1) what is an Aborted CVA and can it be coded as CVA?

Aborted cva can be coded as CVA.As Patients presenting with symptoms of an acute cerebrovascular
infarction that receive treatment with tissue plasminogen activator (tPA), have actually had a cerebral
infarction. Although brain damage may not be visible by CT scan, microscopic changes are present.

2) hyponatremia and SIADH how to code

Both Hyponatremia and SIADH(Syndrome of inappropriate antidiuretic hormone secretion), comes

under excludes 1. So code only SIADH.

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3) Procalcitonin- is an indicator for infection Or sepsisIt is a substance produced by cells in the body that
can help providers to diagnose bacterial infections and sepsis

R
4) BNP- Brain natriuretic peptide, a protein produced by the heart and blood vessels. A BNP test
measures the levels of this protein in your blood.It is an indicator for CHF(Congestive heart failure).
O
5) what is MS drg and APR drg- These are 2 types of DRG which determines the reimbursement value in
IPDRG.
W

6) what are the factors which affect MS drg/Elements which affect DRG- Pdx, CC, MCC, PPX, SPX and
Discharge Disposition
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7) What are the factors which affect APR- DRG- SOI(Severity of illness) and ROM (Risk of Mortality) each
of which is divided into

1- Mild
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2- Moderate

3- Severe

4- Extreme
8) Type 2 MI can never be Pdx
 9) Periprosthetic fractures:

They occur as a result of trauma or pathological conditions. A code for any underlying condition as well
as a code for the specific type of fracture (traumatic or pathological) should also be assigned. If the
reason for admission/encounter is the fracture, the specific type of fracture (traumatic or pathological)
should be sequenced first and the periprosthetic fracture code should be sequenced as a secondary
diagnosis code. These fractures can occur around any prosthesis, but the most common sites are the hip
(M97.0), knee (M97.1), ankle (M97.2), shoulder (M97.3), elbow (M97.4). Subcategory M97.8 identifies
"other" sites of periprosthetic fractures. These codes require a fifth character to specify laterality for

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each joint and also require a 7th character to indicate: initial encounter (A), subsequent encounter (D) or
sequela (S).

10) Guidelines to assign Sdx

Clinical evaluation; or

Therapeutic treatment; or
R
O
Diagnostic procedures; or

Extended length of hospital stay; or

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Increased nursing care and/or monitoring; or

Has implications for future health care needs

11) How many approaches are there in PCS

W

There are totally seven approaches in PCS

open- Thoracotomy/Laprotomy
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percutaneous- Fine needle aspiration

percutaneous endoscopic- Laproscopic assisted cholecytectomy

External- Closed reduction of fracture

Natural or artificial- Colectomy through natural opening

Natural or artifical endoscopic- Colonoscope

Percutaneous assisted natural or artifical endoscopic- Laproscopic assisted Hysterectomy

(Explain each of this with example)

 12) How many root operations are there- 31 Root operations

13) Refer to all 31 root operations with def and one example

14) What is Excludes 1 and Excludes 2

KZ
Excludes 1- Cannot be coded together, untill and unless their etiologies are differents

Excludes 2- Can be coded together

15) Fine needle aspiration and Core needle biopsy

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1) When reporting fine needle aspiration of tissue, such as lymph tissue, report "Extraction" of the body
part for the tissue aspirated when available in the appropriate PCS table. If the appropriate body part
value is not available under "Extraction," then the root operation "Excision" should be reported for fine
O
needle aspiration of tissue. FNA procedures of gas or fluid should be reported to the root operation
"Drainage."
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2) Drainage is the correct root operation when bone marrow is aspirated to obtain bone marrow cells
suspended in fluid. Extraction is the root operation for removal of a sample of solid bone marrow.

3) Tru-cut biopsy is a needle biopsy.

W

4)Core needle biopsy goes to Excision because the larger bore needle “cuts” a core of tissue from the
body part.
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Fine needle (aspiration) biopsy goes to Extraction because it removes tissue (If body part not found
under Extraction then go for Excision)
Percutaneous needle drainage of something inside a body part (abscess, etc) goes to Drainage.

16) BMI should never be assigned as standalone code. always related diagnosis such as Obesity,
Cachexia, malnutrition, FTT (failure to thrive), weight loss should be present
 17)what is a concurrent and retrospective query- If the query is raised, during hospitalization of the
patient it is concurrent query

If the query is raised after patient being discharged from the hosptial then it is a Retrospective query

18) See clinical indictors for all the one which i gave the pdf

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19) POA Indicators concept

20)Root operation of PTCA and CABG

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PTCA- Dilation(If atherectomy is done during PTCA it should be coded separately as Extripaiton root
operation)
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CABG- Bypass root operation
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21)Administration of Blood products such as RBC, platelets, Globulins, Plasma goes for Transfusion Root
operation and for general administration of other therapeutic/diagnostic substances into body then it
goes for Introduction root operation

22)Difference between Aftercare and followup: Aftercare refers to the care provided to a patient after
W

the treatment of a disease or injury has been completed. Follow up refers to the ongoing monitoring of a
patient's condition after treatment to ensure that the condition does not recur or worsen.
SO

23)Cerebral Edema Indicators:

Traumatic head injury, Seizures, memory loss, stroke,ICH Intra cerebral hemorrhage, SDH Subdural
hemorrhage,edema.

24)Treatment for cerebral edema?

Ans: Hyperbaric oxygen therapy, Osmotherapy, Hyperventilation, Ventriculostomy

 25)AKI and dehydration Question:

A patient with nausea, vomiting and lightheadedness for one week was admitted due to severe
dehydration. He was noted to have acute kidney injury secondary to dehydration and was treated with
intravenous fluids. Is the acute kidney injury sequenced as principal diagnosis?

Answer:

The sequencing of dehydration and acute kidney injury should be based on the reason for the admission.

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Query the physician regarding the principal reason that the patient was admitted, if the reason for the
admission is not clearly documented. There is no rule that acute kidney injury should always be
sequenced first.

R
26)Rib fractures and pneumothorax what is pdx?
O
Ans: Pneumothorax as pdx, in tabular list under rib fracture code first intrathorasic injury.
W
27)Can we code Hemiplegia from past medical history?

Ans: No,that time we check for physical examination extremities, extremities are moveable are not, the
extremities are still not moveable we can code hemiplegia but the extremities are movable we do not
code hemiplegia.
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28)Sepsis with aspiration PNA.

Code first sepsis A41.9,Pneumonia J18.9 and aspiration pneumonia J69.0

SO

29)Sepsis with covid sequencing

As present of admission, sepsis and covid both conditions sepsis as pdx and COVID as sdx
The patient admitted with covid,the sepsis is developed during the hospital stay the covid as pdx and
sepsis as secondary with POA N
 30)Sepsis with catheter associated UTI (CAUTI)

The catheter associated UTI complication as pdx and sepsis as sdx

31)what is chorioamnionitis

Chorioamnionitis is a condition that can affect pregnant women. In this condition, bacteria infects the
chorion and amnion (the membranes that surround the fetus) and the amniotic fluid (in which the fetus

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floats). This can lead to infections in both the mother and fetus.

32)Acute respiratory failure and ARDS (Acute respiratory distress syndrome) both are documented

Code only for ARDS

R
O
33)Cocaine induced chest pain what is pdx

Cocaine poisoning as pdx and chest pain as sdx

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34)Which conditions considered from non physician documentation

BMI,GCS,NIHSS,pressure ulcer stage and site, duration of LOC,laterality.

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35)Excision and resection root operation with examples

Excision: removal of small portion of a body part

Examples like partial nephrectomy,biopsy,excision of skin leasions,breastlumpectomy,liver biopsy

SO

Resection: removal of all of a body part

Examples, Totallobectomy,totalmastectomy,total nephrectomy, cholecystectomy, appendectomy

36)History of HTN and DM how to code.

Continuous medication is used we can code current, medication is not using these conditions are
resolved we can code as a personal history.
 37)PTCA Percutaneous transluminal coronary angioplasty

PTCA is the surgical treatment for MI, the root operation dilation, at the time of PTCA we checked for
which type of stent inserted like drug eluting (Cypher,Endeavor,paclitaxel,sirolimus,taxol) or non-drug
eluting ( Bare metal, drug coated, heparin coated).Number of stents inserted(Like 1,2,3,4 or more),
number of coronary arteries involved (Like 1,2,3,4 or more) next we checked for bifurcation, next we
checked for atherectomy performed or not.

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38)What is the DRG value for PTCA with MI?

247 for one to three drug eluting stents

246 4 or more drug eluting stents

R
249 Non drug eluting stent
O
39)What is atherectomy?

An atherectomy is a procedure to remove plaque from an artery (blood vessel). Removing plaque makes
the artery wider, so blood can flow more freely to the heart muscle
W
W

40)IUPC Intra uterine pressure catheter

An intrauterine pressure catheter is a catheter used during management of labor to measure uterine
contractions by taking into account intrauterine pressure and contraction frequency, duration, and
strength. This is mainly of use for an obstetrician or midwife who wants to determine the amount of
SO

oxytocin to use

41)IABP intra aortic balloon pump

An intra-aortic balloon pump (IABP) is a type of therapeutic device. It helps your heart pump more
blood. You may need it if your heart is unable to pump enough blood for your body. The IABP consists
of
a thin, flexible tube called a catheter. Attached to the tip of the catheter is a long balloon.
 42)PICC- peripheral inserted central catheter

43)What is Central Line?

Central line is also called as central venous catheter(CVC). CVC is a catheter placed into a large vein in the
neck (internal jugular vein), chest(subclavian vein or axillary) or groin region (femoral vein).

44)What is use of CVC?

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A. It is used to administer medication or fluids, obtain blood tests (specifically the "central venous
oxygen saturation"), and measure central venous pressure.

45)What is PICC LINE?

R
A PICC is a catheter inserted in a peripheral vein in the arm (cephalic vein, basilic vein, or brachial vein),
and then advanced proximally toward the heart through increasingly larger veins. It is moved forward
O
until the tip of catheter reaches the distal superior vena cava or cavoatrial junction. A peripherally
inserted central catheter (PICC) is generally used for a purpose of prolonged usage (for more than 1
year).
W

46)What is the use of PICC LINE?

It is used for for long chemotherapy treatment, extended antibiotic therapy, or total parenteral nutrition.
W

47)What is the root operation for biopsy?

Based on procedure some times the biopsy root operation considered as drainage example like FNA(Fine
needle aspiration) biopsy of liver, some times considered as excision like breast biopsy, skin biopsy,
SO

stomach and colon biopsy’s, some times considered as extraction like bone marrow and endometrial
biopsy’s.

48)What is the qualifier value for biopsy?

X diagnostic.

49)How many codes required for percutaneous needle biopsy of breast and open partial mastectomy?

2 codes required, one code is percutaneous approach for excision of breast for biopsy and other one is
open excision of breast for open partial mastectomy.
 50)Bone marrow aspiration biopsy endometrial biopsy root operation

Ans: Extraction

51)What is TIPS

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves inserting a stent (tube)
to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure

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of blood flowing through the diseased liver and can help stop bleeding and fluid back up.

52)Lymphadenectomy root operation.

Some of the lymph nodes removal considered as excision and entire chain of lymph nodes

R
removal considered as resection.
O
53)Cervical Cerclage placement root operation

Ans: Restriction
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54)Control of nose bleed root operation

Ans: Destruction
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55)Difference between excisional and non-excisional debridement

ANS: Excisional debridement: the surgical removal or cutting away of tissue, necrosis, or slough using any
sharp object material like scalpel, blade
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Non excisional debridement: The non-operative brushing, irrigating, scrubbing, or washing of devitalized
tissue, necrosis, slough, or foreign material, varsajet, ultra-high-pressure generator with a console and
disposable attachments.Other Examples; ultrasound, whirlpool, mechanical scrubbing, wet to dry
dressing, maggot therapy
 56)Query for debridement?

