Medical Coding Pre Assessment Questions and Answers, Exams of Nursing

Download Medical Coding Pre Assessment Questions and Answers and more Exams Nursing in PDF only on Docsity! D254 Intro to Medical Coding Pre Assessment 40 Questions and Answers 2023 42826: Tonsillectomy, primary or secondary; age 12 or over - A 32-year-old patient was admitted to outpatient surgery for primary tonsillectomy. The tonsils were grasped with a tool and removed. Which CPT code is assigned for this procedure? 42821: Tonsillectomy and adenoidectomy, primary or secondary; age 12 or over 42826: Tonsillectomy, primary or secondary; age 12 or over 42842: Radical resection of tonsil, tonsillar pillars and/or retromolar trigone; without closure 42870: Excision or destruction lingual tonsil, any method (separate procedure) 31254-50: Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) - A 67-year-old patient with sinus issues presented to outpatient surgery for an ethmoidectomy. Per the procedure note, the patient's anterior ethmoid sinuses were removed bilaterally via endoscopic approach. Which CPT code is assigned for this procedure? 31200-50: Ethmoidectomy; intranasal, anterior 31201-50: Ethmoidectomy; intranasal, total 31254-50: Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) 31255-50: Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) 65450-RT (Right): Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization - A patient presents to a physician's office complaining of discomfort in the right eye. The examination concludes there is a lesion on the cornea with chronic inflammation of the epithelium tissue. The physician uses cold therapy to remove the corneal lesion of the right eye. Which CPT code should be assigned for this procedure? 65400-RT (Right): Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium 65435-RT (Right): Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) 65436-RT (Right): Removal of corneal epithelium; with application of chelating agent (e.g., EDTA) 65450-RT (Right): Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization 25111-RT (Right): Excision of ganglion, wrist (dorsal or volar); primary - A 16-year-old patient presents for a preoperative consultation for a right ganglion cyst. The surgeon performed a right volar ganglion cyst excision. A transverse incision was made overlying the cyst with sharp dissection through the skin. Tenotomy scissors and retractors were used in combination with bipolar electrocautery to free the cyst of the surrounding structures. Which CPT code should be assigned for this procedure? 25000-RT (Right): Incision, extensor tendon sheath, wrist (eg, de Quervain's disease) 25001-RT (Right): Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis) 25111-RT (Right): Excision of ganglion, wrist (dorsal or volar); primary 25112-RT (Right): Excision of ganglion, wrist (dorsal or volar); recurrent A4000-A4899: Medical and Surgical Supplies - A patient was admitted with a ruptured appendix and taken into surgery. At the time of the appendectomy, a suspicious nodule at the head of the pancreas was observed. A needle biopsy was performed while the abdomen was open. Which section of the HCPCS Level II code set includes the code for the needle biopsy supplies? A4000-A4899: Medical and Surgical Supplies G0000-G9999: Procedures/Professional Services (Temporary) M0000-M0009: Medical Services P2000-P2999: Laboratory Tests C1785: Pacemaker, dual chamber, rate-responsive (implantable) - A patient with a history of congestive heart failure presents to the emergency room complaining of shortness of breath and chest pains. A cardiac electrophysiologist implants an activity-sensing pacemaker in the chest, generating electric impulses to the right atrium and the right ventricle. After the procedure, the patient is admitted to the hospital for overnight observation. Which HCPCS Level II code should be assigned for the pacemaker? C1785: Pacemaker, dual chamber, rate-responsive (implantable) C1786: Pacemaker, single chamber, rate-responsive (implantable) A 16-year-old patient complains of difficulty breathing, chest pressure, and a moderate dry cough. The patient has not experienced any of the recorded symptoms previously. The chest X-ray reveals acute pulmonary edema. Oxygen is provided until the patient is stable. The patient is prescribed albuterol and discharged home. The clinical findings conclude extrinsic asthma with acute exacerbation. Which ICD-10-CM diagnosis code should be assigned for this encounter? J45.41: Moderate persistent asthma with (acute) exacerbation J45.42: Moderate persistent asthma with status asthmaticus J45.901: Unspecified asthma with (acute) exacerbation J45.902: Unspecified asthma with status asthmaticus C61: Malignant neoplasm of the prostate - A patient is admitted to an ambulatory surgery center at a hospital and undergoes transurethral resection of the prostate for benign prostatic hypertrophy. The patient had a