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 what else?
diameter or lesion and margins excised
According to the CPT, a repair of a laceration that includes retention sutures would be considered what type of closure?
complex
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. What would be the correct coding sequence for this case?
acute cholecystitis
A patient is admitted with spotting. She has 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 fo
miscarriage
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 the co
ask the doctor if the patient has septicemia because of the symptomatology
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:
upcoding
A 65 year old patient with a hx of lungy 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 ED and undergoes a complete workup for
metastatic carcinoma of the brain
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and COPD. What would be the correct coding and sequencing for this case?
infectious gastroenteritis, COPD, angina
A patient is admitted with a hx 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
metastatic carcinoma of the brain, history of carcinoma of the prostate
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 sequence for this case would be:
sequence either pancreatitis or noncalculus cholecystitis as principal diagnosis
According to the UHDDS, the definition of ___ ___ is considered when all conditions that coexist at the time of admission, or develop subsequently, which affect the treatment received and/or length of stay.
other diagnoses
A 7 year old patient was admitted to the ED for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. the SOB and wheezing are unabated following treatment. What diagnoses should be suspected?
asthma with status asthmaticus
A coder might find what on the patients problem list if the medication list contains the drug Procardia?
hypertension
A Physician orders a chest x-ray for an office patient who presents with fever, productive cough, and SOB. 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 r
fever, cough, shortness of breath
Who promotes uniform reporting and statistical data collection for medical procedures, supplies, products and services?
HCPCS
HCPCS stands for..
healthcare common procedure coding system
Provides a detailed classification system for coding the histology, topography, and behavior or neoplasms
ICD-O-D
What provides the most comprehensive controlled vocabulary for coding the content of patient record?
SNOMED CT
What organization originally published ICD-9?
WHO
What organization is responsible for updating the procedure classification of ICD-9-CM?
CMS
At what level of the classification system are the most specific ICD-9-CM codes found?
subclassification level
Assign the correct CPT code for the following procedure: Revision of the pacemaker skin pocket
33222
What are the four-digit ICD-9-CM diagnosis codes?
subcategory codes
What ICD-9-CM codes classify environmental events and circumstances as the cause of an injury, poisoning, or other adverse effect?
E codes
What conditions are included on the hospital-acquired conditions provision list?
pressure ulcers, catheter associated urinary tract infections, falls and fractures
The coding manager at the hospital is seeing an increased number of physicians failing to document the cause and effect of diabetes and its manifestations. What will provide the most comprehensive solution to handle this documentation issue?
present the information at the next medical staff meeting to inform physicians on documentation standards and guidelines
Element of coding quality that represent the degree to which codes accurately reflect the patient's diagnoses and procedures?
validity
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 an appendectomy and subsequently develops two would infections. In th
diabetes
What is the condition established after study to be the reason for hospitalization?
principal diagnosis
What is a prospective payment system implemented for payment of inpatient services?
MS-DRG
In IPPS, the calculation of the DRG begins with the ___ __.
principal diagnosis
IPPS stands for..
inpatient prospective payment system
Diagnosis-related groups are organized into..
major diagnostic categories
NCCI edits prevent improper payments where..
incorrect code combinations are on the claim
Medicare inpatient reimbursement levels are based on..
MS-DRG calculated for the encounter
Coding and billing documentation must be based on the ___ ___.
providers documentation
Failure to use a comprehensive code to inappropriately maximize reimbursement.
unbundling
MS-DRGs may be split into a maximum of ___ payment tiers based on severity as determined by the presence of the major complication/comobidity, a CC, or no CC.
three
Its purpose is to differentiate between conditions present on admission and conditions that develop during an inpatient admission.
POA indicator
The POA indicator is a requirement for...
inpatient medicare claims submitted by hospitals
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. What should be done in this case?
counsel the coder and stop the practice immediately
The NCCI was developed to control improper coding leading to inappropriate payment for...
part B medicare claims
NCCI stands for
national correct coding initiative
Its function is to identify procedures and services that cannot be billed together on the same day of service for a patient
NCCI editor
NCCI edit files contain code pairs called mutually exclusive edits, which prevent payment for...
services that cannot reasonably be billed together
The evaluation of coders is recommended at least quarterly for the purpose of measurement and assurance of..
data quality and integrity
Quality standards for coding accuracy should be..
as close to 100% as possible
The acute care hospital discharges a average of 55 patients per day. The HIM department is open during normal business hours only. The volume productivity standard is 6 records per hour when coding during 4.5 hours per day. Assuming that standards are met
2.85
A coder notes that the patient is taking prescribed Haldol. The final diagnoses on the progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What condition might the coder suspect the patient has and should query the pyhsician?