Type of debridement like excisional or non excisional

Depth of debridement like skin, subcutaneous tissue, muscle fascia, bone, tendon, ligament.

57)What is CHF

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Ans: Heart failure is a condition caused by the heart failing to pump enough blood around the body at
the right pressure. It usually occurs because the heart muscle has become too weak or stiff to work
properly.

Systolic failure: The left ventricle loses itsv ability to contract normally. The heart can't pump with
enough force to push enough blood into circulation.

R
Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally
(because the muscle has become stiff). The heart can't properly fill with blood during the resting period
between each beat.
O
58)What is the treatment for CHF?
W
IV Lasix{ Brand Name Diuretics}

59)What is cardiomyopathy
W

An acquired or hereditary disease of heart muscle, this condition makes it hard for the heart to deliver
blood to the body, and can lead to heart failure.
SO

60)What is CAD ( Coronary artery disease)

The build-up of fats, cholesterol and other substances in and on the artery walls.
 61)What is cardiac tamponade?

It is the compression of the heart caused by the accumulation of fluid inside the pericardium. Cardiac
tamponade is often associated with viral or bacterial pericarditis. This condition typically occurs as a
result of chest trauma, heart rupture, dissecting aortic aneurysm, cancer, cardiac surgery, renal failure,
and/ or acute myocardial infarction. The underlying cause of the tamponade should be sequenced first,
followed by code I31.4.

Cardiac tamponade can be life threatening if left untreated. The goals of therapy are to improve heart
function, relieve symptoms, and treat the tamponade. This can be accomplished with pericardiocentesis

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(root operation “Drainage,” body part “pericardial cavity”) or creation of a pericardial window (root
operation “Drainage,” body part “pericardium”).

62)What is encephalopathy

R
Encephalopathy means any disorder or disease of the brain, or malfunction of brain.
O
63)Types of encephalopathy?

Metabolic encephalopathy, toxic encephalopathy, hepatic encephalopathy, alcoholic encephalopathy,

chronic traumatic encephalopathy,ischemic encephalopathy.
W

64)Treatment for encephalopathy?

Anti-seizure medications, Anti-viral medications, antibiotics.

W

65)Clinical indicators for encephalopathy?

AMS,ALOC,seizure,elevated ammonia levels, metabolic disorders like hyponatremia hypokelimeia,

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acidosis, infections sources like UTI, sepsis and alcohol disorders.

66)What is the difference between hypertensive urgency and emergency?

Ans:A hypertensive urgency is a clinical situation in which blood pressure is very high with minimal or no
symptoms, and no signs or symptoms indicating acute organ damage.

This contrasts with a hypertensive emergency where severe blood pressure is accompanied by evidence
of progressive organ or system damage.
 67)Crushing of stones root operation: Fragmentation

68)Type 2 MI secondary to demand ischemia

Code only for type 2 MI

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69)What is the difference between initial and subsequent MI

The patient admitted for first time we considered as initial MI, again the same patient readmitted with
in 4 weeks with new site of MI considered as subsequent.

70)Types of MI?

R
Type 1: Spontaneous myocardial infarction due to a primary coronary event like plaque rupture.
O
• Type 2: Myocardial infarction secondary to an ischemic imbalance as in coronary vasospasm, anemia or
hypotension.

• Type 3: Myocardial infarction resulting in death when biomarker values are unavailable
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• Type 4a: Myocardial infarction related to percutaneous coronary intervention (PCI) •

Type 4b: Myocardial infarction related to stent thrombosis

• Type 4c: Myocardial infarction due to restenosis ≥50% after an initially successful PCI
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• Type 5: Myocardial infarction related to coronary artery bypass grafting (CABG)

71)Type 2 MI secondary to any condition except demand ischemia, underlining condition as pdx and type
SO

2 MI as secondary.

72)When we code lysis of adhesions?

Ans:The physician documented like extensive lysis of adhesionsor the physician spent greater than 30
minutes for lysis of adhesions and sometimes mentioned as Significant adhesions then we can code
lysis
of adhesions
 73) What is embolization and root operation for embolization

Embolization refers to the passing and lodging of an embolus within the bloodstream. It may be of
natural origin, in which sense it is also called embolism, for example a pulmonary embolism

Root operation for embolization Occlusion

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74)Difference between AKI and ATN

Ans:Acute tubular necrosis (ATN) is the most common cause of acute kidney injury (AKI) in the renal
category (that is, AKI in which the pathology lies within the kidney itself). The term ATN is actually a
misnomer, as there is minimal cell necrosis and the damage is not limited to tubules.

R
75)PROM: Premature rupture of membrane
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76)Abortion: Termination of pregnancy before 20 weeks
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77)What are the discharge dispositions effecting to the DRG?

AMA(Left against medical advice),expired, baby transfer to another facility in newborn case
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78)Give one example for AMA disposition change scenario?

Alcohol abuse and drug abuse

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79)Give me one example for expired disposition change scenario?

MI, cardiac arrest

80)Tell about the induction methods?

Pitocin,Cervidil, Cytotec, oxytocin
 81)What is the difference between induction verses augmentation?

There is a difference between labor augmentation and labor induction. Labor induction is the process of
starting labor before it begins on its own. Augmentation of labor is when labor is already in progress, but
needs a little help to move along.

82)What is the difference between tunneled and non tunneled catheters?

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TUNNELED CATHETERS are placed under the skin and meant to be used for long duration of time.

NON TUNNELED CATHETERS are designed to be temporary and may be put into the vein near neck chest
or groin.

R
83)What is the difference between PICC and CVC

A CVC(central venous catheter) serves as a way to access your blood and helps your medical team deliver
O
medication, blood products, nutrients or fluids directly into your blood stream or to draw blood samples.

