All coding chapter test 3 6-7 chapters cm-cpt, all multiple choice for exam 3 ch4-5-6-7 all combined
according to CPT non-starred surgical procedures are known as a surgical
package
Which of the organs listed below has endocrine and exocrine functions?
pancrease
A new strain of influenza, H1N1, is a highly virulent strain that spread all over the world. This type of epidemiological disease pattern is referred to as a(n)
pandemic
Increasing peristalsis of the intestines, increasing salivation, and a slowing heart rate are examples of
parasympathetic nervous system responses.
The progress of a disease, including initiating factors, signs and symptoms, physical manifestations, residual sequela, prognosis, and finally, the end result, is termed
pathogenesis
Coinsurance payments are paid by the _______ and determined by a specified percentage.
patient (insured)
An Advance Beneficiary Notice (ABN) is a document signed by the
patient indicating whether he/she wants to receive services that Medicare probably will not pay for.
A Medicare Summary Notice (MSN) is sent to ________ as their EOB.
patients (beneficiaries)
some services are covered and paid by medicare before medicaid makes payments because medicaid is considered which of the following?
payer of last resort
These are assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid.
payment status indicator
CMS assigns one _______________ to each APC and each ______________ code.
payment status indicator, HCPCS/CPT
The patient could not breathe on his own, so he was placed on a ventilator.
performance
The muscular contractions that move food through the alimentary canal from the mouth to the anus is referred to as
peristasis
What is the large serous membrane that covers the abdominal organs and lines the abdominal wall?
peritoneum
A 75-year-old patient has a sore tongue with tingling and numbness of the hands and feet. She has headaches and is fatigued. Following diagnostic workup, the doctor orders monthly injections of vitamin B12. This patient most likely has which of the following conditions?
pernicious anemia
Which of the following anatomical parts is involved in both the respiratory and digestive systems?
pharynx
Before leaving the hospital, all newborns are screened for an autosomal recessive genetic disorder of defective enzymatic conversion in protein metabolism. With early detection and a protein-restricted diet, brain damage is prevented. This disease is
phenylketonuria
Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are
physician work, practice expense, and malpractice insurance expense.
In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the "technical" components EXCEPT
physician's services
Which endocrine gland secretes melatonin, which controls the circadian rhythm of an individual?
pineal
The positive belief in a drug and its ability to cure a patient's illness, even if this drug is an inactive or inert substance, typically positively influences a patient's perception of its outcome. This effect is termed a
placebo effect.
Which one of the following cells produces antibodies?
plasma cells
A physician prescribes a diuretic for his patient. He could be treating any of the following disorders EXCEPT
pneumonia
Each of the following conditions fall under the category of COPD EXCEPT
pneumonia
The presence of fluid in the alveoli of the lungs is characteristic of
pneumonia
which of the following groups of healthcare providers contract with a self-insured employer to provide healthcare services
preferred provider organization
The Centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS-DRG payment for certain conditions that the patient was not admitted with, but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicator is referred to as
present on admission.
which of the following reimbursement methods pays providers according to charges that are calculated before healthcare services are rendered?
prospective payment method
A 72-year-old white male patient is on Coumadin therapy. Which of the following tests is commonly ordered to monitor the patient's Coumadin levels?
prothrombin time
The organism transmitted by a mosquito bite that causes malaria is a
protozoa
Maria Giovanni is in the hospital recovering from colon resection surgery. Based on her symptoms, her doctors are concerned about the possibility that she has developed a pulmonary embolism. Which of the following procedures will provide the definitive diagnosis?
pulmonary angiography
CMS-identified "hospital-acquired conditions" mean that when a particular diagnosis is not "present on admission," CMS determines it to be
reasonably preventable.
Reattachment fourth finger
reattachment
Most carbon dioxide is carried in the
red blood cells.
This is the amount collected by the facility for the services it bills.
reimbursement
When the third-party payer returns a claim due to missing, inaccurate, or invalid information, this is called a
rejected claim.
The _______________ is a statement sent to the provider to explain payments made by third-party payers.
remittance advice
Application of free skin graft to the nose status post excision malignant neoplasm
replacement
Reduction fracture right femoral shaft
reposition
gallbladder
resection
Gastric lap band for treatment of morbid obesity
restriction
The leading cause of blindness in the United States is a vision-related pathology caused by diabetes. It is called
retinopathy
Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of _________ payment system.
retrospective, prospective
A four-digit code that describes a classification of a product or service provided to a patient is a
revenue code
The process by which health care facilities and providers ensure their financial viability by increasing revenue, improving cash flow, and enhancing the patient's experience is called
revenue cycle management.
Softening of the bone in children is termed ________.
rickets
Which of the following sequences correctly depicts the flow of blood through the heart to the lungs in order for gas exchange to occur?
right atrium, right Ventricle, pulmonary artery, lungs
A APACHE is a tool used in the insurance industry. What information does this tool provide?
risk of dying
The childhood viral disease that unvaccinated pregnant women should be prevented from contracting because it may be passed to the fetus, thus causing congenital anomalies such as mental retardation, blindness, and deafness, is
rubella
which of the following would a health record technician use to perform the billing function for a physicians office?
screen 837 or CMS 1500
Which procedure will be used to initially diagnose the patient?
serology test
In ______________ anemia, the red blood cells become shaped like elongated crescents in the presence of low oxygen concentration.
sickle cell
An African American couple is undergoing genetic counseling to determine the likelihood of producing children with a recessively genetic blood condition. The genetic tests reveal that the father carries the trait to produce abnormal hemoglobin, HbS, which causes crystallization in RBCs and deforms their shape when O2 is low. This condition causes painful crises and multiple infarcts and is termed
sickle cell anemia
Under APCs, payment status indicator "T" means
significant procedure, multiple procedure reduction applies.
Under APCs, payment status indicator "S" means
significant procedure, multiple procedure reduction does not apply.
The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement to ____________________ for patients with Medicare.
skilled nursing facilities
A HIPPS (Health Insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by home health agencies (HHA) and ____.
skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs)
The most fatal type of lung cancer is
small cell cancer.
Most of the digestion of food and absorption of nutrients occur in the
small intestine.
Sam Spade has been severely injured in an MVA because he was not wearing a seat belt. The organ in his body, situated at the upper left of his abdominal cavity, under the ribs, that is part of his lymphatic system has been ruptured, and he is bleeding internally. Sam needs a surgical procedure known as
splenectomy
Which of the following is not one of the five layers of the epidermis?
stratum fascia
After a claim has been filed with Medicare, a healthcare organization had late charges posted to a patient's outpatient account that changed the calculation of the APC. What is the best practice for this organization to receive the correct reimbursement from Medicare?
submit an adjusted claims to medicare
Which set of muscles controls the movement of the eye up and down?
superior and inferior rectus
Which type of joint, such as the sutures of the skull, has no movement?
synarthrosis
The interaction of two drugs working together to where each simultaneously helps the other achieve an effect that neither could produce alone is termed a
synergistic effect.
Microbiological lab culture and sensitivity tests were performed on the skin scrapings of a groin lesion on a 27-year-old male patient who presented to a local health department clinic. The results confirm infection with Treponema pallidum. He was given a prescription for penicillin and told to return for a follow-up visit in 2 weeks. His diagnosis is
syphilis
In which brain lobe is the processing of smell and hearing stimuli performed?
temporal
This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS's website.
the OIG's Work Plan
On an EKG, what signifies the electronic stimulation of the ventricles?
the QRS wave
This law prohibits a physician from referring Medicare patients to clinical laboratory services where the doctor or a member of his family has a financial interest.
the Stark I Law
what was the result of the Balanced Budget Act of 1997?
the implementation of the APC system
The nose, mouth, sinuses, pharynx, and larynx make up the
the upper respiratory tract.
Diastole occurs when
the ventricles fill.
Under the APC methodology, discounted payments occur when
there are two or more (multiple) procedures that are assigned to status indicator "T."
Necrosis extending down to the underlying fascia is characteristic of a decubitus ulcer in stage
three
A toxic goiter has what distinguishing characteristic?
thyroid hyperfunction
A transfusion of whole blood was administered to the patient.
transfusion
A condition that involves the fifth cranial nerve, also known as "tic douloureux," causes intense pain in the eye and forehead; lower lip, the section of the cheek closest to the ear and the outer segment of the tongue; or the upper lip, nose, and cheek.
trigeminal neuralgia
Old age, obesity, and a family history of diabetes are all characteristics of
type 2 diabetes.
The patient was admitted with diabetic nephropathy. She was diagnosed with type II diabetes five years ago and uses oral antidiabetic drugs daily. The ICD-10-CM diagnosis codes should be reported in this sequence.
type II diabetes with nephropathy combination code + control using oral antidiabetic drug code
Early detection programs apply screening guidelines to detect cancers at an early stage, which provides the likelihood of increased survival and decreased morbidity. Which of the following would NOT be a diagnostic or screening test for colorectal cancer?
upper GI X-ray
Which structure transports urine from the kidneys to the bladder?
ureter
Common kidney stone treatments that allow small particles to be flushed out of the body through the urinary system include all of the following EXCEPT
ureteroscopy and stone basketing.
There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by
using established physician query protocols.
Which of the following is a lethal arrhythmia?
ventricular fibrillation
A mild, atypical lung infection with inflammation and fluid buildup, usually caused by Mycoplasma pneumoniae or other bacteria, in which the patient is mildly ill but does not require hospitalization and is treated with antibiotics is termed
walking pneumonia
CMS identified Hospital-Acquired Conditions (HACs). Some of these HACs include foreign objects retained after surgery, blood incompatibility, and catheter-associated urinary tract infection. The importance of the HAC payment provision is that the hospital
will not receive additional payment for these conditions when they are not present on admission.
Some services are performed by a nonphysician practitioner (such as a physician assistant). These services are an integral yet incidental component of a physician's treatment. A physician must have personally performed an initial visit and must remain actively involved in the continuing care. Medicare requires direct supervision for these services to be billed. This is called
"Incident to" billing.
Assume the patient has already met his or her deductible and that the physician is a Medicare participating (PAR) provider. The physician's standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00. How much reimbursement will the physician receive from Medicare?
$ 48.00
If the Medicare non-PAR approved payment amount is $128.00 for a proctoscopy, what is the total Medicare approved payment amount for a doctor who does not accept assignment, applying the limiting charge for this procedure?
$147.20
Under outpatient prospective payment system, Medicare decides how much a hospital or a community mental health center will be reimbursed for each service rendered. Depending on the service, the patient pays either a coinsurance amount (20%) or a fixed copayment amount, whichever is less. Mr. Smith, who has paid his deductible for the year, was charged $85 for a minor procedure performed in the hospital outpatient department. The fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15. What would Mr. Smith need to pay in this case?
$15
If this physician is a participating physician who accepts assignment for this claim, the total amount the physician will receive is
$200.00
If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount the physician will receive is
$218.50.
If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?
$250.00
Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's non-PAR fee is $57.00. What is the amount Medicare will pay the beneficiary on this claim?
$45.60
f this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is
$66.50.
Treatment for chronic conditions at same time preventive medicine is provided.
-25
Consultation required by payer.
-32
Needle core biopsy of right and left breast.
-50
Arthroscopy of right elbow and closed fracture reduction of left wrist.
-51
Postoperative management of vaginal hysterectomy.
-55
Office consultation as preoperative clearance for surgery.
-56
Inpatient visit performed by surgeon, with decision to perform surgery tomorrow.
-57
Repeat gallbladder x-ray series, same physician
-76
Cholecystectomy reported during postoperative period for treatment of leg fracture.
-79
Assistant surgeon reporting patient's cesarean section, delivery only.
-80
Code anesthesia for decortication of left lung.
00542
Code anesthesia for upper abdominal ventral hernia repair.
00752
Code anesthesia for vaginal hysterectomy.
00944
Code anesthesia for procedures on bony pelvis.
01120
Code anesthesia for total hip replacement.
01214
Code anesthesia for total shoulder replacement.
01638
Code anesthesia for placement of vascular shunt in forearm.
01844
Code anesthesia for cesarean section.
