Medical Coding and Billing Questions and Answers, Exams of Nursing

Download Medical Coding and Billing Questions and Answers and more Exams Nursing in PDF only on Docsity! 2 1. A 65-year-old white male was admitted to the hospital on 1/15 complaining of abdominal pain. The attending physician requested an upper GI series and laboratory evaluation of CBC and UA. The x-ray revealed possible cholelithiasis, and the UA showed an increased white blood cell count. The patient was taken to surgery for an exploratory laparoscopy, and a ruptured appendix was discovered. The chief complaint was: a. Ruptured appendix b. Exploratory laparoscopy c.Abdominal pain d. Cholelithiasis - Answer c. Abdominal pain The nature and duration of the symptoms that caused the patient to seek medical attention as stated in the patient's own words (Odom-Wesley et al. 2009, 331). 2. 84. An individual stole and used another person's insurance information to obtain medical care. This action would be considered: a. Violation of bioethics b. Fraud and abuse c. Medical identity theft d. Abuse - Answer c. Medical identity theft Correct Answer: 84. c. Medical identity theft occurs when someone uses a person's name and sometimes other parts of their identity without the victim's knowledge or consent to obtain medical services or goods (Johns 2011, 773). 3. Identify the ICD-9-CM diagnostic code(s) for acute osteomyelitis of ankle due to Staphylococcus. a. 730.06 b. 730.07 c. 730.07, 041.1 2 d. 730.07, 041.10 - Answer d. 730.07, 041.10 2 b. Chart tracking system c. Chart abstracting system d. Chart encoder - Answer Correct Answer: B With an automated tracking system, it is easy to track how many records are charged out of the system, their location, and whether they have been returned on the due dates indicated (Johns 2011, 402). 10. Identify the appropriate ICD-9-CM diagnosis code for Lou Gehrig's disease. a. 335.20 b. 334.8 c. 335.29 d. 335.2 - Answer Correct Answer: A Index Disease, Lou Gehrig's or Lou Gehrig's disease. Amyotrophic lateral sclerosis is another name for Lou Gehrig's disease. Many diseases carry the name of a person or an eponym. The main terms for eponyms are located in the Alphabetic Index under the eponym or the disease, syndrome, or disorder (Schraffenberger 2012, 13). 11. In the laboratory section of CPT, if a group of tests overlaps two or more panels, report the panel that incorporates the greatest number of tests to fulfill the code definition. What would a coder do with the remaining test codes that are not part of a panel? a. Report the remaining tests using individual test codes, according to CPT. b. Do not report the remaining individual test codes. c. Report only those test codes that are part of a panel. d. Do not report a test code more than once regardless whether the test was performed twice. - Answer Correct Answer: A Reporting additional test codes that overlap codes in a panel allows the coder to assign all appropriate codes for services provided. It is inappropriate to assign additional panel codes when all codes in the panel are not performed. Reporting individual lab codes is appropriate when all codes in a panel have not been provided (AMA 2012b, 402). 2 12. An electrolyte panel (80051) in the laboratory section of CPT consists of tests for carbon dioxide (82374), chloride (82435), potassium (84132), and sodium (84295). If each of the component codes are reported and billed individually on a claim form, this would be a form of: a. Optimizing b. Unbundling c. Sequencing d. Classifying - Answer Correct Answer: B Unbundling occurs when a panel code exists and the individual tests are reported rather than the panel code (AMA 2012b, 402). 13. Coronary arteriography serves as a diagnostic tool in detecting obstruction within the coronary arteries. Identify the technique using two catheters inserted percutaneously through the femoral artery. a. Combined right and left (88.54) b. Stones (88.55) c. Judkins (88.56) d. Other and unspecified (88.57) - Answer Correct Answer: C The Judkins technique provides x-ray imaging of the coronary arteries by introducing one catheter into the femoral artery with maneuvering up into the left coronary artery orifice, followed by a second catheter guided up into the right coronary artery, and subsequent injection of a contrast material (Schraffenberger 2012, 206). Ensuring the continuity of future care by providing information to the patient's attending physician, referring physician, and any consulting physicians is a function of the: a. Discharge summary b.Autopsy report c. Incident report d. Consent to treatment - Answer Correct Answer: A 2 The discharge summary is a concise account of the patient's illness, course of treatment, response to treatment, and condition at the time the patient is discharged (Johns 2011, 78). 15. This document includes a microscopic description of tissue excised during surgery: a. Recovery room record b. Pathology report c. Operative report d. Discharge summary - Answer Correct Answer: B The pathology report describes specimens examined by the pathologist (Johns 2011, 77). 16. CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of services greater than the norm would indicate. These MUEs were implemented on January 1, 2007, and are applied to which code set? a. Diagnosis-related groups b. HCPCS/CPT codes c. ICD-9-CM diagnosis and procedure codes d. Resource utilization groups - Answer Correct Answer: B CMS developed MUEs to prevent providers from billing units in excess and receiving inappropriate payments. This new editing was the result of the outpatient prospective payment system which pays providers passed on the HCPCS/CPT code and units. Payment is directly related to units for specified HCPCS/CPT codes assigned to an ambulatory payment classification (CMS 2012b). 17. Identify the ICD-9-CM diagnostic code for other specified aplastic anemia secondary to chemotherapy. a. 284.9 b. 284.89 c. 285.9 d. 285.22 - Answer Correct Answer: B 2 Index Fitting (of) pacemaker (cardiac). No procedure code exists in ICD-9- CM to describe reprogramming (Schraffenberger 2012, 204-205). 24. Which of the following hospitals are excluded from the Medicare acute-care prospective payment system? a. Children's b. Small community c. Tertiary d.Trauma - Answer Correct Answer: A Children's hospitals are excluded from PPS because the PPS diagnosis-related groups do not accurately account for the resource costs for the types of patients treated (Johns 2011, 321). 25. Which of the following programs has been in place in hospitals for years and has been required by the Medicare and Medicaid programs and accreditation standards? a. Internal DRG audits b. Peer review c. Managed care d. Quality improvement - Answer Correct Answer: D Quality improvement (QI) programs have been in place in hospitals for years and have been required by the Medicare/Medicaid programs and accreditation standards. QI programs have covered medical staff as well as nursing and other departments or processes (LaTour and Eichenwald Maki 2010, 33). 26. Identify the code for a patient with a closed transcervical fracture of the epiphysis. a. 820.09 b. 820.02 c. 820.03 d. 820.01 - Answer Correct Answer: D 2 Index Fracture, femur, epiphysis, capital. Fifth digits are required for further classification of a specific condition. Many publishers include special symbols and/or color highlighting to identify codes that require a fourth or fifth digit (Schraffenberger 2012, 7). 27. What is the best source of documentation to determine the size of a removed malignant lesion? a. Pathology report b. Post-acute care unit record c. Operative report d. Physical examination - Answer Correct Answer: C The total size of a removed lesion, including margins, is needed for accurate coding. This information is best provided in the operative report. The pathology report typically provides the specimen size rather than the size of the excised lesion. Because the specimen tends to shrink, this is not an accurate measurement (Kuehn 2012, 110-111). 28. Which of the following definitions best describes the concept of confidentiality? a. The right of individuals to control access to their personal health information b.The protection of healthcare information from damage, loss, and unauthorized alteration c. The expectation that personal information shared by an individual with a healthcare provider during the course of care will be used only for its intended purpose d.The expectation that only individuals with the appropriate authority will be allowed to access healthcare information - Answer Correct Answer: C Confidentiality refers to the expectation that the personal information shared by an individual with a healthcare provider during the course of care will be used only for its intended purpose (Johns 2011, 49). 29. Identify the ICD-9-CM diagnosis code for Paget's disease of the bone (no bone tumor noted). a. 170.9 2 b. 213.9 c. 238.0 d. 731.0 - Answer Correct Answer: D Index Paget's disease, bone. The main terms for eponyms are located in the Alphabetic Index under the eponym or the disease, syndrome, or disorder (Schraffenberger 2012, 13). 30. Which of the following fails to meet the CMS classification of a hospital- acquired condition? a. Foreign object retained after surgery b.Air embolism c. Gram-negative pneumonia d. Blood incompatibility - Answer Correct Answer: C Gram-negative pneumonia (Johns 2011, 326). 31. Which of the following is (are) the correct ICD-9-CM procedure code(s) for cystoscopy with biopsy? a. 57.34 b. 57.32, 57.33 c. 57.33 d. 57.39 - Answer Correct Answer: C Index Cystoscopy (transurethral), with biopsy (Schraffenberger 2012, 251). 32. Identify the ICD-9-CM diagnosis code for chondromalacia of the patella. a. 717.7 b. 733.92 c. 748.3 d. 716.86 - Answer Correct Answer: A 2 a. CMS-1500 b. CMS-1450 (UB-04) c. UB-92 d. CMS-1400 - Answer Correct Answer: B The electronic claim form (screen 837I) replaced the UB-04 (CMS 1450) paper billing form (Johns 2011, 343). 39. According to the Joint Commission Accreditation Standards, which document must be placed in the patient's record before a surgical procedure may be performed? a.Admission record b. Physician's order c. Report of history and physical examination d. Discharge summary - Answer Correct Answer: C According to the Joint Commission, except in emergency situations, every surgical patient's chart must include a report of a complete history and physical conducted no more than seven days before the surgery is to be performed (Odom-Wesley et al. 2009, 150). 40. The right of an individual to keep information about himself or herself from being disclosed to anyone is a definition of: a. Confidentiality b. Privacy c. Integrity d. Security - Answer Correct Answer: B Privacy is the right of an individual to be left alone. It includes freedom from observation or intrusion into one's private affairs and the right to maintain control over certain personal and health information (Johns 2011, 755). 41. Standardizing medical terminology to avoid differences in naming various medical conditions and procedures (such as the synonyms bunionectomy, McBride procedure, and repair of hallus valgus) is one purpose of: 2 a. Transaction standards b. Content and structure standards c. Vocabulary standards d. Security standards - Answer Correct Answer: C Vocabulary standards establish common definitions for medical terms to encourage consistent descriptions of an individual's condition in the health record (Johns 2011, 227). 42. An outpatient clinic is reviewing the functionality of a computer system it is considering purchasing. Which of the following datasets should the clinic consult to ensure all the federally required data elements for Medicare and Medicaid outpatient clinical encounters are collected by the system? a. DEEDS b. EMEDS c. UACDS d. UHDDS - Answer Correct Answer: C Uniform Ambulatory Care Data Set (Odom-Wesley et al. 2009, 310). 43. Identify the ICD-9-CM diagnostic code for diastolic dysfunction. a. 428.1 b. 428.30 c. 428.9 d. 429.9 - Answer Correct Answer: D Index Dysfunction, diastolic (Schraffenberger 2012, 182-183). 44. Identify the appropriate ICD-9-CM procedure code(s) for a double internal mammary- coronary artery bypass. a. 36.15, 36.16 2 b. 36.15 c. 36.16 d. 36.12, 36.16 - Answer Correct Answer: C Index Bypass, internal mammary-coronary artery (single), double vessel (36.16). Internal mammary-coronary artery bypass is accomplished by loosening the internal mammary artery from its normal position and using the internal mammary artery to bring blood from the subclavian artery to the occluded coronary artery. Codes are selected based on whether one or both internal mammary arteries are used, regardless of the number of coronary arteries involved (Schraffenberger 2012, 203- 204). 45. Identify the CPT code(s) for the following patient: A 2-year-old male presented to the emergency room in the middle of the night to have his nasogastric feeding tube repositioned through the duodenum under fluoroscopic guidance. a. 43752 b. 43761 c. 43761, 76000 d. 49450 - Answer Correct Answer: C Code 43761 is assigned to report repositioning of a nasogastric or orogastric feeding tube through the duodenum. An instructional note guides the coder to report code 76000 when image guidance is performed (AMA 2012b, 235). Which of the following is the correct ICD-9-CM procedure code for a Mayo operation known as a bunionectomy? a. 77.54 b. 77.69 c. 77.59 d. 77.51 - Answer Correct Answer: C Index Bunionectomy or Mayo operation, bunionectomy. The main terms for eponyms are located in the Alphabetic Index under the eponym or the disease, syndrome, operation, or disorder (Schraffenberger 2012, 13). 47. Whereas the focus of inpatient data collection is on the principal diagnosis, the focus of outpatient data collection is on: 2 53. What type of data is exemplified by the insured party's member identification number? a. Demographic data b. Clinical data c. Certification data d. Financial data - Answer Correct Answer: D Financial data include details about the patient's occupation, employer, and insurance coverage (Odom-Wesley et al. 2009, 42). 54. What is the best reference tool for ICD-9-CM coding advice? a.AMA's CPT Assistant b.AHA's Coding Clinic for HCPCS c.AHA's Coding Clinic for ICD-9-CM d. National Correct Coding Initiative (NCCI) - Answer Correct Answer: C AHA's Coding Clinic for ICD-9-CM is a quarterly publication of the Central Office on ICD-9-CM, which allows coders to submit a request for coding advice through the coding publication. 55. Identify the ICD-9-CM diagnostic code(s) for the following: A 6-month-old child is scheduled for a clinic visit for a routine well child exam. The physician documents, "well child, expreemie." a. V20.1, 765.10 b. V20.2 c. V20.2, 765.10 d. V20.2, 765.19 - Answer Correct Answer: C Index Exam, well baby. Premature, infant NEC. Refer to table in Tabular for fifth digit of "0" to note unspecified birth weight (Schraffenberger 2012, 324-328, ). 56. 2 Identify the ICD-9-CM diagnostic code(s) and procedure code(s) for the following: term pregnancy with failure of cervical dilation; lower uterine segment cesarean delivery with single liveborn female. a. 661.01, V27.0, 74.1 b. 661.21, 74.1 c. 661.01, 74.0 d. 661.21, V27, 74.1 - Answer Correct Answer: A Index Delivery, cesarean, poor dilation, cervix (661.0). Refer to the ICD-9- CM Tabular (660-669) for the correct fifth digit of "1," delivered, with or without mention of antepartum condition. Outcome of delivery, single, liveborn. Cesarean section, low uterine segment (Schraffenberger 2012, 282-283). 57. A hospital receives a valid request from a patient for copies of her medical records. The HIM clerk who is preparing the records removes copies of the patient's records from another hospital where the patient was previously treated. According to HIPAA regulations, was this action correct? a. Yes; HIPAA only requires that current records be produced for the patient. b. Yes; this is hospital policy over which HIPAA has no control. c. No; the records from the previous hospital are considered part of the designated record set and should be given to the patient. d. No; the records from the previous hospital are not included in the designated record set but should be released anyway. - Answer Correct Answer: C The designated record set includes health records that are used to make decisions about the individual (Johns 2011, 822). 58. As recommended by AHIMA, HIM compliance policies and procedures should ensure all of the following except: a. Compensation for coders and consultants does not provide any financial incentive to code claims improperly b. The proper selection and sequencing of diagnoses codes c. Proper and timely documentation obtained prior to and after billing 2 d. d The correct application of official coding rules and guidelines - Answer Correct Answer: C Proper and timely documentation of all physician and other professional services must be obtained prior to billing. Facilities should not provide any financial incentive that may tempt a coder to code claims improperly such as upcoding to higher DRGs, which result in higher pay (Johns 20011, 275). 59. What reimbursement system uses the Medicare fee schedule? a.APCs b. MS-DRGs c. RBRVS d. RUG-III - Answer Correct Answer: C The resource-based relative value scale (RBRVS) system was implemented by CMS in 1992 for physicians' services such as office visits covered under Medicare Part B. The system reimburses physicians according to a fee schedule based on predetermined values assigned to specific services (Johns 2011, 326). 60. The CIA of security includes confidentiality, data integrity, and data . a.Accessibility b.Authentication c.Accuracy d.Availability - Answer orrect Answer: D Security measures not only provide for confidentiality, but data integrity and data availability—the CIA of security (Johns 2011, 184). 61. Valley High, a skilled nursing facility, wants to become certified to take part in federal government reimbursement programs such as Medicare. What standards must the facility meet in order to become certified for these programs? a. Joint Commission Accreditation Standards b.Accreditation Association for Ambulatory Healthcare Standards c. Conditions of Participation 2 information while 2 providing the amount needed to accomplish the intended purpose (Johns 2011, 822). 67. CMS identified conditions that are not present on admission and could be "reasonably preventable," and therefore hospitals are not allowed to receive additional payment for these conditions that do present. What are these conditions called? a. a Conditions of Participation b. Present on admission c. Hospital-acquired conditions d. Hospital-acquired infection - Answer Correct Answer: C CMS identified hospital-acquired conditions (not present on admission) as "reasonably preventable," and hospitals do not receive additional payment for cases in which these cases are present (Johns 2011, 326). 68. Which of the following is (are) the correct ICD-9-CM code(s) for laparoscopic cholecystectomy? a. 51.21 b. 51.22, 54.21 c. 51.23, 54.21 d. 51.23 - Answer Correct Answer: D Index Cholecystectomy (total), laparoscopic (Schraffenberger 2012, 237- 238). 69. The HIM manager is concerned about whether the data transmitted across the hospital network is altered during the transmission. The concept that concerns the HIM manager is: a.Admissibility b. Disclosures c.Availability d. Data integrity - Answer Correct Answer: D 2 Data integrity services ensure the data are not altered as they are stored or transmitted electronically (Johns 2011, 184). 70. Medical record completion compliance is a problem at Community Hospital. The number of incomplete charts often exceeds the standard set by the Joint Commission, risking a type I violation. Previous HIM committee chairpersons tried multiple methods to improve compliance, including suspension of privileges and deactivating the parking garage keycard of any physician in poor standing. To improve compliance, which of the following would be the next step to overcoming noncompliance? a. Discuss the problem with the hospital CEO. b. Call the Joint Commission. c. Contact other hospitals to see what methods they use to ensure compliance. d. Drop the issue because noncompliance is always a problem. - Answer Correct Answer: C The HIM manager may compare organizational data with external data from peer groups to determine best practices (Johns 2011, 609). 71. Identify CPT code(s) for the following Medicare patient. A 67-year-old female undergoes a fine needle aspiration of the left breast with ultrasound guidance to place a localization clip during a breast biopsy. a. 10022 b. 10022, 19295-LT c. 10022, 19295-LT, 76942 d. 10022, 76942 - Answer Correct Answer: C Fine needle aspiration with image guidance is coded with 10022. Instructional note directs coder to assign 19295 for placement of localization clip during a breast biopsy. Add radiology code 76942 for supervision and interpretation of ultrasound guidance for localization clip guidance. See instructional notes following code 10022 (AMA 2012b, 59). 72. Identify the ICD-9-CM code for diaper rash, elderly patient. a. 690.10 2 d. 49450 - Answer Correct Answer: D Code 49450 includes replacement of gastrostomy or cecostomy tube, percutaneous, under fluoroscopic guidance including contrast injections(s), image documentation, and report. Therefore, it would not be appropriate to add code 76000 for fluoroscopic guidance, which is already included in the procedure code (AMA 2012b, 258). 78. A family practitioner requests the opinion of a physician specialist in endocrinology who reviews the patient's health record and examines the patient. The physician specialist records findings, impressions, and recommendations in which type of report? a. Consultation b. Medical history c. Physical examination d. Progress notes - Answer Correct Answer: A The consultation report documents the clinical opinion of a physician other than the primary or attending physician. The report is based on the consulting physician's examination of the patient and a review of his or her health record (Johns 2011, 78). 79. Which of the following is (are) the correct ICD-9-CM code(s) for thoracoscopic lobectomy of left lung? a. 32.30 b. 32.41 c. 32.49 d. 34.02, 32.41 - Answer Correct Answer: B Index Lobectomy, lung, segmental (with resection of adjacent lobes), thoracoscopic. Segmental includes the complete excision of a lobe of the lung (Schraffenberger 2012, 227-228). 80. An individual designated as an inpatient coder may have access to an electronic medical record to code the record. Under what access security mechanism is the coder allowed access to the system? a. Role-based 2 b. User-based c. Context-based d. Situation-based - Answer Correct Answer: A Role-based access control (RBAC) is a control system in which access decisions are based on the roles of individual users as part of an organization (Brodnik et al. 2009, 211). 81. Which part of the problem-oriented medical record is used by many facilities that have not adopted the whole problem-oriented format? a. Problem list as an index b. Initial plan c. SOAP form of progress notes d. Database - Answer Correct Answer: C The Subjective, Objective, Assessment, Plan (SOAP) notes are part of the problem- oriented medical records (POMR) approach most commonly used by physicians and other healthcare professionals. SOAP notes are intended to improve the quality and continuity of client services by enhancing communication among healthcare professionals (Odom-Wesley et al. 2009, 217). 82. Which of the following software applications would be used to aid in the coding function in a physician ' s office? a. Grouper b. Encoder c. Pricer d. Diagnosis calculator - Answer Correct Answer: B An encoder is a computer software program designed to assist coders in assigning appropriate clinical codes and helps ensure accurate reporting of diagnoses and procedures (LaTour and Eichenwald Maki 2010, 318-319). 83. Which of the following fails to meet the CMS classification of a hospital- acquired condition? 2 a. Stage I pressure ulcers b. Falls and trauma c. Catheter-associated infection d. Vascular catheter-associated infection - Answer Correct Answer: A Stage I and II pressure ulcers are not considered hospital-acquired conditions but stage III and IV are (Johns 2011, 326). 84. HIM coding professionals and the organizations that employ them have the responsibility to not tolerate behavior that adversely affects data quality. Which of the following is an example of behavior that should not be tolerated? a.Assign codes to an incomplete record with organizational policies in place to ensure codes are reviewed after the records are complete. b. Follow-up on and monitor identified problems. c. Evaluate and trend diagnoses and procedure code selections. d. Report data quality review results to organizational leadership, compliance staff, and the medical staff. - Answer Correct Answer: A The coder is not following established policies (Johns 2011, 265-267). 85. Which classification system is in place to reimburse home health agencies? a. MS-DRGs b. RUGs c. HHRGs d.APCs - Answer Correct Answer: C Home health resource groups (HHRGs) represent the classification system established for the prospective reimbursement of covered home care services to Medicare beneficiaries during a 60-day episode of care (Johns 2011, 334). 86. Identify CPT code(s) for the following patient. A 35-year-old female undergoes an excision of a 3.0-cm tumor of her forehead. An incision is made through the skin and subcutaneous tissue. The tumor is dissected free of surrounding structures. The wound is closed in layers with 2 d. 37.83, 37.72 - Answer Correct Answer: D ICD-9-CM classifies cardiac pacemakers to code 37.8: Insertion, replacement, removal, and revision of pacemaker device. In coding initial insertion of a permanent pacemaker, two codes are required—one for the pacemaker (37.80-37.83) and one for the lead (37.70-37.74) (Schraffenberger 2012, 204-205). 89. Several key principles require appropriate physician documentation to secure payment from the insurer. Which answer (listed here) fails to impact payment based on physician responsibility? a. The health record should be complete and legible. b.The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. c. Documenting the charges and services on the itemized bill. d.The patient's progress and response to treatment and any revision in the treatment plan and diagnoses should be documented. - Answer Correct Answer: C The documentation of the charges and itemized bill is not the responsibility of the physician (Smith 2012, 7-8). 90. The technology commonly used for automated claims processing (sending bills directly to third-party payers) is: a. Optical character recognition b. Bar coding c. Neural networks d. Electronic data interchange - Answer Correct Answer: D EDI allows the transfer (incoming and outgoing) of information directly from one computer to another by using flexible, standard formats (Johns 2011, 348). 91. Two patients were hospitalized with bacterial pneumonia. One patient was hospitalized for three days and the other patient was hospitalized for 30 days. Both cases result in the same DRG with different lengths of stay. Which answer most closely describes how the hospital will be reimbursed? 2 a. The hospital will receive the same DRG for both patients but additional reimbursement will be allowed for the patient who stayed 30 days because the length of stay was greater than the geometric length of stay for this DRG. b.The hospital will receive the same reimbursement for the same DRG regardless of the length of stay. c. The hospital can appeal the payment for the patient who was in the hospital for 30 days because the cost of care was significantly higher than the average length of stay for the DRG payment. d.The hospital will receive a day outlier for the patient who was hospitalized for 30 days. - Answer Correct Answer: B The hospital will receive the same reimbursement regardless of the length of stay (Casto and Layman 2011, 12). 92. This is a statement sent by third-party payers to the patient to explain services provided, amounts billed, and payments made by the health plan. a. Coordination of benefits (COB) b. Explanation of benefits (EOB) c. Medicare summary notice (MSN) d. Remittance advice (RA) - Answer Correct Answer: B An EOB is a statement sent by a third-party payer to the patient to explain the services provided (Johns 2011, 343). 93. Identify the ICD-9-CM code(s) for infected ingrown nail. a. 703.0 b. 703.8, 681.11 c. 681.11 d. 681.9 - Answer Correct Answer: A Index Ingrowing, nail (finger) (toe) (infected) (Schraffenberger 2012, 295). 94. The patient had a total abdominal hysterectomy with bilateral salpingo- oophorectomy. The coder assigned the following codes: 2 58150, Total abdominal hysterectomy, with/without removal of tubes and ovaries 58700, Salpingectomy, complete or partial, unilateral/bilateral (separate procedure) What error has the coder made by using these codes? a. Maximizing b. Upcoding c. Unbundling d. Optimizing - Answer Correct Answer: C Unbundling is the practice of coding services separately that should be coded together as a package because all parts are included within one code and, therefore, one price. Unbundling, done deliberately, could be considered fraud (Kuehn 2012, 347). 95. Bob Smith was admitted to Mercy Hospital on June 21. The physical was completed on June 23. According to Joint Commission standards, which statement applies to this situation? a. The record is not in compliance because the physical examination must be completed within 24 hours of admission. b.The record is not in compliance because the physical examination must be completed within 48 hours of admission. c. The record is in compliance because the physical examination must be completed within 48 hours. d.The record is in compliance because the physical examination was completed within 72 hours of admission. - Answer Correct Answer: A According to the Joint Commission, the physical examination must be completed within 24 hours of admission (Odom-Wesley et al. 2009, 353). 96. The Medicare Modernization Act of 2003 (MMA) launched a Medicare payment and recovery demonstration project that would later develop into recovery audit contractors (RACs) serving as a means to ensure correct payments under Medicare. During the demonstration program, the contractors were able to identify of dollars in improper payments. a. Hundreds 2 2. Identify the correct ICD-9-CM diagnosis code(s) for a patient with near- syncope event and nausea. a. 780.2 b. 780.2, 787.02 c. 780.2, 787.01 d. 780.4, 787.02 - Answer Correct Answer: B Near-syncope and nausea are both signs and symptoms and therefore not integral to the other. Both conditions should be coded (Hazelwood and Venable 2012, 71). 3. The codes in the musculoskeletal section of CPT may be used by: a. Orthopedic surgeons only b. Orthopedic surgeons and emergency department physicians c.Any physician d. Orthopedic surgeons and neurosurgeons - Answer Correct Answer: C Any physician may use the codes in any section of CPT (AHIMA 2012a, 587). 4. In an EHR, what is the risk of copying and pasting? a. Reduction in the time required to document b.The system not recording who entered the data c. Quicker overall system response time d. System thinking that the original documenter recorded the note - Answer Correct Answer: B The system not recording who entered the data (Johns 2011, 433). 5. Mr. Smith is seen in his primary care physician's office for his annual physical examination. He has a digital rectal examination and is given three small cards to take home and return with fecal samples to screen for colorectal cancer. Assign the appropriate CPT code to report this occult blood sampling. 2 a. 82270 b. 82271 c. 82272 d. 82274 - Answer Correct Answer: A CPT code 82270 describes a test for occult blood using feces source for the purpose of neoplasm screening with the use of three cards or single triple card for consecutive collection (AMA 2012b, 417). 6. Identify the punctuation mark that is used to supplement words or explanatory information that may or may not be present in the statement of a diagnosis or procedure in ICD-9-CM coding. The punctuation does not affect the code number assigned to the case. The punctuation is considered a nonessential modifier, and all three volumes of ICD-9-CM use them. a. Parentheses ( ) b. Square brackets [ ] c. Slanted brackets [ ] d. Braces { } - Answer Correct Answer: A Parentheses enclose supplementary words or explanatory information that may or may not be present in the statement of a diagnosis or procedure. They do not affect the code number assigned in the case. Terms in parentheses are considered nonessential modifiers, and all three volumes of ICD-9-CM use them. Bronchiectasis (fusiform) (postinfectious) (recurrent) is an example of a diagnosis statement with nonessential modifiers noted with parentheses (Schraffenberger 2012, 26-28). 7. Documentation regarding a patient's marital status; dietary, sleep, and exercise patterns; and use of coffee, tobacco, alcohol, and other drugs may be found in the: a. Physical examination record b. History record c. Operative report d. Radiological report - Answer Correct Answer: B 2 A complete medical history documents the patient's current complaints and symptoms and lists his or her past medical, personal, and family history (Johns 2011, 63). 8. If an orthopedic surgeon attempted to reduce a fracture but was unsuccessful in obtaining acceptable alignment, what type of code should be assigned for the procedure? a.A "with manipulation" code b.A "without manipulation" code c.An unlisted procedure code d.An E/M code only - Answer Correct Answer: A The "with manipulation" code is used because the fracture was manipulated, even if the manipulation did not result in clinical anatomic alignment. See Musculoskeletal Guidelines, Definitions (AHIMA 2012a, 597). 9. What is the maximum number of diagnosis codes that can appear on the UB-04 paper claim form locator 67 for a hospital inpatient principal and secondary diagnoses? a. 35 b. 25 c. 18 d. 9 - Answer Correct Answer: B As of January 1, 2011, CMS allows a total of 25 ICD-9-CM diagnosis codes (one principal and 24 additional diagnoses) for 837 Institutional claims filing (Schraffenberger 2012, 66). 10. What type of standard establishes methods for creating unique designations for individual patients, healthcare professionals, healthcare provider organizations, and healthcare vendors and suppliers? a. Vocabulary standard b. Identifier standard c. Structure and content standard 2 Tissue transplanted from one individual to another of the same species but different genotype is called an allograft or allogeneic graft (AHIMA 2012a, 592-593). 17. Where would a coder who needed to locate the histology of a tissue sample most likely find this information? a. Pathology report b. Progress notes c. Nurse's notes d. Operative report - Answer Correct Answer: A Histology refers to the tissue type of a lesion. The histology of tissue is determined by a pathologist and documented in the pathology report (Johns 2011, 77). 18. A patient with known COPD and hypertension under treatment was admitted to the hospital with symptoms of a lower abdominal pain. He undergoes a laparoscopic appendectomy and develops a fever. The patient was subsequently discharged from the hospital with a principal diagnosis of acute appendicitis and secondary diagnoses of postoperative infection, COPD, and hypertension. Which of the following diagnoses should not be tagged as POA? a. Postoperative infection b.Appendicitis c. COPD d. Hypertension - Answer **Correct Answer: A Present on admission is defined as present at the time the order for inpatient admission occurs (CMS 2011c, 97). 19. A hospital needs to know how much Medicare paid on a claim so they can bill the secondary insurance. What should the hospital refer to? a. Explanation of benefits b. Medicare Summary Notice c. Remittance advice d. Coordination of benefits - Answer Correct Answer: C 2 Remittance advice (RA) is sent to the provider to explain payments made by third- party payers (Johns 2011, 346). 20. Which of the following would be the best technique to ensure that registration clerks consistently use the correct notation for assigning admission date in an electronic health record (EHR)? a. Make admission date a required field b. Provide an input mask for entering data in the field c. Make admission date a numeric field d. Provide sufficient space for input of data - Answer Correct Answer: B When several people enter data in an EHR, you can define how users must enter data in specific fields to help maintain consistency. For example, an input mask for a form means that users can only enter the date in a specified format (MacDonald 2007, chapter 4). 21. Which of the following threatens the "need-to-know" principle? a. Backdating progress notes b. Blanket authorization c. HIPAA regulations d. Surgical consent - Answer Correct Answer: B A blanket authorization is a common ethical problem when misused. Patients often sign a blanket authorization, which authorizes the release of information from that point forward, without understanding the implications. The problem is the patient is not aware of what information is being accessed (Johns 2011, 778-779). 22. A fee schedule is: a. Developed by third-party payers and includes a list of healthcare services, procedures, and charges associated with each b. Developed by providers and includes a list of healthcare services provided to a patient 2 c. Developed by third-party payers and includes a list of healthcare services provided to a patient d. Developed by providers and lists charge codes - Answer Correct Answer: A A fee schedule is a list of healthcare services and procedures and charges associated with each (Johns 2011, 350). 23. Identify the correct ICD-9-CM diagnosis code for a male patient with stress urinary incontinence. a. 625.6 b. 788.30 c. 788.32 d. 788.39 - Answer Correct Answer: C Index Incontinence, stress, male, NEC 788.32. Category 788.3x indicates incontinence of urine with the fifth digit specific to different types such as urge, stress, mixed, and others (Hazelwood and Venable 2012, 73). 24. Identify the correct ICD-9-CM diagnosis codes and sequence for a patient who was admitted to the outpatient chemotherapy floor for acute lymphocytic leukemia. During the procedure, the patient developed severe nausea with vomiting and was treated with medications. a. 204.00, 787.01, V58.11 b. V58.11, 204.00, 787.01 c. V58.11, 204.00 d. 204.22, 787.01 - Answer Correct Answer: B When a patient is admitted for the purpose of radiotherapy, chemotherapy, or immunotherapy and develops a complication, such as uncontrolled nausea and vomiting or dehydration, the principal diagnosis is the admission for radiotherapy (V58.0), the admission for the antineoplastic chemotherapy (V58.11), or the admission for the antineoplastic immunotherapy (V58.12). Additional codes would include the cancer and the complication(s) (Hazelwood and Venable 2012, 103). 25. Category II codes cover all but one of the following topics. Which is not addressed by Category II codes? 2 Budget neutrality must be maintained annually when the RVUs are adjusted (Casto and Layman 2011, 156). 31. CPT was developed and is maintained by: a. CMS b.AMA c. Cooperating parties d. WHO - Answer Correct Answer: B The AMA developed and maintains CPT. CMS developed and maintains HCPCS Level II codes (AHIMA 2012a, 586). 32. Identify the correct ICD-9-CM diagnosis code for a patient with an elevated prostate specific antigen (PSA) test result. a. 796.4 b. 790.6 c. 792.9 d. 790.93 - Answer Correct Answer: D Review Tabular List: Findings, abnormal, without diagnosis, prostate specific antigen (PSA), 790.93, or Elevation, prostate specific antigen (PSA), 790.93 (Hazelwood and Venable 2012, 69). 33. Identify the correct ICD-9-CM diagnosis code(s) and proper sequencing for urinary tract infection due to E. coli. a. 599.0 b. 599.0, 041.49 c. 041.49 d. 041.49, 599.0 - Answer Correct Answer: B Connecting words or connecting terms are subterms that indicate a relationship between the main term and an associated condition or etiology in the Alphabetic Index. The connecting term "due to" connects the organism E. coli to the urinary tract 2 infection. The instructional note "Use additional code" is found in the Tabular List of ICD-9-CM. This notation indicates that use of an additional code may provide a more complete picture of the diagnosis or procedure. The additional code should always be assigned if the health record provides supportive documentation. Infection, urinary (tract) Tabular List —use additional code to identify organism. Infection, Escherichia coli (Schraffenberger 2012, 22-23, 79). 34. What is it called when a Medicare hospital inpatient admission results in exceptionally high costs when compared to other cases in the same DRG? a. Rate increase b. Charge outlier c. Cost outlier d. Day outlier - Answer Correct Answer: C To qualify for a cost outlier, a hospital's charges for a case (adjusted to cost) must exceed the payment rate for the MS-DRG by a specific threshold amount determined by CMS for each fiscal year (Johns 2011, 374). 35. Health insurance for spouses, children, or both is known as: a. Dependent (family) coverage b. Individual (single) coverage c. Group coverage d. Inclusive coverage - Answer Correct Answer: A Health insurance for spouses, children, or both is known as dependent (family) coverage (Casto and Layman 2011, 5). 36. In a routine health record quantitative analysis review, it was found that a physician dictated a discharge summary on 1/26/20XX. The patient, however, was discharged two days later. In this case, what would be the best course of action? a. Request that the physician dictate another discharge summary. b. Have the record analyst note the date discrepancy. c. Request the physician dictate an addendum to the discharge summary. 2 d. File the record as complete because the discharge summary includes all of the pertinent patient information. - Answer Correct Answer: C An addendum may be included in the medical record to update or supplement documentation that has been recorded (AHIMA 2008b, 83-88). 37. Observation E/M codes (99218-99220) are used in physician billing when: a.A patient is admitted and discharged on the same date. b.A patient is admitted for routine nursing care following surgery. c.A patient does not meet admission criteria. d.A patient is referred to a designated observation status. - Answer Correct Answer: D See instructional notes preceding code 99217. In order to report these codes, the admission order must designate observation status. Whether the patient meets admission criteria or is admitted following surgery does not affect the observation code selection. If the patient is admitted and discharged on the same date, codes 99234-99236 are appropriate (AMA 2012b, 13). 38. When coding a selective catheterization in CPT, how are codes assigned? a. One code for each vessel entered b. One code for the point of entry vessel c. One code for the final vessel entered d. One code for the vessel of entry and one for the final vessel, with intervening vessels not coded - Answer Correct Answer: C The only vessel coded is the final vessel entered. See instructional note preceding code 36000. Intermediate steps along the way are not reported (AHIMA 2012a, 604). 39. The Privacy Rule establishes that a patient has the right of access to inspect and obtain a copy of his or her PHI: a. For as long as it is maintained b. For six years c. Forever 2 The physician principally responsible for the patient's hospital care writes and signs the discharge summary (Odom-Wesley et al. 2009, 200). 46. Under the HIPAA privacy standard, which of the following types of protected health information (PHI) must be specifically identified in an authorization? a. History and physical reports b. Operative reports c. Consultation reports d. Psychotherapy notes - Answer Correct Answer: D The distinction of psychotherapy notes is important due to HIPAA requirements that these notes may not be released unless specifically specified in an authorization (Odom-Wesley et al. 2009, 440). 47. In hospitals, automated systems for registering patients and tracking their encounters are commonly known as systems. a. MIS b. CDS c.ADT d.ABC - Answer Correct Answer: C Automated systems for registering patients and tracking their encounters are commonly known as admission-discharge-transfer (ADT) systems (Johns 2011, 947). 48. Community Hospital implemented a clinical document improvement (CDI) program six months ago. The goal of the program was to improve clinical documentation to support quality of care, data quality, and HIM coding accuracy. Which of the following would be best to ensure that everyone understands the importance of this program? a. Request that the CEO write a memorandum to all hospital staff. b. Give the chairperson of the CDI committee authority to fire employees who don't improve their clinical documentation. c. Include ancillary clinical and medical staff in the process. 2 d. Request a letter from the Joint Commission. - Answer Correct Answer: C Staff participation in the process of developing and implementing a program will contribute to the staff understanding of the importance of the program (Russo 2010, chapter 6). 49. Statements that define the performance expectations and/or structures or processes that must be in place are: a. Rules b. Policies c. Guidelines d. Standards - Answer Correct Answer: D Standards are fixed rules that must be followed, which is different from a guideline that provides general direction (Johns 2011, 416). 50. What was the goal of the MS-DRG system? a. To improve Medicare's capability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to sicker patients and decrease payments for treating less severely ill patients. b.To improve Medicare's capability to recognize poor quality of care and pay hospitals on an incentive grid that allows hospitals to be paid by performance. c. To improve Medicare's capability to recognize groups of data by patient populations, which will further allow Medicare to adjust the hospitals wage indexes based on the data. This adjustment will be a system to pay hospitals fairly across all geographic locations. d.To improve Medicare's capability to recognize practice patterns among hospitals that are inappropriately optimizing payments by keeping patients in the hospital longer than the median length of stay. - Answer **Correct Answer: A For fiscal year 2008, Medicare adopted a severity-adjusted diagnosis- related groups system called Medicare Severity-DRGs (MS-DRGs). This was the most drastic revision to the DRG system in 24 years. The goal of the new MS-DRG system was to significantly improve Medicare's ability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to the sicker patients and decrease payments for treating less severely ill patients (Schraffenberger 2012, 471-473). 2 51. A hospital is planning on allowing coding professionals to work at home. The hospital is in the process of identifying strategies to minimize the security risks associated with this practice. Which of the following would be best to ensure that data breaches are minimized when the home computer is unattended? a. User name and password b.Automatic session terminations c. Cable locks d. Encryption - Answer Correct Answer: B Automatic session termination will help to control access to the computer when unattended by automatically ending the session when not in use, preventing unauthorized access (HHS 2006a). 52. What healthcare organizations collect UHDDS data? a.All outpatient settings including physician clinics and ambulatory surgical centers b.All outpatient settings including cancer centers, independent testing facilities, and nursing homes c.All non-outpatient settings including acute-care, short-term care, long- term care, and psychiatric hospitals; home health agencies; rehabilitation facilities; and nursing homes d.All inpatient settings and outpatient settings with a focus on ambulatory surgical centers - Answer Correct Answer: C The Uniform Hospital Discharge Data Set was promulgated by the US Department of Health, Education, and Welfare in 1974 as a minimum, common core of data on individual acute-care, short-term hospital discharges in Medicare and Medicaid programs. It sought to improve the uniformity and comparability of hospital discharge data. In 1985, the data was expanded to include all nonoutpatient settings (Schraffenberger 2012, 63-65). 53. What should a hospital do when a state law requires more stringent privacy protection than the federal HIPAA privacy standard? a. Ignore the state law and follow the HIPAA standard b. Follow the state law and ignore the HIPAA standard 2 continuity and clarity in documentation (AHIMA 2005). 2 59. Identify the correct ICD-9-CM diagnosis code(s) for a patient with pneumonia and persistent cough. a. 786.2, 490 b. 486, 786.2 c. 486 d. 481 - Answer Correct Answer: C Pneumonia, unspecified, is assigned 486 in the Alphabetic Index. Cough is integral to pneumonia and should not be coded separately (Hazelwood and Venable 2012, 68-73). 60. Per CPT guidelines, a separate procedure is: a. Coded when it is performed as part of another, larger procedure b. Considered to be an integral part of another, larger service c. Never coded under any circumstance d. Both a and b - Answer Correct Answer: B Because a separate procedure is considered a part of, and integral to, another, larger procedure, it is not coded when performed as part of the more extensive procedure. See Surgery Guidelines. It may, however, be coded when it is not performed as part of another, larger service; therefore, answer "c" is not correct (AHIMA 2012a, 586). 61. The uses expert or artificial intelligence software to automatically assign code numbers. a. Functional EHR b. NHIN c. NLP encoding system d. Grouper - Answer Correct Answer: C Natural-language processing (NLP) uses artificial intelligence software to allow digital text from online documents stored in the organization's information system to 2 be read directly by the software, which then suggests codes to match the documentation (Johns 2011, 170). 62. Identify the acute-care record report where the following information would be found: Gross Description: Received fresh designated left lacrimal gland is a single, unoriented, irregular, tan-pink portion of soft tissue measuring 0.8 × 0.6 × 0.1 cm, which is submitted entirely intact in one cassette. a. Medical history b. Medical laboratory report c. Pathology report d. Physical examination - Answer Correct Answer: C A pathology report usually includes descriptions of the tissue from a gross or macroscopic level and representative cells at the microscopic level along with interpretive findings (Johns 2011, 77). 63. If a provider believes a service may be denied by Medicare because it could be considered unnecessary, the provider must notify the patient before the treatment begins by using a(n): a.Advance beneficiary notice (ABN) b.Advance notice of coverage (ANC) c. Notice of payment (NOP) d. Consent for payment (CFP) - Answer Correct Answer: A An advance beneficiary notice (ABN) must be given to the patient to sign prior to treatment if any indication presents that may cause the service to be denied by Medicare (Johns 2011, 350). 64. Identify the acute-care record report where the following information would be found: The patient is a well-developed, obese male who does not appear to be in any distress, but has considerable problem with mobility. He has difficulty rising up from a chair, and he uses a cane to ambulate. VITAL SIGNS: His blood pressure today is 158/86, pulse is 80 per minute, weight is 204 pounds (which is 13 pounds below what he weighed in April). He has no pallor. He has rather pronounced shaking of his arms, which he claims is not new. NECK: Showed no jugular venous distension. HEART: Very irregular. LUNGS: Clear. EXTREMITIES: Edema of both legs. 2 c. State licensure agencies d. Conditions of participation agencies - Answer Correct Answer: C State licensure agencies have regulations that are modeled after the Medicare Conditions of Participation and Joint Commission standards. States conduct annual surveys to determine the hospital's continued compliance with licensure standards (Odom-Wesley et al. 2009, 287). 71. An HIT using her password can access and change data in the hospital's master patient index. A billing clerk, using his password, cannot perform the same function. Limiting the class of information and functions that can be performed by these two employees is managed by: a. Network controls b.Audit trails c.Administrative controls d.Access controls - Answer Correct Answer: D Access control means being able to identify which employees should have access to what data (Johns 2011, 992). 72. Identify the correct ICD-9-CM diagnosis codes for metastatic carcinoma of the colon to the lung. a. 153.9, 162.9 b. 197.0, 153.9 c. 153.9, 197.0 d. 153.9, 239.1 - Answer Correct Answer: C The terms metastatic to and direct extension to are used for classifying secondary malignant neoplasms in ICD-9-CM. For example, cancer described as "metastatic to a specific site" is interpreted as a secondary neoplasm of that site. The colon (153.9) is the primary site, and the lung (197.0) is the secondary site (Hazelwood and Venable 2012, 109). 73. Which organization developed the first hospital standardization program? 2 a. Joint Commission b.American Osteopathic Association c.American College of Surgeons d.American Association of Medical Colleges - Answer Correct Answer: C The American College of Surgeons started its Hospital Standardization Program in 1918 (Johns 2011, 679). 74. Identify the correct ICD-9-CM diagnosis code(s) for a patient with nausea, vomiting, and gastroenteritis. a. 558.9 b. 787.01, 558.9 c. 787.02, 787.03, 558.9 d. 787.01, 558.41 - Answer Correct Answer: A Conditions that are integral to the disease process should not be assigned as additional codes. The nausea and vomiting are integral to the disease, gastroenteritis (Hazelwood and Venable 2012, 68). 75. Which of the following is NOT an accepted accrediting body for behavioral healthcare organizations? a.American Psychological Association b. Joint Commission c. Commission on Accreditation of Rehabilitation Facilities d. National Committee for Quality Assurance - Answer Correct Answer: A The Joint Commission, Commission on Accreditation of Rehabilitation Facilities, and the National Committee for Quality Assurance are all acceptable accrediting bodies for behavioral healthcare settings (Odom- Wesley et al. 2009, 447). 76. Identify the correct ICD-9-CM diagnosis code(s) for a patient with right lower quadrant abdominal pain with nausea, vomiting, and diarrhea. a. 789.03 2 b. 789.03, 787.02, 787.03, 787.91 c. 789.03, 787.91 d. 789.03, 787.01, 787.91 - Answer Correct Answer: D Abdominal pain includes fifth digits to identify the specific parts of the abdomen affected. Nausea and vomiting is a category common to stomach upset. The fifth digits provide specificity. Nausea and vomiting are coded together with a combination code when both exist. Diarrhea usually is a symptom of some other disorder or of a more severe disease, in which case it should not be coded separately. It is often accompanied by vomiting and various other symptoms that should be coded when present. Because, in this case, a distinct disease is not available, all the symptoms should be coded (Hazelwood and Venable 2012, 73). 77. Identify the correct CPT procedure code for incision and drainage of infected shoulder bursa. a. 10060 b. 10140 c. 23030 d. 23031 - Answer Correct Answer: D Index Incision and drainage, shoulder, bursa, resulting in code 23031 (AHIMA 2012a, 598). 78. How does Medicare or other third-party payers determine whether the patient has medical necessity for the tests, procedures, or treatment billed on a claim form? a. By requesting the medical record for each service provided b. By reviewing all the diagnosis codes assigned to explain the reasons the services were provided c. By reviewing all physician orders d. By reviewing the discharge summary and history and physical for the patient over the last year - Answer Correct Answer: B Diagnosis codes are often the primary reason for a service to be considered covered or denied by the insurance company. Local and national policies include diagnosis codes that are used in software edits to automatically deny or approve processed 2 Which of the following would not be found in a medical history? a. Chief complaint b. Vital signs c. Present illness d. Review of systems - Answer Correct Answer: B Medical history documents the patient's current complaints and symptoms and lists the patient's past medical, personal, and family history. The physical examination report represents the attending physician's assessment of the patient's current health status (Johns 2011, 63). 86. When correcting erroneous information in a health record, which of the following is NOT appropriate? a. Print "error" above the entry b. Enter the correction in chronological sequence c.Add the reason for the change d. Use black pen to obliterate the entry - Answer Correct Answer: D In a paper-based health record environment, corrections to health record entries are corrected by drawing a single line through the original entry, writing "error" above the entry, and then the practitioner signs, dates, and times the correction (Johns 2011, 413). 87. What is the maximum number of procedure codes that can appear on a UB-04 institutional claim form via electronic transmission? a. 6 b. 9 c. 15 d. 25 - Answer Correct Answer: D Effective January 1, 2011, CMS allows a total of 25 ICD-9-CM procedure codes for 837 Institutional claims filing (Schraffenberger 2012, 66). 