documented rising prostate-specific antigen and lower urinary tract symptoms of urinary frequency and urgency. The pathology report is positive for adenocarcinoma of the prostate. What is the first-listed ICD-10-CM diagnosis code for this encounter? C61: Malignant neoplasm of the prostate N40.0: Benign prostatic hypertrophy N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms R35.0: Urinary frequency K80.67: Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction and I10: Essential (primary) hypertension - A patient is admitted to the hospital from the emergency department for acute colic. A general surgeon establishes a provisional diagnosis of cholecystitis with cholelithiasis. The patient is documented as having a history of congenital mitral valve leaflet disorder with insufficiency and underwent surgical correction at eight months of age. The patient also has hypertension that has been challenging to control with losartan and hydrochlorothiazide. The patient is closely monitored during this encounter for hypertensive problems. The patient is taken to the operating room and undergoes a cholecystectomy, or cannulation of the bile duct, to remove an obstructing bile duct stone and an intraoperative cholangiogram. The pathology report findings are as follows: Tissue submitted: Gallbladder with cystic duct Findings: Acute and chronic cholecystitis Residual calculi in bile duct and gallbladder No evidence of gangrene or perforations Which ICD-10-CM codes should be assigned for this encounter? K80.01: Calculus of gallbladder with acute cholecystitis with obstruction; R10.83: Colic; and Q23.3: Congenital mitral insufficiency K80.47: Calculus of bile duct with acute and chronic cholecystitis with obstruction and Q23.3: Congenital mitral insufficiency K80.67: Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction and I10: Essential (primary) hypertension R10.83: Colic; K80.01: Calculus of gallbladder with acute cholecystitis with obstruction; and Q23.3: Congenital mitral insufficiency 0DB80ZZ: Excision of small intestine, open approach - A newborn infant is diagnosed with necrotizing enterocolitis (NEC) and has a procedure to remove the damaged sections of the inner lining of the small intestine. Which ICD-10-PCS code should be assigned for this procedure? 0D580ZZ: Destruction of small intestine, open approach 0DB80ZZ: Excision of small intestine, open approach 0DN80ZZ: Release small intestine, open approach 0DQ80ZZ: Repair small intestine, open approach 0VT04ZZ: Resection of prostate, percutaneous endoscopic approach 8E0W4CZ: Other procedure, trunk region, percutaneous endoscopic approach, robotic assisted procedure - A 67-year-old male with prostate cancer is scheduled for a robotic-assisted laparoscopic prostatectomy. In the surgical suite, the surgeon made an extension to the initial incision to assist in the removal of the entire prostate. Which ICD-10-PCS codes are assigned for this procedure? 0VB04ZZ: Excision of prostate, percutaneous endoscopic approach 8E0W0CZ: Other procedure, trunk region, open, robotic assisted procedure 0VB04ZZ: Excision of prostate, percutaneous endoscopic approach 8E0W3CZ: Other procedure, trunk region, percutaneous approach, robotic assisted procedure 0VT00ZZ: Resection of prostate, open approach 8E0W3CZ: Other procedure, trunk region, percutaneous approach, robotic assisted procedure 0VT04ZZ: Resection of prostate, percutaneous endoscopic approach 8E0W4CZ: Other procedure, trunk region, percutaneous endoscopic approach, robotic assisted procedure 0HTV0ZZ; 0HRV0JZ - A 45-year-old female diagnosed with breast cancer is admitted to the hospital for a bilateral total mastectomy followed by reconstruction with a synthetic substitute. Use the codes in the following table to identify which codes to assign for this scenario. ICD-10-PCS Code Code Description 0HBT0ZZ Excision of Right Breast, Open Approach 0HBU0ZZ Excision of Left Breast, Open Approach 0HBV0ZZ Excision of Bilateral Breast, Open Approach 0HRT0JZ Replacement of Right Breast, Open Approach, with Synthetic Substitute 0HRU0JZ Replacement of Left Breast, Open Approach, with Synthetic Substitute 0HRU0KZ Replacement of Left Breast, Open Approach, with Nonautologous Tissue Substitute 0HRV0KZ Replacement of Bilateral Breast, Open Approach, with Nonautologous Tissue Substitute 0HRV0JZ Replacement of Bilateral Breast, Open Approach, with Synthetic Substitute 0HTV0ZZ Resection of Bilateral Breast, Open Approach Which ICD-10-PCS codes are assigned for this procedure? 0HBT0ZZ; 0HBU0ZZ; 0HRV0KZ 0HBU0ZZ; 0HRV0KZ 0HBV0ZZ; 0HRU0JZ; 0HRT0JZ 0HTV0ZZ; 0HRV0JZ 0X6C0ZZ: Medical and surgical, anatomical regions, upper extremities, detachment, elbow region, left, open - A diabetic patient presents at a hospital with increasing complaints of a painful left hand with skin discoloration, swelling, and smelly discharge extending directly below the antecubital fossa region. The patient is not responding as expected to medical management of intravenous antibiotics. The left lower arm infection is gangrenous. The magnetic resonance imaging (MRI) shows osteomyelitis. An orthopedic surgeon recommends surgery for disarticulation of the elbow joint. Which ICD-10-PCS code should be assigned for this procedure? 