Professional Review Guide for the CCS Examination 2010 Edition Toni Cade, MBA, RHIA, CCS, FAHIMA Lisa M. Delhomme, MHA, RHIA PRG Publishing, Inc. Professional Review Guides, Inc.
Professional Review Guide for the CCS Examination, 2010 Edition Toni Cade, MBA, RHIA, CCS, FAHIMA Lisa M. Delhomme, MHA, RHIA Vice President, Career and Professional Editorial: Dave Garza Director of Learning Solutions: Matthew Kane Managing Editor: Marah Bellegarde Senior Acquisitions Editor: Rhonda Dearborn Product Manager: Jadin Babin-Kavanaugh Vice President, Career & Professional Marketing: Jennifer McAvey Senior Marketing Manager: Wendy Mapstone Senior Marketing Manager: Nancy Bradshaw Marketing Coordinator: Erica Ropitzky Production Director: Carolyn Miller Senior Art Director: Jack Pendleton 2011 Delmar, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher. 2010 Current Procedural Terminology 2009 American Medical Association. ALL RIGHTS RESERVED. For product information and technology assistance, contact us at Cengage Learning Customer & Sales Support, 1-800-354-9706 For permission to use material from this text or product, submit all requests online at www.cengage.com/permissions Further permissions questions can be emailed to permissionrequest@cengage.com Library of Congress Cataloging-in-Publication Data: 2010920476 ISBN 10: 1-1111-2796-4 ISBN 13: 978-1-1111-2796-1 Delmar Executive Woods 5 Maxwell Drive Clifton Park, NY 12065-2919 USA Cengage Learning products are represented in Canada by Nelson Education, Ltd. For your course and learning solutions, visit delmar.cengage.com Purchase any of our products at your local college store or visit our corporate website at cengage.com Notice to the Reader Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions. The publisher makes no representations or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the reader's use of, or reliance upon, this material. Printed in United States of America 1 2 3 4 5 13 12 11 10
ABOUT THE AUTHORS Patricia J. Schnering was the founder of PRG Publishing, Inc. and Professional Review Guides, Inc. Mrs. Schnering is a 1995 graduate of the Health Information Management program at St. Petersburg College in St. Petersburg, Florida. In 1998, she was certified as a CCS and, in 1999, she received her RHIA certification. She also has a Bachelor degree from the University of South Florida in Tampa, Florida, with a major in Business Administration. Her HIM experiences include working in Health Information Services supervisory positions, as a HIM consultant and as an adjunct HIM instructor at St. Petersburg College. She has been active in her local and state HIM Associations. Mrs. Schnering was awarded the Florida Health Information Management Association (FHIMA) Literary Award in 2000 and 2005. Lisa M. Delhomme, MHA, RHIA Lisa M. Delhomme is an instructor in the Health Information Management Department at the University of Louisiana at Lafayette, located in Lafayette, Louisiana. She has a Bachelor s degree in Health Information Management and a Master s degree in Health Services Administration. She teaches several courses including CPT coding, legal aspects for healthcare, and computers in healthcare organizations. Prior to teaching, she held a management position at a physician practice and ambulatory surgery center. Mrs. Delhomme has been an active member of the American Health Information Management Association for 10 years. Additionally, she has been involved with committees and projects for the Louisiana Health Information Management Association and Louisiana Medical Group Management Association. iii
About the Authors iv Toni Cade, MBA, RHIA, CCS, FAHIMA Toni Cade is a tenured Associate Professor in the Health Information Management Department at the University of Louisiana at Lafayette. She teaches several courses including healthcare reimbursement methodologies (MS-DRGs, APCs, RUGs, etc.), hospital statistics, case management, performance improvement, medical terminology, and healthcare risk management. She is also the Management Internship Site Coordinator responsible for coordinating affiliation sites throughout the United States. Mrs. Cade has 30 years experience with previous positions, including Data Analyst for the QIO, Utilization Review Supervisor, and Coding Supervisor in a large acute care hospital. Mrs. Cade holds a Bachelor s degree (B.S.) in Medical Record Science and a Master s degree (MBA) in Business Administration. Her credentials include RHIA (Registered Health Information Administrator) and CCS (Certified Coding Specialist). She was also awarded the designation of Fellow (FAHIMA) by the American Health Information Management Association. She is listed in Marquis Who's Who in Medicine and Health Care. Mrs. Cade serves on the Editorial Advisory Board of Health Information Management Manual and For the Record. She has reviewed and authored publications on topics including medical terminology, billing and reimbursement, and healthcare statistics. As an independent consultant, Mrs. Cade has extensive experience conducting seminars in coding and reimbursement. She also consults at acute care hospitals and works with attorneys involved in medical malpractice cases as an expert healthcare data analyst and expert witness. Mrs. Cade has served AHIMA in various positions including delegate, Nominating Committee member, and Fellowship Review Committee member. She was nominated for AHIMA s Champion Award and Educator s Award. She has served her state association, the Louisiana Health Information Management Association (LHIMA), in many capacities, including serving on the Board of Directors, as President, Secretary, and Project Manager of various projects. She was awarded the Distinguished Member Award in 2003. She also received the Outstanding Volunteer Award for her efforts as Coding Roundtable Coordinator in Louisiana in 2003 2004. In 2009, she received the Outstanding Volunteer Award for her efforts in creating a Central Office Coordinator position for LHIMA.
ACKNOWLEDGMENTS First and foremost, I wish to express my gratitude to the authors who collaborated on the book. They are educators and clinical coding experts who worked diligently to provide comprehensive coverage of coding procedures. I am very grateful to have such seasoned professionals working with me on the book. I would like to express my gratitude to all of the authors who have worked on the educational materials PRG Publishing has produced. They are seasoned professionals and excellent educators. They inspire me to work harder to produce better products. Each one of these educators presents a facet of HIM practice necessary to view the HIM arena as a whole. There are very special people in my family who always knew I could do it when I was not sure I could. My husband, Bob, as always, continues to keep me grounded when I tend to spin off in space as I become engrossed in working on the books. He graciously listens to me go on and on about the work s progress throughout the process. And, I could never forget the encouragement my mother provides. Mom, you are always there for me! My mother is my role model for perseverance leading to success. She embodies grace, courage, strength, and endurance. And, of course, I appreciate all the help from my family at Delmar Learning. They have all the answers and have been extremely helpful in guiding me through the publishing system. Thank you all very much! My special reward is knowing that the materials you study here may assist you in preparing for the challenge of the CCS Examination. Thank you for the letters and words of encouragement. I wish you the very best now and throughout your career. Until we meet... PJSPRG@AOL.COM v
TABLE OF CONTENTS INTRODUCTION... ix I. EXAMINATION STUDY STRATEGIES AND RESOURCES... 1 II. CODING REVIEW... 15 Toni Cade, MBA, RHIA, CCS, FAHIMA Lisa M. Delhomme, MHA, RHIA III. HEALTH DATA CONTENT REQUIREMENTS, AND STANDARDS... 51 IV. MEDICAL SCIENCE... 79 V. CLASSIFICATION SYSTEMS AND SECONDARY DATA SOURCES... 101 Lisa M. Delhomme, MHA, RHIA VI. MEDICAL BILLING AND REIMBURSEMENT SYSTEMS... 139 Toni Cade, MBA, RHIA, CCS, FAHIMA VII. ICD-9-CM CODING... 179 Toni Cade, MBA, RHIA, CCS, FAHIMA VIII. CPT CODING... 235 Lisa M. Delhomme, MHA, RHIA IX. CCS CASE STUDY CODING REVIEW... 289 X. CCS CASE STUDY CODING REVIEW ANSWER KEY... 479 XI. CCS MOCK EXAMINATION PART 1 Mock Examination 1... 507 Mock Examination 2... 539 XII. CCS MOCK EXAMINATION PART 2: CODING CASES... 567 XIII. CCS MOCK EXAM ANSWER KEY... 639 APPENDICES APPENDIX A Pharmacology... 651 APPENDIX B Laboratory Testing... 663 APPENDIX C ICD-9-CM Coding Guidelines Effective October 1, 2009... 667 Evaluation form... 779 vii
Introduction
Introduction xi INTRODUCTION TO THE PROFESSIONAL REVIEW GUIDE FOR THE CCS EXAMINATION This examination review guide represents a renewed effort to provide materials for HIM students and professionals. In reviewing the results of past examinations, we found that it would be beneficial for examination candidates to have additional practice in answering multiple-choice questions. We have selected questions and cases to cover the broad topic categories necessary in sitting for the CCS Certification Examination. Researching the questions and cases as you study should increase your knowledge such that, when you encounter similar questions and cases, you can arrive at the correct answer. We believe that this review material will jog your memory and build on information you have already gained through your education and professional experiences. This book provides you with a mix of coding questions and case exercises to both increase your coding skills and provide you with testing that mimics the exam format. The beginning of this book offers suggestions for studying and test-taking strategies. The book is then divided into two additional sections. The first section is a coding review section containing multiplechoice questions and coding case studies. The second section is a mock examination containing a Part I with two sets of sixty (60) multiple choice questions (so that you have two different exams for practice) and a Part II with mock cases to code. The back of the book contains appendices with information on pharmacology, laboratory testing and the ICD-9-CM Coding Guidelines. The questions in this examination review guide are based on the broad competencies listed in the AHIMA Candidate Handbook for the CCS Examination. Review the latest Candidate Handbook when preparing for the exam. The following table (Table 1) displays the major content areas of this book by sections. Table 1 Content Areas for the Professional Review Guide for the CCS Examination Professional Review Guide for the CCS Examination Contents Introduction Examination Study Strategies and Resources Coding Review Section 1 of the book includes the following chapters Health Data Content, Requirements, and Standards 75 Medical Sciences 111 Classification Systems and Secondary Data Sources 110 Medical Billing and Reimbursement Systems 114 ICD-9-CM Coding 211 Questions /Cases CPT Coding 233 CCS Case Study Coding Review 32 Cases Section 2 of the book includes the following Mock Exams Part I Mock Examination Questions Test 1 60 Part I Mock Examination Questions Test 2 60 Part II Mock Examination Cases 13 Cases Appendices Appendix A Pharmacology Appendix B Laboratory Testing Appendix C ICD-9-CM Coding Guidelines Effective October 1, 2009
xii Introduction ABOUT THE COMPETENCIES FOR THE CCS EXAMINATION We suggest that you start by examining the competencies for the Certified Coding Specialist. They are listed as domains and task statement competencies. The competencies were created to reflect the necessary skill level for professional practice. A detailed list of the competencies is provided in the AHIMA Candidate Handbook for the CCS Examination. It is the responsibility of American Health Information Management Association s (AHIMA) Council on Certification (COC) to assess what job tasks are frequently executed by newly certified practitioners. Additionally, the COC determines