CCA EXAM With Complete Solutions Latest Update, Exams of Nursing

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CCA EXAM With Complete Solutions

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Name the 4 Cooperating Parties for ICD-9-CM - correct answers 1) AHIMA, 2) AHA-American Hospital Association,

3. CMS-Centers for Medicare and Medicaid, and 4) NCHS- National Center for Health Statistics What is a POA Indicator? - correct answers The POA- Present on Admission Indicator is used to differentiate between conditins present at the time of admission and conditions that develop during an inpatient admission. The POA Indicator applies to diagnosis codes for claims involving inpatient admissions to acute care hospitals and other facilities. POA - developed by the Cooperating Parties. What organization is responsible for updating the diagnosis classification (Volumes 1 & 2) for ICD-9-CM? - correct answers Volumes 1 & 2 of the ICD-9-CM are updated by NCHS-National Center for Health Statistics. What organization is responsible for updating the procedure classification (Volume 3) for ICD-9-CM? - correct answers Volume 3 of the ICD-9-CM is updated by CMS-Centers for Medicaid and Medicare.

Which classification level of ICD-9-CM codes is the most specific? - correct answers The "sub-classification" level is the most specific level of coding in ICD-9-CM (5-digit codes). What are the levels of ICD-9-CM codes called? - correct answers Category>Subcategory (4-digit)>Sub- classification (5-digit) How many digits are in the Subcategory Level of ICD-9- CM codes? - correct answers There are 4 digits at the Subcategory Level of ICD-9-CM codes. Please describe E Codes. - correct answers E Codes classify environmental events and circumstances as the cause of an injury, poisoning, or other adverse effect. Please describe V Codes. - correct answers V Codes are diagnosis codes that indicate a REASON for the healthcare encounter. Please give brief description of Volume I of the ICD-9-CM Volumes. - correct answers Volume I of the ICD-9-CM contains the TABULAR INDEX - a numerical listing of codes that represent diseases and injuries.

Please give a brief description of Volume 2 of the ICD-9- CM Volumes. - correct answers Volume 2 of the ICD-9-CM contains the ALPHABETIC INDEX to Diseases and Injuries (You should alwasy trust this index). Please give a brief description of Volume 3 of the ICD-9- CM Volumes. - correct answers Volume 3 of the ICD-9-CM contains the TABULAR and ALPHABETIC INDEX to Procedures. Which item is not a purpose of the ICD-9-CM: a-used in the evaluation of medical care planning for healthcare delivery systems, b-used in the collection of data about nursing care, c-used to facilitate data storage and retrieval, or d-used as the basis of epidemiological research - correct answers Collection of data about nursing care is not a purpose of the ICD-9-CM. Which item is not one of the purposes of ICD-9-CM: a- reporting of diagnoses by physicians, b-classification of mortality for statistical purposes, c-the identification of supplies, products & services provided to patients, or d- classification of morbidity for statistical purposes - correct answers The identification of supplies, products & services provided to patients is NOT on of the purposes of ICD-9-CM. Please define "complication". - correct answers A complication is a secondary condition that arises during

hospitalization and is thought to increase the LOS-Length of Stay by at least one day for approximately 75% of patients. Please define "comorbidity". - correct answers Comorbidity is a pre-existing condition that because of its presence with a specific diagnosis will likely cause an increase in the patient's length of stay in the hospital. Please define "principal diagnosis". - correct answers Principal diagnosis is the condition establisdhed, after study, to be chiefly responsible for occasioning the admission to the patient for the hospital. The principal diagnosis is NOT the admitting diagnosis, but the diagnosis found after workup, or even after surgery that proves to the be reason for admission. State the criteria of a "Significant Procedure". - correct answers 1- Surgical in Nature, 2-Carries a procedural risk, 3- Carries an anesthetic risk, 4- Requires specialized training Which volume of ICD-9-CM contains the numerical listing of codes that represent diseases and injuries? - correct answers Volume I - the Tablular List contains the numerical listing of codes that represent diseases and injuries.

What ICD-9-CM codes are alwasy alphanumeric? - correct answers V Codes are always alphanumeric. Which volume of ICD-9-CM contains the Tabular and Alphabetic Index of Porcedures? - correct answers Volume 3 of the ICD-9-CM contains the Tabluar LIst and Alphabetic Index of Procedures. What is the standard terminology used to code medical procedures and services? - correct answers CPT is a comprehensive listing of terms and codes for reporting diagnostic and therapeutic procedures and medical services. According to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? - correct answers Complex Closure would describe the repair of wounds requiring more than layered closure, namely, scar revision, debridement, extensive undermining, stents, or retention sutures. A 7-year old patient was admitted to ER for treatment of shortness of breath. Patient was give epinephrine and nebulizer treatments. The shortness of breath and wheezing are unabated following treatment. What diagnosis should be suspected? [epineprhine-adrenaline hormone secreted by the medulla of the adrenal glands - when injected treats vasoldilation by increasing blood flow] - correct answers Status Asthmaticus: fails to

respond to therapy administered during an asthmatic attack. This is a life-threatening conditions that requires emergency care and likely hospitalization. (Schraffenberger) How is the CPT code determined for an excision of a malignant lesion of the skin? - correct answers The CPT code for an excision of a malignant lesion of the skin by the body area from which the excision occurs and by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter + the most narrow margins required = the excised diameter). Patient admitted for spotting. Patient had been treated 2 weeks prior for a miscarriage with sepsis. Sepsis has resolved and she is afrebrile [having no fever] at this time. Patient is treated with an aspiration dilation and curettage. Products of conception are found. What is the principal diagnosis? - correct answers Miscarriage: subsequent [later] admissions for retained products of conception following a spontaneous or legally induced abortion are assigned the appropriate code from Catogory 634, spontaneous abortion, or 635, legally induced abortion, with a fifth digit of "1" (incomplete). This advise is appropriate even when the patient was discharged previously with a discharge diagnosis of complete abortion.

What is a condition that arises during hospitalization? - correct answers Complication What codes are used to assign a diagnosis to a patient who is seeking healthcare services but is no necessarily sick? - correct answers V Codes are diagnosis codes and indicate a reason for healthcare encounter. What is the 2-digit modifier that may be reported to indicate a physician performed the postoperative management of a patient, but another physician performed the surgical procedure? - correct answers Modifier -55 is used to identify the physician provided ONLY postoperative care services for a particular procedure. [modifiers are appended to the code to provide more information or to alert the payer that a payment change is required.] What does an encoder do for a coder? - correct answers An encoder takes a coder through a series of questions an choices called a logic based encoder. The logic based encoder prompts the user through a variety of questions and choices based on the terminology entered. The coder selects the most accurate colde for a service or condition (and any possible complications or comorbidities). Patient admitted for abdominal pain with diarrhea and diagnosed with infectious gastroenteritis. Patient also has angina and chronic obstruction pulmonary disease. What

is the correct coding and sequence for this case? - correct answers Infectious gastroenteritis; chronic obstructive pulmonary disease; angina - Patients can have several chronic conditions that co-exist at the time of their admision and qualify as additional disgnoses. [the codes for the symptoms "abdominal pain", "diarrhea", "vomiting", or "abdominal cramps" - signs, symptoms, and ill-defined conditions are not to be used as the Principal Diagnosis when a related definitive diagnosis has been established. Chapter 16 CPT Codebook Patient admitted with history of prostate cancer and with mental confusion. Patient completed radiation therapy for prostatic carcinoma 3 years prior and is status post a radical resection of the prostate. A CT Scan of the brain during the current admission reveals metastasis. What is the correct coding and sequencing for this case? - correct answers Metastastic carcinoma of the brain; History of carcinoma of the prostate - for a FORMER malignancy a code from Category V10, personal history of a malignant neoplasm should be used to indicate the former site of malignancy [when a primary malignancy has been previously excised or eradicated from its site and there is NO further treatment directed to that site & no evidence of any existing primary malignancy]. The mention of extension, invasion, or metastatic to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal, with the V10 code used as a secondary code. (Shcraffenberger)

Patient admitted with abdominal pain. Physician states that the discharge diagnosis is pancreatitis versus noncalculus cholecystitis. Both diagnoses are equally treated. What is the correct coding and sequencing for this case? - correct answers Unusual Instance: Sequence EITHER the pancreatitis OR noncalculus cholecystitis as the principal diagnosis - two or more diagnoses equally meet the criteria for the principal diagnosis as determined by the circumstances of admission, diagnostic workup, and the therapy provided. ALSO the Alphabetic Index, Tabular List, or another coding guideline does not provide sequencing direction. In such cases any one of the diagnoses may be sequenced first. 80-year old female frebrile, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. Patient has has

100K organisms of Escherichia coli per cc of urine. Attending physician documents: "urosepsis". How should the coder proceed in this case? - correct answers NEED TO STUDY THIS BEFORE ADDING THE ANSWER 65-year old patient with history of lung cancer is admitted to a healthcare facility with ataxia (without coordination) and syncope (fainting) and a fractured arm-result of a fall. Treatment is a closed reduction of the fracture in the ER department and undergoes a complete workup for metastatic carcinoma of the brain. Patient is found to have metastatic carcinoma of the lung to the brain and undergoes radiation therapy to the brain. What is the principal diagnosis in this case? - correct answers

Metastatic carcinoma of the brain. If treatment is directed at the malignancy, designate the malignancy as the principal diagnosis. The ONLY EXCEPTION to this guideline is if a patient admission or encounter is SOLELY for the administration of chemotherapy, immunotherapy, or radiation therapy which would prompt the coder to assigne the appropriate V Code as the 1st listed or principal diagnosis and diagnosis or problem for which the service is being peformed as the secondary diagnosis. What is the definition of "other diagnoses"? [according to the UHDDS-Uniform Hospital Discharge Data Set - correct answers For reporting purposes "other diagnoses" is interpreted as ADDITIONAL CONDITIONS that affect apatient care in terms of requiring: clinical evaluation or therapeutic treatement or diagnostic procedures or extends the length of stay or increases nursing care and monitoring. What is the UHDDS? - correct answers Uniform Hospital Discharge Data Set is a minimum set of items based on standard definitions to provide consisten data for multiple users. UHDDS is required for reporting Medicare and Medicaid patients and many other health care payers also use most of the UHDDS for the uniform billing system. What are the required data items of UHDDS? - correct answers 1- Principal Diagnosis

2- Other Diagnoses that have a significance for the specific hospital episode 3- All significant procedures 4- Age, Sex, Race of patient 5- Expected Payer 5- Hospital's Identification Patient in the ER for chest pain. Evaluation reveals suspicion of GERD [gastroesophageal reflux disease]. Final diagnosis was "Rule out chest pain versus GERD". What is correct ICD-9-CM code? - correct answers 786.50, Chest pain NOS: The condition should be coded to the highest degree of certainty - such as the sign or symptom the patient exhibits. In the outpatient setting, the condition [here-GERD] in the statement should NOT BE CODED AS IF it existed. Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when a physician qualifies a diagnostic statement as "rule out" or other similar terms indicating uncertainty. A skin lesion is removed from a patient's cheek in the dermatologist's office. Physician documents "skin lesion" in the health record. Before billing the pathology report returns with a diagnosis of basal cell carcinoma. What actions should the coder take for this claim submission? - correct answers Code: Basal Cell Carcinoma: In the OUTPATIENT setting, when diagnostic tests have been interpreted by the physician and the final report is available at the time of coding, code any CONFIRMED or

DEFINITIVE diagnosis(es) that are documented in the record. Do NOT code related signs and symptoms as addtional diagnoses. ******NOTE this differs from the coding practive in the hospital inpatient setting regarding abnormal findings on test results. ********* Epidural given during labor. Subsequently determined the patient would require a C-section for cephalopelvic disproportion [baby's head too large for mother's pelvis] because of obstructed labor [failure of the fetus to descend through the birth canal]. What it the correct ICD- 9-CM diagnostic and the CPT anesthesia codes? - correct answers NEED TO LOOK UP THIS ANSWER Physician correctly prescribes Coumadin [anticoagulant- blood thinner]. Patient takes the Coumadin as prescribed but develops hematuria [blood in the urine] as a result of taking the medication. What the correct way to code this case? - correct answers Hematuria; adverse reaction to Coumadin. An adverse effect can occur when everything is done correctly. Adverse effects can occur in situations where medications are administered properly and prescribed correctly in both therapeutic and diagnostic procedures. The first listed diagnosis is the MANIFESTATION or the nature of the adverse drug effect - in this case HEMATURIA. Locate the drug in the SUBSTANCE colum of the Table of Drugs and Chemicals in the Alphabetic Index to Diseases. Select the E Code for the drug from the Therapeutic Use column of the Table of

Drugs and Chemicals. Use of the E Code is MANDATORY when coding adverse effects. What is the procedure for locating a DRUG? - correct answers Locate the drug in the SUBSTANCE colum of the Table of Drugs and Chemicals in the Alphabetic Index to Diseases. Select the E Code for the drug from the Therapeutic Use column of the Table of Drugs and Chemicals. Use of the E Code is MANDATORY when coding adverse effects. Briefly describe MS-DRG - correct answers MS-DRG (Medical-Severity-Diagnosis-Related Group). It is system to classsify hospital cases in groups. DRG's are used to determine how much Medicare pays the hospital for each "product" [i.e. "appendectomy"] since patients within each group are clinically similar and are expected to use the same level of hospital resources. Each DRG was a payment weight assigned to it based on the average resources used to treat Medicare patients in that DRG. Payment weights are affected by geographic location (cost of living), number of low income patietns in that location, whether the facility is a teaching facility, and if the case is an outlier case (a particularly costly case). Claim information is gathered: ICD diagnoses, procedures, age, sex, discharge status, and the presence of complication or comorbidities. Examples: Normal Newborn, Psychoses, Major Joint Replacement, Chest Pain, Cesarean Section, Simple pneumonia, Heart Failure