PICC(Peripherally inserted central catheter) is one type of CVC

W

84)what is the difference between transfer and replacement?

Transfer: Moving with out taking all or a portion of a body part to another location over the function of
all or a portion of a body part. Ex: tendon transfer, skin pedicel flap transfer.
W

Replacement: Putting in or on a biological or synthetic material that physically takes the place or function
of all or a portion of a body part. Ex: heart valve replacement, total hip replacement, replacement of
cornea.
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85)What is the difference between kyphoplasty and vertebroplasty?

Vertebroplasty: physicians use image guidance, typically fluoroscopy, to inject a cement mixture into the
fractured bone through a hollow needle. Root operation:supplement

Kyphoplastya balloon is first inserted into the fractured bone through the hollow needle to create a
cavity or space, Root operation:Reposition,supplement Approach: Percutaneous
 86)What is difference between occlusion and restriction?

"Restriction” is to partially close, or narrow, the diameter of an orifice or a lumen, whereas the objective
of the root operation “Occlusion” is to completely close an orifice or a lumen.

Examples: Esophagogastric fundoplication, cervical cerclage ,craniotomy with clipping of

cerebralaneurysm.

Occlusion” is to completely close an orifice or a lumen. The orifice may be a natural orifice or an
artificially created orifice.

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Examples: : Ligation of esophagealvein,sterilization,embolization of internal carotid cavernous fistula

87)What is off-pump CABG?

R
Without cardiopulmonary bypass only, CABG is performed.
O
88)What is biventricular ICD.

A Biventricular ICD and pacemaker is a small, lightweight device powered by batteries .This device helps
keep your heart pumping normally.
W

89)What is AICD?

Automatic implantable cardiac defibrillator.

W

90)What is the root operation for VP ( Ventriculo peritoneal) shunt placement: Bypass
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91)Explain about PCS code structure

Ans: All PCS codes are 7 digit codes.

1st character section

 2nd character body system

3rd character root operation

4th character body part

5th character approach

6th character device

7th character qualifier

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92)How many sections in PCS Coding?

Total 17 sections

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93)How will you considered mechanical ventilator start and stop time

The time of intubation will be considered as start time, the time of Extubation is considered as stop time.
O
The codes will depend on duration of ventilation such as.

Less than 24 hours

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24 to 96 hours

Greater than 96 hours

94)CPAP (Continuous positive airway pressure) via tracheotomy will be coded as mechanical ventilation
W

95)What is the root operation for mechanical ventilator?

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Performance - Completely taking over a physiological function by extracorporeal means.

96)What is the root operation for CPAP?

Assistance - Taking over a portion of a physiological function by extracorporeal means

 97)What is the difference between mechanical ventilator verses CPAP?

A ventilator, technically a mechanical ventilator, is a machine that moves air in and out of the lungs and
does the work of breathing that the diaphragm and other muscles normally perform. A standard CPAP
machine provides one constant pressure and cannot move air in and out, thus it cannot ventilate.

98)What is the root operation for tracheostomy?

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Bypass

99)Tell me about some newborn conditions?

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Jaundice,sleepapnea, caput, Mongolian spots, ARDS,Ankyloglossia, transient tachypnea, preterm,
SGA,LGA,murmur, nervus, congenital dermal melanosis, GBS, ABO incompatibility, ASD ( Atrial septal
defect) VSD ( Ventricle septal defect) IDM (Infant of diabetic mother,hydrocele,sacral dimple).
O
100)What is payment system of IP?
W
IPPS (inpatient prospective payment system).

101)Types of documents which we have to handle in IP DRG accounts:

Discharge Summary.
W

Progress Notes.

Consultation Report.

Pathology Report.
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Operative Notes or Procedure Notes (OP).

History and Physical (H&P).

Emergency Department (ED).

 102)Elements in the IP DRG (inpatient diagnosis related grouping)

The elements which we have to give for inpatient accounts:

Admitting Diagnosis (Adx).

Maximum we have to assign from ED and H&P documents.

Admitting diagnosis is the symptom or the condition which is mentioned by the patient on the day of

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admission.

Principle Diagnosis (Pdx)-Heart of the inpatient account.

After the study, the condition which is chiefly responsible for patient’s admission or the condition which
leads to hospitalization.

R
Underlying condition is always Pdx.

Secondary or Additional Diagnosis (Sdx).

O
Secondary diagnoses are coexisting with principle diagnosis.

It may be present on the day of admission or may not

W
Principle Procedure.

Principle procedure is surgical treatment which is directed for the principle diagnosis.

Secondary or Additional Procedures.

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Secondary procedures are coexisting with principal diagnosis

103)Elements require assigning secondary codes

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Diagnostic workup.

Therapeutic treatment.

Increasing care.

Clinical evaluation.

Extended length of stay.

 104)DRG (Diagnosis Related Grouping system):

DRG is a system to classify hospital causes into 467 groups based on the severity of the

diagnosis. Major diagnosis categories (MDC) in the DRG are 25.

DRG is mainly established for uniform billing or uniform payment.

105)One DRG vale classified into 3 types:

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With MCC ** (Major Complications and Comorbidities)

With CC * (Complications and Comorbidities)

Without CC and MCC

R
106)What are the CC/MCC conditions?
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CC/MCC conditions are complications which increase the severity of the illness and increase the complex
treatment, which extends the length of stay. Documenting the presence of one or more CC/MCC
conditions will impact the DRG nothing but inpatient hospital reimbursement, because these are
increasing length of stay and other conditions which are mentioned above.
W
Example of MCC:

Acute respiratory failure.

Acute and chronic systolic congestive heart failure.

W

COVID

Severe protein calorie malnutrition.

Metabolic encephalopathy
SO

ESRD

Pneumonia

sepsis, severe sepsis and septic shock

 107)List of Complications or Comorbidities Conditions:

Chronic Atrial fibrillation

Chronic systolic congestive heart failure.