0XBC0ZZ: Medical and surgical, anatomical regions, upper extremities, excision, elbow region, left, open 0XBF0ZZ: Medical and surgical, anatomical regions, upper extremities, excision, lower arm, left, open 0X6C0ZZ: Medical and surgical, anatomical regions, upper extremities, detachment, elbow region, left, open 0X6F0ZZ: Medical and surgical, anatomical regions, upper extremities, detachment, lower arm, left, open 5A1945Z; 0BH18EZ - 50 Bilateral procedure LT Left (used to identify procedures performed on the left side of the body) RT Right (used to identify procedures performed on the right side of the body) Was this code assignment accurate? Yes, each diagnosis and procedure is correctly reported. No, the diagnosis code does not include the appropriate type and number of characters and digits. Yes, the appropriate modifier is assigned to the procedure code. No, an available procedure code indicating a bilateral service is not assigned. No, not all codes match the scenario. - A liveborn infant is delivered vaginally in a hospital. Within the newborn examination, the provider documents yellowing of the baby's skin and eyes. The provider orders phototherapy for neonatal hyperbilirubinemia. The following codes are assigned: Z38.00: Single liveborn infant, delivered vaginally R17: Jaundice, unspecified P59.9: Neonatal jaundice, unspecified Is this code assignment accurate? Yes, all codes match the diagnoses provided. Yes, all codes are correct and include the correct number of characters and digits. No, the codes are correctly assigned, but they are not correctly sequenced. No, not all codes match the scenario. No, the signs and symptoms codes for dyspnea and fever should be deleted. The pneumonia was documented to be due to pseudomonas. Acute respiratory failure with hypoxia developed after admission and should be sequenced as a secondary diagnosis. - A facility fee coding auditor is reviewing the encounter documentation and the assigned codes for a patient encounter. A patient presented to the emergency room (ER) with complaints of dyspnea and fever for several days. The patient was subsequently admitted to inpatient status in the hospital for pneumonia. The provider documented the bacterial source as pseudomonas, for which the provider put the patient on IV antibiotics. Three days after admission, the patient went into acute respiratory failure with hypoxia and did not recover despite being placed on a ventilator. The coder assigned the following diagnosis codes to meet medical necessity for the encounter: J15.1: Pneumonia due to pseudomonas J96.01: Acute respiratory failure with hypoxia R06.00: Dyspnea, unspecified R50.9: Fever, unspecified Was this code assignment accurate? Yes, the diagnosis codes as submitted are correct, and the codes and descriptors are complete. Yes, the diagnosis codes as submitted are correct, and the sequencing of the diagnoses complies with ICD-10-CM Official Coding Guidelines. No, "J96.01: Acute respiratory failure with hypoxia" should be listed as the principal diagnosis. No, the signs and symptoms codes for dyspnea and fever should be deleted. The pneumonia was documented to be due to pseudomonas. Acute respiratory failure with hypoxia developed after admission and should be sequenced as a secondary diagnosis. No, there is a presumed relationship between congestive heart failure and hypertension unless the provider explicitly states that the hypertension is due to another cause. "I10: Essential (primary) hypertension" should be deleted, and "I50.22: Chronic systolic (congestive) heart failure" should be added. - A coding auditor is reviewing the documentation and the assigned diagnosis codes for a patient encounter. The patient was admitted to the emergency room (ER) with profuse sweating and crushing chest pain radiating to his neck. He had a history of chronic systolic congestive heart failure and hypertension. His cardiac enzymes were elevated, and an electrocardiogram demonstrated a non-ST elevation myocardial infarction (NSTEMI). The discharge diagnosis was acute NSTEMI. The coder assigned the following diagnosis codes to meet medical necessity for the encounter: I21.4: Non-ST elevation (NSTEMI) myocardial infarction I11.0: Hypertensive heart disease with heart failure I10: Essential (primary) hypertension. Was this code assignment accurate? Yes, the diagnosis codes are correct given the documented diagnoses. Yes, the diagnosis codes are correct given the sequencing and application of the coding guidelines for ICD-10-CM. No, the codes "I11.0: Hypertensive heart disease with heart failure" and "I10: Essential (primary) hypertension" should be deleted. They are expressly stated as being a "history," meaning they are no longer existing. No, there is a presumed relationship between congestive heart failure and hypertension unless the provider explicitly states that the hypertension is due to another cause. "I10: Essential (primary) hypertension" should be deleted, and "I50.22: Chronic systolic (congestive) heart failure" should be added. Query the attending physician to verify the CHF diagnosis and document the type and acuity of the heart failure. Include in the query the heart failure documentation, the echo results, and the use of carvedilol and furosemide. - A patient was admitted as an inpatient to the hospital for a non-ST elevation myocardial infarction. The patient underwent cardiac catheterization with coronary angiography, which revealed that the patient had 75% occlusion of the right coronary artery. A drug-eluting stent was inserted after an angioplasty. The patient's medical record documents that the patient has congestive heart failure (CHF), but nothing more than CHF is documented. However, the patient is on carvedilol (Coreg) and furosemide (Lasix). An echocardiogram (echo) was performed, revealing a reduced ejection fraction at 35%, which is synonymous with systolic heart failure. Neither the results of the echo nor the specific type of heart failure was documented by the attending physician in the progress notes or discharge summary. What should the coder do? Code chronic systolic heart failure. The ejection fraction was documented as reduced in the echocardiogram, and the physician documentation shows the patient currently has CHF and is on carvedilol and furosemide, which is sufficient to code for this condition. Code CHF, unspecified. Based on the documentation included in the medical records, this is the only diagnosis or procedure information that can be coded. Query the attending physician to verify the CHF diagnosis and document the type and acuity of the heart failure. Include in the query the heart failure documentation, the echo results, and the use of carvedilol and furosemide. Query the attending physician to document chronic systolic heart failure based on the heart failure documentation and echo results as well as the use of carvedilol and furosemide. Speak to the facility manager or the compliance officer to express concern about the lack of feedback on the quality of coding - An independent review organization (IRO) was hired by a skilled nursing facility (SNF) to conduct coding compliance audits as part of a corporate integrity agreement. The IRO submits its findings directly to the chief financial officer. One of the SNF coders is concerned because the individual coders have not received any feedback from the audits. Which action should the coder take? The coder should have assigned the unspecified pneumonia code as present on the admission indicator of N. The coder should have followed up with the clinical documentation specialist and advised the provider to document postoperative pneumonia as a complication of surgery after assigning 8.2. Access only that information necessary to perform their duties. - A medical coder works for a private metropolitan area hospital known for having celebrities as patients. The coder comes across an encounter with a recognizable name. The patient is a popular actor who is filming a movie in a town nearby. The coder wants as many details as possible and accesses the actor's demographic tab in the electronic health record system, which includes the residence and mailing address of the actor. Which ethical principle of the AHIMA Standards of Ethical Coding does this violate? 8.1. Protect all confidential information obtained in the course of professional service, including personal, health, financial, genetic, and outcome information. 8.2. Access only that information necessary to perform their duties. 9.1. Utilize all tools, both electronic and hard copy that are available to ensure accurate code assignment. 11.2. Take adequate measures to discourage, prevent, expose, and correct the unethical conduct of colleagues. Diagnosis-related group (DRG) assignments - A 100-bed acute care facility has an inpatient case mix index of 1.4. This is significantly higher than the facility's peers in the same state. What should the coding manager analyze to verify appropriate coding practices? Resource-based relative value scale (RBRVS) assignments Diagnosis-related group (DRG) assignments Ambulatory payment classification (APC) assignments Ambulatory payment groups (APG) assignments Compare billing and utilization patterns to facilities that have similar bed sizes, patient mix, physician specialty, or types of services provided - What is a way to monitor the case mix index to determine potential coding or billing issues? Compare the inpatient and outpatient coding practices of similar services provided within the same facility Compare billing and utilization patterns to facilities that have similar bed sizes, patient mix, physician specialty, or types of services provided Compare the policies and procedures for coding and reporting to facilities that have similar bed sizes, patient mix, physician specialty, or types of services provided Compare notes with other health information management (HIM) directors on how they handle physicians who are noncompliant with documentation initiatives Over reimbursement - A coder is reviewing a record on a patient admitted to inpatient status for sepsis due to a COVID-19 infection, which was also the final diagnosis. The health information management (HIM) director has instructed the coder that for COVID-19 cases, the COVID-19 diagnosis code should always be reported as the principal diagnosis if it was present on admission. The coder knows that this conflicts with the ICD-10-CM Official Guidelines for coding and reporting. Diagnosis codes: U07.1: COVID-19 (principal diagnosis) A41.89: Other specified sepsis (secondary diagnosis) What will be the impact if the coder follows the HIM director's instructions? Under reimbursement Zero reimbursement Over reimbursement Partial reimbursement The day surgery's ASC reimbursement will be less than what the facility deserves in many cases. - The physicians at a day surgery center sometimes fail to document the size of skin lesions in their procedure notes. Since the coders cannot rely on the nurses' notes or other supporting clinical staff documentation to assign a CPT procedure code, they always assign the CPT code with the shortest length. What impact will this have on the day surgery's reimbursement? The day surgery will receive the full ASC reimbursement that they deserve for each of these cases. The day surgery will receive the full ASC reimbursement that they deserve in about 50% of the cases. The day surgery will not receive the full ASC reimbursement that they deserve in any of the cases. The day surgery's ASC reimbursement will be less than what the facility deserves in many cases. Discuss with the immediate supervisor how the claim should be submitted to Medicaid only for the remaining balance, not exceeding allowable expenses - A patient receives medical care totaling $7,800 in charges. The patient has two health insurance plans that are billed for reimbursement: Medicare being the primary insurance and state Medicaid being the secondary. Medicare is billed and partially denies a portion of the charges submitted. A balance of $750 remains on the patient's ledger. The denial management coder reviews the explanation of benefits and determines that the coding is correct. The immediate billing supervisor instructs the denial coder to submit the claim to Medicaid for $7,800 in an attempt to collect full reimbursement. What should the denial management coder do? Comply with the immediate supervisor in an attempt to collect the full $7,800 from Medicaid Disregard the immediate supervisor and write off the remaining balance as bad debt to the organization Discuss with the immediate supervisor how the claim should be submitted to Medicaid only for the remaining balance, not exceeding allowable expenses Discuss with the immediate supervisor how the claim should be submitted to Medicaid only when the primary insurance has fully or completely denied the entire claim, not exceeding allowable expenses Because the hospital has received overpayments in terms of the MS-DRG for multiple cases, a focused DRG audit targeting this type of error is necessary so all incorrectly assigned DRGs can be rebilled. This will result in corrective actions to the applicable coders, including education and/or termination. - A patient is admitted to inpatient status with shortness of breath, chronic obstructive pulmonary disease (COPD), and subsequently develops acute hypoxic respiratory failure. The patient is diagnosed with exacerbation of COPD present on admission leading to respiratory failure later in the stay and is subsequently placed on oxygen. The coder decides to make respiratory failure the principal diagnosis to get the highest DRG reimbursement. The coding manager identifies this particular coding trend by one or more coders as a result of an internal audit. MS-DRG 189 (RW 1.2248) Pulmonary Edema and Respiratory Failure Principal diagnosis J96.01-Y: Acute respiratory failure with hypoxia Secondary diagnosis J44.1-Y: Chronic Obstructive Pulmonary Disease with acute exacerbation MS-DRG 194 (RW 1.1239) Chronic obstructive pulmonary disease w/MCC Principal diagnosis J44.1-Y: Chronic Obstructive Pulmonary Disease with acute exacerbation Secondary diagnosis J96.01-Y: Acute respiratory failure with hypoxia What is the impact of this coding trend? Because the hospital has received overpayments in terms of the MS-DRG for multiple cases, these cases will need to be corrected, but not rebilled. The overpayments will also result in added staff hours to correct the issue.