus influenzae
B. Mycoplasma
C. Pneumocystitis
D. Staphylococcal
E. Pseudomonas

5. 1 - $400
Which medication class can be used to control the rate for Atrial Fibrillation with RVR (Rapid Ventricular Rate)?
A. Calcium Channel Blocker (CCB)
B. Angiotensin-converting Enzyme Inhibitors (ACE-I)
C. Angiotensin II Receptor Blocker (ARB)
D. Renin Inhibitor
E. Central-acting Agent

6. 1 - $500
A patient is admitted with acute kidney injury (AKI), BUN 31, Serum Cr 2.10, eGFR 20. Nephrology service is consulted and a recommendation to avoid nephrotoxic medications is made. Which medication(s) below would qualify as nephrotoxic?
A. Aminoglycosides
B. Angiotensin-converting Enzyme Inhibitors (ACE-I)
C. Proton Pump Inhibitor (PPI)
D. Both A and C
E. Both A and B

7. 2 - $100 Part A-What does IPPS stand for and when is it effective?
Part B-What MS-DRG version will IPPS 2019 use?
Part A-Inpatient Prospective Payment System & effective 10/1/2018
Part B-MS-DRG version 36

8. 2 - $200 What do these codes have in common for IPPS 2019?
Diagnosis Code
Description
E72.8
Other specified disorders of amino-acid metabolism
G71.0
Muscular dystrophy
J80
Acute respiratory distress syndrome
K35.89
Other acute appendicitis
K61.3
Ischiorectal abscess
K83.0*
Cholangitis
Q93.5
Other deletions of part of a chromosome
T81.4XXA
Infection following a procedure, initial encounter
Above codes are no longer CCs (deleted from CC list)

9. 2 - $300 Which code(s) is no longer an MCC for IPPS 2019?
Diagnosis Code
Description
B20
Human immunodeficiency virus [HIV] disease
G93.40
Encephalopathy, unspecified
G93.49
Other encephalopathy
I63.8
Other cerebral infarction
K35.2
Acute appendicitis with generalized peritonitis
K35.3
Acute appendicitis with localized peritonitis
All of them-above codes are no longer MCCs (deleted from MCC list)
NB: II-F-16b(1) – Comprehensive Review of CC List for FY 2019: Requested Changes to Severity Levels – Human Immunodeficiency Virus [HIV] Disease (83FR20241)
AHIMA disagrees with the proposed change in severity level of ICD-10-CM code B20, Human immunodeficiency virus [HIV] disease, from an MCC to a CC, as CMS’ data analysis did not strongly suggest that the current severity categorization was inaccurate.

10. 2 - $400
Is Code T8144XA an MCC?
Diagnosis Code
Description
T81.44XA
Sepsis following a procedure, initial encounter
No, it’s not a CC or MCC. Deletion to CC List

11. 2 - $500 Which pneumonia type below is a CC?
Diagnosis Code
Description
A54.84
Gonococcal pneumonia
B06.02
Rubella pneumonia
J18.2
Hypostatic pneumonia
K35.21
Cryptogenic organizing pneumonia
All of them are CCs for IPPS 2019

12. 3 - $100
In what year were MS‐DRGs (Medical Severity DRGs) developed to better account for patients’ severity of illness and resources used.
2007

13. 3 - $200
How many chapters Major Diagnostic Categories (MDCs) are there for MS-DRG version 35?
25 Chapters, by body system or circumstance of admission

14. 3 - $300
Name one factor that MS-DRGs use to classify all human diseases?
MS-DRGs classify all human diseases according to a number of factors including the medical diagnosis, surgical procedures performed, discharge status, and sex of the patient

15. 3 - $400
A hospital’s Medicare payment for a patient is determined by multiplying the ____by the MS-DRG Relative Weight (RW) for the admission.
Base Rate
Per Diem
Blended Rate
Capitated Rate

16. 3 - $500 Name the PRE-MDC which carries the highest relative weight?
DRG 001 Heart Transplant or Impact of Heart Assist System

17. 4 - $100 What is the definition of AHA Coding Clinic
AHA Central Office provides advice on questions on the interpretation and explanation of the proper use of ICD-9-CM, ICD-10-CM/ICD-10-PCS and certain HCPCS codes through AHA Coding Clinic Advisor -
AHA Central Office provides coding advice and publishes the nationally respected AHA Coding Clinic® for ICD-10-CM, available in print or on CD-ROM.

18. 4 - $200
A patient is admitted to the hospital due to altered mental status, and is diagnosed with an acute lacunar infarct and encephalopathy secondary to the lacunar infarction. Would the encephalopathy be coded separately or is it considered inherent to the acute lacunar infarct?
Assign code G93.49, Other encephalopathy, for encephalopathy that occurs secondary to an acute cerebrovascular accident/stroke. Although the encephalopathy is associated with an acute lacunar infarct, it is not inherent, and therefore is coded when it occurs Q2: Pg 9

19. 4 - $300
When a patient is admitted with acute renal failure (ARF) due to dehydration, but only IV hydration is performed and BUN and creatinine return to normal (no renal workup and no renal disease is noted), would the principal diagnosis change? Does the fact that renal workup was or was not done affect the sequencing?
"The fact that renal function was not investigated or worked up does not affect code assignment." This was misleading, in that the renal function in fact would be followed based on close monitoring of the fluid intake and output, as well as the BUN and creatinine. Fluid monitoring requires nursing resources. Even though the only treatment for the acute renal failure is IV hydration, no procedures are done to image or evaluate the kidneys, and treatment with dialysis is not required, it is still appropriate to assign the code for acute renal failure as the principal diagnosis. 2003: Q1, Pg. 22

20. 4 - $400 How would a type II NSTEMI due to demand ischemia coded?
Assign code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, for a T2MI. Typically, a type 2 myocardial infarction is marked by non- ST elevation, and occurs secondary to cardiac stress due to other causes (i.e., ischemia resulting from a supply-and-demand mismatch), without atherosclerotic plaque rupture, but with myocardial necrosis. Therefore, code a type 2 myocardial infarction as a NSTEMI, unless otherwise documented as STEMI. 2017: Q1, Pg. 44

21. 4 - $500
A patient is diagnosed with encephalopathy due to urinary tract infection (UTI). Is code G94, Other disorders of brain in diseases classified elsewhere, assigned? How should encephalopathy due to UTI be coded?
Assign codes G93.49, Other encephalopathy, and N39.0, Urinary tract infection, site not specified. The sequencing of the principal diagnosis would be based on the condition found after study to be responsible for the hospital admission.
 As previously stated in Coding Clinic Second Quarter 2017, pages 8-9, code G94, Other disorders of brain in diseases classified elsewhere, should only be assigned for those conditions with Index entries that directly point to code G94, for certain etiologies. 2018: Q2, Pg. 22

22. 5 - $100 What does an Excludes 1 note mean?
It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.
An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider

23. 5 - $200 What does UHDDS stand for and reporting “other diagnoses”?
For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring:
clinical evaluation;
or therapeutic treatment;
or diagnostic procedures;
or extended length of hospital stay;
or increased nursing care and/or monitoring
The UHDDS item #11-b defines Other Diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current hospital stay are to be excluded.”

24. 5 - $300 How are brackets ([ ]) used in the Tabular List?
482.2 Pneumonia due to Hemophilus influenzae [H. influenzae]
Used to enclose synonyms, alternative wording or explanatory phrases.
Brackets are used in the Alphabetic Index to identify manifestation codes.

25. 5 - $400
In ICD-10 CM Coding Guidelines the word “With” should be interpreted to mean?
“Associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).
For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related
The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

26. 5 - $500
Per ICD-10 CM B. General Coding Guidelines, how is a borderline diagnosis coded?
If the provider documents a "borderline" diagnosis at the time of discharge, the diagnosis is coded as confirmed, unless the classification provides a specific entry (e.g., borderline diabetes).
If a borderline condition has a specific index entry in ICD-10-CM, it should be coded as such. Since borderline conditions are not uncertain diagnoses, no distinction is made between the care setting (inpatient versus outpatient).
Whenever the documentation is unclear regarding a borderline condition, coders are encouraged to query for clarification.

27. Final Jeopardy
A patient is admitted from outpatient surgery department and is subsequently admitted for continuing inpatient care at the same hospital due to Atrial fibrillation prior to undergoing an elective R. knee revision, what is the PDX?
Atrial Fibrillation
If the reason for the inpatient admission is a complication, assign the complication as the principal diagnosis.
If no complication, or other condition, is documented as the reason for the inpatient admission, assign the reason for the outpatient surgery as the principal diagnosis.
If the reason for the inpatient admission is another condition unrelated to the surgery, assign the unrelated condition as the principal diagnosis.
F. Original treatment plan not carried out-Sequence as the principal diagnosis the condition, which after study occasioned the admission to the hospital, even though treatment may not have been carried out due to unforeseen circumstances.