the job tasks that are critical to the practice in other words, the job tasks that, if done incorrectly, could create a negative impact. The task statements are also referred to as the test specifications. The process of identifying those critical job functions was accomplished by conducting a job analysis. The objective was to determine how the practice is evolving and to develop the test specifications and a certification examination to correspond with changes that are occurring in the field. The data that were collected as a result of this research provided the essential elements that were necessary to establish the test specifications for the certifying exam. The COC is responsible for developing and administering the certification examination and determining the eligibility of applicants to write the exam. The task statements for the Certified Coding Specialist are grouped into nine domains. Weights for each domain are assigned. Each weight correlates to the degree of emphasis, or importance, given to each domain as it relates to the health information practice. Table 2 displays the domains you will be responsible for on the examination. Crosswalks between the competencies for the CCS Certification Examination and the questions in the chapters are provided in Table 3. In addition to the competencies, the questions are written in three cognitive levels of testing, which are explained after Table 3. Table 2 CCS Part 1 Examination Content with Percentage of Questions by Domain CCS Part I Examination Content with Percentage Questions by Domain Domains Number of Questions Percentage of Exam Domain 1: Health Information Documentation 9 15% Domain 2: Diagnosis Coding 12 20% Domain 3: Procedural Coding 12 20% Domain 4: Regulatory Guidelines and Reporting 6 10% Requirements for Acute Care (Inpatient) Service Domain 5: Regulatory Guidelines and Reporting 6 10% Requirements for Outpatient Services Domain 6: Data Quality and Management 5 8% Domain 7: Information and Communication Technologies 3 5% Domain 8: Privacy, Confidentiality, Legal and Ethical Issues 3.5 6% Domain 9: Compliance 3.5 6% TOTAL 60 100% Resource: 2009 AHIMA Candidate Handbook for the Certification Examinations Reminder: Monitor AHIMA s Web site for updates on the testing information.
Introduction xiii Table 3 Crosswalk of the CCS Examination Competencies and the Questions in the Chapters Crosswalk of CCS Competencies to Chapter Chapter Name Competency Domain 1 2 3 4 5 6 7 8 9 Total Health Data Content and Standards 19 1 0 0 0 14 14 15 12 75 Medical Science 111 0 0 0 0 0 0 0 0 111 Classification Systems and Secondary Data Sources 30 21 4 15 15 10 4 0 11 110 Medical Billing and Reimbursement Systems 62 1 5 21 13 6 3 0 3 114 ICD-9-CM Coding 0 211 0 0 0 0 0 0 0 211 CPT Coding 11 0 211 0 11 0 0 0 0 233 CCS Mock Examination 1 9 5 17 7 10 5 4 2 1 60 CCS Mock Examination 2 14 4 9 20 8 1 1 0 3 60 Total CCS Questions 256 243 246 63 57 36 26 17 30 974 ABOUT THE COGNITIVE LEVELS OF TESTING FOR THE CCS EXAMINATION The examination questions test your knowledge on three cognitive levels: recall (RE) application (AP) analysis (AN). The recall level tests your memory of basic facts such as being able to identify terms, methods, and procedures. The application level tests your ability to interpret data and information, to apply concepts and principles, to recognize relationships among data, and to calculate mathematical problems. The analysis level measures your ability to solve specific problems by evaluating, comparing, and selecting appropriate solutions for action; and to evaluate information and perform multiple calculations to assemble various elements into a total picture. The general format of Part I of the exam is primarily designed to engage your problem-solving and critical thinking skills. These types of questions require you to translate what you have learned and apply it to a situation. There are sample questions provided on the AHIMA Web site (http:// www.ahima.org) so that you can experience the testing situation.
xiv Introduction CCS EXAMINATION CONTENTS The CCS examination is in a computer-based format. Carefully read the latest Candidate Handbook for the CCS Examination and continue to monitor AHIMA s Web site to look for updated information on the examination format. The handbook is available for downloading in PDF format on the AHIMA Web site (http://www.ahima.org). Part I of the examination has 60 multiple choice questions (50 of the questions are scored and 10 of the questions are not scored). The time constraint is 60 minutes. You will be expected to answer the multiple-choice questions without use of your references and code books. Part II, Medical Record Coding, of the examination has 13 medical cases (4 ambulatory surgery, 1 emergency room, 2 Cardiac Cath/Interventional Radiology/Pain Management) and 6 inpatient cases) to code. For inpatient diagnoses and procedures, use your ICD-9-CM volumes 1-3. Ambulatory care diagnoses are to be coded with ICD-9-CM volumes 1 and 2; and ambulatory procedures are to be coded with CPT. The time allotted for completing Part II of the examination is 3 hours (180 minutes). Table 4 CCS Examination Content provides a summary of the CCS exam content. The key to success on the exam is a thorough knowledge of coding, which can only be achieved through extensive use of and familiarity with the code books. Having to use the code books to answer questions will help increase your speed in the use of both coding books. This book is only one of many tools available to you to prepare. Use a variety of review methodologies (multiple-choice questions, case studies, review of theory, mock exams, etc.) as an effective means of reviewing. These tools can help prepare you for the challenge of the CCS-P coding exam. Table 4 CCS Examination Content CCS Examination Content PART I Number of multiple-choice questions 60 Amount of time for questions 60 minutes Average time to answer each question 1 minutes per question PART II Outpatient Records 7 Ambulatory Surgical Cases 4 Emergency Room 1 Cardiac Cath/Interventional Radiology/Pain Management 2 Inpatient Cases 6 Total number of cases 13 Amount of time for cases 180 minutes Average time to code each case 13.75 minutes per case Total time for examination 4 hours Reminder: Monitor AHIMA s Web site for the latest updates on the testing information. Pass rates from January 1, 2008 to June 30, 2008 for the CCS exam was 49.52%.
ADDITIONAL INSIGHTS ABOUT THE CCS EXAMINATION Introduction xv 1. Computerized Testing: You will be able to review questions on the computer screen to check your answers before you close the exam file on the computer. 2. On-Screen Information: Any additional information needed to complete the multiple choice questions in Part I of the examination will be available on the screen in the testing software. 3. Medical Sciences: These questions tend to be interspersed throughout other topic categories. Medical terminology, Pathophysiology, and anatomy and physiology are a part of the general knowledge base for Health Information Management, coding, and reimbursement. 4. National Exam: Keep in mind that this is a national examination. Concentrate on federal legislation, statutes, and legal issues that would be appropriate nationally in all 50 states. 5. Be prepared to shift gears quickly throughout the exam. Questions on the examination are scrambled and change topics from question to question. Therefore, you may have a CPT coding question, followed by a reimbursement question, followed by an ICD-9-CM question, etc. 6. You will need to bring your ICD-9-CM and AMA CPT-4 coding books to the test. In addition, you may bring a medical dictionary to reference during Part II of the examination. Practicing coding using your coding books will help increase your speed in finding the codes by the book. Remember, the test is timed. The faster you code, the more time you have to choose your answers. It may make the difference in being able to successfully complete the examination in the time allotted. Part I of the examination: You will not be allowed to use your code books to answer the questions or verify the answer you choose. The multiple-choice questions in Part I of the exam are in a narrative form, and any necessary codes and/or code narratives will be supplied in the answer options on the computer screen for you to choose from. Part II of the examination: You will be using the coding books in Part II of the examination. 7. The focus is on critical concepts. Our major focus is on covering the concepts and competencies in the body of knowledge for the Certified Coding Specialist (CCS). The questions and cases on the examination may combine several concepts into one question that may increase the level of difficulty in the question or case. 8. Review the latest candidate handbook. The AHIMA Candidate Handbook for the Certification Examinations contains information on the exam, how to apply for the examination, what to bring, and other pertinent information you need. 9. Make sure that you have the necessary items for admission for testing. Again, review your handbook for specific information on what you will need to bring with you to the examination center. You will need to bring your Authorization to Test (ATT) and two forms of identification (review the accept forms of identification listed in your hand book. You will need code books for Part II of the exam. Bring the following: The ICD-9-CM code book volumes 1 3 (for inpatient diagnoses and procedures); ambulatory care diagnoses are to be coded with ICD-9-CM volumes 1 and 2 AMA CPT (ambulatory procedures are to be coded with CPT) You may also bring a medical dictionary for use in Part II of the examination.