Top 50 IPDRG Basic Questions

INTRODUCTION

Preparing for IPDRG interviews can be challenging, especially when employers assess your knowledge of PCS, Diagnosis section, sequencing rules, Guidelines and Clinical scenarios.

If you are experience inpatient coder or a medical coding student or certified coder, this blog or article will help you strengthen your interview preparation.

In this blog, you will find basic 50 carefully selected IPDRG interview questions with clear practical answers based on the coding guidelines.

INSTRUCTION -

These questions are designed for:

• IP-DRG interview Preparation
• Medical Coding Students
• CPC, CCS, CIC etc. Aspirants
• Quality Analyst (QA)
• Medical Coding Trainers

Read each question carefully before viewing the answer. Try answering it yourself first to improve your interview confidence.

1. How will you define IP DRG?

Answer: IP DRG stands Inpatient Diagnosis Related Group.

It is a payment classification system that groups inpatient hospital admissions based on diagnoses, procedures, severity, and resource utilization.

2. What is the full form of DRG?

Answer: Diagnosis Related Group.

3. Explain MS-DRG?

Answer: MS-DRG stands Medicare Severity Diagnosis Related Group, which considers CC/MCC to determine reimbursement.

4. What are the components of DRG assignment?

Answer:

 - Principal Diagnosis
 - Principal Procedure
 - Secondary Diagnoses
 - CC/MCC
 - Age
 - Sex
 - Discharge Status

5. What is Principal Diagnosis?

Answer: The condition established after study to be chiefly responsible for the admission.

6. What is Principal Procedure?

Answer: The procedure performed for definitive treatment or the procedure most related to the principal diagnosis.

7. What is a Secondary Diagnosis?

Answer: A condition that coexists at admission or develops during hospitalization and affects patient care.

8. What is CC?

Answer: Complication or Comorbidity.

9. What is MCC?

Answer: Major Complication or Comorbidity.

10. Difference between CC and MCC?

Answer: MCC indicates greater severity and usually results in higher reimbursement than a CC.

11. What coding systems are used in IP coding?

Answer:

 ICD-10-CM and ICD-10-PCS

12. Is CPT used for inpatient facility coding?

Answer: No. Inpatient facility coding uses ICD-10-PCS.

13. What is ICD-10-PCS?

Answer: The inpatient procedure coding system used in U.S. hospitals.

14. How many characters are in an ICD-10-PCS code?

Answer: Seven characters.

15. Name the seven ICD-10-PCS characters.

Answer:

1. Section

2. Body System

3. Root Operation

4. Body Part

5. Approach

6. Device

7. Qualifier

16. What is a Root Operation?

Answer: The objective of the procedure.

17. How many Root Operations are there?

Answer: 31 Medical and Surgical root operations.

18. Difference between Excision and Resection?

Answer: Excision removes part of a body part; Resection removes the entire body part.

19. Difference between Fragmentation and Extirpation?

Answer: Fragmentation breaks solid matter into pieces; Extirpation removes solid matter.

20. Difference between Replacement and Supplement?

Answer: Replacement substitutes the body part; Supplement reinforces or augments it.

21. Difference between Repair and Replacement?

Answer: Repair restores the body part without replacing it; Replacement substitutes it.

22. What is POA?

Answer: Present on Admission.

23. POA Indicators?

Answer: Y, N, U, W, 1.

24. What is a Physician Query?

Answer: A compliant request for clarification when documentation is incomplete, conflicting, or ambiguous.

25. When should you query a physician?

Answer: For unclear, conflicting, incomplete, or clinically unsupported documentation.

26. What is Coding Clinic?

Answer: Official coding advice published by AHA for ICD-10-CM and ICD-10-PCS.

27. What is UHDDS?

Answer: Uniform Hospital Discharge Data Set, which defines principal diagnosis and other inpatient reporting requirements.

28. What documents do you review before coding?

Answer:

 H&P

 Progress notes

 Operative report

 Consults

 Labs

 Radiology

 Pathology

 Discharge summary

29. What is Sepsis?

Answer: Life-threatening organ dysfunction caused by infection.

30. Difference between Sepsis and Septic Shock?

Answer: Septic shock is severe sepsis with persistent hypotension despite adequate fluid resuscitation.

31. What is HIV code B20 used for?

Answer: Confirmed HIV disease or AIDS.

32. When do you assign Z21?

Answer: Asymptomatic HIV infection.

33. What is Metastasis?

Answer: Spread of cancer from the primary site to another organ.

34. What is the Neoplasm Table?

Answer: An index used to identify neoplasm codes by site and behavior.

35. Difference between Primary and Secondary Malignancy?

Answer: Primary is the original site; Secondary is metastatic spread.

36. What is CABG?

Answer: Coronary Artery Bypass Graft surgery.

37. PCS Root Operation for CABG?

Answer: Bypass.

38. PCS Root Operation for PTCA?

Answer: Dilation.

39. PCS Root Operation for Pacemaker insertion?

Answer: Insertion.

40. PCS Root Operation for Pacemaker generator replacement?

Answer: Replacement.

41. PCS Root Operation for Total Hip Replacement?

Answer: Replacement.

42. PCS Root Operation for Spinal Fusion?

Answer: Fusion.

43. PCS Root Operation for Biopsy?

Answer: Usually Excision with a diagnostic qualifier (depending on the tissue sampled).

44. What is the difference between Open and Percutaneous approaches?

Answer: Open involves cutting through skin to expose the site; Percutaneous is performed through a small puncture or incision.

45. What is a Device in PCS?

Answer: A material or appliance that remains in the body after the procedure.

46. What is Clinical Validation?

Answer: Ensuring that documented diagnoses are supported by clinical evidence.

47. What is DRG Validation?

Answer: Verifying that the assigned DRG is supported by accurate diagnosis, procedure coding, and documentation.

48. What is Upcoding?

Answer: Assigning codes that increase reimbursement without documentation support.

49. What is Downcoding?

Answer: Assigning codes that understate the documented severity or procedures, resulting in lower reimbursement.

50. Why should we hire you as an IP DRG Coder?

Answer:

I have experience reviewing complete inpatient records, assigning accurate ICD-10-CM and ICD-10-PCS codes, applying Official Coding Guidelines, determining MS-DRGs, identifying CC/MCC conditions, and maintaining coding quality and productivity. I focus on accurate, compliant coding and continuous learning to stay current with coding updates.

Thank You!

•