Question

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

24. Option c : chest pain and abnormal cardiac enzymes elevated in Acute myocardial infarction. So no quires are appropriate for this statement .Remaing statements are need to clarify with documentation and with care providers . a.in pneumonia its need to clarify wether it was bacterial or viral .b.Because lung cancer two types. d. In renal failure documentation problem weather it was chronic or acute.

25. Option B. Coding and billing mainly based on Provider documentation . Remaining are based on choice of medical reimbursement available for patient.

26.Option c.Failure to use Comprehensive code..

Unbundling is the billing of Multiple procedure codes for a group of procedures normally covered by single comprehensive CPT code.

27. Option A. Its aCode for HIV infection . Its need primary sequence in coding because already patient was with well known diagnosis mentioned in diagnosis statement .Next sequence has to give for pneumonia J18.6

28.option D .Diagnosis related group is a system to clasify hospital cases .Based on this Decided what cases comes under outpatient services.

29.Option C . provide code for ablation.Its a surgical removal of body tissue. During the procedure.

Hot biopsy forceps is using forceps technique during biopsy.

30. Option D.In specified : Adinocarcinoma is malignant counter part to adenoma,which is the benign from of such tumors.

31.Option B.99221. Congestive heart failure need hospitalization and inpatient care.

32. Option c .Retrospective method .first given bill and based on bill they will treat.

Based on guide line provided how many possible.

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