Here are some sample questions with answers for inpatient and outpatient coders:
Inpatient Coding:
- What is the difference between MS-DRGs and APR-DRGs?
Answer: MS-DRGs (Medicare Severity Diagnosis-Related Groups) and APR-DRGs (All Patient Refined Diagnosis-Related Groups) are both classification systems used to group patients with similar clinical characteristics and resource utilization. The main difference between them is that MS-DRGs are used for Medicare patients only, while APR-DRGs are used for all patients, regardless of payer.
- What is a major complication or comorbidity (MCC)?
Answer: A major complication or comorbidity (MCC) is a diagnosis that significantly affects the patient’s treatment and length of stay in the hospital. MCCs are conditions that are not only present on admission but also require significant resources to manage during the hospitalization.
- What is a secondary diagnosis?
Answer: A secondary diagnosis is a medical condition that coexists with the primary condition for which the patient is being treated. Secondary diagnoses are used to identify additional conditions that may affect the patient’s treatment and overall healthcare needs.
Outpatient Coding:
- What is the difference between CPT and HCPCS codes?
Answer: CPT (Current Procedural Terminology) codes are used to report medical procedures and services performed by healthcare providers. HCPCS (Healthcare Common Procedure Coding System) codes are used to report supplies, equipment, and services provided to patients. HCPCS codes are often used for Medicare and Medicaid billing.
- What is a place of service code?
Answer: A place of service (POS) code is a two-digit code used to indicate where a healthcare service was provided, such as a hospital, clinic, or physician’s office. POS codes are used to determine the appropriate reimbursement rate for services provided in different settings.
- What is a modifier code?
Answer: A modifier code is a two-digit code used to provide additional information about a procedure or service performed. Modifier codes are used to indicate changes or modifications to the original code, such as a different location or a different approach to the procedure. Modifier codes are used to ensure accurate reimbursement for services provided.