COC Final Exam Questions and Answers 2024, Exams of Nursing

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COC Final Exam Questions and Answers 2024 1.A choledochal cyst is a cyst originating from which structure?: Common bile duct 2.A character's position can be understood as which type of classification that allows different specific values to be inserted into that space, and whose physical position remains stable?: Semi-independent 3.A code from categories Q00-Q99 can be used until the patient reaches what age? Refer to ICD-10-CM guideline I.C.17.: • They can be used throughout the life of the patient unless it has been corrected.

4. A condition where the thyroid is overactive is called:: Thyrotoxicosis 5.A critical access hospital is:: Answer:A facility in a rural area used for hospital inpatient stays, inpatient rehabilitation and psychiatric services, which also offers emergency services Rationale: Medicare beneficiaries in rural areas can receive services from critical access hospitals. CAHs offer 24-hour emergency services seven days a week, hospital inpatient stays, inpatient rehabilitation, and psychiatric services. 6.A cystourethroscopy is examination of what structures?: Bladder and ure- thra
5. A dacryocystectomy describes:: Excision of the lacrimal sac
6. A deficiency of cells in the blood is defined as:: Cytopenia 9.A facility coder:: Must understand the complete revenue cycle process. Ratio- nale: A facility coder must understand the complete revenue cycle process and the impact the coder's role in the overall success. 10.A gonioscopy is an examination of what part of the eye:: Anterior chamber of the eye 11.A hospital CDM contains the following information:: Department number, CPT®/HCPCS Level II code(s), charge, revenue code, inventory number, descrip- tion of service Rationale: Typically, a CDM includes the department number/inter- nal control/inventory number, description of services, revenue center (UB revenue code), CPT ®/HCPCS Level II (procedure codes), and charge for service. 12.A hospital has an obligation to provide emergency services to a patient under what federal act?: Emergency Medical Treatment and Active Labor Act 13.A Medicare patient is scheduled for a procedure Medicare deemed as statutorily excluded. The facility asks the patient to sign the ABN, but the patient refuses. The facility bills the patient for the service and the patient refuses to pay. Is the patient liable in this situation?: Yes If yes, why is

patient liable for the bill? When the statute excludes the service, an ABN is not necessary and refusal to sign the ABN does not exempt the patient from payment responsibility. 14.A Medicare patient was to undergo a procedure based on a diagnosis that was not medically necessary for Medicare reimbursement. The surgery technician presented the ABN appropriately to the patient, but the patient refused to sign the ABN. The surgery technician documented on the ABN that the patient refused to sign. The technician asked the nurse to witness the patient's refusal to sign. The patient insisted on undergoing the procedure and the surgeon agreed to perform the service. Medicare denied the claim because the diagnosis did not support medical necessity for the service. What is the most appropriate action?: The hospital may bill the patient and collect the full amount of the bill. 15.A Medicare secondary payer ensures:: Medicare payment for items or services is prohibited if payment can be paid by another payer under certain conditions.

16. A meningioma is defined as:: Tumor of the meninges 17.A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the:: Prostate 18.A patient arrives at the ED after being involved in an automobile accident. She has multiple lacerations, a contusion on her head, and a sprained ankle. The laceration repair and a level 3 ED visit are reported. Is a modifier necessary? If yes, why?: Yes. Modifier 25 is required on the ED visit to indicate it was separately identifiable from the laceration repair. 19.A patient presented to the hospital outpatient pulmonary clinic for asth- ma follow-up. During the encounter, the physician performed an expanded problem focused history and exam with moderate decision making for this established patient. The documentation supported a low-level E/M for the facility. Later in the evening, the patient suffered an acute asthma attack and went to the ER in the same hospital for treatment. What modifier is used to indicate multiple E/M services occurred on the same date?: 27 20.A patient presents to the hospital-based clinic in her 15th week of preg- nancy with cramping, cervix dilated to 2 cm, and a bulging amniotic sac. The physician confirms a spontaneous abortion is inevitable and decides to manage the patient expectantly with monitoring. How is this coded?: An appropriate E/M code 2 / 9

21.A patient underwent a high cost procedure in urban Vermont. The charge for the procedure was $12,000. The procedure performed was a reconstruc- tion of an elbow joint. The APC payment rate for this procedure is $3,450.00. Does this procedure qualify for an outlier payment?: NO If yes, what is the outlier payment? If no, why does it not qualify?;$12,000 x .454 = $5,448 (.426 = $5112);$3,450 x 1.75 = $6037.5;$4,325 + $3,775 = $8100 Total Exceeds 22.A patient was brought into the ED following accident. The Pt suffered a humerus fracture, which required care and is reported with CPT 23620 (APC assignement of 5111 w/a status indictor of T). The Pt also suffered a break to the forearm and a cast was applied to provide support until th ePt could be seen by an orthopedic surgeon for potential surgery. The CPT code reported was 29075 (APC assignment of 5102 with a status indicator of T). How will the procedures be reimbursed under the OPPS?: 29075 (status indicator T) will be reimbursed 100%, 23620 (status indictor T) will be reduced by 50%) 23.A patient was seen in the physician's office and was directly referred to Observation with atrial fibrillation. Decision was made to perform cardiover- sion (92960 status indicator S), but minutes before defibrillation, the patient went into normal sinus rhythm. After 3 hours in Observation the decision was then made to admit the patient for 2 days for monitoring to test the effectiveness of a new oral medication for atrial fibrillation. Report the CPT ® code(s) and ICD-10-CM code for the outpatient facility.: No outpatient facility charges are filed 24.A pregnant patient presents to the ED with bleeding, cramping, and concerns of loss of tissue and material vaginally. On examination, the physi- cian discovers an open cervical (os) with no products of conception seen. He tells the patient she has had an abortion. What type of abortion has occurred?: Spontaneous 25.A procedure requiring the physician to cut down to the superficial fascia is documented as cutting down into the:: Hypodermis 26.A projection is the path of the X-ray beam. If the projection is frong to back it would be:: Anteroposterior 27.A Pt was admitted to the hospital with abdominal pain, nausea and vomiting, fever, and rule out acute pancreatitis. After extensive workup, no pancreatitis was found and the Pt was DC. What is the principle DX for this Pt?: Acute pancreatitis 28.A routine ABN is appropriate for patients who return to the facility more 3 /

29.A septal dermatoplasty is:: Removal of diseased internasal mucosa and replacement with a graft 30.A statement is sent to the patient as soon as:: Payments are posted and denials are resolved. Rationale: After the business office receives an explanation of benefits (EOB), the claim payment and contractual adjustments are posted and then a statement is mailed to the patient for the amount determined to be patient responsibility. 31.A status indicator of S indicates:: The procedure is paid under OPPS and is not discounted. 32.A surgeon performed a radical mastectomy on the right breast for a 42- year-old woman. The patient requested a permanent prosthesis in the recovery room. The surgeon decided to take the patient back to the operating room later that day and the prosthesis was inserted in the right breast. What modifier should the facility use?: 58 33.A surgeon places a self-retaining indwelling ureteral stent following a cystourethroscopic procedure. Later in the evening, due to complications, the patient returns to the OR for removal of the stent by the same surgeon. Select the appropriate modifier for the stent removal.: 78 34.A surgical procedure creating an opening into the jejunum is defined as a:: Jejunostomy 35.A teaching physician's participation in the patient's care can be docu- mented in the patient's medical chart by:: The physician, resident, or the nurse 36.A type A emergency department includes:: Answer: 24-hours per day, seven days a week access for patient requiring immediate or urgent care Rationale: Type A Emergency Departments are open 24 hours per day, seven days per week for immediate, urgent, and emergent care. 37.Abducens: Controls movement of the lateral rectus muscle of the eye, one of the six muscles of the eyeball 38.Accessory: Responsible for shoulder movements, head rotation, swallowing, visceral move-ments, and voice production 39.According to ICD-10-CM guildelines, when a Pt is seen for management of anemia due to malignancy, how is it reported?: The malignancy is reported first, followed by the code for anemia 40.According to Medicare guidelines, dictated notes must be by the physician before they are placed in the patient's chart.: 4 /

Medicare guidelines, dictated notes must be by the physician before they are placed in the patient's chart. 41.According to the Conditions of Participation (CoP), medical records must be retained in their original or legally reproduced form for a period of at least:: Five years 42.According to the ICD-10-CM guidelines, how is bilateral glaucoma of the same type and stage reported?: A bilateral code can be used to report the type of glaucoma and the stage of glaucoma. 43.According to The Joint Commission's dangerous abbreviation list, which abbreviation is considered to be a dangerous abbreviation and why?: U; can be mistaken for cc.

44. Acoustic: Responsible for hearing and balance (vestibulocochlear nerve)
45. Additional requirements to be certified as a CAH can be found on the:- : Answer:CMS website Rationale: Additional requirements to be certified as a CAH can be found on the CMS website ( www.cms.gov/CertificationandCompli- anc/04_CAHs.asp).
46. Adrenal glands: • On top of each kidney 47.Adrenal medulla: The main function of this gland is the secretion of adrenaline (epinephrine). It acts by raising blood glucose levels; increases blood pressure, heart rate, sweating, respiratory rate and other activities regulated by the sympa- thetic nervous system.
47. All codes in ICD-10-PCS have how many characters?: 7 49.All entries in the medical record must be:: Signed and dated by the author with a method to establish the author's identity. 50.All payers employ the same rules concerning coding and reimburse- ment.: B. False Rationale: PPOs, HM Os, Medicaid, TRICARE/CHAMPUS, Work- ers Compensation, and many private insurers employ their own rules regarding coding and reimbursement. Additional restrictions may apply when participating in a network. 51.All the following are examples of outpatient facilities except:: Answer: OPPS Rationale: OPPS stands for Outpatient Prospective Payment System. This is a payment system and not a type of facility such as CORF, CAH, ASC are. 52.Ambulatory surgical centers include:: Answer: An independent ASC Ratio- nale: Independent ASCs offer ambulatory surgical services or same-day surgeries to patients^5 / who only require services with

ASC is owned by the hospital, it is generally considered to be an extension of the physical hospital and the same as any other outpatient department. In general, an independent ASC must be financially independent from the hospital, not be included on the hospital's cost reports. 53.Amputation:: the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. 54.An ABN rendered in a timely manner is important for the facility to receive payment when Medicare does not cover the service, because the diagnosis does not support medical necessity. The facility may:: Have the patient sign the ABN after administration of anesthesia. 55.An ABN was presented to a 68-year-old Medicare patient for services that might not be covered. The services facing denial were specified on the ABN. The ABN did not specify the reason Medicare might likely deny the claim. The patient signed the ABN and the claim was denied. The patient received a bill from the facility and insists she did not understand the ABN or what she was signing. Is the patient responsible for payment?: The ABN did not specify the reason Medicare might deny the claim, so the patient is not responsible for payment. 56.An active treatment plan for therapy services must identify:: Answer: The diagnosis, the goals of the treatment, the date the plan was established, and the type of modality or procedure used.Rationale: An active therapy treatment plan must identify the diagnosis, the anticipated goals of the treatment, the date the plan was established, and the type of modality or procedure used. 57.An exploratory laparoscopy was performed for right lower abdominal pain. Endometriosis of the pelvic viscera was found and lesions were re- moved with fulguration (58662). A right ovarian cystectomy was also per- formed (58661). What is the expected payment (Medicare and Pt responsibil- ity): $4,833. 58.An ecptopic pregnancy is a complication in which the fertilized ovum is implanted in any tissue other than the?: Uterine wall 59.An operative report for a major surgical procedure should include:: Pre- and post-op diagnosis, title of the procedure, surgeon(s), anesthesiologist/CRNA as well as type of anesthesia used, a detailed report of the procedure and instru- ments and equipment used, postoperative condition, complications and additional information, such as blood loss, drains, catheters, etc. 6 /

60.An orthopedist reduces a fracture and places a cast to maintain the position of the bone during healing. What root operative procedure(s) should be reported?: Reposition 61.An RW of 2.0000 means:: The average costs of providing care to an inPt assigned to that DRG are twice the average costs of prividing car to all inPts 62.Anemia and polycythemia are disorders related to which blood cell?: Ery- throcytes

63. Another term for qui tam relator is:: Whistleblower
64. Annual changes to MS-DRG go into effect:: Annually on Oct 1st 65.AP / Anteroposterior:: the X-ray beam enters the front of body (anterior) and exits back of body (posterior) 66.APCs are based on:: Grouping of outpatient services that are similar clinically and require similar resources 67.Applying the coding concept from ICD-10-CM guideline I.B.l ., which of the following is the recommended method for using your ICD-10-CM code book?: Always consult the Alphabetic Index first. Refer to the Tabular List to locate the selected code. 68.Applying the coding concept from ICD-10-CM guideline I.C.9.a.5, how do you code hypertensive retinopathy?: Sequencing is based on the reason for the encounter 69.Appropriateness of care refers to:: The proper setting of medical care to best treat the patient's diagnosis. Rationale: Appropriateness of care is often used to state proper setting of medical care to best treat the patient's diagnosis. 70.Approximately what percentage of outpatient claims is driven by the CDM?: 75% Rationale: The CDM is essential for obtaining appropriate reimburse- ment. Approximately 75 percent of outpatient services are driven by the CDM. 71.ASC payment indicator N1 indicates the procedure is:: A packaged ser- vice/item; no separate payment is made
65. Avulsion: The forceful tearing away of part of body 73.Based on word parts, what is the definition of a glossectomy?: Surgical removal of the tongue.
66. Based on word parts, what is the definition of a salpingo- oophorectomy?- : Surgical removal of an ovary and tube. 7 /

