Question

QUESTION 1

1. Under the Hospital Outpatient Prospective Payment System (OPPS), payments for services are:

• A.paid on a fee-for-service basis
• B.set in advance
• C.discounted from provider customary fees
• D.based of physician billed charges

10 points  

QUESTION 2

1. Which paper and electronic claims forms are used by hospitals and ambulatory surgery centers to reflect institutional (facility) charges?

• A.CMS 1500 or 837P
• B.UB-92 or 837P
• C.UB-04 or 837I
• D.CMS 1500 or ABN

10 points  

QUESTION 3

1. The excision of benign or malignant lesions cannot be reported in addition to which of the following code sets?

• A.Repairs and Closures (12001-13160)
• B.Skin Replacement Surgery (15002-15278)
• C.Skin Biopsy (11100-11101)
• D.Adjacent Tissue Transfer or Rearrangement (14000-14350)

10 points  

QUESTION 4

1. Hospital outpatient services are reimbursed under which of the following models?

• A.RBRVS
• B.APCs
• C.RUGs
• D.MS-DRGs

10 points  

QUESTION 5

1. In order to calculate the amount of reimbursement a hospital can expert for providing outpatient care, which of the following must you know?

• A.Length-of-stay
• B.MS-DRG assignment
• C.Principal Diagnosis
• D.APC calculations

10 points  

QUESTION 6

1. Which of the following codes would be reported by the hospital for closures done to a 5.0 cm anterior right lower leg wound, and a 2.7 cm posterior right lower leg wound?

• The service was furnished in the emergency department. The medical record indicates that the injuries to the leg included fascia.
• A.13121
• B.12032, 12032-59-XS
• C.12002, 12002-59-XS
• D.12034

10 points  

QUESTION 7

1. A patient undergoes a secondary Achilles tendon repair in the ambulatory surgery center. Which CPT would the ASC report as the primary procedure?

• A.27650
• B.27654
• C.27675
• D.29889

10 points  

QUESTION 8

1. Choose the best codes for the hospital outpatient claim.

A 52-year-old female with a deviated septum has a septoplasty in the outpatient surgery area.

• A.30520, J34.2
• B.30400, J34.2
• C.30630, Q67.4
• D.30620, Q67.4

10 points  

QUESTION 9

1. A 48-year-old female patient has breast carcinoma and presents to the hospital outpatient unit complaining of low energy. The physician orders hemoglobin and hemocrit counts, which were performed.After evaluation, it is determined the patient has anemia in neoplastic disease. The physician orders 3 units of packed red blood cells, which are transfused on the unit.

Which coding is best for the services described here?

• A.D64.81, C50.819
• 36440, 83026, 85060
• B.D64.9, C80.1
• 36430, 85060, 85025
• C.D64.81, C50.919
• 36456, 85018, 85060
• D.C50.919, D63.0
• 36430, 85014, 85018

10 points  

QUESTION 10

1. A 48-year-old female patient has breast carcinoma and presents to the hospital outpatient unit complaining of low energy. The physician orders hemoglobin and hemocrit counts, which were performed.After evaluation, it is determined the patient has anemia in neoplastic disease. The physician orders 3 units of packed red blood cells, which are transfused on the unit.

Which coding is best for the blood products? (See the HCPCS options below.)

HCPCS Code and Descriptor:

P9010

Whole blood for transfusion, per unit

P9021

Red blood cells for transfusion, per unit

P9060

Fresh frozen plasma for transfusion, per unit, donor retested

P9615

Catheterization for collection of specimen

P9045

Infusion, albumin, 5%, 250 ml

• A.P9021
• B.P9045, P9060
• C.P9021 X 3
• D.P9010 X 3, P9615

10 points  

QUESTION 11

1. A resident of a SNF is seen in outpatient surgery for treatment of her dysphagia due to CVA. An EGD with PEG tube insertion was performed and the patient was discharged back to the nursing home.

Which procedural coding should the hospital report for this service?

• A.43761
• B.43752
• C.43246
• D.43235, 43653

10 points  

QUESTION 12

1. A 76-year-old male presents to the OP surgical suite for investigation of suspected bladder tumors. A diagnostic cystoscopy is performed, revealing a normal urethra. However, two bladder tumors of approximately 1.5 cm were identified. At that time, a cystoscopic fulguration of the tumors was accomplished. Prior to fulgeration, a biopsy of the tumors was taken and sent to pathology. The surgeon's operative report lists a post-operative diagnosis of "suspected bladder cancer." The pathology report indicates transitional cell carcinoma in both bladder tumors.

Select the most appropriate reporting for the hospital's services and documented medical necessity.

• A.52234, 88305
• DX: C67.9
• B.52000, 52234, 88305
• DX: D49.0
• C.88307, 52235
• DX: C79.11
• D.52234 X 2
• DX: C67.5

10 points  

QUESTION 13

1. A patient presents on an outpatient basis for an AP and lateral chest x-ray for cough. The radiology report indicates "no abnormal findings." What would be the correct coding for the hospital outpatient radiology department?

• A.71010, 71010-76; J41.0
• B.71020; R05
• C.71022; Z01.811, R05
• D.71035-26; Z00.00

10 points  

QUESTION 14

1. Choose which of the following hospital services is considered outpatient.

• A.Observation status for 24 hours and discharge home.
• B.2 day admission to inpatient status with discharge to SNF.
• C.A patient seen emergently in the ED, followed by admission to ICU.
• D.A patient with a 5-day length of stay in the hospital's rehabilitation unit.

10 points  

QUESTION 15

The hospital billing manager approaches you with concerns over the accurate coding of 12-lead EKGs. Outpatients seen at the hospital for EKG services receive the diagnostic test from an EKG tech in a designated area of the hospital. They are scheduled after physicians have created orders for the EKG. (Emergent cases are always done at the patient's bedside.)

The hospital owns the EKG machines, employs the EKG technicians, and schedules its own outpatient appointments. Several cardiologists interpret the EKGs from home and bill for their own services (they are NOT paid by the hospital).

The billing manager believes that the hospital is losing money on outpatient EKGs because they are being coded improperly. Of the following codes for EKG services, which should the HOSPITAL use for its portion of the EKG services to outpatients?

1. A.93041-Rhythm EKG, 1-3 leads, tracing only, without interpretation and report.
2. B.93005-EKG, 12-leads; tracing only, without interpretation and report.
3. C.93000; EKG, 12-leads, with interpretation, report, and tracing. (Global charge)
4. D.93010-EKG, 12-leads; interpretation and report only.

10 points  

QUESTION 16

Based on CPT coding guidelines, which code(s) would be reported for outpatients receiving 1 hour and 45 minutes of antibiotic infusion in the ED?

• A.96374, 96375
• B.96360, 96361
• C.96372
• D.96365, 96366

10 points  

QUESTION 17

Which coding is correct for a 4-hour-long infusion of pre-packaged electrolytes and normal saline to a patient in observation status?

• A.96374, 96375 X 3
• B.96360, 96361 X 3
• C.96365, 96366 X 3
• D.Observation status patients are paid by MS-DRG, so the CPT would not be coded.

10 points  

QUESTION 18

A group of obstetric patients at the hospital attend a sixty minute therapy group on maternal nutrition. This occurs in the OB/GYN clinic area, under the direction of a registered dietitian, and based off orders signed by each lady's attending OB physician.

Which code should the hospital report for this service?

1. A.90853
2. B.97803 X 2
3. C.97802 X 2
4. D.97804 X 2

10 points  

QUESTION 19

The hospital outpatient pharmacy wants to begin furnishing medication therapy management services for its patients. They intend to meet with patients face-to-face, provide documentation of a pharmacist review of patient history, establish a thorough medication profile, provide consultation to patient about improving treatment outcomes and compliance.

Based off of this description, which codes should the hospital outpatient pharmacy use to capture the services of its pharmacists?

1. A.99401-99409
2. B.99487-99489
3. C.99605-99607
4. D.99601-99602

10 points  

QUESTION 20

The hospital outpatient pharmacy wants to begin furnishing medication therapy management services for its patients. They intend to meet with patients face-to-face, provide documentation of a pharmacist review of patient history, establish a thorough medication profile, provide consultation to patient about improving treatment outcomes and compliance.

Of the following elements, which would you recommend the pharmacists document in their record of service (in addition to those elements already listed)?

1. A.Documentation of FDA-approved literature for each medication prescribed to the patient.
2. B.Documentation that describes the patient's mental status exam.
3. C.Documentation of time spent face-to-face with the patient.
4. D.Documentation of the patient's attending provider.

Answer 1

Ans) 1) A.paid on a fee-for-service basis

Explaination:

- The Outpatient Prospective Payment System (OPPS) is the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care to patients with Medicare. The rate of reimbursement varies with the location of the hospital or clinic.

2) C.UB-04 or 837I

Explaination:

- Any institutional provider can use the UB-04 for billing medical claims. This includes: Community mental health centers. Comprehensive outpatient rehabilitation facilities.

3) C.Skin Biopsy (11100-11101)

Explaination:

- For many years we have used two codes to report skin biopsies. CPT® 11100 for the first lesion and 11101 for each additional lesion biopsied after the first lesion on the same date of service. The new biopsy codes are reported based on method of removal including: Tangential biopsy (11102 and 11103)

4) a. RBRVS

Explaination:

- The resource-based relative value scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers.