Term
When coding a hydrocystoma of the right eyelid, which of the following codes should be used?
A) D23
B)D17.0
C)D23.12
D)D23.11 |
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Definition
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Term
A coder might find which of the following on a patients problem list if the medication list contains the drug Procardia?
Esophagitis
Hypertension
Schizophrenia
AIDS |
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Definition
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Term
If a patient has an excision of a malignant lesion of the skin the CPT code is determined by the body area from which the excision occurs and which of the following:
A)Length of the lesion as described in the pathology report
B) Dimension of the specimen submitted as described in the pathology report
C) Width times the length of the lesion as described in the operative report
D) Diameter of the lesion as well as the margins excised as described in the operative report |
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Definition
| Diameter of the lesion as well as the margins excised as described in the operative report |
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Term
The present on admission indicator is a requirement for:
A) Inpatient Medicare claims submitted by hospitals
B) Inpatient Medicare and Medicaid claims submitted by hospitals
C) Medicare claims submitted by all entities
D) Inpatient skilled nursing facility Medicare claims |
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Definition
| Inpatient Medicare claims submitted by hospitals |
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Term
The patient was admitted with nausea, vomiting and abdominal pain. The physician documents the following on the discharge summary: acute cholecystitis, nausea, vomiting and abdominal pain. Which of the following would be the correct coding and sequencing for this case?
A) Acute cholecystitis, nausea, vomiting, abdominal pain
B) Abdominal pain, vomiting, nausea, acute cholecystitis
C) Nausea, vomiting, abdominal pain
D) Acute cholecystitis |
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Definition
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Term
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. Which of the following would be the correct coding and sequencing for this case?
A) Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina
B) Infectious gastroenteritis; chronic obstructive pulmonary disease; angina
C) Gastroenteritis; abdominal pain; angina
D) Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina |
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Definition
| Infectious gastroenteritis; chronic obstructive pulmonary disease; angina |
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Term
An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis". How should this case be coded?
A) Code sepsis as the principal diagnosis with urinary tract infection due to E.coli as secondary diagnosis
B) Code urinary tract infection with sepsis as the principal diagnosis
C) Query the physician to ask if the patient has septicemia because of the symptomatology
D) Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis |
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Definition
| Query the physician to ask if the patient has septicemia because of symptomatology |
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Term
The practice of using a code that results in a higher payment to the provider than the code that actually reflects the service or item provided is known as:
A) Unbundling
B) Upcoding
C) Medically unnecessary services
D) Billing for services not provided |
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Definition
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Term
A 65-year-old patient with a history of lung cancer is admitted to a healthcare facility with ataxia and syncope and a fractured arm as a result of falling. The patient undergoes a closed reduction of the fracture in the emergency department as well as a complete workup for metastatic carcinoma of the brain. The patient is found to have metastatic carcinoma of the lung to the brain and undergoes radiation therapy to the brain. Which of the following would be the principal diagnosis in this case?
A) Ataxia
B) Fractured arm
C) Metastatic carcinoma of the brain
D) Carcinoma of the lung |
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Definition
| Metastatic carcinoma of the brain |
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Term
According to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure?
A) Complex
B) Intermediate
C) Not specified
D) Simple |
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Definition
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Term
A patient is admitted with a history of prostate cancer and with mental confusion. The patient completed radiation therapy for prostatic carcinoma three years ago and is status post a radical resection of the prostate. A CT scan of the brain during the current admission reveals metastasis. Which of the following is the correct coding sequencing for the current hospital stay?
A) Metastatic carcinoma of the brain; carcinoma of the prostate; mental confusion
B) Mental confusion; history of carcinoma of the prostate; admission for chemotherapy
C) Metastatic carcinoma of the brain; history of carcinoma of the prostate
D) Carcinoma of the prostate; metastatic carcinoma to the brain |
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Definition
| Metastatic carcinoma of the brain; history of carcinoma of the prostate |
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Term
| A patient is admitted with abdominal pain. The physician states that the discharge diagnosis is pancreatitis and noncalculus cholecystitis. Both diagnoses are equally treated. The correct coding and sequencing for this case would be: |
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Definition
| Either pancreatitis or noncalculus cholecystitis sequenced as principle diagnosis |
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Term
When coding a benign neoplasm of skin of the vermilion border of the lip, which of the following codes should be used:
A) D23
B) D10.0
C) D23.0
D) D17.0 |
|
Definition
| D10.0--Benign neoplasm of lip / Benign neoplasm of lip (frenulum) (inner aspect) (mucosa) (vermilion border). EXCLUDES benign neoplasm of skin of lip (D22.0, D23.0) |
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Term
a seven-year-old patient was admitted to the Emergency Room for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and wheezing are unabated following treatment. What diagnosis should be suspected?
A) Acute bronchitis
B) Acute bronchitis with chronic obstructive pulmonary disease
C) Asthma with status asthmaticus
D) Chronic obstructive asthma |
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Definition
| Asthma with status asthmaticus |
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Term
The ICD-10-CM utilizes a placeholder character at certain codes to allow for future expansion of the classification systems. What letter is used to represent this placeholder character?
A) A
B) G
C) U
D) X |
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Definition
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Term
A physician orders a chest x-ray for an office patient who presents with fever, productive cough, and shortness of breath. The physician indicates in the progress notes: *Rule out pneumonia.* What should the coder report for the visit when the results have not yet been received?
A) Pneumonia
B) Fever, cough, shortness of breath
C) Cough, shortness of breath
D) Pneumonia, cough, shortness of breath, fever |
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Definition
| Fever, cough, shortness of breath |
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Term
A patient is admitted with spotting. She had been treated two weeks previously for a miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. She is treated with an aspiration dilation and curettage. Products of conception are found. Which of the following should be the principal diagnosis?
A) Miscarriage
B) Complications of spontaneous abortion with sepsis
C) Sepsis
D) Spontaneous abortion with sepsis |
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Definition
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Term
Which of the following promotes uniform reporting and statistical data collection for medical procedures, supplies, products, and services?
A) Current Procedural Terminology
B) Healthcare Common Procedure Coding System (HCPCS)
C) International classification of diseases, Tenth Revision, Clinical Modification
D) International Classification of Diseases for Oncology, Third Edition |
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Definition
| Healthcare Common Procedure Coding System |
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Term
According to the UHDDS, which of the following is the definition of *other diagnoses*?
A) Is recorded in the patient record
B) Is documented by the attending physician and cannot be documented by any other provider
C) Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay
D) Is documented by at least two physicians and/or the nursing staff
C) Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay |
|
Definition
| Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay |
|
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Term
According to the UHDDS, which of the following is the definition of *other diagnoses*?
A) Is recorded in the patient record
B) Is documented by the attending physician and cannot be documented by any other provider
C) Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay
D) Is documented by at least two physicians and/or the nursing staff
C) Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay |
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Definition
| Is considered all conditions that coexist at the time of admission or develop subsequently that affect the treatment received and/or the length of stay |
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Term
A 65-year-old woman was admitted to the hospital. She was diagnosed with sepsis secondary to methicillin-susceptible Staphylococcus aureus and abdominal pain secondary to diverticulitis of the colon. What is the correct code sequence?
A) A41.1, K57.23, R10.9
b) A41.01, K57.23
c) A41.1, K57.23, B95.61
D) A41.2, K57.23 |
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Definition
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Term
A patient was admitted to the hospital and diagnosed with Type 1 diabetic gangrene. What is the correct code assignment?
A) E10.52
B) E10.9, I96
C) E10.52
D) E11.52 |
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Definition
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Term
Which of the following replaced ICD-9-CM Volumes 1 and 2 in 2015?
A) CPT
B) 'International Classification of Diseases', Tenth Revision, Clinical Modification (ICD-10-CM and ICD-10-PCS)
C)International Classification of Diseases', Tenth Revision (ICD-10)
D) 'International Classification of Diseases', Tenth Revision, Clinical Modification (ICD-10-CM) |
|
Definition
| International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) |
|
|
Term
Which organization originally published ICD-10?
A) AMA
B) CDC
C) US FEDERAL GOVERNMENT
D) WHO--world health organization |
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Definition
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Term
Which of the following provides a detailed classification system for coding the histology, topography, and behavior of neoplasms?
A) CPT
B) HCPCS
C) International Classification of Diseases for Oncology, Third Edition
D) Systematized Nomenclature of Medicine Clinical Terminology |
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Definition
| International Classification of Diseases for Oncology, Third Edition |
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Term
Identify the two-digit modifier that may be reported to indicate a physician performed the postoperative management of a patient but another physician performed the surgical procedure
A) -22 Increased procedural services
B) -54, Surgical care only
C) -32, Mandated Service
D) -55, Postoperative management only |
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Definition
| Postoperative management only |
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Term
Assign the correct CPT code for the following procedure: Revision of the pacemaker skin pocket.
A) 33223, Relocate of skin pocket for implantable defibrillator
B) 33210, Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)
C) 33212, Insertion of pacemaker pulse generator only; with existing single lead
D) 33222, Relocation of skin pocket for pacemaker |
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Definition
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Term
In the inpatient prospective payment system, the calculation of the DRG begins with the:
A) Principal diagnosis
B) Primary diagnosis
C) Secondary diagnosis
D) Surgical procedure |
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Definition
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Term
Assign the correct CPT code for the following: A 63-yo female had a temporal artery biopsy completed in the outpatient surgical center:
A) 32405, Biopsy, lung or mediastinum, percutaneous needle
B) 37609, Ligation or biopsy, temporal artery
C) 20206, Biopsy, muscle, percutaneous needle
D) 31629, Bronchoscopy,rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy (s), trachea, mainstream and/or lobar bronchus (i) |
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Definition
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Term
In ICD-10-PCS, the root operation defined as taking or letting out fluids and/or gases from a body part is:
A) Control
B) Drainage
C) Excision
D) Release |
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Definition
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Term
When reporting an encounter with a patient who is HIV positive but has never had any symptoms, the following code is assigned:
A) B20, Human immunodeficiency virus (HIV) disease
B) Z21, Asymptomatic HIV infection status
C) R75, Inconclusive lab evidence of human immunodeficiency virus
D) Z20.6, Contact with and (suspected) exposure to human immunodeficiency virus (HIV) |
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Definition
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Term
Which of the following provides a system for coding the clinical procedures and services provided by physicians and other clinical professionals?
A) CPT
B) Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision
C) Healthcare Common Procedure Coding System
D) International Classification of Diseases, Tenth Revision, Clinical Modification |
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Definition
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Term
What type of value-based purchasing program is the Hospital-Acquired Conditions Reduction Program?
A) Quality consumer assessment
B) Pay for reporting
C) Quality incentive program
D) Paying for value |
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Definition
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Term
The coding manager at Community Hospital is seeing an increased number of physicians failing to document the cause and effect of diabetes and its manifestations. Which of the following will provide the most comprehensive solution to handle this documentation issue?
A) Have coders continue to query the attending physician for this documentation
B) Present this information at the next medical staff meeting to inform physicians on documentation standards and guidelines
C) Do nothing because coding compliance guidelines do not allow any action
D) Place all offending physicians on suspension if the documentation issues continue |
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Definition
| Present this information at the next medical staff meeting to inform physicians on documentation standards and guidelines |
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Term
A physician query may not be appropriate in which of the following instances?
A) Diagnosis of viral pneumonia noted in the progress notes and sputum cultures showing Haemophilus influenza
B) Discharge summary indicates chronic renal failure but the progress notes documents acute renal failure throughout the stay
C) Acute respiratory failure in a patient whose lab report findings appear not to support this diagnosis
D) Diagnosis of chest pain and abnormal cardiac enzymes indicative of an AMI |
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Definition
| Acute respiratory failure in a patient whose lab report findings appear not to support this diagnosis |
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Term
Which of the following provides the most comprehensive, controlled vocabulary for coding the content of a patient record?
A) CPT
B) HCPCS
C) ICD-10-CM
D) SNOMED CT |
|
Definition
| SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms) |
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Term
A patient is admitted to the hospital with acute lower abdominal pain. The principal diagnosis is acute appendicitis. The patient also has a diagnosis of diabetes. The patient undergoes and appendectomy and subsequently develops two wound infections. In the DRG system, which of the following could be considered a comorbid condition?
A) Acute appendicitis
B) Appendectomy
C) Diabetes
D) Wound infection |
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Definition
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Term
Which of the following is a prospective payment system implemented for inpatient services?
A) APT
B) MS-DRG
C) OPPS
D) RBRVS |
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Definition
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Term
A coding audit shows that an inpatient coder is using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case?
A) Require all coders to implement this practice
B) Report the practice to the OIG
C) Counsel the coder and stop the practice immediately
D) Put the coder on unpaid leave of absence |
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Definition
| Counsel the coder and stop the practice immediately |
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Term
Diagnosis related groups are organized into:
A) Case-Mix classifications
B) Geographic practice cost indices
C) Major diagnostic categories
D) Resource-based relative values |
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Definition
| Major diagnostic categories |
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Term
NCCI edits prevent improper payments in which of the following cases?
A) Medical necessity has not been justified by a diagnosis
B) The account is potentially upcoded
C) The claim contains any of a variety of errors
D) Incorrect code combinations are on the claim |
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Definition
| Incorrect code combinations are on the claim |
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Term
Coding and billing documentation must be based on the:
A) Wishes of the patient
B) Highest available reimbursement amount
C) Most efficient utilization of resources
D) Providers documentation |
|
Definition
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Term
Which of the following is the condition established after study to be the reason for hospitalization?
A) Principal procedure
B) Complication
C) Comorbidity
D) Principal diagnosis |
|
Definition
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Term
MS-DRGs may be split into a maximum of ___ payment tiers based on severity as determined by the presence of a major complication/comorbidity, a CC, or no CC
A) Two
B) Three
C) Four
D) Five |
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Definition
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Term
The purpose of the present on admission and conditions that develop during inpatient admission:
A) Differentiate between conditions present on admission and conditions that develop during an inpatient admission
B) Track principal diagnosis
C) Distinguish between principal and primary diagnosis
D) Determine principal diagnosis |
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Definition
| Differentiate between conditions present on admission and conditions that develop during an inpatient admission |
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Term
What is the PCS code for a patient who had ventilator management for more than 96 hours?
A) 5A1955Z
B) 5A1945Z
C) 5A09557
D) 5A09458 |
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Definition
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Term
The coding supervisor has compiled a report on the number of coding errors made each day by the coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an average of five errors per day, and Bob and Susan each make an average of two errors per days. Given this information, what actions should the coding supervisor make?
A) Counsel Tim and Jane because they have the highest error rates
B) Encourage Tim and Jane to get additional training
C) Provide Bob and Susan with incentive pay for a low coding error rate
D) Take no action because not enough information is given to make a judgment |
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Definition
| Take no action because not enough information is given to make a judgment |
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Term
The National Correct Coding Initiative (NCCI) was developed to control improper coding leading to inappropriate payment for:
A) Part A Medicare claims
B) Part B Medicare claims
C) Medicaid claims
D) Medicare and Medicaid claims |
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Definition
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Term
The function of the NCCI editor is to:
A) Report poor performing physicians
B) Identify procedures and services that cannot be billed together on the same day of service for a patient
C) Identify poor performing coders
D) Identify problems in the national coding system |
|
Definition
| Identify procedures and services that cannot be billed together on the same day of service for a patient |
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Term
Unbundling refers to:
A) Use of a comprehensive code to appropriately maximize reimbursement
B) Use of multiple procedure codes when a comprehensive code is available
C) Combined billing for pre- and post surgery physician services
D) Using the incorrect DRG code |
|
Definition
| Use of multiple procedure codes when a comprehensive code is available |
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Term
The evaluation of coders is recommended at least quarterly for the purpose of measurement and assurance of:
A) Speed
B) Data quality and integrity
C) Accuracy
D) Effective relationships with physicians and facility personnel |
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Definition
| Data quality and integrity |
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Term
Medicare inpatient reimbursement levels are based on:
A) CPT codes reported during the encounter
B) MS-DRG calculated for the encounter
C) Charges accumulated during the episode of care
D) Usual and customary changes reported during the encounter |
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Definition
| MS-DRG calculated for the encounter |
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Term
The acute-care hospital discharges an average of 55 patients per day. The HIM department is open during normal business hours only. The volume productivity standard is six records per hour when coding 4.5 hours per day. Assuming that the standards are met, how many FTE coders does the facility need to have on staff in order to ensure that there is no backlog?
A) 2.85
B) 5
C) 14.26
D) 27 |
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Definition
| 2.85---385 charts per week ÷ 5 days ÷ 27 standard charts per-day = 2.85 |
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Term
A patient who has been diagnosed with hypertension visits her physician on a monthly basis. The nurse conducted the blood pressure check under the physician's supervision. Code the office visit.
A) 99211, Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other health care professional
B) 99201, Office or other outpatient visit for the evaluation and management of a new patient which requires these three key components: problem focused history and examination, straightforward medical decision
C) 99203, Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: detailed history and examination, low complexity medical decision
D) 99212, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: problem focused history and examination, straightforward medical decision |
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Definition
| 99211, Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other health care professional |
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Term
Mary Patient presented to the emergency department with chest pains and shortness of breath. She was treated for congestive heart failure and returned home. Two days later, her symptoms had worsened. She presented again to the emergency department and was admitted to the hospital for inpatient treatment of congestive heart failure. The hospital will bill Medicare for:
A) Two emergency department visits as an outpatient service and the inpatient visit under MS-DRGs
B) One inpatient visit under MS-DRGs
C) One emergency department visit as an outpatient service and one inpatient visit under MS-DRGs
D) Two emergency department visits as an outpatient service and the inpatient visit at a reduced rate under MS-DRGs |
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Definition
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Term
You are the coding supervisor, and you are doing an audit of outpatient coding. Robert Thompson was seen in the outpatient department with a chronic cough and the record states, "rule out lung cancer". What should have been coded as the patient's diagnosis?
A) Chronic cough
B) Observation and evaluation without need for further medical care
C) Diagnosis of unknown etiology
D) Lung cancer |
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Definition
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Term
| The patient was admitted to the outpatient department and had a bronchoscopy with bronchial with |
|
Definition
|
|
Term
The practice of under-coding can affect hospitals MS-DRG case mix in which of the following ways?
A) Makes it lower than warranted by the actual service/resource intensity of the facility
B) Makes it higher than warranted by the actual service/resource intensity of the facility
C) Does not affect the hospital's MS-DRG case mix
D) Coding has nothing to do with a hospital's MS-DRG case mix |
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Definition
| Makes it lower than warranted by the actual service/resource intensity of the facility |
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Term
A select group of reasonably preventable conditions for which hospitals do not receive additional payment when one of the conditions was not present on admission is called:
A) Charge code
B) hospital-acquired condition
C) Principal diagnosis
D) Value-based purchasing list |
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Definition
| Hospital acquired condition |
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Term
When multiple burns are present, the first sequenced diagnosis is the:
A) Burn that is treated surgically
B) Burn that is closest to the head
C) Highest degree burn
D) Burn that is treated first |
|
Definition
|
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Term
NCCI edit files contain code pairs, called mutually exclusive edits, that prevent payment for:
A) Services that cannot reasonably be billed together
B) Services that are components of a more comprehensive procedure
C) Unnecessary procedures
D) Comprehensive procedures |
|
Definition
| Services that cannot reasonably be billed together |
|
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Term
A patient known to have AIDS is admitted to the hospital for treatment of Pneumocystis carinii pneumonia. Assign the principal diagnosis for this patient:
A) B20 Human immunodeficiency virus [HIV] disease
B) J18.9, Pneumonia, unspecified organism
C) B59, Pneumocytosis
D) Z21, Asymptomatic human immunodeficiency virus [HIV] infection staus |
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Definition
|
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Term
Coding productivity is measured by:
A) Quantity
B) Quality
C) Quantity and quality
D) Volume |
|
Definition
|
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Term
A patient is seen as an outpatient to receive chemotherapy for distal esophageal carcinoma. What is the appropriate first-listed diagnosis?
A) Z48.3, Aftercare following surgery for a neoplasm
B) Z51.11, Encounter for antineoplastic chemotherapy
C) C15.5, Malignant neoplasm of lower third of esophagus
D) C15.3, Malignant neoplasm of upper third of esophagus |
|
Definition
| Z51.11, Encounter for antineoplastic chemotherapy |
|
|
Term
Medicare outpatients are grouped by:
A) APC
B) PPS
C) DRG
D) CMS |
|
Definition
| APC (Ambulatory Payment Classification) |
|
|
Term
Which of the following could be a focus of a quality review program?
A) CC and MCC coding rates (MS-DRG)
B) Outpatient code editor failure rates
C) Coding completed by new coders
D) New coding guidelines |
|
Definition
| Coding completed by new coders |
|
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Term
A coding professional may assume a cause and effect relationship between hypertension and which of the following complications?
A) Hypertension and heart disease
B) Hypertension and chronic kidney disease
C) Hypertension and heart and chronic kidney disease
D) Hypertension and coronary artery disease |
|
Definition
| Hypertension and chronic kidney disease |
|
|
Term
What is the benefit to comparing the coding assigned by coders to the coding appearing on the claim?
A) May find that more codes are required to support the claim
B) May find that the charge description master soft coding is inaccurate
C) Serves as a way for HIM to take over the management of patient financial services
D) Could find claim generation issues that cannot be found other ways |
|
Definition
| Could find claim generation issues that cannot be found other ways |
|
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Term
MCC stands for:
A) Massive complication/comorbid condition
B) Many chronic conditions
C) Much chronic congestion
D) Major complication and comorbidity |
|
Definition
| Major complication and comorbidity |
|
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Term
The physician documents that she changed the cardiac pacemaker battery. In CPT, the battery is called:
A) Generation
B) Electrode
C) Dual system
D) Cardioverter |
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Definition
|
|
Term
When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure?
A) Assign the removal by snare technique code
B) Assign the removal by hot biopsy forceps code
C) Assign the ablation code
D) Query the physician as to the method used |
|
Definition
| Query the physician as to the method used |
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