Coronary artery disease.

Chronic kidney disease state IV-V.

Hyponatremia

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UTI

Acute renal failure

Malnutrition

Pleural effusion

Atelectasis
R
O
ascites
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108)Factors Effecting DRG:

Principle diagnosis (main condition) 80%.

Secondary diagnosis (including MCC and CC)

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Principle procedure

Additional or Secondary procedure.

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Discharge Disposition.

Age.

Sex.

Birth Weight
 109)What is RULE OUT and RULED OUT

Rule Out:

It means the physician suspecting the condition it may present on the hospital

admission. Ruled Out:

The condition is not present.

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110)POA (present on admission) Indicators:

POA indicators give the information for a particular condition that is present on the day of admission or
not.

Y= Condition is present on the day of admission.

R
N= Condition is not present on the day of admission, which is established in the middle

of the hospital stay.

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E= Status post history conditions, etc.

U= Undetermined. The condition which is undetermined by the coder as well as the physician unable to
W
find the condition is present on the day of admission or raised during the hospitalization.

W= Clinically Undetermined.

111)CLINICAL INDICATORS
W

Clinical indicators place important role in the Inpatient Department. Indicators are nothing but
symptoms which gives information of a particular disease to confirm or to query.

Acute Respiratory Failure.

SO

SpO2 less than 80%.

Blood pH less than 7.3

pCo2 greater than 50 mg.

PaO2 less than 60 mg.

Respiratory rate greater than 35/min.

Intubation (Intubated).

If patient admitted with respiratory insufficiency, check for respiratory failure.

 112)Sepsis indicators: When there is a localized infection, we should check these below mentioned
indicators.

Body temperature 101 Fahrenheit or 36 degree Celsius.

Tachypnea (increased respiration more than 20 breaths/min).

Tachycardia (increased heart beat more than 90 beats/min).

Positive blood cultures.

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pCo2 less than 32 mmHg.

Increased WBC count (greater than 12000 mm or less than 4000 mm)

Shock (organ dysfunction)

If a patient admitted with localized infection, check for sepsis.

R
113)Aspiration Pneumonia indicators:
O
Esophageal disorder

Dysphagia
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Vomiting

Swollen test

Any oral disorder

W

GERD

If patient presented or admitted with pneumonia check for aspiration pneumonia

SO

114)Anemia

Dropping hemoglobin

Transfusion performed

Hemorrhage

Physician orders iron supplements

Common symptoms (syncope, fatigue, dizziness, and fatigue)

 115)Acute Renal Failure (if patient has any urinary tract problems, we have to check for the urinary
failure based on below mentioned indicators)
Decreased levels of creatinine.

Increased levels of BUN.

Increased levels of potassium.

Presence of edema (any).

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Proteinemia.

Benign prostatic hypertrophy.

If patient admitted with renal insufficiency or severe dehydration, check for renal failure.

R
116)Congestive Heart Failure

Shortness of breath.

Chest pain.
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Ankle edema.

Ejection fraction less than 40% systolic, greater than 50% diastolic.
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Elevated troponin.

Elevated BNP.

Findings in chest x-ray shows pulmonary edema and cardiomegaly.

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IV diuretics.

117)Malnutrition: (when patient admitted with weakness, check for the malnutrition or query for the
SO

malnutrition with below mentioned indicators)

Severe weight loss.

Brittle nails.

Lack of appetite.

Pale skin.
 If patient admitted with weakness, check for malnutrition.

If patient admitted with malnutrition, check for severity.

118)Cerebral edema:

Traumatic head injury

Intra cerebral hemorrhage (ICH)

Subdural hemorrhage (SDH)

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Memory loss

Stroke

Seizures

R
119)What is the different between pressure and non pressure ulcers
O
Pressure ulcers: (also known as pressure sores or bedsores) are injuries to the skin and underlying
tissue, primarily caused by prolonged pressure on the skin. They can happen to anyone, but usually
affect people confined to bed or who sit in the chair or wheel chair for long periods of time.
W
Non pressure: If there is poor circulation such as that caused by venous or arterial insufficiency or
excessive moisture or trauma may develops non pressure ulcers.Skin tears, denuded or excoriated
skin, arterial ulcers, venous stasis ulcers and diabetic/neurotrophic ulcers are NOT pressure ulcers.
W

120)Type of charts which you are doing now?

Ans: OB,newborn,surgery(orthopedic,cardiac,generalsurgery) neurology,

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psychiatric,oncology,bariatric,pediatric,internal medicine, all type of charts.

121)Quality?

95% including all elements (SDX, PDX,CC,MCC,POA, discharge disposition, DRG)

122)Please tell me the recent errors came from the smart auditors?

Missing query opportunity, missing some MCC and CC conditions,some DRG changes in respiratory
cases, missing some bed side procedures like ECHO cardiogram,blood transfusion,
vaccination,TPN,PICC,feeding tube insertion.
 123)What is sepsis?

SIRS due to any localized infection,sepsis is blood infection, the treatment for sepsis is given for
antibiotics.

124)What are the common localized infection sources for sepsis?

Pneumonia,UTI,osteomyelitis,peritonitis,cellulitis,abscess,meningitis

KZ
125)What is bacteremia?

As presence of bacteria in blood stream.

R
126)What is severe sepsis.
O
Sepsis with acute organ failure or acute organ dysfunction
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127)Sepsis secondary COVID.

A41.89 other specified sepsis as pdx and COVID U07.1 as secondary

128)Encephalopathy secondary to sepsis

W

The type of sepsis considered as severe sepsis and the type of encephalopahty considered as metabolic
encephalopathy.
SO

129)sepsis due to CAUTI,What is pdx in this case?

Complication of catheter infection as pdx (T83.511A),N39.0,Y84.6

130)Sepsis due to pneumonia and CAUTI what is pdx?

Sepsis as pdx and complication as secondary, as per sepsis guideline

Sepsis due to any localized infection sepsis as pdx,localized infection as secondary

Another guideline for sepsis, sepsis due to any postoperative complication,complication as pdx and
sepsis as secondary,given scenario, the source of sepsis is both post operative complication and localized
infection,sepsis better DRG than complication,so we give sepsis as pdx
 131)What is term deliver?

Deliver between 37 to 40 weeks

132)What is preterm.

Delivery lessthan 37 weeks

KZ
133)What is post term

Delivery between 40.1 to 42 weeks

134)What is postpartum

6 weeks after Delivery

R
O
135)What is the difference between placental abruption and placental previa
W
Separation of placenta from the wall of the uterus during pregnancy, specially when it occurs
prematurely is called placental abruption.

A condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with
normal delivery of a baby is called placental previa.
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136)What is neonate or newborn age period

0 to 28 days
SO

137)What is AICD firing

AICD(Automated implantable cardioverter-defibrillator).it is a small electronic device that is implanted

into your chest to monitor and correct an abnormal heart rhythm, or arrhythemia.

138)what is acute blood loss anemia?

Ans: Acute blood loss creates anemia due to the loss of red blood cells and depletion of iron. This type of
anemia also referred as posthemorrhagic anemia.
 139)what is post COVID.

Also called Late effect. Sequela of covid 19 or associated symptoms that develops following a previous
covid 19 (use code U09.9)

140)What is difference between poisoning and adverse effect?

Poisoning: Classification of a condition caused by a drug or another substance when used incorrectly

KZ
like,overdose,wrong dose, nonprescribed drug, improper route of administration, given mistake in
physician office, any drug along with alcohol and illegal drug usage like
cocaine,heroin,marijuana,opioid.

Adverse effect: Classification of a condition caused by a drug or another substance when used correctly

141)what is underdosage?

R
O
Reduced his medications

142)what is sequela?
W
Any condition developed after acute phase of illness or injury.

143)What is the difference between DNR and palliative care?

W

DNR (Donot resuscitate) the patient not accepting CPR (Cardiopulmonary resuscitate),they are allowed
to natural death.

Palliative care is specialized medical care for people living with a serious illness. This type of care is
focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of
SO

life for both the patient and the family.

144)A patient is admitted after an episode of unresponsiveness secondary to syncope and urinary tract
infection (UTI). The focus of treatment was directed at the syncope (CT of the head, cardiac work-up,
etc.). During the admission, it is noted that the patient also had mild acute kidney injury (AKI) that was
treated with intravenous hydration. The provider's discharge diagnosis is syncope secondary to
dehydration and AKI. Should AKI always be sequenced as the principal diagnosis, when a patient
presents with an acute kidney injury and dehydration?
 Answer: The sequencing of dehydration and acute kidney injury (acute renal failure) should be based on
the reason for the admission. Query the physician regarding the principal reason that the patient was
admitted, if the reason for the admission is not clearly documented. There is no rule that acute kidney
injury should always be sequenced first.

145)When do we code GCS ( Glasgow coma scale)?

KZ
Only for traumatic head injury, ICH (Intracerebral hemorrhage), SDH (Subdural hemorrhage), SAH ( Sub
arachnoid hemorrhage)

146)When we code NIHSS ( National institutes of health stroke scale) score?

R
Ans: Only for acute CVA cases
O
147)The patient admitted for stage 3 pressure ulcer during the hospital developed stage 4 how to code
this scenario?

We can code both stage 3 POA Y, Stage 4 POA N.

W

148)Anemia due to any cancer. What is Pdx?

Cancer is thePdx, anemia due to cancer combination code is secondary, because anemia due to cancer is
manifestation code as per guideline the manifestation code never used as a principal diagnosis.
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150)What is HAC? Give me some examples?

SO

HAC

Hospital acquired conditions, these conditions are developed during the hospital stay.

Example: Foreign Object Retained After Surgery

Air Embolism

Blood Incompatibility

Stage III and IV Pressure Ulcers

Falls and Trauma

Fractures
 Dislocations

Intracranial Injuries

Crushing Injuries

Burn

Other Injuries

Manifestations of Poor Glycemic Control

KZ
Diabetic Ketoacidosis

Nonketotic Hyperosmolar Coma

Hypoglycemic Coma

Secondary Diabetes with Ketoacidosis

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Secondary Diabetes with Hyperosmolarity

Catheter-Associated Urinary Tract Infection (UTI)

O
Vascular Catheter-Associated Infection

Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG):
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Surgical Site Infection Following Bariatric Surgery for Obesity

Laparoscopic Gastric Bypass

Gastroenterostomy

Laparoscopic Gastric Restrictive Surgery

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Surgical Site Infection Following Certain Orthopedic Procedures

Spine
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Neck

Shoulder

Elbow

Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Certain Orthopedic Procedures:

Total Knee Replacement

Hip Replacement

Iatrogenic Pneumothorax with Venous Catheterization

 151)What is measurement and monitoring?

Measurement describes a single level taken at a point of time and Monitoring describes a series of tests
performed respectively over a period of time.

Measurement and monitoring is the 4th section of med and surgical group. This section classifies
procedures that determine the level of a physiological or physical function. There are two root
operations in this section and they differ in only one respect.

KZ
152)What is difference between assistance and performance?

It is the 5th section of med and surgical group. The extracorporeal assistance and performance section,
for procedures where equipment outside the body is used to assist or perform physiological function.
There are three root operations: assistance, performance, and restoration.
153)What is ECMO?

R
Extracorporeal membrane oxygenation (ECMO), blood is pumped outside of your body to a heart-lung
O
machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body.

155)What is Impella?
W
The Impella device is a catheter-based miniaturized ventricular assist device that pumps blood from left
ventricle (LV) into ascending aorta.
W

156)What is baclofen pump?