mental or behavioral problems
Mary presented to the ED with chest pains and SOB. She was treated for CHF and returned home. Two days later, her symptoms had worsened. She presented again to the ED and was admitted to the hospital for inpatient treatment for CHF. The hospital will bill
One inpatient visit under MS-DRGs
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 5 errors per day, and bob and susan make an average of two error
Take no action since not enough information to make judgement
The practice in which the hospital makes is lower than warranted by the actual service/resource intensity of the facility
undercoding
Condition that is not included on the hospital-acquired conditions provision list for FY 2009
staphlyococcus infections
When multiple burns are present, the first sequenced diagnosis is the:
highest degree burn
A coding professional may assume a cause and effect relationship between hypertension and what other complication?
hypertension and chronic kidney disease
A patient with AIDS is admitted to the hospital for treatment of pneumocystitis carinii pneumonia. Assign the principal diagnosis for this patient:
042, HIV
Coding productivity is measured by...
quantity and quality
The ____ is responsible for issuing official coding guidelines for ICD-9-CM, whereas the ___ is responsible for issuing official guidelines for CPT.
AHA, AMA
Medicare outpatients are grouped by:
APC
What could be a focus of a quality review program?
coding completed by new coders
True or false: Identifying what coder should be disciplined is a reason for establishing a coding quality program
false
What is the benefit to comparing the coding assigned by coders to the coding appearing on the claim
could find claim generation issues
MCC stands for
major complication and comorbidity
When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure?
query the physician as to the method used
The hospital-acquired conditions provision of the Medicare PPS is an example of this type of value based purchasing system.
paying for value
True or false: crutches could be assigned with a CPT
false
True or false: Fall from a curb would be classified as an E code
true
The physician documents that she changed the cardiac pacemaker battery. In the CPT, the battery is called a(n):
generator
A patient is scheduled for an outpatient colonoscopy, but due to a sudden drop in BP, the procedure is cancelled just as the scope is introduced into the rectum. Because of moderately severe mental retardation, the patient is given general anesthesia prio
Assign the colonoscopy with modifier 74
Discontinued outpatient procedure after anesthesia administration is modifier __.
74
When documentation in the health record is not clear, the coding professional should:
query the physician who originated the report
True of false: providers should be queried regarding information in the health record for insignificant information
false
MS-DRG refers to a DRG system developed by ___.
CMS
The ___ operates in the systems of Medicare administrative contractors (MACs) and provides a series of flags that can affect APC payments because it identifies coding errors in claims
OCE
The main purpose of the Correct Coding Initiative (CCI) edits is to prohibit:
unbundling
True or false: Continuing education for accurate coding can be done through coding education by sending staff to external seminars
false
What information would generally be found in a query to a physician?
name and contact number of the individual initiating the query and account number
An accuracy calculation method that divides the number of records where there was no change in APC or DRG assignment by the total number of cases reviewed is considered:
record over record method
True or false: An outcome of coding quality review may be cases where excellent penmanship created challenges for the coders identified
false
When assigning evaluation and management codes for hospital outpatient services, the coder should follow:
hospital guidelines
What is the correct neoplasm type for adenocarcinoma?
malignant
OASIS data are used to access the ____ of home health services.
outcome
A statement or guideline that directs decision making or behavior is called a __.
policy
True or false: examples of high risk billing practices that create compliance risks for healthcare organizations include returned overpayments
false
Corporate compliance programs became common after adoption of __ __ __.
federal sentencing guidelines
The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards is called ___.
accreditation
A group practice has hired an HIT as its chief compliance officer. The current compliance program includes written standards of conduct and policies and procedures that address specific areas of potential fraud. It also has audits in place to monitor comp
hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation
What federal organization is responsible for looking at the issues related to the efficiency and effectiveness of the healthcare delivery system, disease protocols, and guidelines for improved disease outcomes?
AHRQ
AHRQ stands for..
agency for healthcare research and quality
Issues compliance program guidance
OIG
Automatic logoff after inactivity is an example of __ __
data security
A patient has been discharged prior to an administrative utilization review being conducted. What should be performed?
retrospective utilization review
An EHR system can provide better security than a paper record for protected health information system due to ___, ___, and ___.
access controls, audit trails, authentication systems
What accrediting organization has instituted continuous improvement and sentinel event monitoring and uses tracer methodology during survey visits?
joint commission
developing, implementing, and revising the organizations policies is the role of ___ ___.
middle managers
Position descriptions, policies and procedures, training checklists, and performance standards are all examples of ___ __.
staffing tools
The organization has been responsible for accrediting healthcare organizations since the mid 1950s and determines whether the organization is continually monitoring and improving the quality of care they provide.
joint commission
A written description of an organizations formal position
policy
The Deficit Reduction Act of 2005 made..
compliance programs mandatory
A set of processes used to determine the appropriateness of medical services provided during specific episodes of care
utilization managment
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 what else?
diameter or lesion and margins excised
According to the CPT, a repair of a laceration that includes retention sutures would be considered what type of closure?
complex
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. What would be the correct coding sequence for this case?
acute cholecystitis
A patient is admitted with spotting. She has 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 fo
miscarriage
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 the co
ask the doctor if the patient has septicemia because of the symptomatology
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:
upcoding
A 65 year old patient with a hx of lungy 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 ED and undergoes a complete workup for
metastatic carcinoma of the brain
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and COPD. What would be the correct coding and sequencing for this case?
infectious gastroenteritis, COPD, angina
A patient is admitted with a hx 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
metastatic carcinoma of the brain, history of carcinoma of the prostate
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 sequence for this case would be:
sequence either pancreatitis or noncalculus cholecystitis as principal diagnosis
According to the UHDDS, the definition of ___ ___ is considered when all conditions that coexist at the time of admission, or develop subsequently, which affect the treatment received and/or length of stay.
other diagnoses
A 7 year old patient was admitted to the ED for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. the SOB and wheezing are unabated following treatment. What diagnoses should be suspected?
asthma with status asthmaticus
A coder might find what on the patients problem list if the medication list contains the drug Procardia?
hypertension
A Physician orders a chest x-ray for an office patient who presents with fever, productive cough, and SOB. 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 r
fever, cough, shortness of breath
Who promotes uniform reporting and statistical data collection for medical procedures, supplies, products and services?
HCPCS
HCPCS stands for..
healthcare common procedure coding system
Provides a detailed classification system for coding the histology, topography, and behavior or neoplasms
ICD-O-D
What provides the most comprehensive controlled vocabulary for coding the content of patient record?
SNOMED CT
What organization originally published ICD-9?
WHO
What organization is responsible for updating the procedure classification of ICD-9-CM?
CMS
At what level of the classification system are the most specific ICD-9-CM codes found?
subclassification level
Assign the correct CPT code for the following procedure: Revision of the pacemaker skin pocket
33222
What are the four-digit ICD-9-CM diagnosis codes?
subcategory codes
What ICD-9-CM codes classify environmental events and circumstances as the cause of an injury, poisoning, or other adverse effect?
E codes
What conditions are included on the hospital-acquired conditions provision list?
pressure ulcers, catheter associated urinary tract infections, falls and fractures
The coding manager at the hospital is seeing an increased number of physicians failing to document the cause and effect of diabetes and its manifestations. What will provide the most comprehensive solution to handle this documentation issue?
present the information at the next medical staff meeting to inform physicians on documentation standards and guidelines
Element of coding quality that represent the degree to which codes accurately reflect the patient's diagnoses and procedures?
validity
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 an appendectomy and subsequently develops two would infections. In th
diabetes
What is the condition established after study to be the reason for hospitalization?
principal diagnosis
What is a prospective payment system implemented for payment of inpatient services?
MS-DRG
In IPPS, the calculation of the DRG begins with the ___ __.
principal diagnosis
IPPS stands for..
inpatient prospective payment system
Diagnosis-related groups are organized into..
major diagnostic categories
NCCI edits prevent improper payments where..
incorrect code combinations are on the claim
Medicare inpatient reimbursement levels are based on..
MS-DRG calculated for the encounter
Coding and billing documentation must be based on the ___ ___.
providers documentation
Failure to use a comprehensive code to inappropriately maximize reimbursement.
unbundling
MS-DRGs may be split into a maximum of ___ payment tiers based on severity as determined by the presence of the major complication/comobidity, a CC, or no CC.
three
Its purpose is to differentiate between conditions present on admission and conditions that develop during an inpatient admission.
POA indicator
The POA indicator is a requirement for...
inpatient medicare claims submitted by hospitals
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. What should be done in this case?
counsel the coder and stop the practice immediately
The NCCI was developed to control improper coding leading to inappropriate payment for...
part B medicare claims
NCCI stands for
national correct coding initiative
Its function is to identify procedures and services that cannot be billed together on the same day of service for a patient
NCCI editor
NCCI edit files contain code pairs called mutually exclusive edits, which prevent payment for...
services that cannot reasonably be billed together
The evaluation of coders is recommended at least quarterly for the purpose of measurement and assurance of..
data quality and integrity
Quality standards for coding accuracy should be..
as close to 100% as possible
The acute care hospital discharges a average of 55 patients per day. The HIM department is open during normal business hours only. The volume productivity standard is 6 records per hour when coding during 4.5 hours per day. Assuming that standards are met
2.85
A coder notes that the patient is taking prescribed Haldol. The final diagnoses on the progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What condition might the coder suspect the patient has and should query the pyhsician?
mental or behavioral problems
Mary presented to the ED with chest pains and SOB. She was treated for CHF and returned home. Two days later, her symptoms had worsened. She presented again to the ED and was admitted to the hospital for inpatient treatment for CHF. The hospital will bill
One inpatient visit under MS-DRGs
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 5 errors per day, and bob and susan make an average of two error
Take no action since not enough information to make judgement
The practice in which the hospital makes is lower than warranted by the actual service/resource intensity of the facility
undercoding
Condition that is not included on the hospital-acquired conditions provision list for FY 2009
staphlyococcus infections
When multiple burns are present, the first sequenced diagnosis is the:
highest degree burn
A coding professional may assume a cause and effect relationship between hypertension and what other complication?
hypertension and chronic kidney disease
A patient with AIDS is admitted to the hospital for treatment of pneumocystitis carinii pneumonia. Assign the principal diagnosis for this patient:
042, HIV
Coding productivity is measured by...
quantity and quality
The ____ is responsible for issuing official coding guidelines for ICD-9-CM, whereas the ___ is responsible for issuing official guidelines for CPT.
AHA, AMA
Medicare outpatients are grouped by:
APC
What could be a focus of a quality review program?
coding completed by new coders
True or false: Identifying what coder should be disciplined is a reason for establishing a coding quality program
false
What is the benefit to comparing the coding assigned by coders to the coding appearing on the claim
could find claim generation issues
MCC stands for
major complication and comorbidity
When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure?
query the physician as to the method used
The hospital-acquired conditions provision of the Medicare PPS is an example of this type of value based purchasing system.
paying for value
True or false: crutches could be assigned with a CPT
false
True or false: Fall from a curb would be classified as an E code
true
The physician documents that she changed the cardiac pacemaker battery. In the CPT, the battery is called a(n):
generator
A patient is scheduled for an outpatient colonoscopy, but due to a sudden drop in BP, the procedure is cancelled just as the scope is introduced into the rectum. Because of moderately severe mental retardation, the patient is given general anesthesia prio
Assign the colonoscopy with modifier 74
Discontinued outpatient procedure after anesthesia administration is modifier __.
74
When documentation in the health record is not clear, the coding professional should:
query the physician who originated the report
True of false: providers should be queried regarding information in the health record for insignificant information
false
MS-DRG refers to a DRG system developed by ___.
CMS
The ___ operates in the systems of Medicare administrative contractors (MACs) and provides a series of flags that can affect APC payments because it identifies coding errors in claims
OCE
The main purpose of the Correct Coding Initiative (CCI) edits is to prohibit:
unbundling
True or false: Continuing education for accurate coding can be done through coding education by sending staff to external seminars
false
What information would generally be found in a query to a physician?
name and contact number of the individual initiating the query and account number
An accuracy calculation method that divides the number of records where there was no change in APC or DRG assignment by the total number of cases reviewed is considered:
record over record method
True or false: An outcome of coding quality review may be cases where excellent penmanship created challenges for the coders identified
false
When assigning evaluation and management codes for hospital outpatient services, the coder should follow:
hospital guidelines
What is the correct neoplasm type for adenocarcinoma?
malignant
OASIS data are used to access the ____ of home health services.
outcome
A statement or guideline that directs decision making or behavior is called a __.
policy
True or false: examples of high risk billing practices that create compliance risks for healthcare organizations include returned overpayments
false
Corporate compliance programs became common after adoption of __ __ __.
federal sentencing guidelines
The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards is called ___.
accreditation
A group practice has hired an HIT as its chief compliance officer. The current compliance program includes written standards of conduct and policies and procedures that address specific areas of potential fraud. It also has audits in place to monitor comp
hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation
What federal organization is responsible for looking at the issues related to the efficiency and effectiveness of the healthcare delivery system, disease protocols, and guidelines for improved disease outcomes?
AHRQ
AHRQ stands for..
agency for healthcare research and quality
Issues compliance program guidance
OIG
Automatic logoff after inactivity is an example of __ __
data security
A patient has been discharged prior to an administrative utilization review being conducted. What should be performed?
retrospective utilization review
An EHR system can provide better security than a paper record for protected health information system due to ___, ___, and ___.
access controls, audit trails, authentication systems
What accrediting organization has instituted continuous improvement and sentinel event monitoring and uses tracer methodology during survey visits?
joint commission
developing, implementing, and revising the organizations policies is the role of ___ ___.
middle managers
Position descriptions, policies and procedures, training checklists, and performance standards are all examples of ___ __.
staffing tools
The organization has been responsible for accrediting healthcare organizations since the mid 1950s and determines whether the organization is continually monitoring and improving the quality of care they provide.
joint commission
A written description of an organizations formal position
policy
The Deficit Reduction Act of 2005 made..
compliance programs mandatory
A set of processes used to determine the appropriateness of medical services provided during specific episodes of care
utilization managment