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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that are present across multiple settings and have existed since childhood. This patient’s symptoms are acute and situational, triggered by a recent stressor (grandfather’s illness), which makes ADHD less likely as the primary diagnosis.
Choice B reason: Adjustment disorder with mixed anxiety and mood is a stress-response syndrome that arises within three months of an identifiable stressor. The patient’s concentration problems, sadness, decreased energy, restlessness, and sleep difficulties are all temporally linked to the stressor of caring for a sick grandparent. This diagnosis fits the acute onset of emotional and behavioral changes in response to a significant life event.
Choice C reason: Separation anxiety disorder involves excessive fear or anxiety concerning separation from attachment figures. While the patient has concern for his grandfather, his anxiety is not rooted in separation from a primary attachment figure but rather in worry about the grandfather’s illness and responsibilities at home.
Choice D reason: Generalized anxiety disorder is characterized by excessive, uncontrollable worry about multiple areas of life for at least six months. The patient’s anxiety is specific to a recent stressor rather than pervasive across multiple domains, making GAD less likely.
Correct Answer is C
Explanation
Choice A reason: The MMSE is influenced by education level and may underestimate cognitive abilities in individuals with limited formal education, leading to false positives for impairment.
Choice B reason: The MoCA is a sensitive tool for detecting mild cognitive impairment, but it also relies on literacy and educational background, potentially biasing results in those with low education.
Choice C reason: The SLUMS is specifically designed to account for varying education levels and provides adjusted scoring for individuals without a high school diploma, making it more accurate for initial cognitive assessment in this patient.
Choice D reason: The Mini-Cognition test is brief and useful in certain settings, but it is less comprehensive and may not adequately account for education-related biases, limiting its diagnostic accuracy in this patient.
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