A baclofen pump is a device that delivers a medication called baclofen to the spinal canal. The baclofen
pump is surgically implanted near the abdomen, with a catheter (a thin flexible tube) running to the
spinal canal to deliver the medication.
SO

157)The patient admitted with dehydration, given IV fluids, dehydration due to cancer what is pdx?

Ans: Dehydration as pdx and cancer by site as secondary.

158)What is the root operation for thrombectomy?

Ans:Extirpation: Removalof solid materials from the body part.

 159)Meconium staining indicators?

Apnea, Bluish skin in infants, breathing problem, limpness in infants at birth

160)late preterm infant:

Question:

KZ
An infant was born at 37 weeks and five days gestation via low transverse cesarean section. The
provider’s diagnostic statement listed, “Late preterm infant.” The ICD-10-CM does not provide a code for
preterm infants with a gestational age greater than 36 completed weeks. However, the ICD-10-CM
Official Guidelines for Coding and Reporting state, “Providers utilize different criteria in determining
prematurity. A code for prematurity should not be assigned unless it is documented.” What code is
assigned for a late preterm infant, who is beyond 36 weeks gestation?

Answer:

R
Do not assign a code for “late preterm infant.” Query the physician whether the newborn is “small for
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dates” or “light for dates.” ICD-10-CM does not classify a diagnosis of “late preterm infant.” The clinical
definition of a “late preterm” infant, according to a statement from the American Academy of Pediatrics,
refers to infants born at 34 0/7 through 36 6/7 weeks’ gestation. See the following link for the American
Academy of Pediatrics and the American College of Obstetricians and Gynecologists position statement
W
pertaining to “Late Preterm Infant”: http://pediatrics. aappublications.org/content/120/6/1390

ICD-10-CM does not classify infants with a gestational age of 37 weeks or more as preterm. There is an
existing code P07.39, Preterm newborn, gestational age 36 completed weeks. This has an inclusion term,
“Preterm newborn, gestational age 36 weeks, 0 days through 36 weeks, 6 days.” Coding Clinic Third
Quarter 2017 27
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161)Whipple Procedure
SO

The Whipple procedure, also known as a pancreaticoduodenectomy, is a multipart surgery performed as

a treatment primarily for people affected by pancreatic cancer. It may also be performed to treat
tumors, cysts and other disorders of the pancreas, bile duct and/or the duodenum, such as pancreatitis,
ampullary cancer, bile duct cancer, neuroendocrine tumors and/or trauma to the pancreas or small
intestine.

The intent of the Whipple procedure is to remove the head of the pancreas, which is where most tumors
occur, and therefore, prevent the tumor from growing and spreading to other organs. However, because
the pancreas is so integrated with other organs, the surgeon must also remove the duodenum,
gallbladder, a portion of the common bile duct and sometimes a portion of the stomach. At the
completion of the procedure, the surgeon must reconnect the remaining organs to allow for normal
digestive function after surgery.

There are two general types of Whipple procedures: the conventional Whipple
 (pancreaticoduodenectomy) and the pylorus sparing Whipple. In a conventional Whipple, typically the
head of the pancreas, entire duodenum, gallbladder, and a portion of the stomach and common bile
duct are removed. What primarily differentiates the pylorus sparing Whipple from the standard Whipple
procedure is that the pylorus is preserved, and no part of the stomach is removed. The preservation of
the stomach and proximal duodenum sustains the function of the gastric reservoir, allowing more
normal gastric emptying. In both procedures, the digestive tract is reconstructed with the remaining
organs.

162)Removal of sternal wire root operation?

Extirpation

KZ
163)Laparoscopic cholecystectomy converted to open?

Code as open cholecystectomy and additional code for laparoscopy inspection and one diagnosis code
for laparoscopy procedure converted to open.

R
164)How to raise a query?
O
First we select the appropriate query template like POA query, establishment query, reason for admission
query or specificity and acute query and ruled in or ruled out query, after that I mentioned the
W
appropriate clinical indicators and copy past content from the specific condition is mentioned in
documentation.

165)Abdominal aortic aneurysm repair with graft root operation?

W

Restriction

166)A patient with a history of HIV presents with recurrent pneumonia. When a patient has a history of
SO

HIV and presents due to recurrent pneumonia, which code is more appropriate, B20 or Z21? Is recurrent
pneumonia considered an AIDS defining condition/ illness?

Answer:

Assign code Z21, Asymptomatic human immunodeficiency [HIV] infection status, if the provider does not
document that the pneumonia is an HIV-related illness. Do not assign code B20, Human
immunodeficiency virus [HIV] disease, based solely on the patient being diagnosed with recurrent
pneumonia. Provider documentation should specifically indicate pneumonia as an HIV-related illness. If
the documentation is unclear regarding the patient's HIV illness, query the provider for clarification.
 167)What is the root operation for cesarean?

Extraction

168)CABG?
CABG Coronary artery bypass graft, this is the surgical treatment for CAD.

At the time of CABG checked number of bypass grafts performed

KZ
Bypass from and to, like aorta to coronary artery,coronary artery to coronary artery,LIMA to coronary
artery, RIMA to coronary artery,

saphenous vein graft is used or not, saphenous vein graft is performed we can give additional code for
excision of vein graft

R
cardiopulmonary bypass is performed we can code additional code.
O
169)What is functional quadriplegia?

Functional quadriplegia is the complete inability to move due to severe disability or frailty caused by
another medical condition without physical injury or damage to the spinal cord
W

170)what is the difference between replacement and transfer.

Replacement: “Putting in or on biological or synthetic material that physically takes the place and/or
W

function of all or a portion of a body part.”

Transfer:"Moving, without taking out, all or a portion of a body part to another location to take over the
function of all or a portion of a body part."
SO

171)Bakri balloon pump?

