Medical Coding Practice Exam, Exams of Nursing

Download Medical Coding Practice Exam and more Exams Nursing in PDF only on Docsity! CCS PRACTICE EXAM 1 & 2 LATEST EXAM 2023- 2024 ACTUAL EXAM 200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES| (ALREADY GRADED A+) |BRAND NEW!! A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm. The x-ray showed a fracture of ulna. Patient underwent closed reduction of fracture right proximal ulna, and an elbow-to-finger cast was applied. What diagnostic and procedure codes should be assigned? S52.101AUnspecified fracture of upper end of right radius, initial encounter for closed fracture S52.101BUnspecified fracture of upper end of right radius, initial encounter for open fracture S52.001AUnspecified fracture of upper end of right ulna, initial encounter for closed fracture S52.001BUnspecified fracture of upper end of right ulna, initial encounter for open fracture 0PSH0ZZReposition right radius, open approach 0PSK0ZZReposition right ulna, open approach 24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without manipulation 24675Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); with manipulation 25560Closed treatment of radial and ulnar shaft fractures; without manipulation 29075Application, cast; elbow to finger (short arm) a. S52.101A, S52.001A, 0PSK0ZZ b. S52.101B, S52.001B, 0PSH0ZZ c. S52.101B, S52.001B, 25560, 29075 d. S52.001A, 24675 - Correct answer: D The patient has a fracture of the right proximal ulna and closed reduction is necessary. In the ICD-10-CM Code Book, under Fracture, ulna, proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT. According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure (AMA CPT Professional Edition 2020, 182). (Note: Since this is an ambulatory surgery center case, CPT codes are assigned rather than ICD-10-PCS codes.) A laparoscopic tubal ligation is completed. What is the correct CPT code assignment? A patient with acute respiratory failure, hypertension, and congestive heart failure is admitted for intubation and ventilation. The patient's heart failure is stable on current medications. What are the correct diagnosis codes and sequencing? I10Essential hypertension I11.0Hypertensive heart with heart failure I50.9Heart failure, unspecified J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia a. J96.00, I11.0, I50.9 b. I50.9, J96.00, I10 c. J96.20, I10, I50.9 d. I50.9, J96.20, I11.0 - Correct answer: A The patient was admitted and treated for respiratory failure. The other conditions present are also coded. The classification presumes a causal relationship between hypertension and congestive heart failure unless the physician documents otherwise (Leon-Chisen 2020, 228-231; CMS 2020a, Section I.C.10.b., 53, Section I.C.9.a, 46; AHA Coding Clinic 2017 1st Quarter, 47). A 64-year-old female was discharged with the final diagnosis of acute renal failure and hypertension. What coding guideline applies? a. Use combination code of hypertension and chronic renal failure. b. Use separate codes for hypertension and chronic renal failure. c. Use separate codes for hypertension and acute renal failure. d. Use combination code for hypertension and acute renal failure. - Correct answer: C There is not a combination code for acute renal failure and hypertension. Acute kidney failure is not the same as chronic kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-47; Leon-Chisen 2020, 262). A patient was discharged from the same-day-surgery unit with the following diagnoses: posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, and was treated for mild acute renal failure. Which codes are correct? E11.36Type 2 diabetes mellitus with diabetic cataract E11.29Type 2 diabetes mellitus with other diabetic kidney complication E11.9Type 2 diabetes mellitus without complications H25.9Unspecified age-related cataract H25.21Age-related cataract, morgagnian type, right eye H25.041Posterior subcapsular polar age-related cataract, right eyeI10Essential hypertension I12.9Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified chronic kidney disease N17.9Acute kidney failure, unspecified a. H25.21, E11.29, I12.9, N17.9 b. E11.36, H25.041, I10, N17.9 c. H25.9, E11.29, I12.9, N17.9 d. H25.041, E11.9, I12.9 - Correct answer: B The patient has posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, acute renal failure. The hypertension and diabetes are not related to the renal failure as it is acute and not chronic. Because of this, no combination code is assigned for hypertension, diabetes and chronic renal failure. However, the diabetes and cataract are related conditions which are coded using a combination code. The classification presumes a relationship between diabetes and cataracts (CMS 2020a, Sections I.A.15, 12-13 and I.B.9., 15; AHA Coding Clinic 2016 2nd Quarter, 36-37; AHA Coding Clinic 2019 2nd Quarter, 30). 145 Correct0 Wrong1 Carcinoma of multiple overlapping sites of the bladder. Diagnostic cystoscopy and transurethral fulguration of bladder lesions over the dome and posterior wall (1.9 cm.) was completed. A biopsy was taken of a lesion in the lateral wall. What modifier should be added to the biopsy procedure code? a. -50, Bilateral procedure b. -51, Multiple procedures c. -59, Distinct procedural service d. -99, Multiple modifiers - Correct answer: C The surgery is done on two distinct areas within the bladder with two distinct approaches. The biopsy is not of the area that was resected and warrants the use of -59 (CPT Assistant Sept. 2001; CPT Professional Edition 2020, Appendix A). A bronchoscopy with multiple biopsies of the left bronchus was completed and revealed adenocarcinoma. What, if any, modifier should be added to the procedure code billed by the facility? a. -59, Distinct procedural service b. -51, Multiple procedures c. -76, Repeat procedure or service by same physician d. No modifiers should be reported - Correct answer: D The procedure is reported with code 31625, the description of which indicates biopsy of single or multiple sites. When reporting this code, it is not necessary to indicate multiple procedures as the code itself does that (AMA CPT Professional Edition 2020, Appendix A). A patient is admitted with fever and urinary burning. Urosepsis is suspected. The discharge diagnosis is Escherichia coli, urinary tract infection; sepsis ruled out. Which of the following represents the diagnoses to report for this encounter and the appropriate sequencing of the codes for those conditions? a. Fever, urinary burning, urosepsis b. Fever, urinary burning, sepsis c. Escherichia coli sepsis d. Urinary tract infection, Escherichia coli - Correct answer: D Symptoms are not coded when a related definitive diagnosis is present on discharge. The patient has a discharge diagnosis of urinary tract infection, secondary to E. coli. A secondary code of B96.20 is assigned to identify E. coli as the cause of the infection (CMS 2020a, Section II.A., 108). A patient was admitted to the emergency department for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. In addition to gastroenteritis, the final diagnostic statement included angina and chronic obstructive pulmonary disease. List the diagnoses that would be coded and their correct sequence. a. Abdominal pain, infectious gastroenteritis, chronic obstructive pulmonary disease, angina b. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina c. Gastroenteritis, abdominal pain, angina d. Diarrhea, chronic obstructive pulmonary disease, angina - Correct answer: B The abdominal pain and diarrhea are not coded as they are symptoms integral to the diagnosis of infectious gastroenteritis. Review Coding Guideline IV.D for additional information on coding of symptoms, signs, and ill-defined conditions (CMS 2020a, Section IV.D., 113). A patient was admitted to the endoscopy unit for a screening colonoscopy. During the colonoscopy, polyps of the colon were found and a polypectomy was performed. What diagnostic codes should be used and how should they be sequenced? Z12.11Encounter for screening for malignant neoplasm of colon C34.31Malignant neoplasm of lower lobe, right bronchus or lung P26.9Unspecified pulmonary hemorrhage originating in the perinatal period R04.2Hemoptysis a. C34.31, R04.2 b. R04.2 c. C34.31 d. C34.30, P26.9, R04.2 - Correct answer: C The diagnosis after study (lung cancer) was present on admission. The symptom (hemoptysis) of the carcinoma should not be assigned and therefore, will not have a POA indicator. Code P26.9 would not be assigned because it is not diagnosed and only applies to the perinatal period (CMS 2020a, Appendix I, 117-121). A condition is considered present on admission when it is: a. The principal diagnosis b. In accordance with medical staff bylaws c. A condition that occurs prior to an inpatient admission d. Present within three days after admission - Correct answer: C It is important to understand the time frame for assigning a status code specifying that a condition is present on admission. A condition is present on admission when it occurs prior to inpatient admission (CMS 2020a, Appendix I, 117-121). A newborn is diagnosed with meconium aspiration at birth. What is the appropriate POA indicator for the meconium aspiration? a. Y b. N c. U d. W - Correct answer: A Conditions present at birth are considered POA for newborns (CMS 2020a, Appendix I, 117121). A woman is admitted to the hospital for an exacerbation of COPD and mentions a lump she has noticed in her right breast. While she in the hospital, a biopsy is done of the breast lump and a diagnosis of ductal carcinoma is made. What is the POA assignment for the carcinoma? a. Y b. N c. U d. W - Correct answer: A Even though the diagnosis of cancer was made after admission, the patient clearly had the condition when admitted. Therefore, a POA indicator of Y should be assigned (CMS 2020a, Appendix I, 117-121). The use of the outpatient code editor (OCE) is designed to: a. Correct documentation of home health visits b. Facilitate reporting of adverse drug events c. Reduce the use of computer assisted coding d. Identify incomplete or incorrect claims - Correct answer: D The code editor software reviews many data elements and compares them to what data specifications are required in order to weed out incomplete or incorrect claims (Smith 2020, 314315). Medicare's identification of medically necessary services is outlined in: a. Program transmittals b. Claims processing manual c. Local coverage determinations Medicare exerts control of provider reimbursement through adjustment of this component of the resource-based relative value scale (RBRVS). a. Conversion factor b. Geographic adjustment c. Relative value unit d. Practice expense - Correct answer: A The conversion factor is Medicare's method for directly controlling provider reimbursement as it is a constant that is applied across the board for all providers (Casto 2018, 143). The process of collecting data elements from a source document is known as: a. Extracting b. Mining c. Abstracting d. Drilling - Correct answer: C Abstracting is the process of taking data elements from a source document to enter into an automated system (Sayles 2020, 70). What piece of claims data from Hospital A alerts a payer that the patient was transferred to Hospital B? a. Admission source b. Admit diagnosis c. Discharge disposition d. Discharge diagnosis - Correct answer: C The discharge disposition that is assigned to a patient's record will indicate to the payer whether the patient was discharged or transferred (Casto 2018, 125). When a patient is transferred from an acute-care facility to a skilled nursing facility, what abstracted data element can impact the DRG assignment? a. Admission source b. Patient's blood type c. Discharge disposition d. Patient's age - Correct answer: C The patient's discharge disposition can impact the DRG assignment when a transfer takes place from acute care to skilled care (Casto 2018, 125). For a patient with a principal diagnosis of septicemia, reporting which of the following procedures will have the greatest impact on the MS-DRG? a. Excision of left main bronchus, percutaneous endoscopic approach, diagnostic (0BB74ZX) b. Excision of toe nail, external approach (0HBRXZZ) c. Extraction of perineum skin, external approach (0HD9XZZ) d. Respiratory ventilation, greater than 96 consecutive hours (5A1955Z) - Correct answer: D The ventilator management is the procedure that will impact the MS-DRG to provide appropriate reimbursement. The MS-DRG with the highest weight is 870 (CMS 2019b). Respiratory Ventilation, Greater than 96 Consecutive Hours (5A1955Z). Medicare DRG assigned: 0870, SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS DRG weight = 06.3243. Incorrect answer option explanations provided for clarity: Bronchoscopy with biopsy (0BB74ZX) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0393 (incorrect) Debridement of toenail (0HBRXZZ) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0393 (incorrect) Nonexcisional debridement of skin ulcer with abrasion (0HD9XZZ) reference: Medicare DRG assigned: 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 + HOURS W/O MCC MDC: 18 DRG weight = 1.0393 (incorrect) c. Congestive heart failure d. Mitral valve stenosis - Correct answer: B The CPK elevation with MB enzymes elevated and the EKG ST changes denote a possible MI (Leon-Chisen 2020, 393-396). A patient is admitted to the psychiatric unit of an acute-care facility. Almost every day for the past month, the patient has experienced loss of interest in most or all activities, which is a change from her prior level of functioning.. She has also gained 15 lbs, has difficulty falling asleep, feels fatigued, and has difficulty making decisions. What potential diagnosis most closely fits the patient's overall symptoms? a. Insomnia b. Major depression c. Reye's syndrome d. Bipolar disorder - Correct answer: B The symptoms provided are indicative of a depressive disorder (Leon-Chisen 2020, 173). A patient is admitted to the hospital complaining of abdominal pain. Following evaluation, it was determined that the patient had an obstruction of the left colon due to adhesions from a prior abdominal surgery. The patient underwent laparotomy with lysis of adhesions. What conditions and procedures should be coded? a. Abdominal pain, abdominal adhesions, abdominal obstruction, laparotomy, lysis of adhesions b. Abdominal adhesions, abdominal obstruction, postoperative complications of the digestive system, laparotomy, lysis of adhesions c. Abdominal adhesions with obstruction, lysis of adhesions d. Abdominal adhesions, abdominal obstruction, postoperative complications of the digestive system, lysis of adhesions - Correct answer: C The patient has abdominal adhesions with obstruction, and lysis of adhesions was performed. The abdominal pain is not coded as it is a symptom (CMS 2020a, Section I.B.5, 18; Leon- Chisen 2020, 134-135). A patient is diagnosed with infertility due to endometriosis and undergoes an outpatient laparoscopic laser destruction of pelvic endometriosis. In order to code this encounter accurately, what steps must the coder take? a. Review the operative report to determine what procedure codes to use. Determine the site or sites of endometriosis so codes with the highest specificity may be assigned. Use infertility as a principal diagnosis. b. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified. Assign a principal diagnosis of infertility. c. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified as principal. Assign a secondary diagnosis of infertility. d. Review the operative report to determine what procedure codes to use. Determine the site or sites of endometriosis so codes with the highest specificity may be assigned. Assign endometriosis as the principal diagnosis. Assign infertility as a secondary condition. - Correct answer: D There may be endometrial implants throughout the pelvic cavity that may attach to various anatomic structures, such as the fallopian tube, ovary, and omentum. These locations should be identified so that the appropriate diagnostic codes can be assigned and the appropriate procedure codes can be assigned based on the destruction of the endometrial implants. Therefore, the correct answer is to review the operative report to determine what procedure codes to use and determine the site or sites of endometriosis so that codes with the highest specificity may be assigned. Also, use the diagnosis of infertility as a secondary condition (Schraffenberger and Palkie 2020, 463-465; Leon-Chisen 2020, 270). In order to accurately code a cardiac catheterization, in addition to the approach and the side of the heart into which the catheter was inserted, what else needs to be determined? d. The nausea, vomiting, and edema are indicative of chronic renal failure not acute. - Correct answer: C The patient should have a diagnosis related to taking the medication Lisinopril, which is usually hypertension (Brinda 2020, 186-187). A patient comes in with right upper quadrant pain, nausea, and vomiting. An x-ray confirms inflammation in the gallbladder. The patient has been dealing with episodes like this for the past six months. The final diagnosis in the discharge statement is appendicitis. What discrepancy is noted in this record? a. The diagnosis indicates acute appendicitis b. There is no discrepancy, code the appendicitis c. The diagnosis indicates chronic appendicitis d. The diagnosis indicates acute on chronic cholecystitis - Correct answer: D The clinical indicators of RUQ pain, nausea, and vomiting point to cholecystitis, confirmed by xray. Since this is an acute episode with the patient having ongoing issues for several months, it is acute on chronic (Schraffenberger and Palkie 2020, 379-380). A patient comes in with right upper quadrant pain, nausea, and vomiting. An x-ray confirms inflammation in the gallbladder. The patient has been dealing with episodes like this for the past six months. The final diagnosis in the discharge statement is appendicitis. What should be one to correct the discrepancy? a. Since the patient came in with pain, it is appropriate to assign the code for acute appendicitis b. A query should be issued to determine the diagnosis as it seems appendicitis is incorrect c. A clinical documentation improvement specialist should be contacted to verify the diagnosis d. There is no discrepancy, code the appendicitis - Correct answer: B A query is necessary to clarify the conflicting documentation (AHIMA 2019c). A resident physician continually documents "CHF" without further clarification in patients' medical records. What is the most likely rationale for this documentation practice? a. No problem exists with this documentation as CHF without further clarification is acceptable. b. The resident is not qualified to make a more definitive determination of the type of CHF. c. The resident lacks knowledge regarding the need for further clarification. d. There is not enough information to determine the type of CHF. - Correct answer: C The resident likely does not recognize the impact that further clarification of the type of CHF would have (Schraffenberger and Palkie 2020, 24). A patient is scheduled for elective surgery for cataract removal of the left eye. The operative report indicates the surgery on the right eye is performed with the use of phacoemulsification and intraocular lens insertion." What discrepancy is noted in this documentation? a. The use of irrigation and aspiration is not mentioned b. No mention of implantation of intraocular lens c. No indication if general anesthesia was used d. Laterality is not in agreement - Correct answer: D The cataract is first mentioned as being of the left eye, and in the report the procedure is documented as being performed on the right eye (Schraffenberger and Palkie 2020, 40) An inpatient progress note on day two states there is a stage three pressure ulcer of the sacrum that requires debridement. The coding professional composes a query to determine if this condition was present on admission (POA) by asking the physician if the pressure ulcer listed in the progress note of day two was present on admission—yes or no? Is that an acceptable query? Why or why not? a. No. Yes/no queries are not acceptable in any circumstances. b. No. Yes/no queries require clinical indicators. c. Addressing the impact the query has on quality indicators d. Providing a concise presentation of facts and clinical indicators - Correct answer: D Coders should give a concise, clear statement of the reason for the query and supply supporting clinical indicators (AHIMA 2019c). A patient was admitted with heart failure within one week of a heart transplant. Due to the timing, the coder thought the heart failure may indicate a transplant rejection.. What action(s) should the coding staff take? a. Query the physician. b. Assign the codes for the transplant rejection and the heart failure. c. Assign only the code for the transplant rejection. d. Assign only the code for heart failure. - Correct answer: A When the documentation is not clear regarding a potential complication, it is appropriate to query the physician (CMS 2020a, Section II.B., 109; Leon-Chisen 2020, 36, 38). A patient had a normal pregnancy and delivery with loose nuchal cord around neck. Delivery was accompanied by an episiotomy with repair with birth of liveborn male infant. Delivery room record states "no evidence of fetal problem." What is the query opportunity for this record? a. Age of the patient b. Weeks of gestation/trimester c. If there was adequate prenatal care d. If the pregnancy was high-risk - Correct answer: B Documentation of weeks of gestation or trimester is necessary in order to assign appropriate pregnancy/delivery code (Schraffenberger and Palkie 2020, 480). A toddler comes into the hospital admitted from the ER with the following: shortness of breath, wheezing, runny nose, and positive RSV test. The final diagnosis was viral infection upon discharge three days later. What condition should the coder query for in this scenario? a. Acute bronchiolitis b. Acute bronchitis c. Croup d. Laryngitits - Correct answer: A Query for acute bronchiolitis—in this case a viral infection caused by the RSV. Symptoms of bronchiolitis include the shortness of breath, wheezing, and runny nose (Schraffenberger and Palkie 2020, 349). While admitted for an exacerbation of COPD, a patient developed swelling in the lower legs and had increasing shortness of breath despite the COPD treatment. An echocardiogram was performed that showed an ejection fraction of 33 percent. A urinalysis showed albuminuria. Breathing treatments continued with the addition of Lasix to the medication regime. In the final diagnostic statement, the physician mentions only the COPD exacerbation. What is the query opportunity for this record? a. Coronary artery disease b. Acute congestive heart failure c. Pleural effusion d. Atrial fibrillation - Correct answer: B The symptoms of lower extremity swelling and shortness of breath, along with the reduced ejection fraction are indicative of congestive heart failure (Schraffenberger and Palkie 2020, 315318). Which of the following condition combinations would benefit from a query? a. Hypertension and ESRD The medical staff bylaws are required by accreditation and regulatory organizations to refer to the timeline required for record completion (Handlon 2020, 244; Brinda 2020, 190). Generally, data quality is defined as: a. Ensuring the greatest amount of data possible is obtained from the medical record b. Ensuring the accuracy and completeness of an organization's data c. Ensuring accuracy of the data collected for the case-mix index d. Ensuring the data for external reporting is optimized - Correct answer: B Data quality may have slightly different meanings because there are several disciplines that work with data in healthcare. Generally, ensuring the accuracy and completeness of an organization's data is a definition that can be agreed upon by the organization (Johns 2020, 85). The Joint Commission considers management that supports decision making to be important for safety and quality. What kind of management supports decision making? a. Resource management b. Risk management c. Information management d. Case management - Correct answer: C The goal of information management is to support decision-making (Lee-Eichenwald 2020, 356). According to Medicare requirements, a history and physical must: a. Be coded based on the uniform hospital discharge proposal b. Include the patient's weight, height, body mass index, and year of birth c. Be completed for each patient no more than 30 days before or 24 hours after admission or registration, but prior to surgery d. Discuss the educational plans for the patient including diet, exercise, and plans for smoking cessation - Correct answer: C Bylaws must include a requirement that a history and physical exam must be completed and documented for each patient no more than 30 days before or 24 hours after admission or registration, but prior to surgery or a procedure requiring anesthesia services (Medicare Conditions of Participation, Medical Staff 2014, 482.22(c)(5)). Medicare reimbursement depends on all of the following, except: a. The correct designation of the principal diagnosis b. The number of codes that are assigned c. The presence or absence of additional codes that represent complications, comorbidities, or major complications/comorbidities d. Procedures performed - Correct answer: B While the presence or absence of additional codes that represent complications, comorbidities, or major complications/comorbidities are all important to determine the MS-DRG as part of Medicare Acute Inpatient Prospective Payment System, the number of codes is not a factor (Leon-Chisen 2020, 573-574; Rinehart-Thompson 2020a, 271-272). A coder reviews a medical record and determines that a code Medicare has designated as "unacceptable principal diagnosis" is the correct code to assign. What should the coder do? a. Assign another code from the history and physical as the principal diagnosis b. Assign the code even though the insurer may not pay the claim c. Use a comorbidity as the principal diagnosis d. Assign a code from the outpatient visit prior to admission - Correct answer: B While Medicare may specify that a given condition is not acceptable, if that condition is what is documented, the coder has no other option but to code what is documented even though the insurer may not pay the claim (Leon-Chisen 2020, 33). A payer's policy does not cover tetanus injections when provided as a preventive service but will cover them when provided as a postinjury service. If the injection is provided in the emergency department, what part of the claim will need to be modified to indicate the injection was a postinjury service rather than a preventive service? The ABO incompatibility was a transfusion reaction which is on the CMS hospital-acquired conditions list (CMS 2020c). An urgent care facility located near a national park treats a significant number of patients with snake bites. Patients receive treatment with antivenom. On occasion, a patient must later be admitted to the hospital. Can the urgent care facility provide the hospital with a list of names of patients treated with snake antivenom? a. Only the names of patients who are admitted to the hospital for continuation of care could be provided. b. A full list of names could be provided. c. No information can be obtained under any circumstances. d. A list of patients may be available after consultation with the medical director. - Correct answer: A Only records that are required for care or authorized by the patient can be released by the urgentcare facility to the acute-care facility (Rinehart-Thompson 2017a, 216-217; Rinehart- Thompson 2020a, 272-277). The patient was admitted for breast carcinoma in the right breast at two o'clock. This was removed via lumpectomy. An axillary lymph node dissection, performed along with the lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the patient's neighbors, who works at the hospital, called the coding department to get the patient's diagnosis because she is a cancer survivor herself. The coder should: a. Discuss the case with the coworker b. Report the incident to hospital security c. Give the caller false information d. Explain that discussing the case would violate the patient's right to privacy - Correct answer: D Disclosing information without the patient's written consent violates the patient's right to privacy (Rinehart-Thompson 2017a, 221-230; Hamilton 2020, 669-670). The billing department has requested that copies of patients' final coding summaries with associated code meanings for Medicare be printed remotely in the admission department. Currently, they only request the summaries when there is an unspecified procedure. On previous visits to the admission department, the coding supervisor has found the coding summaries were left on a table near the patient entrance. Of the actions presented here, what would be the best action for the coding supervisor to take? a. Comply with the request. b. Refuse to undertake this without