01961
The results of the amniocentesis showed the fetus has Down syndrome. The special care that will be provided to the mother during the rest of her pregnancy will be supported by code:
035.1xx0 Maternal care for (suspected) chromosomal abnormality in fetus
In ICD-10-PCS, extraction left intraocular lens without replacement, percutaneous
08DK3ZZ
In ICD-10-PCS, EGD with removal FB from duodenum
0DC98ZZ
In ICD-10-PCS, left knee arthroscopy with reposition of the anterior horn medial meniscus
0SSC4ZZ
In ICD-10-PCS, ESWL left ureter wave lithotripsy
0TF7XZZ
The case-mix index (CMI) for the top 10 MS-DRGs above is
1.278.
The number of days Medicare will cover SNF inpatient care per benefit period is limited to which of the following?
100
Under ASC PPS, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at _____ and all remaining procedures are reimbursed at ______.
100%, 50%
Patient presents to the radiology department where a fine-needle aspiration of the breast is performed utilizing computed tomography.
10009
Jason McCall, a 51-year-old male, has a pilonidal cyst. Dr. Bonneti performs an I&D (incision and drainage).
10080
In ICD-10-PCS, normal delivery with episiotomy
10E0XZZ, 0W8NXZZ
Patient presents to the hospital for debridement of a diabetic ulcer of the left ankle. The patient has a history of recurrent ulcers. Medication taken by the patient includes Diabeta, and the patient was covered in the hospital with insulin sliding scales. The decubitus ulcer was debrided down to the bone.
11043
Ethan Monahan, a 73-year-old male, came to see Dr. Greenberg for the removal of some skin tags on his left cheek. Dr. Greenberg administered a local anesthetic and then electrosurgically destroyed the nine tags. The tags were sent to pathology for testing.
11200
seventeen skin tags were removed by electrocautherization from the patient back and neck ? what is the correct CPT coding for this procedure
11200,11201
Patient presents to the operating room for excision of three lesions. The 1.5 cm and 2 cm lesions of the back were excised with one excision. The 0.5 cm lesion of the hand was excised. The pathology report identified both back lesions as squamous cell carcinoma. The hand lesion was identified as seborrheic keratosis.
11604, 11420
Denita Tauber found a sore on her neck. The lab test identified it as a malignant lesion, and Dr. Capp excised the lesion, measuring 2.9 cm with margins.
11623
Warren Samuels, a 47-year-old male, owns a landscaping business. While he was reviewing some property to write a proposal, the family's toy poodle bit him on the leg. While the 12-cm wound was not severe, Warren wanted Dr. Dawson to check it out. Dr. Dawson performed a simple repair and applied a bandage.
12004
Cletus Jones, a 23-year-old male, was in a fight at a hockey game and was hit in the head with a bottle, which caused some deep lacerations in his scalp. Dr. Fairchild performed a layered closure of the wounds: one 2.0 cm; one 4.5 cm; and two lacerations that were 1.0 cm each in length.
12034
Patient presents to the emergency room with lacerations of right lower leg that involved the fascia. Lacerations measured 5 cm and 2.7 cm. Repair for the wound required the physician to close the epidermal and dermal layers.
12034
Patient presents to the emergency room with lacerations sustained in an automobile accident. Repairs of the 3.3 cm skin laceration of the left leg that involved the fascia, 2.5 cm and 3 cm lacerations of the left arm involving the fascia, and 2.7 cm of the left foot, which required simple sutures, were performed. Sterile dressings were applied.
12034, 12002-59
Patient presents to the operating room where a 3.2 cm malignant lesion of the shoulder was excised and repaired with simple sutures. A 2 cm benign lesion of the cheek was excised and was repaired with a rotation skin graft.
14040, 11604
Patient presents to the operating room for excision of a 4.5 cm malignant melanoma of the left forearm. A 6 cm x 6 cm rotation flap was created for closure.
14301
When all third-party payments have been received and contractual allowances have been written off, the remaining balance is categorized as the patient responsibility. Best practice is to have the patient responsibility amount be less than what percentage of the total balance?
15
The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the non-PAR fee schedule amount. The limiting charge is
15%
Under ASCs, bilateral procedures are reimbursed at ________ of the payment rate for their group.
150
Under ASC PPSs, bilateral procedures are reimbursed at _______ of the payment rate for their group.
150%
Patient presents to the hospital for skin grafts due to previous third-degree burns. The burn eschar of the back was removed. Once the eschar was removed, the defect size measured 10 cm x 10 cm. A skin graft from a donor bank was placed onto the defect and sewn into place as a temporary wound closure.
15002, 15273
A 10 sq cm epidermal autograft to the face from the back
15115
Nonhuman graft for temporary wound closure. Patient has a 5 cm defect on the scalp.
15275
Colleen Sizmauski, a 59-year-old female, came to Dr. Lafferty's office to have an epidermal facial checmical peel performed.
15788
Colleen Sizzle, a 59-year-old female, came to Dr. Kraft's office to have an epidermal facial chemical peel performed.
15788
Facelift utilizing the superficial musculoaponeurotic system (SMAS) flap technique.
15829
Hannah Lopez, a 63-year-old female, is bedridden with two broken legs in traction. Dr. Quinn excised an ischial pressure ulcer with a primary suture.
15940
Jackie Thurman, a 35-year-old female, was seen by her regular physician, Dr. Callman, after she spilled a pot of boiling water on her stomach and legs. Thankfully, her apron and corduroy dress absorbed most of the heat, and she only had first-degree burns. Dr. Callman performed initial local treatment and sent her home.
16000
Ruth Ann Marcelle, a 9-year-old female, had a partial thickness burn on her hand. Dr. Assiss performed a debridement and dressing of the injury.
16020
Ruth Ann Marcelle, a 9-year-old female, had a partial thickness burn on her hand. Dr. Wright performed a debridement and dressing of the injury.
16020
outpatient surgery was performed for the laser removal of the five benign facial lessons. no tissue were sent to pathology. which of the following represents the correct coding and sequencing?
17000,17003,17003,17003,17003
Frank Mulrooney, a 43-year-old male, came to see Dr. Johnston, his podiatrist, for the removal of a benign plantar wart from the sole of his left foot. Dr. Johnston administered a local anesthetic and then destroyed the wart using a chemosurgical technique. A protective bandage was applied to the foot, and Frank was sent home with an appointment to return in one week for a follow-up check.
17110
Patient presents to the operating room where the physician performed, using imaging guidance, a percutaneous breast biopsy utilizing a rotating biopsy device.
19081
Female patient has a percutaneous needle biopsy of the left breast lesion in the lower outer quadrant. Following the biopsy frozen section results, the physician followed this with an excisional removal of the same lesion.
19120-LT
excision of 3 breast lesions with preoperative placement of needle localization wire by the surgeon
19125,19126,19126,19290,19291,19291
Cassandra Twillinger, a 29-year-old female, is postmastectomy and comes in today so Dr. Edwin can perform a breast reconstruction with free flap.
19364
Under ASC-PPS, the patient is responsible for paying the coinsurance amount based upon ____ of the national median charge for the services rendered.
20%
The patient is financially liable for the coinsurance amount, which is
20%%
Patient is brought to the emergency room following a shark attack. The paramedics have the patient's amputated foot. The patient is taken directly to the operating room to reattach the patient's foot.
20838
Patient presents to the emergency room following an assault. Examination of the patient reveals blunt trauma to the face. Radiology reports that the patient suffers from a fracture to the frontal skull and a blow-out fracture of the orbital floor. Patient is admitted and taken to the operating room where a periorbital approach to the orbital fracture is employed and an implant is inserted.
21390
Open I&D of a deep abscess of the cervical spine
22010
Chronic nontraumatic rotator cuff tear. Arthroscopic procedure of the shoulder with removal of foreign body and open rotator cuff repair
23412, 29819-59
Mr. Jones is a 67-year-old patient who only has Medicare's Part A insurance. Given the information here, if Mr. Jones used 36 lifetime reserve days, how many does the patient have left to be used at a later date?
24 days
Patient presents to the emergency room following a fall from a tree. X-rays were ordered for the left upper arm, which showed a fracture of the humerus shaft. The emergency room physician performed a closed reduction of the fracture and placed the patient in a long arm spica cast. Code the procedures, excluding the X-ray.
24505-LT
how many major diagnostic categories are there in the MS-DRG system?
25
Patient comes into his physician's office complaining of wrist pain. Physician gives the patient an injection and sends the patient to the hospital for an arthrography. Code the complete procedure.
25246, 73115
percutaneous skeleton fixation of distal radial fracture requiring manipu;action with external fixation
25611
Patient presents to the hospital with a right index trigger finger. Release of the trigger finger was performed.
26055-F6
Patient presents with a traumatic partial amputation of the second, third, and fourth fingers on the right hand. Patient was taken to the operating room where completion of the amputation of three fingers was performed with direct closure.
26951-F6, 26951-F7, 26951-F8
Trauma patient was rushed to the operating room with multiple injuries. Open reduction with internal fixation of intertrochanteric femoral fracture and open reduction of the tibial and fibula shaft with internal fixation were performed.
27244, 27758
Patient presents to the emergency room following a fall. X-rays were ordered for the lower leg, and results showed a fracture of the proximal left tibia. The emergency room physician performed a closed manipulation of the fracture with skeletal traction.
27532-LT
repair secondar achilles tendon
27654
No book:Patient was seen for excision of two interdigital neuromas from the left foot.
28080, 28080
Dr. Torres performed a repair of the secondary tendon flexor in Bobby Morton's right foot. He first performed an open tenotomy and then did the repair with a free graft.
28202
keller procedure
28292
Patient presents to the hospital with ulcer of the right foot. Patient is taken to the operating room where a revision of the right metatarsal head is performed.
28899
diagnostic and surgical arthroscopy of the right knee with lateral meniscectomy
29881
Dr. Quartermain performed a rhinoplasty to correct the nasal deformity on Frank Chestnut, a three-year-old male born with a cleft palate. The tip, septum, and osteotomies were all treated
30462
Dr. Quartermain performed a rhinoplasty to correct the nasal deformity on Frank Chestnut, a three-year-old male born with a cleft palate. The tip, septum, and osteotomies were all treated.
30462
Patient with a deviated nasal septum that was repaired by septoplasty
30520
surgical nasal endoscopy with polypectomy
31237
Patient presents to the surgical unit and undergoes unilateral nasal endoscopy, partial ethmoidectomy, and maxillary antrostomy.
31254, 31256-51
Patient has been diagnosed with metastatic laryngeal carcinoma. Patient underwent subtotal supraglottic laryngectomy with radical neck dissection.
31368
Lye burn of the larynx repaired by laryngoplasty
31599
Patient was involved in an accident and has been sent to the hospital. During transport, the patient develops breathing problems and, upon arrival at the hospital, an emergency transtracheal tracheostomy was performed. Following various X-rays, the patient was diagnosed with traumatic pneumothorax. A thoracentesis with insertion of tube was performed.
31603, 32554
Patient with laryngeal cancer has a tracheoesophageal fistula created and has a voicebox inserted.
31611
Tracheostoma revision with flap rotation
31614
Patient has a bronchoscopy with endobronchial biopsies of three sites.
31625
Bronchoscopy with multiple transbronchial right upper and right lower lobe lung biopsy with fluoroscopic guidance
31628, 31632
Patient was admitted with hemoptysis and underwent a bronchoscopy with transbronchial lung biopsy. Following the bronchoscopy, the patient was taken to the operating room where a left lower lobe lobectomy was performed without complications. Pathology reported large cell carcinoma of the left lower lobe.
31628, 32480
thoracentesis with insertion of tube for pneumothorax
32002
Upper lobectomy of the right lung with repair of the bronchus
32480, 32501
Patient has recurrent spontaneous pneumothorax, which has resulted in a chemical pleurodesis by thoracoscopy.
32650
Patient presents to the operating room where a CABG x 3 is performed using the mammary artery and two sections of the saphenous vein.
33533, 33518
Patient undergoes construction of apical-aortic conduit with an insertion of a single-ventricle ventricular assist device.
33975
carotid artery embolectomy
34001
No book: The patient had a thrombectomy, without catheter, of the peroneal artery, by leg incision.
34203
Patient complains of recurrent syncope following carotid thromboendarterectomy. Patient returns 2 weeks after initial surgery and undergoes repeat carotid thromboendarterectomy.
35301
Patient has a history of PVD for many years and experiences chest pains. The patient underwent Doppler evaluation, which showed a common femoral DVT. Patient is now admitted for thromboendarterectomy.
35371
Patient returns to the operating room following open-heart bypass for exploration of blood vessel to control postoperative bleeding in the chest.
35820
The physician punctures the left common femoral to examine the right common iliac.
36245
Blood transfusion of three units of packed red blood cells
36430
Eighty-year-old patient has carcinoma and presents to the operating room for placement of a tunneled implantable centrally inserted venous access port.
36561
Patient is admitted with alcohol cirrhosis and has a TIPS procedure performed.
37182
varicoses vein ligation and stripping of long saphenous vein
37720
Trauma patient is rushed to the operating room with multiple injuries. The patient had his spleen removed due to a massive rupture, with repair of the lacerated diaphragm.
38100, 39501
Patient has a bone marrow aspiration of the iliac crest and of the tibia.
38220, 38220-59
Patient has breast carcinoma and is now undergoing sentinel node biopsy. Patient was injected for sentinel node identification and two deep axillary lymph nodes showed up intensely. These two lymph nodes were completely excised. Path report was positive for metastatic carcinoma.
38525, 38792
Patient diagnosed with cystic hygroma of the axilla, which was excised
38550
Laparoscopic retroperitoneal lymph node biopsy
38570
Laparoscopy with multiple biopsies of retroperitoneal lymph nodes
38570
Excision of mediastinal cyst
39200
The best practice for a system hold for all charges to be entered into the billing system and all coding to be completed is:
4-days post-discharge or visit
a patient is admitted to your hospital 6 weeks post myocardial infraction with severe chest pains. which is the correct code?
410.1x (acute MI)
Young child presents with cleft lip and cleft palate. This is the first attempt of repair, which includes major revision of the cleft palate and unilateral cleft lip repair.
42215, 40700
Two-year-old patient returns to the hospital for cleft palate repair where a secondary lengthening procedure takes place.
42220
Injection snoreplasty for treatment of palatal snoring
42299
tonsillectomy on a 6 year old boy
42825
Tonsillectomy on a 14-year-old
42826
Patient presents with a history of upper abdominal pain. Cholangiogram was negative, and patient was sent to the hospital for ERCP. During the procedure, the sphincter was incised and a stent was placed for drainage.
43274
Patient arrives to the hospital and has a Nissen fundoplasty done laparoscopically.
43280
Patient has a history of hiatal hernia for many years, which has progressively gotten worse. The decision to repair the hernia was made, and the patient was sent to the operating room where the repair took place via the thorax and abdomen.
43336
Laparoscopic gastric banding
43770
Morbidly obese patient comes in for vertical banding of the stomach.
43842
Patient presents to the emergency room with right lower abdominal pains. Emergency room physician suspects possible appendicitis. Patient was taken to the operating room where a laparoscopic appendectomy was performed. Pathology report was negative for appendicitis.
44970
laparoscopic adrenalectomy
44970
Patient underwent anoscopy followed by colonoscopy. The physician examined the colon to 60 cm.
45378
colonoscopy with removal of polyps by hot biopsy forceps and by snare technique
45384,45385
Based on the this patient volume, during this time period, the MS-DRG that brings in the highest "total" reimbursement to the hospital is
470
Ultrasonic guidance for the needle biopsy of the liver. Code the complete procedure.
47000, 76942
Patient was admitted for right upper quadrant pain. Workup included various X-rays that showed cholelithiasis. Patient was taken to the operating room where a laparoscopic cholecystectomy was performed. During the procedure, the physician was unable to visualize through the ports, and an open cholecystectomy was elected to be performed. An intraoperative cholangiogram was performed. Pathology report states acute and chronic cholecystitis with cholelithiasis.
47605
No book:A 4-year-old had a repair of an incarcerated inguinal hernia. This is the first time this child had been treated for this condition
49501
Laparoscopic repair of umbilical hernia
49652
The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of ____ years, unless state law specifies a longer period.
5
Two weeks ago, Dr. Sweetzer perfomed an ureteroneocystostomy with cystoscopy and ureteral stent placement laparoscopically on Patricia Worster. However, today he must perform an open procedure on her to drain a renal abscess that was discovered. Code the drainage of Patricia's renal abscess.
50020
Nephrectomy with resection of half of the ureter
50220
Patient undergoes partial nephrectomy for carcinoma of the kidney.
50240
Removal of nephrostomy tube with fluoroscopic guidance
50389
Patient comes to the hospital with a history of right flank pain. Urine tests are negative. Radiology examination reveals that the patient has renal cysts. Patient is now admitted for laparoscopic ablation of the cysts.
50541
Patient has ovarian vein syndrome and has ureterolysis performed.
50722
Closure of ureterocutaneous fistula
50920
Patient presented to the operating room where an incision was made in the epigastric region for a repair of ureterovisceral fistula.
50930
Ureterolithotomy completed laparoscopically
50945
Patient has extensive bladder cancer. She underwent a complete cystectomy with bilateral pelvic lymphadenectomy and creation of ureteroileal conduit.
51595
Female with 6 months of stress incontinence. Outpatient therapies are not working and the patient decides to have the problem fixed. Laparoscopic urethral suspension was completed.
51990
Patient presents to the operating room for fulguration of bladder tumors. The cystoscope was inserted and entered the urethra, which was normal. Bladder tumors measuring approximately 1.5 cm were removed.
52234
Excision of 2.5 cm bladder tumor with cystoscopy
52235
Litholapaxy, 3 cm calculus
52318
Placement of double-J stent
52332
Patient presents to the hospital with right ureteral calculus. Patient is taken to the operating room where a cystoscopy with ureteroscopy is performed to remove the calculus.
52352-RT
transurethral ballon dilation of prostatic urethra
52510
Excision of Cowper's gland
53250
Male with urinary incontinence. Sling procedure was performed 6 months ago, and now the patient has returned for a revision of the sling procedure.
53442
Male patient has been diagnosed with benign prostatic hypertrophy and undergoes a transurethral destruction of the prostate by radiofrequency thermotherapy.
53852
Laser destruction of penile condylomas
54057
Patient has been diagnosed with prostate cancer. Patient arrived in the operating room where a therapeutic orchiectomy is performed.
54520
Patient undergoes laparoscopic orchiopexy for intra-abdominal testes.
54692
Scrotal wall abscess drainage
55100
Male presented to operating room for sterilization by bilateral vasectomy
55250
Hydrocelectomy of spermatic cord
55500
Patient has been followed by his primary care physician for elevated PSA. Patient underwent prostate needle biopsy in the physician's office 2 weeks ago, and the final pathology was positive for carcinoma. Patient is admitted for prostatectomy. The frozen section of the prostate and one lymph node is positive for prostate cancer with metastatic disease to the lymph node. Prostatectomy became a radical perineal with bilateral pelvic lymphadenectomy.
55815
Patient has a Bartholin's gland cyst that was marsupialized.
56440
Patient has been diagnosed with carcinoma of the vagina, and she has a radical vaginectomy with complete removal of the vaginal wall.
57111
Patient was admitted with a cystocele and rectocele. An anterior colporrhaphy was performed.
57240
Patient has been diagnosed with uterine fibroids and undergoes a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
58150
Hysteroscopy with D&C and polypectomy
58558
Patient was admitted to the hospital with sharp pelvic pains. A pelvic ultrasound was ordered, and the results showed a possible ovarian cyst. The patient was taken to the operating room where a laparoscopic destruction of two corpus luteum cysts was performed.
58662
Laparoscopic tubal ligation utilizing Endoloop
58671
Patient is at a fertility clinic and undergoes intrauterine embryo transplant.
58974
Amniocentesis
59000
Patient is admitted to the hospital following an ultrasound at 25 weeks, which revealed fetal pleural effusion. A fetal thoracentesis was performed.
59074
Patient is 6 weeks pregnant and complains of left-sided abdominal pains. Patient is suspected of having an ectopic pregnancy. Patient has a laparoscopic salpingectomy with removal of the ectopic tubal pregnancy.
59151
A D&C is performed for postpartum hemorrhage.
59160
A pregnant patient has an incompetent cervix, which was repaired using a vaginal cerclage.
59320
Patient in late stages of labor arrives at the hospital. Her OB physician is not able to make the delivery, and the house physician delivers the baby vaginally. Primary care physician resumes care after delivery. Code the delivery.
59409
Cesarean delivery with antepartum and postpartum care
59510
Attempted vaginal delivery in a previous cesarean section patient, which resulted in a repeat cesarean section
59620
Patient is 24 weeks pregnant and arrives in the emergency room following an automobile accident. No fetal movement or heartbeat noted. Patient is taken to the OB ward where prostaglandin is given to induce abortion.
59855
Terminally ill patients with life expectancies of ______ may opt to receive hospice services.
6 months or less
Mycobacterium tuberculosis is the organism that causes tuberculosis (TB), typically a respiratory disorder. It is currently experiencing resurgence in the United States and many other countries. What is the average time frame in which all patients with new, previously untreated TB must have daily antibiotic therapy?
6-12 months
Patient comes in for a percutaneous needle biopsy of the thyroid gland.
60100
Unilateral partial thyroidectomy
60210
On May 1, Dr. Monmouth performed a percutaneous core needle biopsy on Stephan English. Two days later, after reviewing the results of the biopsy, Dr. Monmouth performs a complete thyroidectomy on Stephan. Code both procedures.
60240, 60100
Patient undergoes total thyroidectomy with parathyroid autotransplantation.
60240, 60512
Left carotid artery excision for tumor of carotid body
60605
Laparoscopic adrenalectomy, complete
60650
Patient is admitted to the hospital with facial droop and left-sided paralysis. CT scan of the brain shows subdural hematoma. Burr holes were performed to evacuate the hematoma.
61154
Patient has metastatic brain lesions. Patient undergoes stereotactic radiosurgery gamma knife of two lesions.
61796, 61797
Patient with Parkinson's disease is admitted for insertion of a brain neurostimulator pulse generator with one electrode array.
61885
Patient has rhinorrhea, which requires repair of the CSF leak with craniotomy.
62100
Spinal tap
62270
Patient comes in for steroid injection for lumbar herniated disk. Marcaine and Aristocort were injected into the L2-L3 space.
62322
Laminectomy and excision of intradural lumbar lesion
63272
Patient requires repair of a 6 cm meningocele.
63702
Injection of anesthesia for nerve block of the brachial plexus.
64415
Patient has right sacroiliac joint dysfunction and requires a right S2-S3 paravertebral facet joint anesthetic nerve block with image guidance.
64493
carpal tunnel disease open
64721
Patient comes in through the emergency room with a wound that was caused by an electric saw. Patient is taken to the operating room where two ulna nerves are sutured.
64836, 64837
Patient undergoes enucleation of left eye, and muscles were reattached to an implant.
65105-LT
Aphakia penetrating corneal transplant
65750
Radial keratotomy
65771
Patient undergoes ocular resurfacing construction utilizing stem cell allograft from a cadaver.
65781
Patient returns to the physician's office complaining of obscured vision. Patient has had cataract surgery 6 months prior. Patient requires laser discission of secondary cataract.
66821
Patient suffers from strabismus and requires surgery. Recession of the lateral rectus (horizontal) muscle with adjustable sutures was performed.
67311, 67335
Correction of trichiasis by incision of lid margin
67830
Lagophthalmos correction with implantation using gold weight.
67912
Patient is admitted for a blepharoplasty of the left lower eyelid and a repair for a tarsal strip of the left upper lid.
67917-E1, 15820-E2
Drainage of simple external ear abscess
69000
Patient comes into the office for removal of impacted earwax.
69210
Modified radical mastoidectomy
69505
Patient came in for excision of a middle ear lesion.
