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ICD-10 > DRG Test > Flashcards

DRG Test Flashcards

1
Q

What does DRG stand for?

A

Diagnosis Related Group

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2
Q

What does MDC stand for?

A

Major Diagnostic Category

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3
Q

What does C/C stand for?

A

Complication/Comorbidity

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4
Q

What does G/Los stand for?

A

Geometric Length of Stay

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5
Q

What does CMS stand for?

A

Center for Medicare Medicaid Services

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6
Q

What is an MDC?

A

One of 26 subdivisions to which all of the ICD-9 CM codes have been assigned on the basis of organ system.

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7
Q

DRG assignment is based on what?

A

Principal Diagnosis, Secondary Diagnosis, C/C, Principal and Secondary Procedure.

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8
Q

What are the two special DRG’s?

A

981-Extensive operating room procedure unrelated to principal diagnosis.
986-Prostatic OR procedure unrelated to principal diagnosis.

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9
Q

What is relative weight?

A

The more it weighs, the more it pays.

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10
Q

What is a case-mix index?

A

It is the sum of all DRG relative weights divided by the total number of Medicare patients treated by the hospital over a specific period of time.

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11
Q

Operating Room procedure categories are what?

A

Hierarchical and based on intensity of resource consumption.

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12
Q

A patient with multiple OR procedures will be assigned to the surgical group based on what?

A

The most resource intensive procedure.

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13
Q

Hierarchical structure is from where to where on a decision tree?

A

Left to Right

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14
Q

What does POA stand for?

A

Present on Admission

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15
Q

What is the definition of POA?

A

Present at the time the order for inpatient admission occurs.

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16
Q

What is a POA assigned to?

A

The principal and secondary diagnosis as well as external cause of injury codes.

17
Q

What does a (Y) represent for POA’s?

A

Yes. Present at the time of inpatient admission.

18
Q

What does (N) represent for POA’s?

A

No. Not present at the time of inpatient admission.

19
Q

What does (U) represent for POA’s?

A

Unknown. Documentation is insufficient to determine if condition is present on admission.

20
Q

What does (W) represent for POA’s?

A

Clinically Undetermined. Provider is unable to clinically determine whether condition was present on admission or not.

21
Q

What is MEDPAR?

A

The Medicare Provider Analysis and Review file. It stores twenty percent of the bills that hospitals submit for payment for inpatient services rendered to Medicare Beneficiaries.

22
Q

In what setting are DRGs used?

A

Inpatient

23
Q

A patient can have how many DRGs per visit?

A

One

24
Q

What is the type of software used to help determine DRGs?

A

A grouper

25
Q

What is the G/LOS?

A

How many days a patient should get to recover.

26
Q

True or False: You can change the principal diagnosis for a higher DRG if it is in the same MDC?

A

True

ICD-10 (4 decks)

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