further explanation. c. Ignore the request. d. Explain to the billing department supervisor that leaving the coding summary in public view violates the patient's right to privacy. - Correct answer: D Health information should not be left in public view (Rinehart-Thompson 2017b, 257). Code sets that are mandated under HIPAA include all of the following except: a. National Drug Codes b. ICD-10-CM and ICD-10-PCS c. CPT d. Hierarchical Condition Category - Correct answer: D Hierarchical condition categories are used for risk adjustment but are not part of the HIPAA designated code sets. Hierarchical condition category (HCC) coding is a risk-adjusted reimbursement model based on the reporting of ICD-10-CM diagnosis codes (Casto 2018, 31-34, 238). The electronic transactions and code sets standards are found under which part of HIPAA? a. Administrative Simplification b. Privacy Rule At work one day, Mary, who is an outpatient coding professional, overheard another outpatient coder mention that whenever she has a chart to code with a procedure that she is unfamiliar with, she assigns an unlisted CPT code. This allows her to keep up her productivity numbers rather than taking time to research the procedure. What is Mary's ethical responsibility upon learning this information? a. None, as she is an outpatient coder and the Code of Ethics applies only to inpatient coders b. None, because it is within coding guidelines to assign an unlisted CPT procedure code c. Report this to her coding manager as the Code of Ethics requires coders to take steps to correct unethical behavior of colleagues d. Report this to the facility's risk manager in order to prevent claim denials - Correct answer: C AHIMA's Standards of Ethical Coding (11.2) require that coding professionals take steps to address the unethical behavior of colleagues (AHIMA House of Delegates 2016). A facility recently implemented a computer-assisted coding (CAC) program to assist their coding staff. Since that time, the coding manager has found that one coder, who previously struggled to meet productivity, is now leading the coding staff in productivity. A review shows that he is accepting all CAC suggested codes without validation. Is there an ethical issue here? a. Yes, the coding professional is required to utilize CAC as a tool, but not without validating the code choices. b. Yes, CAC codes can be assigned only after a coder has independently arrived at the same codes by using a code book. c. No, CAC codes are populated based on provider documentation and do not require validation. d. No, CAC programs are built by coding professionals, so the auto-suggested codes can automatically be assigned. - Correct answer: A The Standards of Ethical Coding from AHIMA state that CAC programs should be used as a tool, but require coding professionals to use their knowledge in order to assign the correct codes (AHIMA House of Delegates 2016). A retired coding professional has let her CCS credential lapse. However, she is interested in doing some part-time work for a local hospital that only hires credentialed coders. When interviewed, she is asked about her credential and answers that "I have been credentialed as a CCS." Is there an ethical issue with this statement? a. No, because it is truthful. b. Yes, because the statement does not clearly express that the credential is no longer in effect. c. No, because the responsibility for additional information is on the interviewer. d. Yes, because the statement is untruthful. - Correct answer: B The coding professional must be truthful regarding the status of her credential. She knows the facility requires a credential and has avoided telling the full truth in order to secure a position (AHIMA House of Delegates 2016). Coders at a physician group practice often collaborate on finding the appropriate diagnosis and procedure codes. They do not have access to an encoder, and the books they use are four years old. When they are uncertain about the code selection, they query the physicians. Based on this information, is there anything unethical going on? a. Yes; coders should not be collaborating to arrive at diagnosis and procedure codes. b. Yes; it is necessary for coders to have access to an encoder to assign codes. c. Yes; coders should have current books in order to assign appropriate codes. d. Yes; coders should not be querying in a physician office to assign codes. - Correct answer: C AHIMA's Standards of Ethical Coding state that coders must abide by the conventions and guidelines of the coding classifications, which means they must have access to current tools (that is, books) (AHIMA House of Delegates 2016). A patient has a principal diagnosis of pneumonia (J18.9) (MS-DRG 195). Which of the following may legitimately change the coding of the pneumonia in accordance with the UHDDS and relevant clinical documentation?