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CIC Practice Exam Questions with 100%

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Whichiprocedureicodeidescribesithisibedsideiprocedure? Diagnosis:iHypotensioniwithisepsis Consent:iEmergent Procedure:iLeftifemoraliarterialilineiplacementiforiinfusionitreatmentiw ithiantibioticsiandivasopressors. Description:iTheileftigroiniwasicleansediandidrapediiniaisterileifashion.iA ni 18 igaugeineedleiwasitheniadvancediintoitheileftifemoraliartery.iGoodi bloodiflowiwasiobtained.iUsingiaiSeldingeritechnique,iaicatheteriwasiad vancedioveritheiwireiintoitheileftifemoraliartery.iItiwasisewniiniplaceiwit hi 2 - 0 isilk.iGoodiwaveformiwasiseenionitheimonitor.iNoiimmediateicomplica tionsiwereinotediwithithisiprocedurei-iCorrectiAnswer-04HL33Z YourihospitaliusesianiEHRiforiallidocumentationiofialliservices,iincludingi codingiandibilling.iYouritowniisihitiwithiaitornadoiandiyourihospitaliisiba dlyidamagediincludingitheiservers,inetworkiconnectionsiandicomputers .iHowidoiyouiprovideimedicalirecordsiforipatientsitransferreditoiotherifa cilitiesiforitheiricare?i-iCorrectiAnswer- Youiobtainicopiesifromiyouridisasterirecoveryiserver WhichiofitheifollowingidescribesiaiviolationiofiHIPAA'siprivacyirule?i- iCorrectiAnswer-

AinurseiandianiorderlyiatiaistateihospitalidiscusseditheiHIV/AIDSistatusio fiaipatientiiniearshotiofiotheripatients Whichiofitheifollowingidiseasesiisiaimalignancyiofitheilymphaticisystem? i-iCorrectiAnswer-Hodgkin'sidisease Aidrugiwhichiendsiinitheisuffix,i-prili,iisiconsideredia(n):i- iCorrectiAnswer-ACEiinhibitor Aipatientiisiadmittediwithineckipainifollowingiaicollisioniwithianotheriso ftballiplayeriatiaicommunityibaseballifield.iTheidiagnosisiatitheitimeiofidi schargeiisirightiinternalicarotidiarteryidissectionilikelyisecondaryitoitrau ma.iTheidiagnosesicodediforithisiinjuryiare:i-iCorrectiAnswer- I77.71,iW51.XXXA,iY93.64,iY92. HowimanyiMajoriDiagnosticiCategoriesi(MDCs)iareiinitheiMS- DRGisystem?i-iCorrectiAnswer- 25 WhatiPOAiindicatoriwouldiyouiuseiforitheifollowingiscenario? Ai 45 iyearioldifemaleipresentsitoitheiERiwithishortnessiofibreath,icoughia ndiaihighifever.iTheiERidoctorigetsiaichestix- rayiwhichiindicatesipneumoniaisoiheiadmitsitheipatient.iShortlyiafteriad missionitheipatientideterioratesiandidevelopsisepsis.iInihisidischargeisu mmaryitheidoctoriindicatesitheipatient'sidiagnosesiasisepsisisecondaryit oipneumonia,iorganismiunknown.iAiqueryiofitheiphysicianiindicatesiitiisi

unknowniifitheipatientiwasisepticiprioritoiadmission.iWhatiPOAiindicato riwouldiyouiassigniforisepsis?i-iCorrectiAnswer-W WhatiisitheicorrectiCMSidefinitioniforiPOAiindicatoriW?i- iCorrectiAnswer- Clinicallyiundetermined.iProvideriunableitoiclinicallyidetermineiwhethe ritheiconditioniwasipresentiatitheitimeiofiinpatientiadmission Theiinpatientiadmissionicertificationiformimustibeisignedibyiwhom?i- iCorrectiAnswer-Theiadmittingioriattendingiphysician Ai 74 iyear- oldiMedicareipatientiisiseeniinitheioutpatienticardiacicatheterizationide partmentiofitheihospitaliforiatypicalichestipain.iTheileftihearticatheteriz ationirevealsithatitheipatientihasi 3 - vesselicoronaryiarteryidisease.iTheipatientireturnsitoitheihospitalitwoid aysilateriwithiaiNon-STEMIiandiisitakenitoitheioperatingiroomiforiai 3 - vesseliCABG.iUnderiwhatiMedicareiruleiwillitheileftihearticatheterizatio nitechnicalicomponentibeibundlediintoitheiinpatientistay?i- iCorrectiAnswer-Threeidayipaymentiwindow WhichitypeiofiDRGisystemiusesidegreesiofiSeverityiofiIllnessiandiRiskiofi MortalityitoidetermineitheiDRG?i-iCorrectiAnswer-APR-DRG UnderitheiOPPS,i________iisiaitermithatirefersitoianiitemithatiwillinotire ceiveiseparateipaymentibecauseiitiisiconsideredianiintegralipartiofianot

heriserviceithatiisipaidiunderitheiOPPS.i-iCorrectiAnswer- Packaging/Bundling UnderiAPCsipaymentistatusiindicatoriCiindicates:i-iCorrectiAnswer- Inpatientionlyiprocedure Ifiaipatientiisiadmittediforisurgery,iTheiJointiCommissionirequiresithatiai historyiandiphysicalibeiavailableiforireviewiinitheipatient'simedicalirecor d:i-iCorrectiAnswer- Noimoreithani 30 idaysiprioritoisurgery,ioriwithini 24 ihoursiafteriadmissio n,ibut,iprioritoitheisurgery Theilocalicoverageideterminationiprovidedidiscussesicoverageiforiinpati ent,iobservationiandioutpatientiservices.iBasedionitheiguidelinesiinithei LCDiwhichistatementiisitrue: I.iConditioniCodei 44 icanionlyibeiapplieditoiaiclaimiifitheiphysicianichange sitheipatientistatusifromiinpatientitoioutpatientiprioritoidischarge.II.iTh eiuseiofiConditioniCodei 44 icanibeibasedisolelyionitheiphysician'sidocum entationiofitheiorderifromiinpatientitoioutpatient. III.iMedicareiwillinotipayiforianyiPartiBiservicesifurnisheditoianiinpatienti whenipaymenticannotibeimadeiunderiPartiAibecauseitheiinpatientiadmi ssioniwasidetermineditoibeinotimedicallyinecessary.iIV.iConditioniCodei 44 iisireportedionitheioutpatienticlaim.i-iCorrectiAnswer- IiandiIViareicorrect

AipatientiwithiendistageilivericanceriisiadmitteditoiHospiceiforiendiofilifei care.iThisiserviceiwouldibeicoverediunder:i-iCorrectiAnswer- MedicareiPartiA Aniexternaliauditinotesiaitrendiofiincorrectlyicodingicardiacicatheterizat ioniprocedures.iAfteritheiauditoriissuesiaireport,iwhatiareitheinextistepsi theicodingidepartmentishoulditake?i-iCorrectiAnswer- Reviewiresultsiwithistaffiandieducateiasineeded;icorrectiandirebilliclaim siasiallowed;icontinueitoimonitoriforiimprovement AiviolationiofitheiFalseiClaimsiActimayiincludeiwhichiofitheifollowing: I.iUnknowinglyisubmittingiaifalseiclaimitoitheigovernmentII.iDeliberateii gnoranceiofitheitruthiorifalsityiofitheiinformationionitheiclaimiIII.iKnowi nglyisubmittingiaifalseiclaimitoitheigovernmentIV.iRecklessidisregardiofi theifalsityiofitheiinformationioniaiclaimi-iCorrectiAnswer-II,iIII,iand/oriIV WhichiofitheifollowingitypesioficorrectiveiactionsicanibeiimposedibyiaiM ACiasiairesultiofiaicompleximedicalireview? I.iProviderinotificationi/ifeedback II.iPrepaymentioriPostpaymentireviewiIII.iCriminalilitigationi- iCorrectiAnswer-IiandiIIionly Ifiaiproviderineedsitoimakeiaichangeitoianientryiinitheielectronicimedicali record,ihe/sheishould:i-iCorrectiAnswer- Identifyitheiincorrectientry,iandiwriteiaisignediandidatediaddendumitoit heirecorditoimakeithe

correction Theiabbreviationi"TORB"istandsifor:i-iCorrectiAnswer- telephoneiorder,ireadiback AlliofitheifollowingiareidataielementsiofitheiUniformiHospitaliDischargei DataiSeti(UHDDS)iexcept:i-iCorrectiAnswer-Admittingidiagnosis Iniaipersonisufferingifromialcoholiabuseiwhichiofitheifollowingimolecule siaccumulateiinitheiliver?i-iCorrectiAnswer-Lipids Whichioneiofitheifollowingilistedidrugsiisinotiaicalciumichanneliblockingi drug?i-iCorrectiAnswer-Propranolol HowidoesiCACiimproveicodingiprocesses?i-iCorrectiAnswer- Allowsicodersitoireviewimoreidocumentationifaster Documentationibyitheiprovideristates,i"Complicationsiofideliveryiinclud eimeconiumipassage,ibabyiwasivigorous.iinfantiisiatiriskiforirespiratoryid istressisecondaryitoimeconiumidelivery,iwilliobserveirespiratoryistatusic losely"iHowishouldi"meconiumipassage"ibeicoded?i-iCorrectiAnswer- P03. Meconiumipassageiduringideliveryiisiclinicallyisignificant.iTheseiinfantsi areimonitoredisinceitheiconditionicaniadverselyiaffectinewborns.iThisic onditioniisiindexediPassagei-iMeconium.iThisiisiainewbornicondition.

Theichiefiresponsibilitiesiforithisiemergingiroleiwouldibeitoireviewitheia ppropriatenessiofiDRGiassignmentiofiinpatienticlaims,ireportiinconsiste nciesiiniDRGiassignment,iandimonitoritrendsiinitheiOIGiWorkiPlan.i- iCorrectiAnswer-DRGiValidator Howioftenishouldiaithoroughichargemasterireviewibeiconducted?i- iCorrectiAnswer-Annually Theikeyifactoriinideterminingiinpatientistatusiis:i-iCorrectiAnswer- Aniadmittingiorderibyitheiattendingiphysician Selectingitheiappropriateidischargeistatusiisinecessaryibecause:i- iCorrectiAnswer- Theidischargeidispositioniwilliaffectihowitheiclaimiisipaid Thisitypeiofiinpatientifacilityiusesicase- mixigroupsi(CMGs)iratherithaniDRGsitoigroupicasesithatiareisimilariacco rdingitoitheirifunctionalimotoriandicognitiveiscoresiandiage.i- iCorrectiAnswer-InpatientiRehabilitationiFacility UnderitheiOutpatientiProspectiveiPaymentiSystem,iHCPCSiLeveliIIicodei J9034,iInjection,ibendeka,i 1 img,iisiassigneditheistatusiindicatori"K",iindi catingithatiitiisiainonipass- throughidrugiandibiological.iTherefore,itheidrugiandibiologicalipaymenti is:i-iCorrectiAnswer-PaidiunderiaiseparateiAPCipayment

Theilocalicoverageideterminationiattachedidiscussesicoverageiforicolor ectalicanceriscreening.iBasedionitheiLCD,iwhichiofitheifollowingiareitrue: Aipatientiwithianiaverageiriskioficolonicanceriisicoverediforiaiscreeningic olonoscopyieveryifiveiyears. Aipatientiwithiaihighiriskioficolonicanceriisicoverediforiaiscreeningicolon oscopyieveryitwoiyears. Aihigh- riskipatientiisiwhoimeetsioneiorimoreiofitheseiqualifications:ipatientiwh oihasiaisiblingioriparentiwhoihadicolorectalicancer,iaipersonalihistoryiofi adenomatousipolyps,ioriaipersonalihistoryioficolonicancer MedicareicoversioneiscreeningiFecaliOccultiBlooditestionceiaiyeariforipa tientsiagedi 50 iyearsioriolder.i-iCorrectiAnswer-II,iIIIiandiIViareicorrect. ProvidersimustisupplyiailiabilityinoticeiifiservicesidelivereditoiaiMedicar eibeneficiaryiareitoibeireducedioriterminatedifollowingideliveryioficover edicare,iorithoughtinotitoibeicovered.iForiInpatienti(BilliType:i11x,i 18 x,i 2 1x,i41x)itheiliabilityinoticeiisireferreditoias:i-iCorrectiAnswer-HINN FailureitoisupplyianiABNitoiaipatientiwhenirequirediwilliresultiin:i- iCorrectiAnswer-Theiproviderinotibeingiableitoishifticostitoitheipatient WhichistaffimemberiwouldiuseitheiPEPPERireport? I.iComplianceiofficeri II.iRiskiManagementi

III.iCoder IV.iQualityiAssurancei-iCorrectiAnswer-I,iIII,iandiIV TheifirstileveliofiappealiforitraditionaliMedicareiisiasiknowniasi________ __i;ianditheiappellantimustifileitheirequestiforiappealiwithini____daysiof itheireceiptiofitheiinitialidetermination.i-iCorrectiAnswer- Redetermination,i 120 idays Considerationsiforionsiteiauditorsiinclude: I.iFindingitheiauditoriaiprivateispaceitoiwork II.iCoordinatingiappropriateiaccessitoielectronicirecords III.iProvidingicopies/accessitoihardcopyirecordsi IV.iRequestingiexitiinterviewsiwithiauditorsi-iCorrectiAnswer- I,iII,iIII,iandiIViareicorrect Whichiofitheifollowingirepresentianiactionithatishouldibeitakeniregardin githeiOIGiworkplaniannually? I.iUseiitiasianieducationalitooliforicodersiandiclinicians II.iReadithroughitheiworkiplan III.iItiisinotiairequiredicodeiupdateisoiitishouldibeiignored IV.iIncorporateiitemsifromitheiworkiplaniintoiyouriinternaliauditingiactiv itiesi-iCorrectiAnswer-I,iIIiandiIViareicorrect

AccordingitoitheiOIG,itheiuseioficopyiandipasteifunctionsitoicloneiinform ationiiniEHRsicreates:iI.iDifficultyiforicodingiandibillingistaffimembersitoi telliwhichiactivitiesiwereicompletediinitheicurrentivisit,ipossiblyileadingi toiinappropriateicharges.iII.iAnieasyiwayiforiunethicaliprovidersiand/ori unethicalistaffimembersitoiusei"cloned"iinformationitoicreateifraudule ntirecordsioriclaims.iIII.iAiclearipictureiofiservicesiprovidediduringitheipa tient'sistay.iIV.iAccurateiandicompleteidocumentation.i- iCorrectiAnswer-IiandiII AccordingitoitheiOIG:iCopy- pasting,ialsoiknowniasicloningienablesiusersitoiselectiinformationifromi oneisourceiandireplicateiitiinianotherilocation.iWhenidoctors,inurses,iori othericliniciansicopy- pasteiinformationibutifailitoiupdateiitioriensureiaccuracy,iinaccurateiinf ormationimayienteritheipatient'simedicalirecordiandiinappropriateichar gesimayibeibilleditoipatientsiandithird- partyihealthicareipayers.iFurthermore,iinappropriateicopy- pastingicouldifacilitateiattemptsitoiinflateiclaimsiandiduplicateioricreatei fraudulenticlaims. Theiminimumidataiseti(MDS)iisiusedibyinursingifacilitiesiforiwhichiofithei followingipurposes?i-iCorrectiAnswer- Asiaitoolitoistandardizeiassessmentsiandimanagementioficare TheiMDSiisiaitoolirequiredibyiCMSiforinursingifacilities.iItiisiuseditoiimple mentistandardizediassessmentsiandimanagementioficare.iIficanialsoibei useditoireportiqualifyioficareiissuesiandireimbursementiunderitheiSkille diNursingiFacilityiProspectiveiPaymentiSystemi(SNFiPPS).iItiisinotiusedit oicertifyiaiSNFioritoitestihealthcareiproviders.iItiisialsoinotiuseditoideter mineiorireportimisuseiofigovernmentifunds.

Ailivingiwilliandiaidesignationiofidurableipoweriofiattorneyiisianiexample iofiwhatitypeiofiformiinitheimedicalirecord?i-iCorrectiAnswer- AdvanceiDirectives Aiprincipaliprocedureiisiaitypeiofiprocedureithatiisiperformediforitheifoll owingipurposes:iI.iDefinitiveitreatmentiofiprincipalidiagnosisiII.iDiagnos ticiprocedureiforisecondaryidiagnosisiwithiNOiprocedureiperformedirel ateditoitheiprincipalidiagnosisiIII.iExploratoryipurposesiIV.iCustodiali- iCorrectiAnswer-IiandiII Inigeneral,idefinitiveitreatmentsiareimoreiimportantithanidiagnosticipro cedures,iwithianyiprocedureirelateditoitheiprincipalidiagnosisirankingihi gherithanithoseiforiaisecondaryidiagnosis.iPrincipaliProcedureiHierarchy iProceduresirelateditoiprincipalidiagnosis:iTheidefinitiveitreatmentimost irelateditoitheiprincipalidiagnosisiisitheiprincipaliprocedure.iIfinone,iaidi agnosticiprocedureimostirelateditoitheiprincipalidiagnosisiisitheiprincipa liprocedure.iIfinoiprocedureirelateditoiprincipalidiagnosis:iTheidefinitivei treatmentiforiaisecondaryidiagnosisiisitheiprincipaliprocedure.iIfinone,iai diagnosticiprocedureiforiaisecondaryidiagnosisiisitheiprincipaliprocedur e Cancersiderivedifromiconnectiveitissuesisuchiasibone,icartilage,imusclei orihematopoieticitissuesiareiclassifiediasiwhichiofitheifollowing:i- iCorrectiAnswer-Sarcoma Aisarcomaiisiaicancerithatiarisesifromitransformedicellsiofimesenchymali origin.iThus,imalignantitumorsimadeioficancerousibone,icartilage,ifat,im uscles,iorihematopoieticitissuesiare,ibyidefinition,iconsideredisarcomas. iLipomasiareibenignitumorsicomposediofiadiposeitissue.iBothiadenomas

iandicarcinomasiareitumorsicomprisediofiepithelialitissue;ihowever,iade nomasiareibenigniwhileicarcinomasiareimalignant. WhatiisiNaturaliLanguageiProcessingi(NLP)?iI.iAimethodiofitapeirecorder idictationiII.iAimethodiofivoiceirecognitioniIII.iProductiusediiniCACi- iCorrectiAnswer-IIiandiIII NLPiisitheiprocessibyiwhichiaicomputeritakesitheinaturalivoiceidictationi anditranslatesiitiintoitypeditext.iThisicanibeiusediforinormalitranscriptio n,itherebyieliminatingiorilesseningitheiworkiofiaihumanitranscriptionist;i but,iitiisialsoiusediinicomputer- aidedicodingisoftwareitoirecognizeikeyiwords. CACiworksiwithiwhichiofitheifollowingiforidataiabstraction?i I.iCPT®i II.iICD- 10 - CMi III.iSNOWMED-CTi IV.iLOINCi V.iRxNormi VI.iTranscriptioni VII.iDictationi-iCorrectiAnswer-I,iII,iIII,iIV,iV,iVI,iandiVII Computeriassistedicodingi(CAC)ifunctionsiincludeisearchesiforispecificidi agnosticistatementsiandiuniqueianatomicalisiteiacronymitermsiand/ori abbreviationsiwithinianyidocumentifromianyimedicalirecordiproduct.iSu chidocumentsicaniconsistiofistructuredidataidrivenibyihealthcareiprovid ersidocumentationioficareidirectlyiintoianiorganization'siEHRisystem(s).i

Oritheiabstractedidocumentationicanibeipulledifromiunstructuredidatai drivenibyihealthcareiprovidersidocumentingicareiinianiorganization'sico mplementaryiEHRisystems,isuchiasitextidataigeneratedibyianiorganizati on'siDictation/Transcription/iSpeechiRecognitioni(Voicei/iTexti/iSpeech )isystems.iAlso,isuchiCACifunctionsiincludeiidentifyingiICD- 10 - CM/PCS,iPresentioniAdmission,iprincipal,iandisecondaryidiagnoses,iandi proceduresiforihospitaliinpatientidocuments;ialongiwithiCPTiprincipalia ndisecondaryiproceduresiforiambulatoryi(officeioutpatient)idocuments. iCACisystemsiareialsoiableitoiabstractinomenclatureicodes,isuchiasiSNO MED- CT,iRxNorm,iandiLOINCiforiclinical,ipharmaceutical,iandilaboratoryidocu ments,irespectively.iBeingiableitoihaveiappropriateidiagnosisiandiproce dureicodeisuggestionsioccuriatitheipoint-of- care,iasidocumentationiisienterediintoitheirecord,iisicentralitoiimprovin githeifunctionalityiofiCAC. WhichiofitheifollowingiareivalidiPOAiindicators?i-iCorrectiAnswer- U,iW,iN,i1,iY ItiisirequiredibyiCMSithatiallihospitalsisubmititheiPOAiindicatoriforiallipri maryiandisecondaryidiagnosisithatiareipresentiuponiadmissionitoitheiho spital.iThisiPOAiindicatorihelpsitoidetermineireimbursementiforiexisting iconditionsiandihelpsitrackihospitaliacquirediconditions. Thereiareifouriindicatorsitoiassignitoidiagnosisicodesitoiindicateiwhethe ritheiconditioniwasipresentioniadmissioni(POA). Yi-Yes,itheiconditioniwasipresentioniadmission. Ni-iNo,itheiconditioniwasinotipresentioniadmission.

Ui- iUnknown.iPOAiUishouldinotibeiroutinelyiassigned.iCodersiareiencourag editoiqueryitheiprovideriwhenitheidocumentationiisiunclear. W-iClinicallyiundetermined 1 i-iEnteriai 1 ionitheiUB- 04 iformiifitheidiagnosisiisiexemptifromiPOAireporting. TheiICD- 10 - CMiguidelinesiforireportingiPOAiindicatoriareiiniAppendixiI. AicoderiiniaihospitaliisiusingiaigrouperitoicalculateiMS- DRGiassignment.iTheicoderinoticesithatithereiareimultipleiMS- DRGsithaticouldibeiassigned,itheicoderishould:i-iCorrectiAnswer- ChooseitheiMS- DRGirelateditoitheiprimaryidiagnosisicodeiandiproceduresiassignediforit heicase MS- DRGsiareiassignedibasedioniainumberiofifactorsiwithidiagnosisiandiproc edureicodesibeingiaimainidrivingiforce.iTheicoderishouldiassignitheiMS- DRGimosticloselyirelateditoitheireasoniforivisitiandiinilineiwithitheiprinci palidiagnosisiassignediaccordingitoicodingiguidelines. Ideally,itheichargemasterishouldinotibeitheiresponsibilityiofiaisingleipers on.iWhichiofitheifollowingipeople/departmentsishouldibeiinvolvediwith iannualichargemasterireviews?i I.iHIM/Codingi II.iFinancei

III.iPharmacyi IV.iLabiand/oriRadiologyi-iCorrectiAnswer-I,iII,iIII,iandiIV Whoiisiresponsibleiforirequestingitheipre- certificationiforianielectiveioriplannedihospitaliadmission?i- iCorrectiAnswer- Provideri(primaryicareioriattendingiphysician)iorifacilityirenderingiservic e TheiProvideri(PrimaryiCareioriAttendingiPhysician)iorifacilityirenderingit heiserviceiisiresponsibleiforirequestingitheipre- certificationiforielectiveioriplannediinpatientiservices.iTheiproviderisub mitsidocumentationiandiinformationitoipre- certifyitheiphysicianiservices.iTheifacilityisubmitsitheisameiinformationit oipre-certifyitheiservicesiprovidedibyitheifacility. IniwhatihospitalisettingidoesiMedicare'si 3 - dayipaymentiwindowibecomei 1 - dayiwindowiinstead?i-iCorrectiAnswer- PsychiatricihospitalsiAccordingitoiCMS,itheihospitaliandihospitaliunitsisu bjectitoithei 1 - dayipaymentiwindowipolicyi(insteadiofithei 3 - dayipaymentiwindow)iareipsychiatricihospitalsiandiunits,iinpatientireha bilitationihospitalsiandiunits,ilong- termicareihospitals,ichildren'sihospitalsiandicancerihospitals. Typeiofibilli(TOB)icodei 0121 iindicates:i-iCorrectiAnswer- Hospital,iinpatienti(MedicareiPartiBionly)iAdmitithroughidischargeiclai m.iTheifirstidigiti- 0 iisitheileadingioriheaderi0.iTheisecondidigiti- 1 iindicatesiaihospitalifacility.iTheithirdidigiti-

2 iindicatesitheipatientiisiaiMedicareiPartiBipatientionly,ianditheifourthidi gitiindicatesithisiisianiadmitithroughidischargeiclaim UnderiAPCs,ipaymentistatusiindicatoriSiindicates?i-iCorrectiAnswer- Significantiprocedure,inon- discountediUnderitheiAPCisystem,iailistiofistatusiindicatorsioripaymentii ndicatorsiisiassigneditoieveryiHCPCS/CPTicode.iTheiindicatorsiidentifyih owiaiserviceiisipaidiwhenicoveredibyiMedicare.iTheistatusiindicatori"S"ii dentifiesitheiserviceiasisignificantiprocedure,ipaidiunderiOPPSiandinotis ubjectitoidiscountiwheniperformediwithiadditionaliprocedures. ElectroniciHealthiRecordsi(EHR)ihelpiwithiclinicalidocumentationiimpro vementi(CDI)idueitoitheifollowing:iI.iIticanipromptiphysiciansiforiadditio naliinformationiII.iNaturalilanguageiprocessingi(NLP)caniallowiforimorei effectiveidocumentationiinilessitimeiIII.iComputeriinterfacesicaniprovid eiphysiciansiwithidecisionisupportitoolsiimprovingipatienticarei- iCorrectiAnswer-I,iIIiandiIII AniEHRiwithidecisionisupportianditemplatesicaniprovideiphysiciansiwith itheiabilityitoidictateiusingiNLPiandireceivingipromptsifromitheiDecisioni SupportiSystemi(DSS)ianditemplatesitoiincludeiinformationiheimightiha veiotherwiseileftioffiifiheihadinotibeenipromptedibyitheiEHRitemplateian diDSSiprompts.iThisiwilliimproveidocumentationiforicoding,iqualityiofica reiandiintensityiofiservice. Aicoderishouldiconsideriusingiaiprovideriqueryiwhen:iI.iDocumentationii siillegibleiII.iDocumentationiisiunclearioriincompleteiIII.iDocumentationi providesiaidiagnosisiwithouticlinicalivalidation,ioriviceiversaiIV.iDocume ntationidoesinotiincludeitheiprecertificationinumberi-iCorrectiAnswer-

I,iII,iandiIIIiAiqueryiisiaicommunicationitooliuseditoiclarifyidocumentatio niinitheihealthirecordiforiaccurateicodeiassignment.iTheidesiredioutcom eifromiaiqueryiisianiupdateiofiaihealthirecorditoibetterireflectiaipractitio ner'siintentiandiclinicalithoughtiprocesses,idocumentediiniaimanneritha tisupportsiaccurateicodeiassignment.iTheifinalicodedidiagnosesiandiproc eduresiderivedifromitheihealthirecordidocumentationishouldiaccurately ireflectitheipatient'siepisodeioficare. UseitheilinkiaboveiforitheiPDFiforithisiquestion.iAccordingitoitheiNCDifori BloodiTransfusionsiunderiHospitaliPartiAiCoverageiandiPaymentiwhichi ofitheifollowingistatementsiisifalseiiniregardsitoiHospitaliCoverageiandiP ayment.i-iCorrectiAnswer- TheiDRGipaymentidoesinoticoveritheibloodiandibloodiservices,iandithes eiareiservicesiareipaidiseparatelyiunderiMedicareiPartiA. AccordingitoitheiLCD,iasiprovidediini§1886iofitheiAct,iunderitheiprospect iveipaymentisystemi(PPS),itheidiagnosisirelatedigroupi(DRG)ipaymentito itheihospitaliincludesiallicoveredibloodiandibloodiprocessingiexpenses,i whetheriorinotitheibloodiisieventuallyiused.iUnderiitsiprovideriagreeme nt,iaihospitaliisirequireditoifurnishioriarrangeiforiallicoverediservicesifur nisheditoihospitalipatients.iMedicareipaymentiisimadeitoitheihospital,iu nderiPPSioricostireimbursement,iforicoverediinpatientiandioutpatientise rvices,iandiitiisiintendeditoireflectipaymentiforiallicostsiofifurnishingithos eiservices. AiMedicareipatientipresentsitoiaihospitaliforiaiScreeningiColonoscopy.iT hisipreventativeiserviceiwouldibeicoverediunder:i-iCorrectiAnswer- MedicareiPartiBiMedicareiPartiBi(MedicaliInsurance)ihelpsicoveridoctor s'iservicesiandioutpatienticare.iItialsoicoversisomeiotherimedicaliservice

sithatiPartiAidoesn'ticover,isuchiasisomeiofitheiservicesiofiphysicaliandioc cupationalitherapists,iandisomeihomeihealthicare.iPartiBihelpsipayiforit heseicoverediservicesiandisuppliesiwhenitheyiareimedicallyinecessary. Whichiofitheifollowingicouldirepresentianiexampleiofifraudi&iabuse?iI.iA ifacilityiselectsitheiprincipalidiagnosesibasedionitheimosticomplicatediill nessitheipatientisuffersifromiduringianiadmissioniforihigheriMS- DRGiII.iAicoderidoesinotifullyiunderstanditheicodingiguidelinesiandiinad vertentlyiselectsianiinaccurateicodeiforiaiprocedure.iIII.iAicoderiomitsion eiofitheiprocedureicodesiforiaicomplicatedicardiacicatheterizationicasei- iCorrectiAnswer-Iionly AlliofitheifollowingiareiwithinitheiOIG'siscopeiofilegaliactivitiesiinihealthc areiEXCEPT:i-iCorrectiAnswer- SuingifacilitiesiforimalpracticeiTheiOfficeiofiInspectoriGeneral'si(OIG)ime thodsitoiresolveiciviliandiadministrativeihealthicareifraudicasesiincludeili tigationiofiprogramiexclusions,icivilimonetaryipenaltiesi(CMP),iandiasse ssments.iOIGialsoinegotiatesiandimonitorsicorporateiintegrityiagreeme ntsi(CIA)iandiissuesifraudialerts,iadvisoryibulletins,iandiadvisoryiopinion s.