Question:

The patient was taken to the operating room post vaginal delivery for control of bleeding using a Bakri
balloon. We are unsure if the Bakri balloon is coded to the Obstetrics section or the Medical and Surgical
Section. If coded to Medical and Surgical, what are the appropriate body part and approach characters?
 Answer:

The root operation "Control" is used since the intent of the procedure is to stop postprocedural
(delivery) bleeding. The root operation "Control" is only available in the general anatomic regions, and in
this case "genitourinary tract" is the appropriate general anatomic region. For control of vaginal bleeding
using the Bakri balloon assign the following ICD- 10-PCS code:

0W3R7ZZ Control bleeding in genitourinary tract, via natural or artificial opening

172)What is AICD

KZ
Automated Implantable Cardioverter Defibrillator (AICD)

An implantable cardioverter defibrillator (ICD or AICD) is a permanent device in which a lead (wire)
inserts into the right ventricle and monitors the heart rhythm. It is implanted similar to a single chamber
pacemaker.

R
173)When the physician inserted AICD?
O
Cardiac arrythemic conditions like cardiomyopathy,AV block,SSS{ Sick sinus syndrome}tachy brady
syndrome.
W
174)What is pacemaker?

A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest
(just below the collarbone) to help regulate slow electrical problems with the heart. A pacemaker may
be recommended to ensure that the heartbeat does not slow to a dangerously low rate.
W

175)misfiring of an automatic implantable cardioverter defibrillator (AICD) device

Malfunctioning of AICD, that is mechanical complication

SO

176)what is rhabdomyolysis?

A breakdown of muscle tissue that releases a damaging protein into the blood.

177)What is the lab test for rhabdomyolysis?

Serum CPK ( creatine phosphokinase)

 178)What is the treatment for atelectasis?

spirometry, antibiotics

179)When you raised a query for specific organism?

In pneumonia cases, the sputum culture is positive for any specific organism like MRSA,MSSA,E.coli, by
that time we should raise a query.

KZ
180)What is Tcell immunotherapy

181)Coding clinic for AKI and BPH

R
182)Patient admitted for ARF and opoid overdose, both conditions are treated equally, what is the PDX
O
183)What is the root operation for FNA biopsy of lung
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184)Hartman procedure

Ans:The Hartmann procedure is an operative procedure in which the sigmoid colon is resected with the
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proximal end terminated as a colostomy and the distal end (rectum) oversewn. This permits the later
takedown of the colostomy and anastomosis of the end of the colon to the rectal stump. A true
Hartmann procedure is done on the left side only and, therefore, its classification as a left
hemicolectomy is correct.
SO

A Hartmann-like procedure is performed on other portions of the colon, however. When the term
"Hartmann procedure" or "Hartmann-like" is used to describe partial resection of another portion of the
colon.

185)What is the root operation for Hartmann procedure?

Reposition, sometimes excision and sometimes resection

 186)H&P done with in 30 may be used in the patient record as long as changes that may have

occur or documented at the time of admission

187)Cardizem is prescribed to treat HTN

188)Which of the following conditions are caused by a Virus? HIV, Rubella, Cirrhosis

KZ
189)What is the common side effect for bronchiodilators- Palpitations

R
190)ET and Mechanical ventilation; ET tube is inserted and mechanical ventilation for 26 Hours
O
5A1945Z; 0BH17EZ
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191)A pt arrives at the facility due to likely stroke. Prior to the transfer, tPA was admisitered to the

Hospital A and infusion was ongoing that the time of transport and admitting the facility,. Should the

tPA administration procedure be coded for hospital A

Ans:Yes, Because the Infusion was initiated by Hospital A, The procedure is coded
W

192)A pt with lupus is admitted to the hospital in ARF, should the lupus is sequence first?
SO

Ans:Yes, The lupus is the underlying condition and should be seq before the ARF

193)A pt with uncontrolled DM II is admitted with nausea, vomiting, Abd pain. After Diagnostic study

indicating CBC, Abdominal US. It is demonistated the pt is suffering from Acute appendicitis with

Peritonitis. What is PDx

K35.3
 194)A 68yrs old man with a HX of Atherosclerotic heart diseae is admitted to the hospital with SOB,
diaphoresis and chest pain. After really the pt was found to have CHF. The following Dx`s were listed

Atherosclerotic heart dx, CHF, Chest pain and SOB. Which of the following is PDx? Ans:I50.9

195)A 68yr old male pt z admitted with persistent cough, SOB, Hemoptoyisisand Hx of smoking. The pt

has a hx of HTN. Up on admission the following procedures were performed. Upper GI series, Chest X

KZ
ray, Bronchoscopy with biopsy of RT bronchusand membrane of Upper lobe of the Lung Left. The

discharge dx`s is LEft Upper Lobe Lung Carcinoma.What r d correct dx?

Ans:C34.12, I10, Z87891

R
196)A 34ys old male pt is admitted for confusion. The pt is ambulated to the hsptl and he falls breaking
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his RT Hip.

POA indicator would be assign to the Fx hip?

W
N

197)A 79yr Old pt with COPD & acute asthma exacerbation is admitted to the medical floor The pt
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fell and broke his RT femoral Neck fx. Reduction is done.

Wt is the POA indicator and codes

J44.1 POA Y
SO

S42.301A POA N

0P5F04Z

198)During an admission for an AMI, The pt undergoes a PTCA of the LAD and PTCA and Stent

placement in RC. What in/are the correct ICD 10 PCS coding?

 Ans: 02703DZ, 02703ZZ

199)Transfusion of RBC central line

30243N1

200)Injection or infusion of Chemotherapy

3E03305

KZ
201)Normal deliver, 1st degree perineum laceration

10E0XZZ , OWQNXZZ

R
202)Excisional debridement, amputation of toes

0Y6Q0Z0 , 0HBNXZZ
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203)PICC insertion(IJ Vein), intubation done
W
05HN33Z , 3E043XZ , 0BH17EZ , 5A1935Z

204)Hip replacement with (Kypho plasty) robotic assistance

W

0SRB0JZ , 8E0Y3CZ
SO