Question

 

In order to calculate the amount of reimbursement a hospital can expert for providing outpatient care, which of the following must you know?

	A.	Length-of-stay
	B.	Principal Diagnosis
	C.	MS-DRG assignment
	D.	APC calculations

Which of the following codes would be reported by the hospital for closures done to a 5.0 cm anterior right lower leg wound, and a 2.7 cm posterior right lower leg wound?

The service was furnished in the emergency department. The medical record indicates that the injuries to the leg included fascia.

	A.	12002, 12002-59-XS
	B.	12032, 12032-59-XS
	C.	13121
	D.	12034

Answer 1

1. In order to calculate the amount of reimbursement for an outpatient services provided APC Calculation must be needed.

So answer is option D

Rationale : Length of stay cannot be applicable for outpatient services, DRG codes are used for inpatient services.Principal diagnosis alone cannot be determined the reimbursement. APC is Ambulatory Payment Classification is the method of US Services that pays for the outpatient services.

2. Closure of anterior and posterior wound closure of right leg with 5 and 2.7 cms includes the code as 12032, 12032-59-XS.

So option B is correct

Rationale : This repair includes fascia and the extra procedure was also performed .Additional 59 modifier can be used in case of additional services provided and here one more wound closure was also happened.12002 is a simple closure where as 12032 is a layered closure this can be considered as the wound also includes fascial closure.