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COC 2022 - FINAL EXAM QUESTIONS
W/O CODES (SET 2)
Destruction of lesions of the vulva can be donw with "cryosurgery". This method uses: - Extreme cold Differences between coding surgical and diagnostic procedures for the outpatient facility and the provider: - Answer: Modifiers and payment methodology are different for the outpatient facility and the provider Response Feedback: Rationale: In most cases, the codes selected for surgical procedures and diagnostic procedures are the same whether you are coding for the outpatient facility or the provider. Modifiers and payment methodology are different for the outpatient facility and for the provider. Discuss the purpose of "scout" films in the radiology setting. - Scout films may be performed prior to an actual imaging study with contrast or delayed imaging. Scout films are not coded separately as they are considered part of the basic procedure. Dislocation: - injury or disability caused when the normal position of a joint or other part of the body is disturbed. Documentation criteria require that the medical record should be _____________ and __________. - complete, legible Documentation standards are classified into the following categories: - Patient specific data and information; Additional standards for specific patient populations, for example, operative/invasive procedures, ambulatory care, emergency, clinical trials, etc. DRG assignment can be affected by up to how many procedures during a stay? - Twenty-five DRGs represent the average resources needed to treat Pts that fall in the same DRG. If a hosptial is able to treat a Pt for a condition at a cost that is less than the Medicare reimbursement amount, what happens to the excess money? - The hospital keeps the excess amount Each MS_DRG is assigned to a Major Diagnostic Category. How many categories are there? - Twenty Five Each page of the medical record should contain the patient's or. - name, patient ID number. Electrocautery - Instrument for directing electrical energy through tissue for lesion destruction
Electrodessication - The use of monopolar high frequency electrical current for lesion removal Examples of procedures considered "inpatient only" include: - Surgical thoracoscopy, laminectomies, vertebral corpectomy, enterostomies, risky invasive procedures Facial - Controls facial muscles around the eyes, forehead, external ear, and mouth; sensa-tion of taste; and certain salivary and lacrimal (tear) glands Field: - Geometric area defined by a collimator at the skin surface Food moves through the digestive tract by what means? - Peristalsis For Medicare how is each claim paid for outpatient facility reimbursement? - Each claim is paid based on the determined interim outpatient reimbursement rate. Rationale: During the year-end cost report settlement, the prior year's entire outpatient claims are analyzed via a computer system. This method is to determine an interim reimbursement rate on which to pay the following year's Medicare claims. For OPPS, critical care is paid at two levels. What is the distinguishing factor for payment? - One level for critical care services, another level when trauma activation occurs in addition to critical care For surgical procedures involving a primary surgeon and an assistant surgeon, who is the person responsible for the information in the procedural note? - Primary surgeon Rationale: For surgical procedures with more than one surgeon, the primary surgeon is responsible for the procedural note. A resident, intern, or assistant can dictate the note, but the primary surgeon must indicate agreement by reading and signing it. For the UB-04 Form, which provider type qualifier is used to report the rendering provider? - 82 Fractionation: - Division of total planned dose into number of smaller doses given over time Ganglion cyst: - are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid. Glossopharyngeal - Responsible for swallowing, secretion of saliva, sensations of the throat and taste sensations for the back of the tongue Hospitals are required to provide a list of standard charges on the internet and update the list at least annually. - True
ICD-10-PCS can easily be expanded without disrupting the ___________ of the system.
- Structure ICD-10-PCS code descriptions do not include __________ or common procedure names. - Eponyms ICD-10-PCS is composed of how many sections? - 17 ICD-10-PCS preserves the capacity to define _________, _________, and _________ procedures accurately using stable terminology in the form of characters and values. - past, present and future If a code change in the chargemaster increases or decreases revenue, the person responsible for the chargemaster should: - Refer the issue to the Finance/Accounting Department If a diabetic patient uses insulin, and the type of diabetes is not documented, what type of diabetes would be coded according to ICD-10- CM guidelines? - Type 2 If a patient is brought into the Emergency Department due to an accident at work to determine the specific drug and the quantity in the patient's system, is the test performed presumptive or definitive? - Definitive; identifies specific drugs and associated metabolites If a portion of a body part is removed (ie, lobe of lung) and PCS includes a value for the specific body part (lobe of lung) for the anatomic subdivision, the root operation and body part value should identify, what? - Resection, anatomical subdivision If a procedure is discontinued before completion (and prior to any other root operation being performed) report the code for: - Root operation performed or inspection of the body part of anatomical region inspected If a woman has a pap smear performed by her gynecologist, what part of the female anatomy is involved? - Cervix If an ST elevation myocardial infarction converts to a non-ST elevation myocardial infarction in the course of thrombo- lytic therapy, how is it coded? (Reference ICD-10- CM guideline I.C.9.e.l) - Code only STEMI If invalid information such as an invalid ICD-10-CM code, invalid age, or incorrect sex is submitted on a claim, what DRG is assigned? - DRG 999 If the Operative Report indicates that the postoperative diagnosis is a benign lesion, and the pathology report indicates a malignant lesion, what diagnosis is reported? - Code the malignant lesion.