88. 2 What are possible "add-on" payments that a hospital could receive in addition to the basic Medicare DRG payment? a.Additional payments may be made for locum tenens, increased emergency room services, stays over the average length of stay, and cost outlier cases. b.Additional payments may be made to critical access hospitals, for higher-than- normal volumes, unexpected hospital emergencies, and cost outlier cases. c.Additional payments may be made for increased emergency room services, critical access hospitals, increased labor costs, and cost outlier cases. d.Additional payments may be made to disproportionate share hospitals for indirect medical education, new technologies, and cost outlier cases. - Answer Correct Answer: D Medicare provides for additional payment for other factors related to a particular hospital's business. If the hospital treats a high percentage of low-income patients, it receives a percentage add-on payment applied to the MS-DRG adjusted base payment rate. This add-on payment, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payments to hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve these areas. Hospitals that have approved teaching hospitals also receive a percentage add-on payment for each Medicare discharged paid under IPPS, known as the indirect medical education (IME) adjustment. The percentage varies, depending on the ratio of residents to beds. Additional payments are made for new technologies or medical services that have been approved for special add-on payments. Finally, the costs incurred by a hospital for a Medicare beneficiary are evaluated to determine whether the hospital is eligible for an additional payment as an outlier case. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases (Schraffenberger 2012, 471-473). 89. What is the name of the national program to detect and correct improper payments in the Medicare Fee-for-Service (FFS) program? a. Medicare administrative contractors (MACs) b. Recovery audit contractors (RACs) c. Comprehensive error rate testing (CERT) d. Fiscal intermediaries (FIs) - Answer Correct Answer: B Congress directed HHS to conduct a three-year demonstration project using RACs to detect and correct improper payments in the Medicare 2 traditional fee-for-service program. Congress further required HHS to make the RAC program permanent and nationwide by January 1, 2010 (Schraffenberger 2012, 475). 2 c. Conduct a verification audit. d.Alert hospital legal counsel of the practice. - Answer Correct Answer: B Documentation policies are used to define the acceptable practices that should be followed by all applicable staff to ensure consistency, continuity, and clarity in documentation (AHIMA 2005). 96. What is a chargemaster? a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage of eligible expenses after the deductible has been met b.A plan that converts the organization's goals and objectives into targets for revenue and spending c.A financial management form that contains information about the organization's charges for the healthcare services it provides to patients d. Charged amounts that are billed as costs by an organization to the current year's activities of operation - Answer Correct Answer: C A chargemaster is a financial management form that contains information about the organization's charges for the healthcare services it provides to patients. Answer "a" is coinsurance. Answer "b" is budget. Answer "d" is expense (Johns 2011, 1116). 97. Identify the correct sequence and ICD-9-CM diagnosis code(s) for a patient with dysphasia secondary to old cerebrovascular accident sustained one year ago. a. 787.20, 438.12 b. 784.59, 438.12 c. 438.12 d. 787.20, 438.89 - Answer Correct Answer: C The residual condition or nature of the late effect is sequenced first, followed by the cause of the late effect. Late effect exceptions occur when the late effect code has been expanded at the fourth- and fifth-digit level to include the manifestations. In this case, only one code is necessary to describe both the residual condition and cause of the late effect (Hazelwood and Venable 2012, 62). 98. 2 HIPAA regulations: 2 a. Never preempt state statutes b.Always preempt state statutes c. Preempt less-strict state statutes where they exist d. Preempt stricter state statutes where they exist - Answer **Correct Answer: C HIPAA regulations preempt less strict state statutes where they exist (Johns 2011, 820). 99. An employee in the physical therapy department arrives early every morning to snoop through the clinical information system for potential information about neighbors and friends. What security mechanisms should be implemented to prevent this security breach? a.Audit controls b. Information access controls c. Facility access controls d. Workstation security - Answer Correct Answer: B An EHR can be viewed by multiple users and from multiple locations at any time, and organizations must have in place appropriate security access control measures to ensure the safety of the data (Johns 2011, 435). 100. The is a type of coding that is a natural outgrowth of the EHR. a.Automated codebook b. Computer-assisted coding c. Logic based encoder d. Decision support database - Answer Correct Answer: B Computer-assisted coding is defined as the use of computer software that automatically generates a set of medical codes for review, validation, and use based on the documentation from the various providers of healthcare (AHIMA 2010b, 62; LaTour and Eichenwald Maki 2010, 400). 1. The patient, a 47-year-old male with adenoma of the prostate, is being treated in the outpatient surgery suite. The urologist inserts an endoscope in the penile urethra and 2 should be included on the problem list? 2 a. Problem number, problem description, date problem entered b. Problem number, problem name, date of consent for treatment c. Patient identifying information, problem number, examination results d. Problem name, date of onset, physical exam - Answer Correct Answer: A The problem list describes any significant current and past illnesses and conditions as well as the procedures the patient has undergone (Johns 2011, 94). 7. Identify the CPT procedure code(s) for an automated CBC with automated differential. a. 85027 b. 85025 c. 85041 d. 85007, 85025 - Answer Correct Answer: B Index Blood Cell Count, hemogram, added indices, resulting in code range 85025- 85027. The codes for reporting CBCs (complete blood counts) are very specific and should be carefully reviewed. The appropriate code for a CBC with automated white blood cell differential is 85025 (AHIMA 2012a, 628). 8. Who is responsible for ensuring the quality of health record documentation? a. Board of directors b.Administrator c. Provider d. Health information management professional - Answer Correct Answer: C The provider is responsible for ensuring the quality of the documentation of the healthcare record (Brodnik et al. 2009, 128). 9. Identify the CPT procedure code(s) and correct modifier for a thyroid stimulating hormone (TSH) when medical necessity is not met and the patient signs a required waiver of liability signifying the patient will be responsible for payment if the test is 2 not covered by Medicare. Another name for waiver of liability is Advance Beneficiary Notice (ABN). a. 84443-GA b. 80418-GA c. 84443-GY d. 80418-GY - Answer Correct Answer: A Index Thyroid simulating hormone, 80418, 80438-80440, 84443. Code 84443 is the correct code for a TSH while the rest of the codes are panels including several tests. Modifier -GA is listed in the front cover of the CPT Professional Edition and signifies the patient was given a notice of non- coverage also known as waiver of liability or ABN (AMA 2012b, 427; CMS 2010d; CMS 2010e). 10. A Medicare Advantage Plan (like an HMO or PPO) is a health coverage option under what part of Medicare? a. Part A b. Part B c. Part C d. Part E - Answer Correct Answer: C Medicare Part C combines Medicare Part A and Medicare Part B coverage and is operated by private insurance companies that are approved by and under contract with Medicare to form Medicare Advantage Plans (Johns 2011, 293). 11. The use of computer software that automatically generates a set of medical codes for review, validation, and use based on clinical documentation provided by healthcare practitioners is the definition of: a. Natural language processing b. Voice recognition c. Computer-assisted coding d. Electronic health record - Answer Correct Answer: C Computer-assisted coding utilizes computer software to generate codes from the data provided (Sayles and Trawick 2010, 360). 2 b. Services that are components of a more comprehensive procedure c. Unnecessary procedures d. Comprehensive procedures - Answer Correct Answer: A The mutually exclusive edit applies to improbable or impossible combinations of codes (Johns 2011, 347). 18. A patient is scheduled for a colonoscopy, but due to sudden drop in blood pressure, the procedure is canceled just as the scope is introduced into the rectum. Because of moderately severe mental retardation, the patient is given a general anesthetic prior to the procedure. How should this procedure be coded by the hospital? a.Assign the code for a colonoscopy with modifier -74. b.Assign the code for a colonoscopy with modifier -52. c.Assign an anesthesia code only. d. Do not assign a code because no procedure was performed. - Answer Correct Answer: A Per CPT coding guidelines, when a planned procedure is terminated prior to completion for cause, the intended procedure is coded with a modifier. See instructions for use of modifiers in Appendix A. When a procedure is terminated after the induction of anesthesia, modifier -74 is appended to the intended procedure. See Medicare billing requirements for specific rules for canceled endoscopy procedures (AMA 2012b; AHIMA 2012a, 635). 19. In determining the data collection requirements for Medicare patients in a long-term care facility, the health information technician would consult standards from: a. CARF b. CMS c. The Joint Commission d. NCQA - Answer Correct Answer: B The CMS has Conditions of Participation that apply to healthcare organizations that participate in the Medicare program (Johns 2011, 98). 20. A quantitative review of the health record for missing reports and signatures that occurs when the patient is in the hospital is referred to as 2 a: 2 a. Prospective review b. Retrospective review c. Concurrent review d. Peer review - Answer Correct Answer: C Quantitative analysis can occur concurrently while the patient is in the hospital (Johns 2011, 410). 21. Where would information on treatment given on a particular encounter be found in the health record? a. Problem list b. Physician's orders c. Progress notes d. Physical examination - Answer Correct Answer: C Progress notes are chronological statements about the patient's response to treatment during his or her stay at the facility (Kuehn 2011, 10). 22. Identify the CPT procedure code(s) for a SPECT bone scan. a. 78710 b. 78803 c. 78607 d. 78320 - Answer Correct Answer: D Index Bone, nuclear medicine, SPECT, resulting in code 78320. The acronym SPECT stand for single photon emission computed tomography and is a more sophisticated form of CT scanning. Unlike basic x-ray CT scanning, SPECT involves injected radionuclides and is considered a form of nuclear medicine. It is being supplanted to some extent now by PET (positron emission tomography) scanning, which is capable of better resolution and sensitivity (AHIMA 2012a, 625). 23. 2 a. 50590 b. 52353 c. 43265 d. 28890 - Answer Correct Answer: A Index Lithotripsy, kidney, resulting in code 50590 or 52353. Review of the available codes indicates that code 50590 is correct because there is no mention of cystourethroscopy (AHIMA 2012a, 609). 29. Which is a feature of managed care? a. Control and reduce the costs of care b. Monitor the activity of physician supervision c. Provide incentive for prospective payment d.Allow the patient to choose several primary physicians - Answer Correct Answer: A The purpose of managed care is to control or reduce the costs of healthcare for which the third-party payer must reimburse the providers and to ensure continuing quality of care (Casto and Layman 2011, 9). 30. Which of the following is often cited as a reason to implement an electronic health record (EHR)? a. Improve patient safety b. High cost of EHR c. Staff time required to implement the EHR d. Simplicity of implementation changes to workflow - Answer Correct Answer: A The primary benefits of EHRs are quality and patient safety (Johns 2011, 173). 31. Who may sign an authorization for use and disclosure when the patient is a minor? a. The minor's parent or legal guardian b.The patient 2 c. The physician d.The social worker - Answer Correct Answer: A As a general rule, minors are legally incompetent and unable to make decisions regarding the use and disclosure of their own healthcare information. This authority belongs to the minor's parent(s) or legal guardians(s) unless an exception applies (Brodnik et al. 2009, 243). 32. A 75-year-old male patient was admitted for an acute exacerbation of chronic systolic congestive heart failure and severe mitral regurgitation and aortic stenosis. What would be the correct code assignment for this case? a. 428.23, 396.2 b. 428.23, 428.0, 396.2 c. 428.0, 394.1, 424.1 d. 391.8, 396.2 - Answer Correct Answer: B Code 428.23, 428.0 and 396.2 2 would be the correct codes with 428.23 serving as the principal diagnosis. Code 428.23 is described as systolic heart failure in acute and chronic conditions. The code for mitral valve insufficiency and aortic valve stenosis is a combination code of 396.2. Code 428.0 is not an inherent component of diastolic or systolic heart failure and must be coded separately (AHIMA 2012a, 651). 33. An audit of a hospital's electronic health system shows that diagnostic codes are not being reported at the correct level of detail. This indicates a problem with: a. Data granularity b. Data consistency c. Data comprehensiveness d. Data relevancy - Answer Correct Answer: A Data granularity requires that the attributes and values of data be defined at the correct level of detail for the intended use of the data (Johns 2011, 48). 34. A physician takes the medical records of a group of HIV-positive patients out of the hospital to complete research tasks at home. The physician mistakenly leaves the records in a restaurant, where they are read by a 2 newspaper reporter who publishes an article that identifies the patients. The physician can be sued for: 2 An HIM professional who releases health information that he or she knows will result in genetic discrimination is violating the ethical principle of: a.Autonomy b. Beneficence c. Justice d. Nonmaleficence - Answer Correct Answer: D Nonmaleficence means to do no harm. With regard to the patient and the healthcare team, the HIM professional is obligated to protect health, medical, genetic, social, personal, financial, and adoption information: Clinical information (genetic risk factors) must be protected as well as behavioral information. It is important to protect genetic and social information so that patients will not be vulnerable to the risks of discrimination (LaTour and Eichenwald Maki 2010, 311-312). 38. The present on admission (POA) indicator is a requirement for a. Inpatient Medicare claims submitted by acute care hospitals b. Inpatient Medicare and Medicaid claims submitted by hospitals c. Medicare claims submitted by all entities d. Inpatient skilled nursing facility Medicare claims - Answer Correct Answer: A The POA indicator applies to diagnosis codes for claims involving inpatient admission to acute-care hospitals or other facilities, as required by law or regulation for public health reporting (Schraffenberger 2012, 58; CMS 2011c, 97-102; Johns 2011, 325). 39. Which of the following software applications would be used to aid in the coding function in a physician's office? a. Grouper b. Encoder c. Pricer d. Diagnosis calculator - Answer Correct Answer: B 2 An encoder is a computer software program designed to assist coders assign appropriate clinical codes. An encoder helps ensure accurate reporting of diagnoses and procedures (LaTour and Eichenwald Maki 2010, 318-319). 40. An infusion that lasts less than 15 minutes would be reported with a(n): a. Intravenous infusion code b. Intravenous piggyback code c. Intravenous or intra-arterial push code d. Intravenous hydration code - Answer Correct Answer: C An infusion that lasts less than 15 minutes should be reported with an IV push code per the CPT coding guidelines of the CPT Professional Edition based on the instructional notes preceding the hydration notes (AMA 2012b, 518; AHIMA 2012a, 630). 41. Patient data collection requirements vary according to healthcare setting. One would expect a data element would be collected in the MDS, but would not be collected in the UHDDS. a. Personal identification b. Cognitive patterns c. Procedures and dates d. Principal diagnosis - Answer Correct Answer: B According to UHDDS requirements, answers a, c, and d represent items collected about inpatients. Only answer b represents a data item collected more typically in long-term care settings and required in the MDS (Johns 2011, 98). 42. Identify the CPT procedure code(s) and correct modifiers for a basic metabolic panel with ionized calcium and an additional test for carbon dioxide on the same day. Keep in mind that a carbon dioxide test is part of the basic metabolic panel. a. 80047 b. 80047, 82374 c. 80047, 82374-91 2 d. 80048, 82374-91 - Answer Correct Answer: C Index Organ or disease-oriented panel, metabolic, basic to reference codes 80047 and 80048. Code 80047 includes ionized calcium for the correct panel code. Index Carbon Dioxide, blood or urine to arrive at code 82374. Add modifier -91 to the carbon dioxide code to signify the test was performed twice on the same day and is separately reportable. Modifier - 91 represents a repeat clinical diagnostic laboratory test, and should be used for a repeat test even when the first test is part of a panel represented by a panel code (AMA 2012b, 402). 43. Identify the CPT procedure code(s) for laparoscopic Nissen fundoplication. a. 43279 b. 43280 c. 43327 d. 43289 - Answer Correct Answer: B Index Fundoplasty, esophagogastric, laparoscopic, resulting in code 43280. Indexing the main term Nissen operation results in this cross-reference: see fundoplasty, esophagogastric, laparoscopic, results in code 43280 (AHIMA 2012a, 608). 44. For coding and billing professionals, being compliant means to perform one's job functions according to the laws, regulations and guidelines with integrity as set forth by Medicare and other third-party payers. This is an example of:: a. Ethics b. Skills c. Behaviors d. Education - Answer Correct Answer: A, Following the AHIMA Standard of Ethical Coding, sets forth guidelines that all coding and billing professionals understand in ethical decision making (Casto and Layman 2011, 34). 45. Under local anesthesia and ultrasound guidance, a patient underwent radiofrequency ablation of an incompetent greater saphenous vein in the right lower extremity. Assign the appropriate CPT code(s). a. 36475-RT