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After starting a new job, a coder realizes that the clinic she works for still uses the 1997 CPT E/M guidelines. From an ethical point of view, what is her best course of action?
A: Say nothing because management is responsible for keeping abreast of changes in coding guidelines.
B: Immediately discuss this with the relevant personnel and suggest education sessions for the provider and staff.
C: Wait for the next staff meeting, at which point the topic maybe brought up by someone more senior.
D: Do nothing because management likely has a reason for this; she has no ethical obligation here.
What data do coders abstract from the medical record?
A: Demographic data
B: Procedure dates
C: Admission dates
D: All the above
A 65-year-old woman with no comorbidities had a total replacement of her left knee by an open approach. What information needs to be documented in order for the correct ICD- 10-PCS code to be selected?
A: The manufacturer and model of the implant
B: The type of cement used in performing the procedure
C: The type of implant used and whether it was cemented
D: The type of implant used and the manufacturer
What is the function of grouper software?
A: Placing codes in a claim in the correct sequence
B: Organizing eligible subscribers into group health insurance plans
C: Arranging diagnosis codes into a "tree"
D: Categorizing patients based on the diagnoses or services provided
What is the principal diagnosis for the following scenario? A patient with uterine fibroids, who is scheduled for elective hysterectomy the next day, presents to the ED with weakness and shortness of breath. On examination, she is found to be severely anemic. Gynecology is consulted, and the patient is admitted for a blood transfusion. A total abdominal hysterectomy with bilateral salpingo- oophorectomy (TAH/BSO) is performed the next day, and the patient is discharged 2 days later in stable condition.
A: Uterine fibroids, because that was the underlying cause of her other conditions
B: Shortness of breath, because it showed the severity of her anemia
C: Uterine fibroids, because TAH/BSO was the principal procedure
D: Anemia, because it was the condition that required hospital admission for a blood transfusion
A Medicare patient had neuroplasty of the right wrist performed for carpal tunnel syndrome. What documentation would support medical necessity in this case?
A: Documentation of failed conservative treatment prior to surgery
B: Postoperative notes that document resolution of the carpal tunnel syndrome symptoms
C: A preoperative history and physical performed for medical clearance
D: An operative note signed by the surgeon
Which one of the following best matches the goal of HIPAA with regard to PHI?
A: Limit PHI to necessary use only, and penalize any persons who violate confidentiality rules intentionally or unintentionally.
B: Educate health professionals about the Privacy Rule to prevent violations.
C: Restrict PHI use to the minimum necessary standard, and identify violators of confidentiality rules.
D: Protect PHI, but penalize only those who intentionally violate confidentiality rules.
A claim for administration of Rocephin infusion in a hospital's outpatient infusion center was submitted to Medicare along with the medication administration record. Was the documentation sufficient?
A: Yes, this is sufficient because medical necessity was documented.
B: No, this is insufficient because a signed order for Rocephin was not included.
C: Yes, this is sufficient because administration of the infusion was documented.
D: Documentation sufficiency will be determined by the payers response.
A medical coding company suffers a data breach after one employee opened a phishing email. Under which law can the company be directly fined?
A: HIPAA
B: The Affordable Care Act
C: The HITECH Act
D: The Social Security Act
Do commercial payers have to adopt the 2021 CPT E/M code revisions?
A: No, but they often voluntarily choose to adopt them to make transactions easier.
B: Yes, under HIPAA. covered health plans must use the most recent version of the CPT.
C: No, HHS does not set standards for commercial plans.
D: Yes, if they contract with physicians who treat Medicare patients.
Correct
A new patient is seen in a family practice clinic. During the visit, he reports asymptomatic coronary artery disease that was previously diagnosed in another state. What information from his external records would help in selecting the most specific code for this condition?
A: The age at which he was diagnosed
B: History of tobacco use
C: Presence of hyperlipidemia
D: Prior coronary artery bypass grafting
Which one of these is NOT likely to result from the misuse of EHR templates?
A: Inclusion of a different provider's signature
B: Overdocumentation
C: Failure to accurately record the patient's condition
D: Documentation that does not accurately reflect the services provided
A 55-year-old man is admitted from the ED for acute ischemic stroke. He did not receive tissue plasminogen activator. Select the condition that would increase the MS-DRG if present on admission.
A: Chronic pain syndrome
B: Bacterial meningitis
C: Mixed hyperlipidemia
D: Benign prostatic hyperplasia
What is the correct coding for a patient with early-onset Alzheimer's disease and agitation?
A: F02.811, G30.0, because in the ICD-10 Alphabetic Index dementia is the primary code
B: G30.0 only, because in the ICD-10 Alphabetic Index dementia is an alternative code
C: G30.0 only, because in the ICD-10 Alphabetic Index dementia is a synonym
D: G30.0, F02.811, because in the ICD-10 Alphabetic Index dementia is the manifestation
Which program uses a score based on patient safety/adverse events and hospital- acquired infections, to reduce payments for hospital claims?
A: AHRQ Quality Indicator Program
B: Medicare's HAC Reduction Program
C: Medicare's Hospital Readmissions Reduction Program
D: MACRA