Question

QUESTION 20

1. Identify the correct diagnostic coding for a patient who arrives for outpatient laboratory services. The physician order states these are conducted to monitor the patient's Coumadin levels. A prothrombin time (PT) is performed to check the patient's long-term use of anticoagulant.

   	A.	Z13.0
   	B.	Z51.81, Z79.01
   	C.	Z79.01, Z00.01
   	D.	Z00.00

10 points   

QUESTION 21

1. According to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure?

   	A.	Intermediate
   	B.	Complex
   	C.	Simple
   	D.	Unspecified

10 points   

QUESTION 22

1. The practice of using a code that results in higher payment to the provider than the code that actually reflects the service or item provided is known as what?

   Hint: Physician E&M codes are frequently associated with this.

   	A.	Upcoding
   	B.	Medically unnecessary services
   	C.	Carve outs
   	D.	Unbundling

10 points   

QUESTION 23

1. Which coding system would be used most frequently for the uniform billing of medical supplies, drugs, products, and similar items?

   	A.	CPT
   	B.	ICD-10-PCS
   	C.	ICD-O
   	D.	HCPCS

10 points   

QUESTION 24

1. A physician query may not be appropriate in which of the following instances?

   	A.	Diagnosis of viral pneumonia noted in a progress note and sputum cultures growing bacterial pathogens
   	B.	An operative report stating "lung cancer" when the pathology report states non-small cell carcinoma
   	C.	A final diagnosis of chest pain and abnormal cardiac enzymes indicative of an AMI
   	D.	Discharge summary indicating chronic renal failure when the progress notes document acute renal failure throughout the stay

10 points   

QUESTION 25

1. Coding and billing functions must be based on which of the following?

   	A.	Most efficient utilization of resources
   	B.	Provider documentation
   	C.	Patient preferences
   	D.	Highest available reimbursement amounts

10 points   

QUESTION 26

1. Which of the following represents the simplest definition of unbundling?

   	A.	Failure to use multiple procedure codes
   	B.	Assigning improper APCs
   	C.	Failure to use a comprehensive code
   	D.	Billing for global charges when only the professional component was supplied

10 points   

QUESTION 27

1. A patient with HIV positive status presents to urgent care complaining of chest pain and fever. After investigation, the physician determines pneumonia is present. For the physician claim, which diagnosis must be sequenced first (as primary)?

   	A.	B20
   	B.	Z21
   	C.	Z20.6
   	D.	J18.9

10 points   

QUESTION 28

1. Medicare hospital outpatient services are grouped by:

   	A.	APC
   	B.	RVU
   	C.	RUG
   	D.	DRG

10 points   

QUESTION 29

1. When endoscopy documentation does not specify the method used to remove a lesion during the procedure, which is the appropriate action to take? Choose from the list below.

   	A.	Assign a code for removal by hot biopsy forceps
   	B.	Ask nursing staff to document the removal in their notes
   	C.	Assign a code for ablation
   	D.	Query the physician responsible for the case

10 points   

QUESTION 30

1. Which of the following neoplasia types is correct for an adenocarcinoma?

   	A.	Benign
   	B.	Uncertain behavior
   	C.	Malignant
   	D.	Unspecified

10 points   

QUESTION 31

1. A Medicare patient is admitted to observation status as a result of suspected congestive heart failure. Using the table below, select the most appropriate code(s) for the hospital to report for this outpatient encounter:

   HCPCS/CPT Code	Descriptor
   G0378	Hospital Observation Service, per hour
   99221	Initial Hospital Care, per day, for evaluation and management of an inpatient
   99291	Critical Care, evaluation and management of the critically ill patient, first 30-74 minutes
   G0380	Level I Hospital Emergency Department visit

   	A.	99221
   	B.	G0378
   	C.	G0378, 99221
   	D.	G0380

10 points   

QUESTION 32

1. Which of the following reimbursement methods pays providers according to charges that are calculated before health care services are rendered?

   	A.	Resource-based payment approach
   	B.	Fee-for-service model
   	C.	Retrospective payment methodology
   	D.	Prospective payment system

10 points   

QUESTION 33

1. An electrolyte panel (80051) consists of test for carbon dioxide (82374), chloride (82435), potassium (84132), and sodium (84295). If a physician's office bills each component individually on the claim form, this would be an example of which of the following?

   	A.	Unbundling
   	B.	Optimization
   	C.	Sequencing
   	D.	Balance billing

10 points   

QUESTION 34

1. Of the following classification systems, which would be used to locate supply codes for durable medical equipment (DME) and surgical implants?

   	A.	ICD-10-PCS
   	B.	APCs
   	C.	HCPCS
   	D.	ICD-10-CM

10 points   

QUESTION 35

1. A family practitioner requests the opinion of a physician specialist in endocrinology. This specialist reviews the patient's health record and examines the patient. This physician specialist records findings, impressions and recommendations. Which service and type of report are being supplied by the specialist?