75.Based on word parts, what is the definition of a tracheostomy?: Creation of a hole in the trachea.

76. Based on word parts, what structure does paronychia refer to?: Nail 77.Benefits a an effective compliance plan include:: • Faster, more accurate payment of claims • Faster billing mistakes • Diminished chance of a payer audit • Last chance of running afoul of self-referral and anti-kickback statutes 78.Billing incident-to in the physician's office means:: Under certain circum- stances the physician bills for the services performed by qualified employees as though the physician performed the services. Rationale: Incident-to for the physi- cian's office, means that the physician can bill for services provided by qualified employees as though the physician personally performed
77. Blepharoplasty is performed on which part of the body?: Eyelid 80.Bone marrow harvesting is a procedure to obtain bone marrow from a donor. Bone marrow collected from a close relative is:: Allogenic 81.Bursa:: a fluid-filled sac or saclike cavity, especially one countering friction at a joint. 82.By what payment method is the inpatient hospital facility reimbursed by Medicare?: IPPS/MS-DRG Rationale: The Medicare Inpatient Prospective Pay- ment System (IPPS) was developed to help Medicare predict and control costs for hospital inpatient services. Medicare pays hospitals a fixed amount for inpatient services based on the severity-adjusted diagnostic group, which is referred to as the Medicare Severity Diagnosis Related Groups (MS-DRGs). 83.By what payment method is the inPt hospital facility reimbursed by Medicare?: IPPS/MS-DRG 84.CAHs have:: Answer: No more than 25 inpatient beds used for either inpatients or swing bed services Rationale: CAHs can have no more than 25 inpatient beds used for either inpatient or swing bed services. 85.Calculate the reimbursement for MS-DRG 813, Coagulations Disorders, with a relative weight of 1.6115. The hospital base rate is $3,201.00.: $5,158. 86.Cauda equina: The end of the spinal cord, including the nerve roots of those nerves below the first lumbar nerve
78. Cauterize: The use of heat or chemicals to burn or cut 88.Chondroplasty:: a surgical procedure used to smooth damaged 8 /

to move freely and without pain. The knee joint is covered in articular cartilage, which is a smooth tissue that allows the joint to move without friction. 89.Circumduction:: a conical movement of a body part, such as a ball and socket joint or the eye. Circumduction is a combination of flexion, extension, adduction and abduction. 90.CMS has two sets of guidelines for selecting the level of an E/M ser- vice:: 1995 Evaluation and Management Documentation Guidelines and 1997 Evaluation and Management Documentation Guidelines. 91.COC™ credential recognizes expertise in:: Answer: Outpatient hospital and ambulatory surgical center coding Rationale: The Certified Professional Coder (COC™) credential recognizes expertise in the area of outpatient hospital and ambulatory surgical center coding. 92.Complete the series for passage of airflow to the lungs: nose, trachea, bronchi, alveoli.: Bronchioles 93.Conditions of Participation are:: Standards found in the Federal Register Rationale: The sets forth standards in Conditions of Participation (CoP) and Con- ditions for Coverage (CfC) that must be met in order to participate in Medicare and Medicaid Programs. The standards include guidelines for documentation and apply to both hospitals and ambulatory surgery centers. 94.CPT ® code 36215 is for selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family. What appendix can help you determine the order of vascular families?: Ap- pendix L 95.CPT Critical Care guidelines provide a list of codes considered inclusive to critical care services. How should these codes be reported by the Facility on the UB-04?: All services performed in conjunction with critical care should be reported, even if they are considered inclusive to the critical care codes by CPT® definition

96. Critical care is:: A condition, not a location.
97. Cryosurgery: A procedure using low temperatures for lesion removal
98. Cytopathology is the study of:: Cells 99.Debridement is best described as:: Removal of dead or damaged tissue as from a wound
99. Decompression: Removal of pressure 9 /

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COC Final Exam

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