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Question 1. According to UHDDS guidelines, which of the following is the best definition of the Principal Diagnosis? A) The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. B) The most resource-intensive condition treated during the hospital stay. C) The first condition listed on the physician’s consultation report. D) The condition that has the highest MS-DRG weight. Answer: A Explanation: The Uniform Hospital Discharge Data Set (UHDDS) defines the principal diagnosis as the condition responsible for the patient's admission after clinical evaluation and study. Question 2. Which of the following root operations in ICD- 10 - PCS describes cutting out or off, without replacement, a portion of a body part? A) Resection B) Excision C) Extraction D) Destruction Answer: B Explanation: Excision is defined as cutting out or off, without replacement, a portion of a body part, whereas Resection involves the entire body part. Question 3. Under the IPPS, what does the abbreviation MS-DRG stand for? A) Medical Severity Diagnosis Related Group B) Medicare Special Diagnosis Related Group C) Medicare Severity Diagnosis Related Group D) Multi-System Diagnosis Related Group Answer: C Explanation: MS-DRG stands for Medicare Severity Diagnosis Related Group, which is the system used by Medicare to reimburse inpatient hospitals.
Question 4. A patient is admitted with an acute myocardial infarction. During the stay, the patient also requires treatment for chronic obstructive pulmonary disease (COPD). The COPD would be classified as what? A) Principal Diagnosis B) Principal Procedure C) Complication or Comorbidity (CC) D) Manifestation Answer: C Explanation: A comorbidity is a pre-existing condition that, because of its presence with a specific principal diagnosis, will likely cause an increase in the length of stay or resource use. Question 5. Which of the following is a HIPAA-mandated requirement for medical record security? A) Ensuring all records are stored in paper format. B) Implementing administrative, physical, and technical safeguards. C) Allowing any employee to access any patient's record at any time. D) Deleting records immediately after the patient is discharged. Answer: B Explanation: HIPAA requires covered entities to protect protected health information (PHI) through specific administrative, physical, and technical safeguards to ensure data integrity and confidentiality. Question 6. In ICD- 10 - PCS, the fourth character of the code represents which of the following? A) Section B) Root Operation C) Body System D) Body Part Answer: D Explanation: The 7-character structure of ICD- 10 - PCS defines the 1st as Section, 2nd as Body System, 3rd as Root Operation, and 4th as Body Part. Question 7. Which regulatory body is responsible for protecting the integrity of the Department of Health and Human Services (HHS) programs through audits and investigations?
B) Whether an inpatient admission is appropriate for payment under Medicare Part A. C) The deadline for coding a chart after discharge. D) The time the cafeteria closes in a facility. Answer: B Explanation: The 2-Midnight Rule states that inpatient admissions are generally appropriate for Medicare Part A payment if the physician expects the patient to require hospital care that spans at least two midnights. Question 11. Which document in the medical record provides a summary of the patient’s stay, including the reason for hospitalization, significant findings, and follow-up instructions? A) Operative Report B) History and Physical (H&P) C) Discharge Summary D) Pathology Report Answer: C Explanation: The discharge summary is a clinical report prepared by a physician or other health professional at the conclusion of a hospital stay. Question 12. In ICD- 10 - PCS, the root operation "Resection" is used when: A) A portion of a body part is removed. B) All of a body part is removed. C) A body part is moved to a different location. D) A device is put into a body part. Answer: B Explanation: Resection involves cutting out or off, without replacement, all of a body part. Question 13. Which of the following is considered a "Major Complication or Comorbidity" (MCC) in the MS-DRG system? A) Essential Hypertension B) Acute Respiratory Failure
C) Mild Malnutrition D) Chronic Blood Loss Anemia Answer: B Explanation: Acute Respiratory Failure is a severe condition that significantly increases resource intensity and is classified as an MCC in the MS-DRG system. Question 14. What does the "72-hour Rule" (or 3-day window) refer to in hospital billing? A) Coders must complete all charts within 72 hours of discharge. B) Diagnostic and related outpatient services provided within 72 hours of admission must be bundled into the inpatient claim. C) Patients must be seen by a doctor every 72 hours. D) Insurance must authorize admission within 72 hours. Answer: B Explanation: The 72-hour rule requires hospitals to include outpatient services provided in the three days prior to admission on the inpatient bill if they are diagnostic or related to the admission. Question 15. If a physician uses "copy-paste" functionality in an EHR and includes outdated or inaccurate information from a previous encounter, this is known as: A) Data Integrity B) Documentation Cloning C) Interoperability D) Meaningful Use Answer: B Explanation: Documentation cloning (or copy-paste) occurs when a provider copies information from a previous entry and pastes it into a new one, which can lead to inaccurate "note bloat" and compliance risks. Question 16. Which ICD- 10 - PCS character represents the "Approach"? A) 3rd B) 4th C) 5th
Answer: B Explanation: Coding for severe sepsis requires documentation of the systemic infection plus at least one associated acute organ dysfunction. Question 20. Which entity publishes the "Coding Clinic," providing official coding advice and guidelines? A) CMS B) AHIMA C) American Hospital Association (AHA) D) AAPC Answer: C Explanation: The AHA’s Central Office on ICD- 10 - CM/PCS publishes the Coding Clinic, which is the official source for coding advice. Question 21. Which part of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care? A) Medicare Part A B) Medicare Part B C) Medicare Part C D) Medicare Part D Answer: A Explanation: Medicare Part A is specifically dedicated to hospital insurance, covering inpatient services and related facility care. Question 22. In ICD- 10 - PCS, the root operation "Bypass" means: A) Taking out a body part. B) Altering the route of passage of the contents of a tubular body part. C) Expanding the orifice of a body part. D) Putting in a living body part from another person. Answer: B
Explanation: Bypass involves rerouting the flow of solids, liquids, or gases within a tubular body part, such as in a coronary artery bypass graft. Question 23. What does "NCD" stand for in the context of Medicare coverage? A) National Coding Department B) National Coverage Determination C) Non-Coverage Document D) National Clinical Data Answer: B Explanation: National Coverage Determinations (NCDs) are policies developed by CMS to describe the circumstances under which Medicare will cover specific items or services nationwide. Question 24. Which of the following describes "Medical Necessity"? A) Any service a patient requests. B) Services or supplies that are proper and needed for the diagnosis or treatment of a medical condition. C) The most expensive treatment option available. D) Services provided after the patient has recovered. Answer: B Explanation: Medical necessity refers to health care services or supplies needed to prevent, diagnose, or treat an illness, injury, or condition that meet accepted standards of medicine. Question 25. The CDM (Charge Description Master) is primarily used for: A) Assigning diagnosis codes. B) Tracking the physician's hours. C) Listing and pricing every service, supply, and procedure provided by the hospital to automatically generate charges. D) Determining the principal diagnosis. Answer: C Explanation: The CDM is a comprehensive database used by healthcare facilities to automate the billing process for recurring services and supplies.
Question 29. A "HINN" (Hospital Issued Notice of Non-coverage) is given to a Medicare patient when: A) The patient is being discharged. B) The hospital determines that the inpatient stay is not medically necessary or is not covered by Medicare. C) The patient requests a private room. D) The surgery was successful. Answer: B Explanation: HINNs are used to inform Medicare beneficiaries that the hospital stay (or a portion of it) is not expected to be covered by Medicare, allowing the hospital to potentially bill the patient. Question 30. Which anatomical term refers to a structure that is located closer to the midline of the body? A) Lateral B) Medial C) Distal D) Proximal Answer: B Explanation: Medial refers to being toward the middle or midline of the body; lateral is away from the midline. Question 31. What is the correct term for an infection that is acquired while a patient is receiving care in a hospital? A) Pre-existing condition B) Community-acquired infection C) Healthcare-associated infection (Nosocomial) D) Acute exacerbation Answer: C Explanation: Healthcare-associated (or nosocomial) infections are those that patients get while receiving treatment for medical or surgical conditions in a facility.
Question 32. In ICD- 10 - PCS, the character "Z" is used as a placeholder for: A) An unknown body part. B) No device or no qualifier. C) A robotic approach. D) A life-threatening condition. Answer: B Explanation: The letter "Z" is used in ICD- 10 - PCS characters 6 (Device) and 7 (Qualifier) to indicate that there is no device or no qualifier applicable to the procedure. Question 33. The "OIG Work Plan" is published how often? A) Once every 10 years. B) It is updated continuously/monthly to reflect ongoing and new areas of focus. C) Only when a new President is elected. D) Every week. Answer: B Explanation: While formerly published annually, the OIG Work Plan is now updated dynamically on the OIG website to highlight new areas of focus for audits and investigations. Question 34. Which of the following root operations involves putting in or on all or a portion of a living body part from another individual or animal? A) Replacement B) Supplement C) Transplantation D) Insertion Answer: C Explanation: Transplantation is defined as putting in or on all or a portion of a living body part from another individual or animal to take over the function of all or a portion of a similar body part. Question 35. A "Late Effect" (Sequela) in ICD- 10 - CM coding is: A) A condition that occurs during the acute phase of an illness.
C) The procedure that matches the Principal Diagnosis usually comes first, but in PCS there is no "principal" procedure, only the "Principal Diagnosis" drives the DRG. D) It should not be coded. Answer: C Explanation: In the inpatient setting, we assign all relevant procedures. The MS-DRG is driven by the Principal Diagnosis and any procedures performed that move the case into a surgical DRG. Question 39. What is the root operation for a "Percutaneous needle aspiration of a cyst"? A) Excision B) Drainage C) Extirpation D) Fragmentation Answer: B Explanation: Drainage is the root operation defined as taking or letting out fluids and/or gases from a body part. Question 40. Which of the following is true regarding the ICD- 10 - CM "Official Guidelines for Coding and Reporting"? A) They are only suggestions. B) They are a set of rules that have been developed to accompany the ICD- 10 - CM classification and have the force of law. C) They only apply to outpatient coding. D) They are written by pharmaceutical companies. Answer: B Explanation: The ICD- 10 - CM guidelines are approved by the Cooperating Parties (AHA, AHIMA, CMS, NCHS) and are required under HIPAA. Question 41. A patient with end-stage renal disease (ESRD) requires regular dialysis. Which of the following medications might be used to treat the associated anemia? A) Insulin B) Epogen (Epoetin alfa)
C) Warfarin D) Lasix Answer: B Explanation: Epogen is commonly used in patients with ESRD to treat anemia by stimulating the production of red blood cells. Question 42. In ICD- 10 - PCS, what approach is used when a procedure is performed via an endoscope through a natural orifice? A) Open B) Percutaneous C) Via Natural or Artificial Opening Endoscopic D) Percutaneous Endoscopic Answer: C Explanation: If an endoscope is inserted through a natural opening (like the mouth or anus) to perform a procedure, the approach is "Via Natural or Artificial Opening Endoscopic." Question 43. Which of the following is a "Key Indicator" used in Clinical Documentation Improvement (CDI) programs? A) Employee turnover rate. B) The hospital’s Case Mix Index (CMI). C) The number of parking spots. D) The flavor of the day in the cafeteria. Answer: B Explanation: CMI reflects the average weight of the hospital's MS-DRG assignments and is a common metric used to evaluate the effectiveness of documentation and coding. Question 44. What is the root operation for a "Lithotripsy of a kidney stone"? A) Extraction B) Fragmentation C) Destruction
D) Reattachment Answer: A Explanation: Transfer involves moving a body part to another location without complete detachment, often used in skin flaps or nerve transfers. Question 48. What is the purpose of the Joint Commission’s "National Patient Safety Goals"? A) To lower the cost of bandages. B) To improve patient safety by focusing on problems in health care safety and how to solve them. C) To increase the speed of physician dictation. D) To mandate the use of paper charts. Answer: B Explanation: The National Patient Safety Goals focus on areas of risk such as medication errors, surgical site infections, and patient identification. Question 49. Which modifier is NOT used in the ICD- 10 - PCS system? A) None; PCS does not use modifiers. B) - 59 C) - RT D) - LT Answer: A Explanation: ICD- 10 - PCS is a standalone classification system for inpatient hospital procedures that does not utilize modifiers; instead, specific details are built into the 7 characters. Question 50. If a patient is admitted with dehydration due to underlying gastroenteritis, how is the sequencing determined? A) Dehydration is always principal. B) Gastroenteritis is always principal. C) If both are treated, the condition that occasioned the admission is principal. D) Dehydration is not coded if the gastroenteritis is coded. Answer: C
Explanation: Sequencing depends on the physician's documentation regarding which condition was primarily responsible for the admission. Question 51. Which of the following is the correct root operation for an "Appendix removal"? A) Excision B) Resection C) Extraction D) Destruction Answer: B Explanation: Because the entire appendix (the entire body part) is removed, the root operation is Resection. Question 52. What is the UHDDS definition of "Other Diagnoses"? A) Only conditions that are life-threatening. B) Conditions that coexist at the time of admission, develop subsequently, or affect patient care. C) Only conditions that the patient had ten years ago. D) Conditions that the patient’s family members have. Answer: B Explanation: Other diagnoses include conditions that affect patient care in terms of requiring clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of stay, or increased nursing care. Question 53. If a patient is admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD), which is the principal diagnosis? A) Chronic Obstructive Pulmonary Disease B) Acute Exacerbation of COPD C) Acute Respiratory Failure D) Shortness of Breath Answer: B Explanation: Per ICD- 10 - CM guidelines, when a patient is admitted for an acute exacerbation of a chronic condition, the code for the chronic condition with the exacerbation is sequenced first. Question 54. Which of the following is a technical safeguard under HIPAA? A) Locked doors. B) Information access controls (e.g., unique user IDs).
Question 58. Which medication is a common anticoagulant that would signal a coder to look for a diagnosis of Atrial Fibrillation or DVT? A) Warfarin (Coumadin) B) Lisinopril C) Metformin D) Omeprazole Answer: A Explanation: Warfarin is a blood thinner (anticoagulant) used to prevent or treat blood clots; its use often indicates underlying conditions like A-Fib or venous thromboembolism. Question 59. What is the 6th character in an ICD- 10 - PCS code used for? A) Approach B) Body Part C) Device D) Qualifier Answer: C Explanation: The 6th character identifies the device that remains in or on the body part after the procedure is completed. Question 60. A "Chargemaster" (CDM) error typically affects which of the following? A) The accuracy of the physician's diagnosis. B) High-volume, routine services like lab tests and X-rays. C) The principal diagnosis selection. D) The selection of a root operation. Answer: B Explanation: The CDM contains the codes for routine supplies and services that are automatically triggered by clinical departments rather than being manually coded by a coder. Question 61. Which of the following is an example of an "Internal" audit finding? A) A RAC auditor finding a DRG upcode. B) A facility’s own compliance team identifying missing physician signatures. C) An OIG report on nationwide outliers. D) A payer denying a claim for lack of medical necessity.
Answer: B Explanation: Internal audits are conducted by the organization itself to ensure compliance with regulations and internal policies. Question 62. Which anatomical plane divides the body into superior (upper) and inferior (lower) portions? A) Sagittal B) Coronal C) Transverse (Axial) D) Midsagittal Answer: C Explanation: The transverse or axial plane cuts horizontally across the body, dividing it into top and bottom sections. Question 63. What is the root operation for "Taking out an intraocular lens without replacement"? A) Excision B) Extraction C) Removal D) Destruction Answer: C Explanation: Removal is the root operation used for taking out or off a device from a body part. Question 64. According to ICD- 10 - CM guidelines, how should "History of" codes be used? A) As the principal diagnosis only. B) To indicate a condition that no longer exists and for which the patient is not receiving any current treatment. C) To indicate a condition the patient is currently being treated for. D) They should never be used in inpatient coding. Answer: B Explanation: "History of" codes are used for past conditions that have been resolved and may impact future care but are not currently present. Question 65. The "Minimum Data Set" (MDS) is a standardized assessment tool primarily used in which setting? A) Acute care hospitals
