According to the Centers for Medicare and Medicaid Services (CMS), what two items must be documented on a patient's claim for reimbursement?
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Healthcare Common Procedure Coding System (HCPCS)
International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) and Healthcare Common Procedure Coding System (HCPCS)
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Current Procedural Terminology (CPT)
International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) and Current Procedural Terminology (CPT)
The Correct Answer is C
Choice A reason: While ICD-10-CM correctly identifies diagnoses, HCPCS codes are primarily used for billing Medicare Part B services, durable medical equipment, and supplies, which is not the standard for all outpatient claims.
Choice B reason: ICD-10-PCS is used mainly for inpatient hospital procedure coding, not outpatient services. Combining it with HCPCS does not reflect routine outpatient claim requirements.
Choice C reason: ICD-10-CM codes provide accurate diagnosis documentation, and CPT codes specify the procedures or services performed. CMS requires both for proper claim processing and reimbursement for outpatient services, making this combination the correct answer.
Choice D reason: ICD-10-PCS codes are intended for inpatient hospital procedures rather than outpatient billing. CPT codes are correct for procedures, but pairing them with ICD-10-PCS does not meet CMS outpatient documentation requirements.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Duty to patient refers to the legal obligation of the healthcare provider to adhere to a standard of care for patients. While this duty exists in the scenario, the act of administering gentamicin improperly does not represent the duty itself.
Choice B reason: Breach of duty occurs when a healthcare provider fails to meet the standard of care, as in administering a nephrotoxic or ototoxic drug without appropriate monitoring. This failure directly constitutes a breach in professional responsibility.
Choice C reason: Proximate cause is the direct link between the breach and the harm suffered. In this case, while the gentamicin administration caused the hearing loss, proximate cause is the connection, not the act of malpractice itself.
Choice D reason: Damages refer to the harm or loss suffered by the patient, such as hearing loss or occupational impairment, but they are not the act of malpractice itself.
Correct Answer is C
Explanation
Choice A reason: Williams syndrome presents with distinctive “elfin” facial features, cardiovascular anomalies, and overly friendly behavior, not the described features.
Choice B reason: Rett syndrome primarily affects girls and involves loss of purposeful hand skills, language regression, and stereotypic hand movements.
Choice C reason: Fragile X syndrome is characterized by intellectual disability, long face, large ears, midface hypoplasia, hyperextensible joints, and short stature, matching this patient’s presentation.
Choice D reason: Turner syndrome affects females and is characterized by short stature, webbed neck, and gonadal dysgenesis, not the features described.
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