Impetigo is best described as: - A bacterial skin infection In a composite APC, Medicare pays: - A single rate of service, which is reported with a combination of HCPCS codes on the same date of service or different dates of service. In a typical hospital's CDM layout, three asterisks indicate that these services: - Do not have a CPT®/HCPCS Level II code built into the CDM. In context of the ear, what does conduction refer to? - Sound waves In facilities, internal guidelines for E/M should: - Relate the intent of the CPT® code descriptor to the intensity of the hospital resources used. In regard to X-rays, lab tests, and other ancillary services, documentation should include the and of those services in the medical record. - reasons for, results In the hospital outpatient facility, all facility services must be: - Answer: Billed on a UB- 04 claim form Rationale: All outpatient hospital facility services are reported on the UB- 04 claim form. In the ICD-10-CM Alphabetic Index next to Hypertension, what do the terms in parentheses indicate? - Supplementary words that can be present or absent with the diagnosis hypertension and does not affect the code to which it is assigned. In the outpatient facility, add-on codes are: - Reported In what circumstance is it appropriate to report HCPCS Level II code G0379? - When a physician in the community has seen a patient in the office and the physician refers the patient directly to observation. In what formats can an X-ray order NOT be received? - Telephone order without a written order In which circumstances would an external cause code be reported? - Causes of injury or health condition. In which quadrant is the gallbladder located? - Right upper quadrant Inflammation of the membrane lining the abdominal coavity and covering the abdominal organs is called: - Peritonitis Inpatient only procedures are based on what criteria? - Invasive in nature, need for postoperative care, and the underlying physical condition of the Pt requiring surgery Intervertebral discs: - lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the
Medical necessity is defined by the payer as services: - Consistent with the diagnosis, in accordance with standards of good medical practice, and with the most appropriate level of care provided in the most appropriate setting. Medical student documentation is limited to: - History, exam, and medical decision making when the documentation is not signed and reviewed by the teaching physician. Medicare assigns payment status indicator services to CPT ® and HCPCS level II codes provided in: - Outpatient hospital Rationale: A payment status indicator is assigned to every HCPCS code to identify how the service or procedure described by the code is paid under the hospital OPPS. What exception did Medicare issue to rule 3.3.2.4 Signature Requirements effective 8- 25-15.. - CMS permits the use of a rubber stamp for signature in accordance with the Rehabilitation Act of 1973 in the case of an author with physical disability, after approval of disability by the CMS contractor Medicare IPPS applies to: - Most acute care hospitals Medicare Part B pays which outpatient services: - Emergency Rooms, Clinic Visits, Blood and blood products Rationale: Medicare pays for most Medicare Part B outpatient services, which include: X-rays, Sutures, Emergency room (ER) and clinic visits, Casts, Surgical procedures, Miscellaneous procedures, Blood and blood products Medicare payment for inPt eligible new tech is based on the cost to the hospital for the new tech. Medicare pays: - 50% for the costs of the new tech in excess of the full MS- DRG payment Medicare reimbursable drugs are found in this code book. - HCPCS Level II Rationale: Medicare reimbursable drugs are found in the HCPCS Level II code book. Medicare reimbursable drugs must be billed in the appropriate dosage amount defined by the long descriptor of their respective HCPCS Level II codes and adjusted for the units to reflect the amount of drug administered. MeV: - Radiation dosage in million electron volts = maximum energy level of the X-ray beam Modifier TC is reported on the UB-04 claim form. True or False? Why? - False. Modifier TC indicates the technical component. This is understood in the facility setting and is not reported on the UB-04. Multifield: - Use of three or more fields to deliver dosage Muscle is attached to bone by what method? - Tendons, aponeurosis and directly to the bone
Name an example of when a problem caused by diabetes is NOT sequenced after the code for diabetes. Refer to ICD- 10-CM guideline I.C.4.a.5.a. - When a patient's insulin pump malfunctions Name four reasons why chronological documentation of patient care is important. - 1. Enable the physician and other healthcare professionals to plan and evaluate the patient's immediate treatment, and to monitor his or her healthcare.; 2. Enhance communication and promote continuity of care among physicians and other healthcare professionals involved in the patient's care.;3. Facilitate claims review and payments.;4. Assist in utilization review and quality of care evaluations.;5. Reduce complicated medical reviews.;6. Provide clinical data for research and education.;7. Serve as a legal document to verify the services (for example, in defense of an alleged professional liability claim). Name three benefits of an effective compliance plan. - Faster, more accurate payment of claims, Fewer billing mistakes, Diminished chances of payer audit, Last chance of running afoul of self-referral and anti-kickback statutes Neuroendocrine glands - Exerts chemical control over the human body by maintaining homeostasis NI is a: - Payment indicator Oblique: - Body part is rotated so it does not produce an AP/PA projection. The X-ray beam enters at an angle that is neither frontal (AP or PA) nor lateral. Observation services provided for more than 8 hours are considered packaged in which circumstance? - When reported with a procedure assigned a status indicator T. OCE Edit 22-Invalid modifier is applied to a facility claim. The claim has modifier 63 appended to one of the procedure codes. Which appendix might help determine the reason for this edit? - Appendix F OCE is an abbreviation for: - Outpatient Code Editor Oculomotor - Controls movement of four of the six muscles of the eyeball, the upper eyelid, and the muscles that constrict the pupils Olfactory - Sense of smell