   	A.	Consultation
   	B.	Follow-up
   	C.	Interpretation
   	D.	Peer review

10 points   

QUESTION 36

1. All of the following items are packaged into an APC under OPPS, EXCEPT FOR:

   	A.	Recovery room
   	B.	Anesthesia drugs
   	C.	Professional charges
   	D.	Surgical supplies

10 points   

QUESTION 37

1. This means that a service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care:

   	A.	Covered charge
   	B.	Excluded service
   	C.	Capitated amount
   	D.	Medical necessity

10 points   

QUESTION 38

1. Once all data are posted to a patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems. The auditing systems run each claim through a set of edits specifically designed for the various payers. The auditing system identifies data that have failed edits and flags the claim for correction. These internal auditing systems are called what?

   	A.	Scrubbers
   	B.	Clearinghouses
   	C.	Encoders
   	D.	Groupers

10 points   

QUESTION 39

1. Select the official ICD recommendations concerning the coding of secondary ("other") diagnoses for physician and outpatient services.

   	A.	Code all documented conditions that coexist at the time of the encounter, require or affect patient care treatment or management, or have an impact on current care.
   	B.	Code all conditions which coexist at the time of encounter, followed by the appropriate code from the V72 series (Special Investigations and Examinations).
   	C.	Code every condition documented on the encounter form or superbill, regardless of whether or not it has any impact on current health care needs.
   	D.	Do not code secondary diagnoses for physician or hospital outpatient reporting purposes.

10 points   

QUESTION 40

1. In determining which diagnosis code to sequence as first-listed (Primary) for physician or hospital outpatient services, the coder utilizes general coding guidelines, as well as chapter-specific guidelines and sequencing requirements of the tabular section. In addition, which other determinant helps the coder identify which code to list first for such encounters?

   	A.	The condition, diagnosis, problem, or other reason shown in the medical record to be chiefly responsible for the services provided.
   	B.	That condition, diagnosis, problem or other reason listed first in the medical record by the attending provider of service.
   	C.	That condition, diagnosis or problem determined to be most resource-intensive, severe, or acute in the set of diagnoses listed in the medical record.
   	D.	The condition established after study to be chiefly responsible for occasioning the admission the admission to the hospital.

10 points   

QUESTION 41

1. Of the following, which statement is true concerning the use of uncertain diagnoses for physician and hospital outpatient reporting?

   	A.	Follow internal policy on matters of coding uncertain diagnoses for outpatient or physician services.
   	B.	Query the provider on whether to code uncertain diagnoses for physician or outpatient services.
   	C.	Code uncertain diagnoses as if they actually exist.
   	D.	Do not code uncertain diagnoses, but code to the highest degree of certainty.

Answer 1

20.

Ans : B Z51.81, Z79.01

Code	Description
Z13.0	Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Z51.81	Encounter for therapeutic drug level monitoring
Z79.01	Long term (current) use of anticoagulants
Z00.01	Encounter for general adult medical examination with abnormal findings
Z00.00	Encounter for general adult medical examination without abnormal findings

21 .

Ans: B. Complex

1.Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure.Simple repairs are—as the name indicates—fairly straightforward, and require only single-layer closure of the affected area. Such repairs involve only the skin; deeper layers of tissue are unaffected.

2.Intermediate repair require one layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure.
In other words, wounds requiring intermediate repairs are deeper than those requiring simple repair. Per CPT, some single-layer closures may qualify as complex repairs, if the wound is “heavily contaminated” and requires “extensive cleaning or removal of particulate matter.When searching documentation for clues as to the complexity of repair, statements such as “layered closure,” “involving subcutaneous tissue,” and/or “removal of debris,” “extensive cleansing,” etc., point to an intermediate repair. Lack of these details, or a statement of “single layer closure,” suggests a simple repair.

3.Complex repairs involve wounds that are deeper and more dramatic, which may require debridement or significant revision:
Complex repair require more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents, or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.An operative note detailing such an extensive, reconstructive repair should be easily distinguished from other repair types, due to the need for procedures well beyond cleansing and suturing at one or more levels.

22.

Ans : A Upcoding

.2.Medically Unnecessary Services:- Health care items and services are considered “medically unnecessary,” and therefore not reimbursable by Medicare or Medicaid, when they are not “reasonable and necessary for the diagnosis or treatment of illness or injury.
3.Carve out :That portion of a provider bill denied for payment (for example, by an insurer). The term may be modified by a time period (for example, day c.).
4. Unbundling (also known as fragmentation) is the billing of multiple procedure codes for a group of procedures normally covered by a single, comprehensive CPT code. .

23.

Ans :- D .HCPCS

1. Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.
2. ICD-10-PCS will be the official system of assigning codes to procedures associated with hospital utilization in the United States. ICD-10-PCS codes will support data collection, payment and electronic health records. ICD-10-PCS is a medical classification coding system for procedural codes.
3. The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.
4. The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs.