CCS-P Study Set With Complete Solution: Medical Coding Questions and Answers, Exams of Advanced Education

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CCS-P Study Set With Complete Solution

According to AMA medical decision making is measured by - Correct Answer-1. number of dx or management options

2. amount and complexity of data review
3. risk of complications CPT Assistant - Correct Answer-provides official guidance in CPT coding published by the AMA A barrier to wide spread use of automated code assignments is - Correct Answer-poor quality of documentation When should coders assign codes from lab reports alone - Correct Answer-Never. If findings are out of normal range and the physician has ordered additional testing or treatment; consult with the physician as to whether the Dx should be added or if an abnormal finding should be listed. 4 cooperating parties of ICD-9 and responsibilities of each - Correct Answer-NCHS (national center for health statistics): maintaines dx classifications in Vol 1& CMS: maintains procedural classification in Vol 3 AHIMA & AHA: give advice & assistance on coding guidelines in conjunction with health information management practitioners, physicians, & other users of ICD- When can code 99291 (E/M critical care) be used in place of a medical visit or ER code

• Correct Answer-When the patient meets the definition of critical care and receives outpatient care on the same day limiting charge - Correct Answer-this is the amount a NON PAR Medicare provider can collect from a patient in excess of 15% over the NON PAR Medicare approved amount. When does CMS send the payment directly to the patient - Correct Answer-when a NON PAR provider does not accept assignment hard coding - Correct Answer-refers to CPT/HCPCS codes that appear in the hospitals chargemaster and will be included automatically on the patient's bill. CAC- computer assisted coding - Correct Answer-AHIMA defines as the use of computer software that automatically generates a set of medical codes for review , validation, and use based upon the documentation provided by the various providers of healthcare.

modifier: A1-principle physical of record - Correct Answer-required for patients covered by Medicare when reporting Initial Hospital Service codes POMR- PROBLEM ORIENTED MEDICAL RECORD - Correct Answer-Organized by problem number Database: history and physical Problem List: titles, numbers, dates of problems..."Table of Contents" of the record Initial Plan: describes diagnostic, therapeutic, and patient education plans Progress Note: documents the progress of a patient throughout the episode of care Discharge Note/ Transfer Note: summarizes episode of care and current status of patient Cost Sharing Provision of Health Ins. - Correct Answer-formulary for drugs co-pay benefit limitations Common Complication of Labor and Delivery - Correct Answer-forceps or vacuum extractor delivery without mention of indication renal sphincter tear, not associated with 3rd degree peritoneal laceration trauma to perineum and vulva during delivery HIPAA law in regards to children under 18 - Correct Answer-defers to state law on matters that concern minors disease index - Correct Answer-list diagnostic codes in order physician index - Correct Answer-lists cases in order by physician name or number master patient index - Correct Answer-cross reference patient name and medical record number operation index - Correct Answer-list medical records by operative procedures Point of Care Service - Correct Answer-when clinical documentation is entered in computer at the same time and location of service Federal Register - Correct Answer-published by CMS. Contains both proposed and final notes for Conditions of Participation for hospitals

NEC - Correct Answer-Books fault> Doctor has detail documented, book does not contain matching detail NOS - Correct Answer-Doctors fault> Doctor lacks specific documentation although ICD has detailed options V codes - Correct Answer-supplemental classification Problem based include: need for vaccine Fact based include: history of, outcome of delivery Service based: dialysis, chemo, therapy When is an interval H&P permitted - Correct Answer-when a patient is readmitted for the same or related problem with-in 30 days Required data for Acute Care and ER records - Correct Answer-physical findings lab and diagnostic test results follow-up instructions subpeona duces tecum - Correct Answer-ONLY reason that warrants the original patient chart to leave the premisses of the hospital OBRA - Correct Answer-Omnibus Budget Reconciliation Act of 1987 MDS - Correct Answer-Minimum Data Set- used to collect assessment data elements on Nsg home episodes facility data dictionary - Correct Answer-includes security levels for each form field and definitions for all entities Consultation Report - Correct Answer-used for obscure diagnoses. patients that physicians are not sure of the best therapeutic action and / or question of criminal activity o patient. Medical Staff By Laws, Rules, and Regulations - Correct Answer-H&P Exam completed documentation is due within 24 hours after admission prior to surgery. integrated health record - Correct Answer-arranged in strict chronological order SOMR-Source Oriented Health Record - Correct Answer-organized by subject matter, then chronologically within each subject; labs together, progress notes together etc. methicillin-resistant staphyllococus - Correct Answer-SUPERBUG, a major source of hospital-acquired infections

Prion Disease - Correct Answer-family of rare progressive neuro-degenerative disorders. Including: Creutzfeldt-Jakob disease (human) Varient Creutzfeld-Jakob disease (human) Gertsmann-Straussler-Scheinker Syndrome (human) Fatal Familial Insomnia Kuru, aka TSE's transmissible spongiform encephalopathies Synthroid - Correct Answer-Rx prescribed to replace small levels of thyroid hormone criteria for assigning CPT preventative medicine codes - Correct Answer-age Fetal Death - Correct Answer-state law determines weight and weeks of gestation, normal parameters are 500 + grams or 22 + weeks of gestation missed abortion - Correct Answer-fetal death prior to completion of 22 weeks gestation Unlisted codes in CPT - Correct Answer-only use when there is actually no code for the procedure DO NOT USE when the coder does not understand the procedure or document additional information MUST be submitted with the claim including; description of procedure, time/ effort necessary to preform procedure, type of equipment required, medical reason for procedure Superbill - Correct Answer-Aka; charge ticket Data Quality Analysis - Correct Answer-accuracy accessibility comprehensives consistency currency definition granularity integrity precision relevancy timeliness NON PAR Medicare reimbursement - Correct Answer-95% of the PAR Medicare allowed. Providers can bill up to 115% of the NON PAR allowed amount. CPT Key components - Correct Answer-history exam medical decision making

CPT contributing Components - Correct Answer-counseling coordination of care nature of presenting problem time HCPCS Modifies A1 - Correct Answer-required for initial hospital service codes when billing Medicare Psychotherapy codes are assigned based on - Correct Answer-time discounted charges - Correct Answer-provider charges full rate to insurance carrier but has an arrangement with the insurance carrier to pay at a discounted rate. Physicians usually write off the discount but may bill the patient for all of the portion of remaining balance. Usual Customary Fee profile - Correct Answer-based on usual fee submitted by that provider combined with the customary fee for that code insurance pays the lowest of; the physician amount, area customary fee, or schedule of benefits negotiated fee schedule - Correct Answer-created between physician and insurance company agreed flat rate per procedure, visit, or service negotiations based on supply and demand negotiations normally mandate agreed rate are considered payment in full and not allowed to balance bill the patient RBRVS: resource-based relative value scale - Correct Answer-national fee system used to calculate the approved amount for Medicare payments value assigned to each CPT code based on work involved, cost, and malpractice expenses conversion factors published Federal Register each December Management of a Fee Schedule requires - Correct Answer-How the practice is reimbursed for services basic value of services provided

going rates of services in the market place signals indicating fees need adjustment DO NOT charge less than the payer will pay. Fee Evaluations - Correct Answer-should occur at least annually unless practice has 100% negotiated and / or capitated rates evaluate codes that provide 80% of revenue for the practice Freedom Information Unit - Correct Answer-send letter to request answers to questions regarding coding policies payment rates, or payment policies from Medicare only 1 specific request per letter for a quick and accurate response Where are payor specific guidelines found - Correct Answer-procedure manuals, newsletters, and bulletins published by the payor Local and National coverage Determinations - Correct Answer-provide guidelines that cover medical necessity Klebsiella - Correct Answer-gram negative pneumonia clinical data - Correct Answer-relates to diagnosis and treatment documentation in the health record Radiology reports can be used for coding when - Correct Answer-used to clarify an outpatient diagnosis or reason for service contraceptive sterilization - Correct Answer-V25. ABN: advanced beneficiary notice - Correct Answer-waiver required by Medicare for all physician office procedures when there is a question as to whether or not the service will be paid for by Medicare issued each time each questionable service is provided linking - Correct Answer-explains medical necessity of a procedure on a claim Medicare Prescription Drug, Improvement and Modernization Act of 2003 - Correct Answer-stipulates that IC-9-CM diagnosis and procedure codes will be issued twice a year April 1st October 1st

Effective ways to select an audit sample - Correct Answer-random sample of records for all physicians in a group all services provided on a randomly selected day all rejected claims during a specific time period Spreadsheet software - Correct Answer-application that will allow facilitate data collection and analysis beneficial because charts and graphs can be incorporated For example: physician to computerize the office budget including; personnel expenses, office expenses, and office supply expenses Unbundling is discovered as a common practice the appropriate action to be taken by the office manager is - Correct Answer-refund over payments from a third party parer due to this practice Risk areas identified by the OIG (office of inspector general) - Correct Answer-billing for noncovered services as if they are covered billing for a more expensive service than the one actually preformed coding/charging one or two middle levels of service codes develops an annual work plan that delineates the specific target areas that will be monitored in a given year common bacterial diseases - Correct Answer-staphylococcus aureus staphylococci streptococci streptococcus pyogenes streptococcus pneumonia gonorrhea meningitis salmonella E. coli cholera mycoplasma bacillus C. perfringens chlamydia trachomatius bubonic plague clostridium tuberculosis

hansens disease syphilis lyme disease newborn period defined as - Correct Answer-birth through the 28th day following birth elderly primigravida - Correct Answer-women giving birth to her first child after the age of 35 coding guideline for late effects is - Correct Answer-residual condition is sequenced first, followed by the cause of the late effect Late Pregnancy - Correct Answer-over 40 weeks of gestation ventricular septal defect - Correct Answer-abnormal communication or opening in the ventricular septum that allows blood to shunt from the left ventricle to the right ventricle best report to use in determination of the size of a removed malignant lesion - Correct Answer-operative report Protonix - Correct Answer-treats esophagitis Haldol - Correct Answer-Schizophrenia potassium replacement - Correct Answer-treats Hypkalemia Retrovir - Correct Answer-treats AIDS aspiration pneumonia - Correct Answer-caused by inhaled food, liquid, or oil by a patient with pneumonia Progress Note - Correct Answer-contains information regarding treatment provided Common Viral diseases - Correct Answer-Epstein-Barr adenoviridae adenovirus arbovirus encephalitits aseptic meningitis cytomegalovireus (CMV) Hepatitis Herpes simplex HIV influenza A & B measles mumps

papilloma viruses paralytic poliomyelitis respiratory syncytial virus rubella varicella zoster rabies clustering - Correct Answer-practice of coding/charging one or two middle levels of service exclusively for all patient encounters following a coding audit, the manager should - Correct Answer-provide education about the results and then perform a follow-up audit to update the office encounter form yearly - Correct Answer-use Appendix B of CPT to reference code additions, deletions, and revisions Database - Correct Answer-computerized record of all patients including basic demographic and encounter data Encoder - Correct Answer-used to aid in the coding function in a physicians office Qui tam plaintiffs - Correct Answer-private citizens who may bring suit on behalf of themselves and the government against fraudulent healthcare providers minimum necessary - Correct Answer-governed by HIPAA Privacy Rule only the minimum necessary amount of information necessary to fulfill the purpose of the request should be shared with internal users and external requestors HIPAA does not allow the following information to be shared with the patient themselves

• Correct Answer-oral information psychotherapy notes information compiled in the anticipation of, or for use in a civil, criminal, or administrative action or proceeding revenue production report - Correct Answer-shows the number of times a particular procedure is coded and the total revenue produced as a result of the coding shows most frequently used codes in the practice reliability - Correct Answer-consistency of any data set documenting time according to E/M service guidelines - Correct Answer-both the time spent counseling or coordinating care and the total tiem of the visit must be documented

Depro-Provera - Correct Answer-birth control and estrogen replacement benefits of email - Correct Answer-to clarify treatment instructions or medication administration for patients and healthcare providers adverse effect - Correct Answer-hypersensitivities or allergic reactions that occur as qualitatively different responses to a drug, which are acquired only after re-exposure to the drug is the definition of an adverse effect abnormal laboratory findings - Correct Answer-are not coded unless indicated there clinical significance by the physician PDR-physicians desk reference - Correct Answer-authoritative source of FDA approved information on prescription drugs including usage, warnings and drug interactions Coding Clinic - Correct Answer-Published quarterly by the Central Office on ICD-9-CM Coding of the American Hospital Association-AHA providing office ICD-9 coding guidelines charge summary - Correct Answer-aka office service report contains summary of all billing data entered for the practice each day claim redetermination - Correct Answer-first step in claims appeal process claims are reviewed by an individual who was not involved in the initial claim review determination request must be make within 120 days of receiving the initial claim determination validity - Correct Answer-accuracy of data Stark Law - Correct Answer-prohibits a physician from referring patients to an entity for services paid for by federal or state health benefits programs if a physician has a financial relationship with the entity