AI in Inpatient DRG Coding Quiz

Answers and explanations appear as you take the quiz.

1. In an AI-assisted inpatient coding workflow, which component actually assigns the MS-DRG?
   • The natural language processing model
   • The attending physician's signature
   • The deterministic grouper software, using the assigned codes
   • The payer's claims scrubber
2. Why doesn't adding more secondary diagnosis codes automatically raise an MS-DRG?
   • The severity tier depends on at least one qualifying CC or MCC, and CC exclusions can drop related diagnoses
   • MS-DRGs ignore secondary diagnoses
   • Only procedures affect the DRG
   • Payers cap claims at five diagnosis codes
3. For a short-term acute care inpatient stay, how do the official guidelines treat a diagnosis documented at discharge as 'probable'?
   • It can never be coded
   • It is coded only as a symptom
   • It is coded only if a lab confirms it
   • It may be coded as if it were established
4. Why might a DRG validation tool send cases whose only MCC is acute respiratory failure to a second reviewer?
   • Acute respiratory failure is not a valid ICD-10-CM code
   • Diagnoses like this often draw payer clinical-validation denials when indicators are weak
   • Respiratory cases never go through the grouper
   • Medicare does not pay for respiratory care
5. A model assigns a DRG using last fiscal year's grouper for a patient discharged in November. What is the problem?
   • MS-DRG definitions and CC/MCC lists are updated each fiscal year starting October 1
   • Groupers are updated only every ten years
   • November discharges use APR-DRGs by law
   • Grouper versions only affect outpatient claims
6. What is the main benefit of showing a working DRG while the patient is still in the hospital?
   • It replaces final coding
   • It lets the hospital bill the payer every day
   • Documentation gaps can be fixed while the patient is still in the hospital
   • It removes the need for a principal diagnosis
7. How do APR-DRGs differ from MS-DRGs, as described in the guide?
   • APR-DRGs ignore diagnoses entirely
   • APR-DRGs are used only for outpatient surgery
   • APR-DRGs have exactly two tiers
   • APR-DRGs add four severity-of-illness and risk-of-mortality subclasses
8. What does what-if grouping tell a reviewer?
   • Which single code change would alter the DRG and by how much
   • Which physician wrote the discharge summary
   • The patient's insurance eligibility
   • The hospital's base rate for next year