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DOMAIN III - GEORGETTE'S (DIAGNOSIS & TREATMENT)REVIEW 2024 WITH COMPLETE SOLUTIONS
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DOMAIN III - GEORGETTE'S (DIAGNOSIS & TREATMENT)REVIEW 2024 WITH COMPLETE SOLUTIONS
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DOMAIN III - GEORGETTE'S (DIAGNOSIS &TREATMENT)REVIEW 2024 WITH COMPLETE
SOLUTIONS
1. If the patient has a diagnosis of septicemia, which of the following procedures
will increase the MS-DRG assignment the most?
A) Bronchoscopy with left bronchus biopsy (0BB74ZX)
B) Debridement of toenail (OHBRXZZ)
C) Nonexcisional debridement of skin ulcer of perineum with abrasion (OHD9XZZ)
D) Respiratory ventilation. Greater than 96 consecutive hours
D) The ventilator management is the procedures that will affect the MS-DRG to provide
appropriate reimbursement. The MS-DRG with the highest weight is 870.
2. Medicare depends on the following, except:
A) The correct designation of the principal diagnosis
B) Policies and procedures of the medical staff
C) The presence of absence of additional codes that represent complications,
comorbidities, or major complications/comorbidities
D) Procedures performed
B) Policies and procedures of the medical staff are not relevant. But the other areas of
diagnoses, additional conditions, and procedures are all important to determine the MS-
DRGs.
3.A coder reviews a medical record and determines that a code Medicare has
designated as "unacceptable principal diagnosis" is the correct code to assign.
What should the coder do?
A) Assign another code from the history and physical as the principal diagnosis
B) Assign the code even though the insurer may not pay the claim
C) Use a comorbidity as the principal diagnosis
D) Assign a code from the outpatient visit prior to admission
B) While Medicare may specify that a given condition is not acceptable, if that condition
is what is documented, the coder has no other option but to code what is documented
even though the insurer may not pay the claim
4. A condition is present on admission when:
A) It is the principal diagnosis
B) It is accordance with medical staff bylaws
C) A condition that occurs prior to an inpatient admission
D) It is present within 3 days after admission
C
5. Documentation from the nursing or other allied health professionals ' notes can
be used to establish which of the following diagnoses:
A) Body Mass Index (BMI)
B) Malnutrition
C) Aspiration pneumonia
D) Fatigue
, A) The physician must establish the diagnosis--obesity or morbid obesity---and the
additional information can be pulled from ancillary documentation to establish the
correct code assignment from BMI
6. Documentation in the record reveals that a patient is admitted with an acute
exacerbation of COPD (MS-DRG 192) A higher paying DRG may be appropriate if
documentation is present in the record at the time the decision was made to
admit the patient that confirms a diagnosis associated with which of the
following:
A) Angina was treated with nitroglycerin prn for chest pain
B) Atrial fibrillation and underwent a cardioversion while hospitalized
C) Blood gases of pO2, of 58, pCO2 of 55, pH of 7.32 upon admission and treated
with intubation and mechanical ventilation for 23 hours
D) Anemia and was given a blood transfusion
C) The acute exacerbation of COPD with blood gases of pO2, of 58, pCO2 of 55, pH of
7.32 reflects possible respiratory failure. The patient was treated with intubation and
mechanical ventilation for 23 hours. MS-DRG 0208 is a correct reflection of the patient's
severity illness and appropriate reimbursement based on the documentation when
compared to the MS-DRG associated with acute exacerbation of COPD
7. A female patient is diagnosed with congestive heart failure. Which of the
following will increase the MS-DRG weight if present on admission?
A) Atrial fibrillation
B) Stage III pressure ulcer
C) Blood loss anemia
D) Coronary artery disease
B) MS-DRG 291 (weight=01.5174) for CHF with stage III pressure ulcer would optimize
the MS-DRG. MS-DRG 293 (weight = 00.6751) is assigned for CHF alone, with atrial
fibrillation, with blood loss anemia, and with coronary disease all remain the same
8. If the principal diagnosis is an initial episode of an anterior wall myocardial
infarction, which procedure will result in the highest DRG?
A) Mechanical ventilator
B) Insertion central venous catheter
C) Right heart cardiac catheterization
D) Trans bronchial lung biopsy
D) MS-DRG 264 (weight = 02.6674) for MI with transbronchial lung biopsy would result
in the highest reimbursement. MS-DRG 282 (weight = 00.7736) would be assigned for
MI alone, and with insertion central venous catheter. MS-DRG 282 (weight= 00.77360)
would be assigned for MI with mechanical ventilator.
9. Patient admitted with hemorrhage due to placenta previa with twin pregnancy.
This patient had two prior (Cesarean section) deliveries. Emergency C-section
was performed due to the hemorrhage. The appropriate principal diagnosis would
be:
A) Prior cesarean sections
B) Placenta previa without hemorrhage
C) Twin gestation
D) Placenta previa with hemorrhage
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