69540
Myringoplasty
69620
Patient with a traumatic rupture of the eardrum. Repaired with tympanoplasty with incision of the mastoid. Repair of ossicular chain not required.
69635
Patient with chronic otitis media requiring transtympanic eustachian tube catheterization.
69799
Insertion of cochlear device inner ear
69930
Patient with Bell's palsy requiring a total facial nerve decompression
69955
Decompression internal auditory canal
69960
CT scan of the head with contrast
70460
Patient presents to the hospital for a two-view chest X-ray for a cough. The radiology report comes back negative. What would be the correct codes to report to the insurance company?
71046
Patient comes into the outpatient department at the local hospital for an MRI of the cervical spine with contrast. Patient status post automobile accident.
72142
Patient undergoes X-ray of the foot with three views.
73630
Obstetric patient comes in for a pelvimetry with placental placement.
74710
Pregnant female comes in for a complete fetal and maternal evaluation via ultrasound.
76811
Unilateral mammogram with computer-aided detection with further physician review and interpretation.
77065
Patient has carcinoma of the breast and undergoes proton beam delivery of radiation to the breast with a single port.
77520
SPECT bone imaging
78320
Administration of initial oral radionuclide therapy for hyperthyroidism
79005
Basic metabolic panel (calcium, total) and total bilirubin
80048, 82247
A physician orders a lipid panel on a 54-year-old male with hypercholesterolemia, hypertension, and a family history of heart disease. The lab employee in his office performs and reports the total cholesterol and HDL cholesterol only.
82465, 83718
Creatinine clearance
82575
Vitamin B12
82607
Clotting factor VII
85230
Partial thromboplastin time utilizing whole blood
85730
Hepatitis C antibody
86803
Chlamydia culture
87110
Pathologist performs a postmortem examination, including the brain, of an adult. Tissue is sent to the lab for microscopic examination.
88025
Cytopathology of cervical Pap smear with automated thin-layer preparation utilizing computer screening and manual rescreening under physician supervision
88175
Pathologist bills for gross and microscopic examination of medial meniscus
88304
What code is used for a culture of embryos less than 4 days old?
89250
Huhner test and semen analysis
89300
An established 3-year-old patient was seen by his pediatrician for a DTaP immunization. The pediatrician also provided documentation for a minimal level office visit in addition to the immunization.
90700, 90471, 99211-25
No book:Patient was seen today for regular hemodialysis. No problems reported, tolerated procedure well.
90935
Caloric vestibular test using air, monothermal
92538
A physician performs a PTCA with drug-eluting stent placement in the left anterior descending artery and angioplasty only in the right coronary artery.
92928-LD, 92920-RC
The patient's physician performed a balloon angioplasty (PTCA) with insertion of drug-eluting stent in the right coronary artery.
92928-RC
Cardioversion of cardiac arrhythmia by external forces
92960
Transesophageal echocardiography (TEE) with probe placement, image, and interpretation and report
93312
Patient presents to the emergency room with chest pains. The patient is admitted as a 23-hour observation. The cardiologist orders cardiac workup, and the patient undergoes left heart catheterization via the left femoral artery with visualization of the coronary arteries and left ventriculography. The physician interprets the report. Code the heart catheterization.
93458
Which code listed below would be used to report an esophageal electrogram during an EPS?
93615
Comprehensive electrophysiologic evaluation (EPS) with induction of arrhythmia
93620
IV push of one antineoplastic drug
96409
One-half hour of IV chemotherapy by infusion followed by IV push of a different chemotherapy
96413, 96411
Osteopathic manipulative treatment to three body regions
98926
Patient with hematochromatosis had a therapeutic phlebotomy performed on an outpatient basis.
99195
The patient is a 52-year-old male from out of state visiting his daughter. He left his medications for his benign hypertension at home and is now here in the clinic in need of a prescription. A problem focused history and examination is performed and a prescription is given to the patient.
99201
The patient is on vacation and presents to a physician's office with a lacerated finger. The physician repairs the laceration and gives a prescription for pain control and has the patient follow up with his primary physician when he returns home. The physician completes problem-focused history and physical examination with straightforward medical decision making. Also checked is a laceration repair for a 1.5 cm finger wound.
99201, 12001
A patient receives individual psychotherapy for 30 minutes. The doctor also provides medical E/M services for this established patient that includes a problem-focused history, a problem-focused examination, and straightforward level of medical decision making
99212, 90833
An established patient returns to the physician's office for follow-up on his hypertension and diabetes. The physician takes the blood pressure and references the patient's last three glucose tests. The patient is still running above-normal glucose levels, so the physician decides to adjust the patient's insulin. An expanded history was taken, and a physical examination was performed.
99213
The patient is a 34-year-old established patient seen in the clinic by her dermatologist. She is followed for extensive psoriasis involving her scalp, trunk, and arms. It has now worsened and spread to her palms, and she is now also complaining of joint pain. The spread to her hands has made it difficult to do many of her day-to-day tasks. A detailed history and examination are performed. The examination includes inspection of the affected areas in addition to bending and rotation of joints. A long discussion took place regarding a change in her medications to try to gain better control of her psoriasis and slow down the systemic progression. Topical and systemic treatment was decided on.
99214
A patient who was on observation status for 48 hours is discharged from the hospital. The patient was being observed after a motor vehicle accident for subdural hematoma, subsequently ruled out. Code only the discharge services and diagnosis.
99217
An established patient was seen in her primary physician's office. The patient fell at home and came to the physician's office for an examination. Due to a possible concussion, the patient was sent to the hospital to be admitted as an observation patient. A detailed history and physical examination were performed, and the medical decision was low complexity. The patient stayed overnight and was discharged the next afternoon.
99218, 99217
Initial observation of a patient was for upper abdominal pain, dizziness, and anemia. A comprehensive history and examination was performed. Moderate complexity decision making was conducted to admit the patient to observation to treat and rule out causes of the patient's anemia.
99219
A 16-year-old female is being admitted by her family practice physician with a 2-week history of fatigue and fever. It has been progressively getting worse. She is suffering from dehydration. The physician performs a comprehensive history to look for explanations for her fatigue, including recent activity level and recent sleep habits. A detailed examination is performed and she is diagnosed with mononucleosis and admitted for treatment.
99221
A 69-year-old established female patient presents to the office with chronic obstructive lung disease, congestive heart failure, and hypertension. The physician conducts a comprehensive history and physical examination and makes a medical decision of moderate complexity. Physician admits the patient from the office to the hospital for acute exacerbation of CHF.
99222
A 56-year-old male with an established history of ASHD of native arteries and past stent placement is admitted through the emergency room with acute onset of chest pain. An EKG was performed and troponin levels taken. Both showed evidence of the patient having an acute inferior wall myocardial infarction. The cardiologist performs a comprehensive history, with the chief complaint, 4 from the history of present illness (HPI), a complete review of systems (ROS), and past, family, and social history (PFSH). The history includes the information that the pain started a week ago but last night worsened. Also on a scale of 1 to 10, he rated the pain an 8. It was also discovered that the patient has not been attending regular appointments in the clinic setting. A comprehensive examination was performed along with high complexity medical decision making (MDM), including management of the patient's acute MI and reviewing data of the medical history of the patient. He was taken immediately to the cardiac catheterization lab to look for the source for the patient's MI.
99223
A 2-year-old boy with bacterial pneumonia is hospitalized and has had 5 days of antibiotic therapy. Today the child developed a fever of 101F with a mild rash on his torso. In a subsequent hospital visit, the attending physician performed a problem focused history and examination. The MDM complexity was low.
99231
This is a follow-up visit on a 28-year-old male who is admitted with the diagnosis of headaches. The patient is subsequently seen because the physician needs to follow up on test results that weren't back yet at the initial consultation. This will help to find a possible cause of headaches and course of treatment. A problem focused history and examination and low-complexity decision making is made after viewing the CT results. The diagnosis of tension headaches was made and treatment options discussed.
99231
The initial consulting physician subsequently sees a 55-year-old patient injured at work when he fell from a house roof and struck his head. The patient had a right frontal parietal craniotomy 6 days previously and is recovering rapidly. The initial consultation was requested regarding a possible drug reaction that produced a rash on the upper torso. The consultant recommended a medication change, but after 48 hours the patient had no improvement. The physicain re-evaluates for other possible causes of the rash. An expanded problem focused interval history and a physcial examination were performed. The MDM complexity was moderate.
99232
a 55 year old male patient is sent to surgeons office for hemorrhoids...
99241
A 44-year-old patient, with chronic mastoiditis, was seen in consultation by the ENT specialist in the office. Her physician was inquiring as to the advantages of surgery versus continued anibiotic treatment when an acute flare comes on. The ENT specialist recommends surgery because of the increasing severity with each acute flare. She is fearful of the surgery because of the need to go under general anesthetic and a fear of permanent hearing loss. The physician performs an expanded problem focused history to include the duration of this problem and how many acute flares a year the patient experiences. An expanded problem focused examination and straightforward decision making is completed. It is determined that with the number of acute flares a year and the increasing severity of each case that surgery is recommended. The patient's fears are laid to rest and the patient decides to go ahead with the surgery.
99242
A 47-year-old female was sent by her family practice physician for an office consultation with a gynecologist. The patient has been suffering with moderate pelvic pain, a heavy sensation in her lower pelvis, and marked discomfort during sexual intercourse. In a detailed history, the gynecologist noted the location, severity, and duration of her pelvic pain and related systems. In the review of systems, the patient had positive findings related to her gastrointestinal, genitourinary, and endocrine body systems. The physician noted that her medical history was noncontributory to the present problem. The detailed physical examination centered on her gastrointestinal and genitourinary systems, with a complete pelvic examination. The physician ordered laboratory tests and a pelvic ultrasound to determine uterine fibroids, endometritis, or other internal gynecological pathology. The MDM complexity was moderate.
99243
A 38-year-old female has severe low back pain due to trauma injury she experienced as a factory worker 4 years ago. The chronic pain has become almost unbearable, and her internal medicine physician cannot go any further with her treatment. An initial outpatient consultation is requested and the patient is sent to see the pain management specialist for suggestions to control the chronic pain. A comprehensive history is taken, including all of the pertinent information regarding her injury. During the comprehensive examination the patient's gait and movement were observe. Moderate-complexity decision making is performed, including different treatment options. A separate note is dictated to show the requesting physician what results were found during the visit and the decision on treamtment of her pain.
99244
An 83-year-old patient is seen at the local nursing home. The patient suffers from severe COPD. Routine labs were drawn on the patient by her primary doctor and her blood sugar came back abnormal. Fasting glucose was then taken and was high. The endocrinologist was asked to render an opinion on a possible diagnosis of diabetes. A problem focused history and examination and straightforward decision making were mad. Diabetes was diagnosed and treatment started. The endocrinologist contacted the primary physician and discussed treatment of the patient. Report services for the endocrinologist only.
99251
A 46-year-old male is admitted to the hospital with a progressive staphylococcal pneumonia that is not responding to treatment. A request is made for the infectious disease physician on staff to render his opinion for treatment. The patient is seen in initial inpatient consultation. An expanded problem focused history and examination are performed. After looking at the sputum cultures, the physician decides on the most effective antibiotic for treatment. The decision making is straightforward.
99252
An inpatient urological consultation is performed for a 32-year-old female who recently had an elective abortion performed on an outpatient basis. The woman has been admitted with a high fever, pelvic pain, and dysuria. During a detailed history, the urologist notes in the the history of present illness that the patient's symptoms began about 2 days after the abortion and progressed to the acute phase, which she is in at the present time. The location of the pain is in the lower abdomen and rated 9 on a scale of 1 to 10. She reports the quality of the pain to be sharp and stabbing. In the review of systems, the physician notes positive responses in 5 of the 12 body systems investigated. The urologist notes a negative medical history related to urinary symptoms other than a mild cystitis about 10 years ago. The detailed physical examination performed by the urologist centers on the genitourinary system and gastrointestinal system in significant detail. The medical decision making is low. Given the patient's past surgical procedure and physical findings at the present, the consultant considers the diagnoses of pyelonephritis, cystitis, pyelitis, and endometritis.
99253
Patient is admitted to the hospital with acute abdominal pain. The attending medical physician requests a surgical consult. The consultant agrees to see the patient and conducts a comprehensive history and physical examination. To rule out pancreatitis, the physician orders lab work, along with an ultrasound of the gallbladder and an abdominal X-ray. Due to the various diagnosis possibilities and the tests reviewed, a moderate medical decision was made.
99254
Services were provided to a patient in the emergency room after the patient twisted her ankle stepping down from a curb. The emergency room physician ordered X-rays of the ankle, which came back negative for a fracture. A problem-focused history and physical examination were performed, and ankle strapping was applied. A prescription for pain was given to the patient. Code the emergency room visit only.
99281
Patient presents to the emergency room complaining of right forearm/elbow pain after racquetball last night. Patient states that he did not fall but overworked his arm. Past medical history is negative and the physical examination reveals the patient is unable to supinate. A four-view X-ray of the right elbow is performed and is negative. The physician signs the patient out with right elbow sprain. Prescription of Motrin is given to the patient.
99281-25, 73080
A doctor provides critical care services in the emergency department for a patient in respiratory failure. He initiates ventilator management and spends an hour and 10 minutes providing critical care for this patient. Code only critical care.
99291
Patient arrives in the emergency room via a medical helicopter. The patient has sustained multiple life-threatening injuries due to a multiple-car accident. The patient goes into cardiac arrest 10 minutes after arrival. An hour and 30 minutes of critical care time is spent trying to stabilize the patient. Code only critical care.
99291, 99292
The physician provided services to a new patient who was in a rest home for an ulcerative sore on the hip. A problem-focused history and physical examination were performed, and a straightforward medical decision was made.
99324
A 57-year-old male patient is having his annual physical. Due to a family history of coronary artery disease and his sedentary lifestyle, his doctor orders a total blood cholesterol panel. What is the optimal level of total cholesterol in the blood for adults?
< 200 mg/dL
Which of the following statements BEST summarizes the current status of cervical cancer?
A new three-shot vaccination series protects against the types of HPV that cause most cervical cancer cases.
Patient is initially admitted and treated for an amebic abscess of the liver. During the stay the patient developed a "hospital acquired bacterial pneumonia."
A06.4, J15.9, Y95
Patient was initially admitted and treated for an amebic abscess of the liver. During the stay the patient developed a "hospital acquired bacterial pneumonia."
A06.4, J15.9, Y95
Patient was initially admitted and treated for an amoebic abscess of the liver. During the stay, the patient developed a "hospital acquired bacterial pneumonia."
A06.4, J15.9, Y95
A patient was admitted with severe sepsis due to MRSA with septic shock and acute respiratory failure with hypoxia.
A41.02, R65.21, J96.01
The patient was admitted with severe sepsis due to MRSA with septic shock and acute respiratory failure with hypoxia.
A41.02, R65.21, J96.01
A patient is admitted with poliovirus meningitis.
A80.9, G02
A patient is admitted with poliovirus meningitis:
A80.9, G02
A patient is admitted with fever and severe headache. The physician's diagnostic statement at discharge is: Fever and severe headache probably due to viral meningitis.
A87.9
A patient is admitted with fever and severe headache. The physician's diagnostic statement at discharge is: fever and severe headache possibly due to viral meningitis.
A87.9
A patient, who is HIV positive, has raised red or purple lesions that appear on his skin, in his mouth, and almost everywhere on his body. What is the stage of his disease process in today's medical terminology?
AIDS
Health care claims transactions use one of three electronic formats, including which one of those listed below?
ANSI ASC X12N 837 format
The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called
APCs
Based on CMS's DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as
APR-DRGs.
Currently, which prospective payment system is used to determine the payment to the "physician" for physician services covered under Medicare Part B, such as outpatient surgery performed on a Medicare patient?
ASC PPS
Which of the following is a liver function test?
AST (SGOT)
The "discharged, not final billed" report (also known as "discharged, no final bill" or "accounts not selected for billing") includes what types of accounts?
Accounts that have been discharged and have not been billed for a variety of reasons
Which of the following statements is FALSE regarding the use of modifiers with the CPT codes?
All modifiers will alter (increase or decrease) the reimbursement of the procedure.
The most common etiology of dementia in the United States is
Alzheimer's disease.
How often are the Medicare fee schedule updated?
Annually
Why are there "black box warnings" on antidepressant medications regarding children and adolescents?
Antidepressants increase the risk of suicidal thinking and behavior in some children and adolescents.
The patient was admitted with AIDS-related Kaposi's sarcoma of the skin.
B20, C46.0
The patient was admitted with AIDS-related Kaposi's sarcoma of the skin.
B20, C46.1
Ellis was diagnosed HIV-positive two years ago. He has now been admitted into Cengage Hospital with HIV-related lobar pneumonia. Report this with code or codes:
B20, J18.1
A 32-year-old female patient presents with right arm (dominant) paralysis due to childhood poliomyelitis.
B91, G83.21
A 32-year-old female patient presents with right arm (dominant) paralysis due to childhood poliomyelitis. B91, G83.21 A80.39 A80.39, G83.21 A80.39, G83.3
B91, G83.21
The federal legislation that focused on healthcare fraud and abuse issues, especially as they relate to penalties, was the:
Balanced Budget Act of 1997
____________ is the most common type of skin cancer, and _________ is the most deadly type of skin cancer.
Basal cell carcinoma, malignant melanoma
A Medicare benefit period is defined as:
Beginning the day the Medicare patient is admitted to the hospital and ending when the patient has been out of the hospital for 60 days in a row, including the day of discharge
A patient is admitted with abdominal pain. A CT and MRI of the abdomen reveal a malignant neoplasm to the head of the pancreas with metastatic disease to the peritoneal cavity.
C25.0, C78.6
a patient is admitted with abdominal pain. A CT and MRI of the abdomen reveal a malignant neoplasm to the head of the pancreas with metastatic disease to the peritoneal cavity
C25.0, C78.6
A patient has malignant melanoma of the skin of the back, nose, and scalp. The patient will be scheduled to undergo a radical excision of the melanoma.
C43.59, C43.31, C43.4
a patient has malignant melanoma of the skin of the back nose and scalp the patient will be scheduled to undergo a radical excision of the melanoma
C43.59, C43.31, C43.4
Dr. Jones performed a left breast biopsy on Anne Smith. The results confirmed a diagnosis of invasive ductal carcinoma, in the lower outer quadrant. This principal diagnosis code is:
C50.512
A patient goes to an OP Clinic with a large growth on the left side of the neck. An MRI is performed and demonstrates metastatic disease to the lymph nodes.
C77.0, C80.1
A patient to an OP Clinic with a large growth on the left side of the neck. An MRI is performed and demonstrates metastatic disease to the lymph nodes.
C77.0, C80.1
A patient is admitted with malignant ascites with widespread metastatic peritoneal lesions, primary site sigmoid colon; sigmoid colon resection 6 months ago.
C78.6, R18.0, Z85.038
Terry is post-mastectomy from breast cancer. Sadly, she has now found out that the cancer has metastasized to her parietal lobe of her brain. Report the brain cancer with code:
C79.31 Secondary malignant neoplasm of brain
A patient with a history of malignant neoplasm of the lung status post lobectomy was admitted after experiencing a violent seizure lasting more than several minutes. During the course of the hospitalization the patient has continued to have seizures. Workup revealed metastatic lesions to the brain. The patient's seizures were treated with IV Dilantin.
C79.31, R56.9, Z85.118
a patient with a history of malignant neoplasm of the lung status post lobectomy was admitted after experiencing a violent seizure lasting more than several minutes...
C79.31, R56.9, Z85.118
A patient with a history of malignant neoplasm of the lung status post lobectomy was admitted after experiencing a violent seizure lasting more than several minutes. During the course of the hospitalization, the patient has continued to have seizures. Workup revealed metastatic lesions to the brain. The patient's seizures were treated with IV Dilantin.
C79.31, Z85.118
A patient presents to an outpatient clinic with a large growth on the left side of the neck. Examination reveals primary malignant neoplasm of lymph nodes. Confirmed diagnosis of nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck.
C81.01
Coronary arteries may become blocked, either partially or totally, due to atherosclerosis and lead to an AMI. Which of the following procedures would be used to improve the coronary blood flow by building an alternate route for the blood to bypass the blockage by inserting a portion of another blood vessel, typically the saphenous vein?
CABG
Henry experienced sudden sharp chest pain that he described as heavy and crushing. His pain and past medical history caused Dr. James to suspect that Henry was having an acute myocardial infarction (AMI). Which of the following tests is a more specific marker for an AMI?
CK-MB
the billing form used to report physician services is the
CMS 1500
When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service.
CPT Code 99291 (critical care)
The unique number that identifies each service or supply in the CDM and links each item to a particular department is known as the:
Charge code
In a typical acute-care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error-fee claims (clean claims) are submitted to third-party payers?
Claims processing
In a typical acute-care setting, the Explanation of Benefits, Medicare Summary Notice, and Remittance Advice documents (provided by the payer) are monitored in which revenue cycle area?
Claims reconciliation/collections
Most chief financial officers view the HIM department's most essential role in the revenue cycle management to be:
Coding of the record
Community Hospital has launched a clinical documentation improvement (CDI) initiative. Currently, clinical documentation does not always adequately reflect the severity of illness of the patient or support optimal HIM coding accuracy. Given this situation, which of the following would be the best action to validate that the new program is achieving its goals?
Conduct a retrospective review of all query opportunities for the year
which of the following is definition of revenue cycle management?
Coordination of all administrative and clinical functions that contribute to the capture management and collection of patient service revenue
Which of the following is the definition of revenue cycle management?
Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
Which term refers to the electronic transmission of information from a provider to a health plan to determine a patient's eligibility for services?
Coordination of benefits transaction
When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a
Corporate Integrity Agreement.
Which of the following is not reimbursed according to the Medicare outpatient prospective payment system?
Critical access hospital
which of the following is not reimbursed according to the Medicare outpatient prospective payment system
Critical access hospital
A chronic inflammatory bowel disease where affected segments of the bowel may be separated by normal bowel tissue is characteristic of
Crohn's disease.
A patient is admitted with sickle cell anemia with crisis.
D57.00
A patient is admitted with sickle cell pain crisis.
D57.00
A patient is admitted with sickle cell vaso-occlusive pain crisis.
D57.00
A patient is admitted with aplastic anemia secondary to chemotherapy administered for multiple myeloma initial encounter.
D61.1, T45.1x5A, C90.00
A patient is admitted for treatment of anemia, neutropenia, and thrombocytopenia.
D61.818
A patient is admitted for post-op anemia due to acute blood loss. Patient is 5 days status post-cholecystectomy.
D62
A patient is readmitted for post-op anemia due to acute blood loss. Patient is 5 days status postcholecystectomy.
D62
A patient is readmitted for postoperative anemia due to acute blood loss. Patient is 5 days status postcholecystectomy.
D62, K91.840
A patient is admitted with anemia due to end-stage renal disease. The patient is treated for anemia.
D63.1, N18.6
A patient is admitted for treatment of anemia, neutropenia, and thrombocytopenia.
D64.9, D70.9, D69.6
A patient is admitted with idiopathic thrombocytopenia and purpura.
D69.3
To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report. Though this report has no standard title, it is often called the
DNFB (discharged, not final billed).
What is the current name of the Resource Based Relative Value Scale System?
DRG
______ classifies inpatient hospital cases into groups that are expected to consume similar hospital resources.
DRG
HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT
DSM
All of the following are required elements of a charge description master except:
Date of service
all of the following are required elements of a charge description master except:
Date of service
Dr. Gastron fulgurated a rectal polyp of the patient. The root operation term used for this ICD-10-PCS code is:
Destruction
The patient's account balance is displaying a negative balance. What should the healthcare organization do to resolve this situation?
Determine which payer overpaid and return the funds
The phrase "bad debt" refers to accounts that include money owed by the patient and are:
Determined by the facility to be uncollectible
Which of the following services would be included in the 72-hour payment window and included in the inpatient MS-DRG payment to an acute-care hospital?
Diagnostic laboratory testing
______________ is usually the first symptom of benign prostate hyperplasia.
Difficulty in urinating
The amount of money owed a healthcare facility when claims are pending is called:
Dollars in accounts receivable
a local safety council requests statistics on the number of head injuries occurring as a result of skateboarding accidents during the last year. to retrieve this data you will need to have the correct
E-codes and ICD-9-CM codes
A patient is a type 2 diabetic with chronic kidney disease dependent on dialysis.
E11.22, N18.6, Z99.2
A patient is a type 2 diabetic with chronic kidney disease requiring dialysis.
E11.22, N18.6, Z99.2
A patient is admitted with Diabetes Mellitus Type II; diabetic heel ulcer with necrosis of the muscle.
E11.621, L97.403
A patient is admitted with diabetes mellitus type 2; diabetic heel ulcer with necrosis of the muscle.
E11.621, L97.403
A female, 68 years old, was admitted with type 2 diabetes mellitus with a diabetic ulcer of the left heel involving the subcutaneous layer of the skin. The patient will be scheduled for wound care with whirlpool treatments.
E11.621, L97.421
A female, 68-year old, was admitted with type 2 diabetes mellitus with a diabetic ulcer of the left heel involving the subcutaneous layer of the skin. The patient will be scheduled for wound care with whirlpool treatments.
E11.621, L97.421
A patient was found at home in a hypoglycemic coma. This patient had never been diagnosed as being diabetic.
E15
A patient is admitted with severe protein calorie malnutrition.
E43
A patient is admitted with severe protein calorie malnutrition.
E46
Judy does not like outside activities. After the blood test results came back, her physician diagnosed her with Vitamin D deficiency and gave her a prescription.
E55.9 Vitamin D deficiency, unspecified
A patient is admitted to the hospital for treatment of dehydration following chemotherapy as treatment for right ovarian cancer.
E86.0, C56.1
A 67-year-old man is admitted with acute dehydration secondary to lymphocytic colitis previously diagnosed as acute gastroenteritis. He is treated with IV fluids for the dehydration.
E86.0, K52.832
A 67-year-old man is admitted with acute dehydration secondary to nausea and vomiting that is due to acute gastroenteritis. He is treated with IV fluids for the dehydration.
E86.0, K52.9
A patient is admitted to the hospital for treatment of dehydration following chemotherapy as treatment for right ovarian cancer.
E86.01, C56.1
a patient is admitted to the hospital for treatment of dehydration following chemotherapy as treatment for right ovarian cancer
E86.01, C56.1
Which of the following pieces of equipment records the electrical activity of the brain?
EEG
CDI staff should revisit cases:
Every 24 to 48 hours
A patient is admitted with acute alcohol intoxication with a blood alcohol level of 113 mg/100 ml.
F10.120, Y90.5
A patient is admitted with acute alcohol intoxication with a blood alcohol level of 113 mg/100 ml.
F10.129, Y90.5
A patient is admitted with delirium tremens with alcohol dependence.
F10.221
A patient is admitted with withdrawal delirium tremens with alcohol dependence.
F10.231
A patient with chronic paranoia due to cocaine dependence with intoxication and drug delirium.
F14.221
A patient is diagnosed with chronic paranoia due to cocaine dependence with intoxication and drug delirium.
F14.250, F14.221
A patient is admitted with catatonic schizophrenia.
F20.2
A patient is admitted with severe recurrent major depression without psychotic features.
F33.2
Randy has been home from Iraq for three months and comes in to see Dr. Jones for his weekly appointment. He has recurring flashbacks of his time in the war zone, and he is having difficulty sleeping. Dr. Jones is providing therapy for his on-going PTSD. The correct code is:
F43.12 Post-traumatic stress disorder, chronic
Which entity is responsible for processing Part A claims and hospital-based Part B claims for institutional services on behalf of Medicare?
Fiscal intermediary/MAC
The facility's Medicare case-mix index has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding quality review should be performed?
Focused audit
The most recent coding audit has revealed a tendency to miss secondary diagnoses that would have increased the reimbursement for the case. Which of the following strategies will help to identify and correct these cases in the short term?
Focused reviews on lower weighted MS-DRGs from triples and pairs
The most recent coding audits has revealed a tendency to miss secondary diagnoses that would have increased the reimbursement for the case. Which of the following strategies will help to identify an correct these cases in the short term?
Focused reviews on lower weighted MS-DRGs from triples and pairs
Brian is 35 years old and has just been diagnosed with Alzheimer's disease. Report this with:
G30.0 Alzheimer's disease with early onset
A patient is diagnosed with Alzheimer's disease and early onset dementia, and frequently wanders away from home.
G30.0, F02.81, Z91.83
A patient is diagnosed with early onset Alzheimer's disease and early onset dementia and frequently wanders away from home.
G30.0, F02.81, Z91.83
A patient has intractable status epilepticus.
G40.311
A 32-year-old female patient presents with right arm (dominant) paralysis due to childhood poliomyelitis.
G83.21, B91
A patient is admitted for pain control secondary to metastatic carcinoma of the spinal cord.
G89.3, C79.49, C80.1
A patient is admitted for pain control secondary to metastatic carcinoma of the spinal cord. A carcinoid tumor was removed from his lower lobe three years ago for primary lung malignancy, now non-evident.
G89.3, C79.49, Z85.110
Which of the following apply to radiological and other procedures that include professional and technical components and are paid as a lump sum to be divided between physician and healthcare facility?
Global payments
A patient is admitted with sensorineural deafness of the left ear. No problems with the right ear. The patient was fitted for a hearing aid.
H90.42
A patient is admitted with sensorineural deafness of the left ear. The patient was fitted for a hearing aid.
H90.42
A patient is being cared for in his or her home by a qualified agency participating in Medicare. The data-entry software used to conduct all patient assessments is known as
HAVEN
Home Health Agencies (HHAs) utilize a data entry software system developed by the Centers for Medicare and Medicaid Services (CMS). This software is available to HHAs at no cost through the CMS website or on a CD-ROM.
HAVEN (Home Assessment Validation and Entry)
The codes used in a charge description master are:
HCPCS Levels I and II
the codes used in a charge description master are:
HCPCS Levels I and II
This data is used because it provides a uniform system of identifying procedures, services, or supplies. Multiple columns can be available for various financial classes.
HCPCS/CPT code
The term "hard coding" refers to
HCPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill.
what data set is managed by the National Committee for Quality Assurance (NCQA)
HEDIS
what legislation resulted in the NPI?
HIPAA
Genital warts are caused by
HPV
In ICD-10-PCS, during a 90-day residential substance abuse treatment program, the therapist worked one-on-one with the patient performing cognitive behavioral counseling.
HZ32ZZZ
The collection of information on healthcare fraud and abuse was mandated by HIPAA and resulted in the development of:
Healthcare Integrity and Protection Data Bank
the collection of information on healthcare fraud and abuse was mandated by HIPAA and resulted in the development of:
Healthcare Integrity and Protection Data Bank
The patient's pathology report revealed the presence of Reed-Sternberg cells. This is indicative of
Hodgkin's disease.
Which disease is a malignancy of the lymphatic system?
Hodgkin's disease.
Which of the following is a hereditary disease of the cerebral cortex that includes progressive muscle spasticity and mental impairment leading to dementia?
Huntington's disease
The patient was found to have an obstruction of the aortic value due to rheumatic process. The correct code to report this is:
I06.0 Rheumatic aortic stenosis
A patient has end-stage kidney disease, which resulted from malignant hypertension.
I12.0, N18.6
A patient has end-stage kidney disease, which resulted from malignant hypertension. I12.0, N18.6 I10, N18.6 I13.11, N18.6 I15.1, N18.6
I12.0, N18.6
A patient is admitted with chronic kidney disease stage 3 due to hypertension and type 1 diabetes mellitus.
I12.9, E10.22, N18.3
A patient is admitted with chronic kidney disease stage III due to hypertension and type 1 diabetes mellitus.
I12.9, E10.22, N18.3
A patient is admitted with multiple problems. He has hypertensive kidney disease, CKD stage 3, and acute systolic congestive heart failure.
I13.0, I50.21, N18.3
A patient is admitted with acute ST inferolateral wall myocardial infarction. Several days later during the same episode of care, the patient sustained a subsequent non-ST subendocardial myocardial infarction.
I21.19, I22.2
A patient with a diagnosis of coronary artery disease with ischemic chest pain. No history of CABG.
I25.119
A patient is diagnosed with psychogenic paroxysmal tachycardia.
I47.9, F54
A patient is admitted with a thrombosis of the right middle cerebral artery, with hemiplegia affecting the right dominant side.
I63.311, I69.351
A patient is admitted with a cerebral infarction of the right middle cerebral artery, caused by an embolus, with hemiplegia affecting the right dominant side.
I63.411, I69.351
Darlene had a CVA (cerebrovascular accident) two months ago, and she is still having not able to speak. Dr. Smith diagnosed her with aphasia following a nontraumatic intracerebral hemorrhage. Report this with:
I69.128 Aphasia following nontraumatic intracerebral hemorrhage
After having a cerebrovascular (CVA) accident, Lorraine has been having difficulty in swallowing. The physician diagnosed this as a sequela of the CVA. Report this with code:
I69.991 Dysphagia following unspecified cerebrovascular disease
A patient with atherosclerotic peripheral vascular disease of the left lower leg with intermittent claudication. Past surgical history is negative.
I70.212
The following coding system(s) is/are utilized in the Inpatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement.
ICD-10-CM/ICD-10-PCS codes
The following coding system(s) is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.
ICD-10-CM/ICD-10-PCS codes
Which of the following agencies is responsible for providing healthcare services to American Indians and Alaska natives?
IHS
what is the main difference between an HMO health plan and POS health plan
In a POS health plan, the enrollee can choose what provider to see for care without the need for a referral or a designated primary care physician
Which of the following establish eligibility standards for enrollment in Medicaid?
Individual states
Based on this patient volume, the MS-DRG that brings in the highest total profit to the hospital is
It cannot be determined from this information.
Which of the following is characteristic of Graves' disease?
It is an autoimmune disease.
The HPV vaccine, Gardasil, is recommended for all children/young adults between the ages of 9 and 26 years. It is a quadrivalent vaccine. What is the definition of quadrivalent?
It prevents infection from the four most prevalent types of HPV that cause cervical cancer.
A patient is admitted for treatment of influenza and pneumonia.
J11.00
A patient presents to the outpatient department for a chest X-ray. The physician's order lists the following reasons for the chest X-ray: fever and cough, rule out pneumonia. The radiologist reports that the chest X-ray is positive for double pneumonia.
J18.9
A patient presents to the outpatient department for a chest x-ray. The physician's order lists the following reasons for the chest x-ray: fever and cough, rule out pneumonia. The radiologist reports that the chest x-ray is positive for double pneumonia.
J18.9
Ralph has been suffering with sinusitis for the last three months. The pain is right between his eyes. He goes to see the doctor, finally, who diagnoses him with chronic sinusitis. Report this with code:
J32.1 Chronic frontal sinusitis
A patient is admitted with acute respiratory failure with hypercapnia due to chronic asthmatic bronchitis with acute exacerbation. Treatment consisted of IV steroids.
J44.1, J96.02
A patient is admitted for control of exacerbation of chronic obstructive lung disease. The patient had stopped taking the prednisone as prescribed due to gaining weight, a known side effect for this drug.
J44.1, T38.0x6A, Z91.14
A patient is admitted with acute exacerbation chronic obstructive pulmonary disease with a history of tobacco dependence.
J44.1, Z87.891
A patient is admitted with extrinsic asthma with status asthmaticus with bronchospasm.
J45.902
A patient is admitted with acute respiratory failure with hypercapnia due to acute asthmatic bronchitis with status asthmaticus. Treatment consisted of IV steroids. term-59
J45.902, J96.02
A patient is admitted with an exercise-induced bronchospasm.
J45.990
A patient has aspiration pneumonia with pneumonia due to Staphylococcus aureus.
J69.0, J15.211
A patient is admitted for infection of the tracheostomy stoma secondary to cellulitis of the neck.
J95.02, L03.221
A patient is admitted with acute gastric ulcer with hemorrhage and perforation.
K25.2
A patient is admitted to the hospital for repair of a recurrent incarcerated ventral hernia. The surgery is canceled after the chest x-ray revealed lower lobe pneumonia. The patient is placed on antibiotics for treatment of the pneumonia.
K43.0, J18.9, Z53.09
A patient is admitted to the hospital for repair of a recurrent incarcerated epigastric hernia. The surgery is canceled after the chest X-ray revealed lower lobe pneumonia. The patient is placed on antibiotics for treatment of the pneumonia.
K43.6, J18.1, Z53.09
A patient is admitted for rectal bleeding. The laboratory results reveal chronic blood-loss anemia. The CT and the Bleeding Scan results of the abdomen revealed that the rectal bleeding is due to Crohn's disease of the descending colon.
K50.111, D50.0
A patient is admitted for rectal bleeding. The laboratory results reveal chronic blood-loss anemia. The CT and the bleeding scan results of the abdomen revealed that the rectal bleeding is due to Crohn's disease of the descending colon.
K50.111, D50.0
A patient has diverticulitis of the large bowel with abscess. Patient was treated with IV antibiotics.
K57.20
No book:Diverticulitis large bowel with ascending colon abscess was the diagnosis for a patient who was admitted with abdominal pain..
K57.20, 0D1K0Z4
A patient is admitted with bleeding esophageal varices with alcoholic liver cirrhosis and portal hypertension. The patient is alcohol dependent.
K70.30, I85.11, K76.6
A patient is admitted with acute gangrenous cholecystitis with cholelithiasis.
K80.00
Dr. Mathews performed surgery on Nathan Weston to remove his gallbladder, after he was diagnosed with cholelithiasis with cholecystitis. Report this condition with:
K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction
No book:Patient is admitted for elective cholecystectomy for treatment of chronic cholecystitis with cholelithiasis. Prior to administration of general anesthesia, patient suffers cerebral thrombosis.
K80.10, I66.9, Z53.09
A patient is admitted with acute gangrenous cholecystitis with cholelithiasis.
K81.0, K82.A1
A male patient is admitted with gastrointestinal hemorrhage resulting in acute blood-loss anemia. A bleeding scan fails to reveal the source of the bleed.
K92.2, D62
A male patient is admitted with gastrointestinal hemorrhage resulting in acute blood-loss anemia. A bleeding scan fails to reveal the source of the bleeding.
K92.2, D62
A patient is admitted with a wound open to the left finger with cellulitis due to a dog bite initial encounter. The patient is given IV antibiotics for treatment of the infection.
L03.012, S61.201A
A patient is admitted with an open wound to the left finger with cellulitis due to a dog bite, initial encounter. The patient is given IV antibiotics for treatment of the infection.
L03.012, S61.259A, W54.0xxA
A patient is admitted with dermatitis due to prescription topical antibiotic cream used as directed by a physician, initial encounter.
L25.1, T49.0x5A
A patient is admitted with a stage 1 pressure ulcer of the sacrum. During the hospitalization, the ulcer progressed to a stage 2.
L89.151, L89.152
A patient is admitted with a stage 1 pressure ulcer of the sacrum. During the hospitalization, the ulcer progressed to a stage 2.
L89.152
A patient is admitted with a pressure ulcer left buttock stage 2.
L89.322
A patient is admitted with a pressure ulcer of the left buttock stage 2.
L89.322
This information is published by the Medicare Administrative Contractors (MACs) to describe when and under what circumstances Medicare will cover a service. The ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda.
LCD (Local Coverage Determinations)
Which of the following types of care is not covered by Medicare?
Long-term nursing care
A patient is admitted with pyogenic arthritis of the right hip due to Group A Streptococcus. Treatment consisted of IV antibiotics.
M00.251
A patient is admitted with pyogenic arthritis of the right hip due to group A streptococcus. Treatment consisted of IV antibiotics.
M00.251, B95.0
A patient is admitted with a back pain. A myelogram demonstrated the reason for the back pain is a herniated lumbar intervertebral disc with radiculopathy.
M51.16
A patient is admitted with a fracture to the L1 vertebrae secondary to postmenopausal senile osteoporosis, initial encounter.
M80.08xA
A patient has a pathological fracture of the left femur due to metastatic bone cancer. The past medical history is significant for lung cancer.
M84.552, C79.51, Z85.118
A patient has a pathological fracture of the left femur due to metastatic bone cancer. The past medical history is significant for lung cancer.
M84.552A, C79.51, Z85.118
A patient has a pathological fracture of the left femur due to metastatic bone cancer. The past medical history is significant for surgical removal of cancer of the lung.
M84.552A, C79.51, Z85.118
Dr. Pedric diagnosed the child with complete physeal arrest of the growth plate of the tibia, right limb, close to the child's ankle. Report this with:
M89.164 Complete physeal arrest, right distal tibia
The patient was diagnosed with anterior spinal artery compression syndrome affecting T10-T12. Report this with code:
M89.164 Complete physeal arrest, right distal tibia
Which of the following is a severe, chronic, two-phased, bacterial respiratory infection that has become increasingly difficult to treat because many antibiotics are no longer effective against it?
MDR-TB
Which of the following is made up of claims data from Medicare claims submitted by acute-care hospitals and skilled nursing facilities?
MEDPAR
Which type of diagnostic test involves the use of electromagnetic waves to produce very detailed images of soft tissue structures of the body?
MRI
While in the hospital, an external, single read, EKG was performed on the patient. The root operation term used for this ICD-10-PCS code is:
Measurement: determining the level of a physiological or physical function at a point in time
Given the following information, from which payer does the hospital proportionately receive the least amount of payment?
Medicaid
____ is a joint federal and state program that provides health care coverage to low-income populations and certain aged and disabled individuals.
Medicaid
What is the name of the program funded by the federal government to provide medical care to people on low incomes or with limited financial resources?
Medicaid..
This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service.
Medicare Physician Fee Schedule (MPFS)
The ________________________ refers to a statement sent to the patient to show how much the provider billed, how much Medicare reimbursed the provider, and what the patient must pay the provider.
Medicare Summary Notice
The______refers to a statement sent to the patient to show how much the provider billed how much Medicare reimbursed the provider and what the patient must pay the provider
Medicare summary notice
______ requires present on admission (POA) indicator to be assigned to the ___________ diagnosis(es) for all claims for __________________admissions.
Medicare, principal and secondary, inpatient
A male patient presents to the ED with acute renal failure. He is also being treated for hypertension.
N17.9, I10
A patient is admitted with multiple problems. He has hypertensive kidney disease, CKD stage III, and acute systolic congestive heart failure.
N18.3, I12.9, I50.21
A patient is admitted with anemia due to end-stage renal disease. The patient is treated for anemia.
N18.6, D63.1
A patient is admitted with acute hemorrhagic cystitis. The patient was treated with IV antibiotics.
N30.00
A patient is admitted with acute hemorrhagic cystitis. The patient was treated with IV antibiotics.
N30.01
A patient is admitted with acute urinary tract infection due to E. coli.
N39.0, B96.20
A patient admitted with gross hematuria and benign prostatic hypertrophy.
N40.0, R31.0
A patient was admitted with gross hematuria and benign prostatic hypertrophy.
N40.0, R31.0
A patient is admitted that has urinary retention secondary to benign prostatic hypertrophy.
N40.1, R33.8
The physician's H&P for admission makes no mention of the patient's UTI. The present on admission indicator is ___.
N=No
The Unified Medical Language System (UMLS) is a project sponsored by the
National Library of Medicine
This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.
National Provider Identifier (NPI)
____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.
Never events or sentinel events
When a provider agrees to accept of assignment from Medicare, the provider has agreed to:
Not bill patients for the balance
Janie was brought into the ED with acute lower abdominal pain. Ultrasound showed a left tubal pregnancy. She was taken into the procedure room immediately. Report this condition with:
O00.102 Left tubal pregnancy without intrauterine pregnancy
No book:Incomplete abortion complicated by excessive hemorrhage; dilation and curettage performed.
O03.1, 10D17ZZ
A patient is admitted with pregnancy-induced hypertension with severe edema and proteinuria and 24 weeks gestation.
O14.12, Z3A.24
A patient is admitted with pregnancy-induced hypertension with severe edema and 24 weeks gestation.
O14.12, Z3A24
Gabrielle was 15-weeks pregnant, and Dr. Jones has diagnosed her with diabetes mellitus. They are going to try to control this using a special diet, and she will come back for a follow-up in one month. The correct principal diagnosis code is:
O24.410 Gestational diabetes mellitus, in pregnancy, diet controlled
A patient is admitted for gestational diabetes, insulin-controlled, 28 weeks gestation.
O24.414, Z3A.28
A patient is admitted for gestation diabetes insulin controlled 28 weeks gestation.
O24.414, Z3A28
A patient is admitted with obstructed labor due to breech presentation. A single liveborn infant was delivered via Cesarean section. Do not assign the code for the procedure.
O32.1xx0, Z37.0
A patient is admitted with obstructed labor due to breech presentation. A single live-born infant was delivered via cesarean section. Do not assign the code for the procedure.
O32.1xx1, Z37.0
A patient is admitted who is 39 weeks gestation normal delivery single full-term newborn. During the same episode of care, patient experiences a 36-hour delayed hemorrhage following the delivery.
O72.2, Z3A.39, Z37.0
A patient is admitted who is 39 weeks gestation and has a normal delivery of a single full-term newborn. During the same episode of care, patient experiences a 36-hour delayed hemorrhage due to retained portion of the placenta following the delivery.
O80, Z37.0, O72.2
No book:Vaginal delivery with episiotomy of full-term liveborn infant. Patient undergoes repair of delivery episiotomy and postdelivery elective vaginal endoscopic ligation of fallopian tubes bilaterally.
O80, Z37.0, Z30.2, 10E0XZZ, 0W8NXZZ, 0UL74ZZ
A woman has a vaginal delivery of a full-term live-born infant after 38 weeks gestation.
O80, Z37.0, Z3A.38
A woman has a vaginal delivery of a full-term liveborn infant after 38 weeks gestation.
O80, Z37.0, Z3A.38
In the Medical Surgical Section, the seventh character position represents?
O80, Z37.0, Z3A.38
A patient is seen in the ED at 22 weeks gestation who is HIV positive and asymptomatic.
O98.712, Z21, Z3A.22
A patient is seen in the ED at 22 weeks gestation who is HIV positive.
O98.712, Z21, Z3A.22
The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the
OASIS (Outcome and Assessment Information Set).
In processing a Medicare payment for outpatient radiology exams, a hospital outpatient services department would receive payment under which of the following?
OPPS
in processing a medicare payment for outpatient radiology exams a hospital outpatient services department would receive payment under which of the following?
OPPS
The patient's left inner ear was infected. The diagnosis is:
Otitis interna
Baby boy Jones was born and found to have congenital pneumonia due to chlamydia. Report this condition with:
P23.1 Congenital pneumonia due to Chlamydia
A 1-week-old infant is admitted to the hospital with a diagnosis of urinary tract infection contracted prior to birth. The urine culture is positive for E. coli.
P39.3, A49.8
An infant has hypoglycemia and a mother who had been diagnosed with type 2 diabetes 5 years ago.
P70.1
An infant has hypoglycemia and a mother with diabetes.
P70.1
A "pill-rolling" tremor of the hand is a characteristic symptom of
Parkinson's disease.
Some services are covered and paid by Medicare before Medicaid makes payments because Medicaid is considered which of the following?
Payer of last resort
Which of the following groups of healthcare providers contracts with a self-insured employer to provide healthcare services?
Preferred provider organization
Which of the following reimbursement methods pays providers according to charges that are calculated before healthcare services are rendered?
Prospective payment method
When a provider accepts assignment, this means that the:
Provider accepts as payment in full the allowed charge from he fee schedule
When a provider accepts assignment, this means that the:
Provider accepts as payment in full the allowed charge from the fee schedule
A patient is admitted with cervical spina bifida with hydrocephalus.
Q05.0
A newborn infant is transferred to Community General Hospital for treatment of an esophageal atresia. What codes should be reported for Community General Hospital?
Q39.0
In conducting a qualitative review, the clinical documentation specialist sees that the nursing staff has documented the patient's skin integrity on admission to support the presence of a stage in pressure ulcer. However, the physician's documentation is unclear as to whether this condition was present on admission. How should the clinical documentation specialist proceed?
Query the physician to determine if the condition was present on admission.
A patient is admitted with right lower quadrant abdominal pain. The discharge diagnosis is listed as abdominal pain due to gastroenteritis or diverticulosis.
R10.31, K52.9, K57.90
A patient is admitted with malignant ascites with widespread metastatic peritoneal lesions, primary site sigmoid colon; sigmoid colon resection 6 months ago.
R18.0, C78.6, Z85.038
A patient admitted with gross hematuria and benign prostatic hypertrophy.
R31.0, N40.0
A patient is admitted with dizziness as a result of taking phenobarbital as prescribed, initial encounter.
R42, T42.3x5A
A patient is admitted with fever due to bacteremia.
R78.81
A patient is admitted with fever due to bacteremia.
R78.81, R50.9
A woman has a Pap smear that detected cervical high-risk human papillomavirus (HPV). The DNA test was positive.
R87.810
A patient was admitted with hemoptysis; a CT of the chest revealed a lung mass.
R91.8
A patient was admitted with hemoptysis; a CT of the chest revealed a lung mass.
R91.8, R04.2
what is the abbreviation given to the prospective payment system used for skilled nursing facilities
RUGs
A Medicare patient had two physician office visits, underwent hospital radiology examinations, clinical laboratory tests, and received take-home surgical dressings. Which of the following could be reimbursed under the outpatient prospective payment system?
Radiology examinations
There should be four primary percentages that should be calculated and tracked to assess clinical documentation improvement (CDI) programs. These include all of the following except:
Record agreement rate
This initiative was instituted by the government to eliminate fraud and abuse and recover overpayments, and involves the use of ______________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government.
Recovery Audit Contractors (RAC)
The charge description master relieves the HIM department of _____ that does not require documentation analysis.
Repetitive coding
The most common rickettsia disease in the United States is
Rocky Mountain spotted fever.
A patient is admitted with a gunshot wound to the right upper quadrant of the abdomen, which involves a moderate laceration to the liver, initial encounter.
S36.115A, S31.600A
A patient developed a malunion of the left medial condyle humeral fracture. The original injury occurred 4 months ago.
S42.462P
A patient developed a malunion of the medical condyle humeral fracture. The original injury occurred 4 months ago.
S42.462P
A patient is seen for a cast removal. Six weeks ago, the patient underwent open reduction internal fixation for a displaced fracture left radial styloid process.
S52.512D
While building a swing set in the backyard, Paul hammered a nail through his left thumb. There was no damage to the nail. His wife drove him to the ED for treatment. Report this condition with:
S61.032A Puncture wound without foreign body of left thumb without damage to the nail, initial encounter
A patient is admitted with a left wrist laceration, with embedded glass that involved the radical nerve, initial encounter.
S61.522A, S64.22xA
After the car accident, Arlene was brought to the ED with a closed oblique fracture of the femur, right side. Report this with:
S72.334A Nondisplaced oblique fracture of shaft of right femur, initial encounter
A patient is admitted with a left nondisplaced comminuted patella fracture, a displaced left spiral fracture of the shaft of the fibula, and a displaced comminuted fracture of the shaft of the left tibia, initial encounter.
S82.045A, S82.442A, S82.252A
A patient is admitted with a nondisplaced fracture of the left medial malleolus, initial encounter. The fracture was treated with a cast.
S82.52xA
A patient is admitted with a nondisplaced fracture of the left medial malleolus, initial encounter. The fracture was treated with a cast.
S82.55xA
A patient was admitted for removal of internal pins from the left ankle. One month ago the patient sustained a displaced bimalleolar fracture to the left ankle.
S82.842D
A patient was admitted for removal of internal pins from the left ankle. One month ago, the patient sustained a traumatic displaced bimalleolar fracture to the left ankle.
S82.842D
This program provides additional federal funds to states so that Medicaid eligibility can be expanded to include a greater number of children.
SCHIP
Which of the following would a health record technician use to perform the billing function for a physician's office?
Screen 837P or CMS 1500
After a claim has been filed with Medicare, a healthcare organization had late charges posted to a patient's outpatient account that changed the calculation of the APC. What is best practice for this organization to receive the correct reimbursement from Medicare?
Submit an adjusted claim to Medicare
In the ED, after the fire at her office, Elaine was found to have third-degree burn on her forearm and a second degree burn on her upper arm, right side. Report this with:
T22.391A Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, initial encounter
During an art project, using acid to etch metal, some acid splashed on the back of her left hand. The burn was severe and she went to the ED where the damage was assessed at third-degree. Report this with:
T23.762A Corrosion of third degree of back of left hand, initial encounter
A woman experienced third-degree burns to her thigh and second-degree burns to her right and left foot, initial encounter. She stated that the burns were from hot liquid.
T24.319A, T25.222A, T25.221A
A patient is admitted for intentional overdose of valium and acute respiratory failure with hypoxia.
T42.4x2A, J96.01
Harold has been getting emetogenic chemotherapy and his physician prescribed Aprepitant (an antiemetic). He took a dose, thinking that he forgot to take it earlier, as scheduled. He actually then, overdosed, causing a bad reaction. At the ED, he was diagnosed with:
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental, initial encounter
A patient is admitted with an anaphylactic reaction due to eating strawberries, initial encounter.
T78.04xA
Dr. Freen saw this patient, for the first time, and diagnosed her with a blood stream infection due to a port-a-cath malfunction. The principal diagnosis code is:
T80.211A Bloodstream infection due to central venous catheter, initial encounter
A patient had an intra-abdominal cholecystectomy 3 days ago and is now readmitted with cellulitis at the site of the operative incision.
T81.43xA, L03.311
A patient had a cholecystectomy 3 days ago and is now readmitted with cellulitis at the site of the operative incision.
T81.4xxA, L03.311
Active armed services members and their qualified family members are covered by which of the following healthcare programs?
TRICARE
This program, formerly called CHAMPUS (Civilian Health and Medical Program-Uniformed Services), is a health care program for active members of the military and other qualified family members.
TRICARE
What is the name of the federally funded program that pays the medical bills of the spouses and dependents of persons on active duty in the uniformed services?
TRICARE
Most facilities begin counting days in accounts receivable at which of the following times?
The date the bill drops
Indicate the second step in proper sequencing in the MS-DRG logic used to assign a case to a particular MS-DRG.
The principal diagnosis determines the MDC assignment.
Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?
The provider cannot bill the patients for the balance between the MPFS amount and the total charges.
Why must influenza immunizations be developed and administered on an annual basis?
The virus mutates significantly each year.
The coordination of benefits transaction (C)B) is important so that:
There is no duplication of benefits paid
Which of the following is a common registration error that will affect the revenue cycle?
Transposed digits in the social security number, date of birth, or policy number
ICD-10-PCS procedure codes are used on which of the following forms to report services provided to a patient?
UB-04
The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the
UB-04.
A 37-year-old female goes to her family physician complaining of dysuria, urgency, fever, and malaise. A UA is performed, and upon gross examination is found to be turbid and has an unusual odor. Microscopic examination reveals a rod-shaped microorganism. A 24-hour culture produces a colony count greater than 100,000/mL of Escherichia coli. This would indicate a diagnosis of
UTI
A 13-year-old patient is brought to her pediatrician with a 2-week history of fatigue, an occasional low-grade fever, and malaise. The pediatrician indicates it is a possible infection but needs to know what type of infection. She orders a hematology laboratory test to determine the relative number and percentage of each type of leukocytes. This test is referred to as a
WBC diff
Which of the following insurance covers healthcare costs and lost income associated with work-related injuries?
Workers' compensation
Patient Accounts has submitted a report to the revenue cycle team detailing $100,000 of outpatient accounts that are failing NCD edits. All attempts to clear the edits have failed. There are no ABNs on file for these accounts. Based only on this information, the revenue cycle team should:
Write off the failed charges to bad debt and bill Medicare for the clean charges
The patient is admitted in preterm labor. The present on admission indicator is
Y=Yes
The physician's H&P at admission includes that the patient was diagnosed with type 2 diabetes mellitus in 2015. The present on admission indicator is
Y=Yes
The patient presents for a screening examination for lung cancer.
Z03.89
A patient is admitted for observation for a head injury. The patient was struck while playing football. The patient also suffered a minor laceration to the forehead. Head injury was ruled out.
Z04.3, S01.81xA
The patient presents for a screening examination for lung cancer.
Z12.2
Positive HIV test in a patient who is asymptomatic and has a high-risk lifestyle for HIV infection.
Z21, Z72.89
A newborn infant is born in the hospital, vaginal delivery. Physical examination demonstrates molding of the baby's scalp, which resolved prior to discharge without treatment.
Z38.00
A newborn is born in the hospital vaginal delivery. Physical examination demonstrates molding of the baby's scalp, which resolved prior to discharge without treatment.
Z38.00
A Newborn infant is born in the hospital vaginal delivery with a unilateral hard cleft palate and cleft lip.
Z38.00, O37.1
A full-term newborn vaginal delivery born in the hospital. The birth is complicated by cord compression, which affected the newborn
Z38.00, P02.5
A full-term newborn vaginal delivery born in the hospital. The birth is complicated by cord compression, which affected the newborn.
Z38.00, P02.5
A full-term newborn, vaginal delivery, is born in the hospital. The birth is complicated by cord compression, which affected the newborn.
Z38.00, P02.5
A newborn infant is born in the hospital, delivered vaginally, and sustained a fracture of the clavicle due to birth trauma.
Z38.00, P13.4
A preterm infant born in the hospital vaginal delivery 36 weeks gestation is treated for neonatal jaundice.
Z38.00, P59.9, P07.39
A preterm infant born in the hospital, vaginal delivery, 36 weeks gestation, is treated for neonatal jaundice.
Z38.00, P59.9, P07.39
A newborn infant is born in the hospital, vaginal delivery, with a unilateral hard cleft palate and cleft lip.
Z38.00, Q37.1
A full-term infant born in the hospital, vaginal delivery, was diagnosed with infantile polycystic kidneys, specifically identifying cystic dilation of the collecting ducts.
Z38.00, Q61.11
A patient is admitted with a fracture to the L1 vertebrae secondary to postmenopausal senile osteoporosis, initial encounter.
Z38.00, Q61.11
A full-term infant born in hospital vaginal delivery was diagnosed with polycystic kidneys.
Z38.00, Q61.19
A full-term newborn vaginal delivery was born in the hospital to a mother who is addicted to cocaine; however, the infant tested negative.
Z38.00, Z03.79
A full-term newborn, vaginal delivery, was born in the hospital to a mother who is addicted to cocaine; however, the infant tested negative.
Z38.00, Z05.2
A preterm infant 34 weeks gestation is born via Cesarean section and has severe birth asphyxia.
Z38.01, P84, P07.37
A preterm infant, 34 weeks gestation, is born via cesarean section and has severe birth asphyxia.
Z38.01, P84, P07.37
A patient is being admitted for chemotherapy for primary lung cancer, left lower lobe.
Z51.11, C34.32
No book:Mary is 6 weeks postmastectomy for carcinoma of the breast. She is admitted for chemotherapy.
Z51.11, C50.911
A patient is admitted for chemotherapy for treatment of breast cancer with liver metastasis. She had a mastectomy 4 months ago. Chemotherapy is given today. (Do not assign a procedure code for chemotherapy.)
Z51.11, C78.7, Z85.3
A patient is admitted for chemotherapy for treatment of breast cancer with liver metastasis. She had a mastectomy 4 months ago. Chemotherapy is given today. (Do not assign a procedure code for the chemotherapy).
Z51.11, C78.7, Z85.3
A patient is admitted for chemotherapy for treatment of breast cancer with liver metastasis. She had a mastectomy 4 months ago. Chemotherapy is given today. (Do not assign a procedure code for the chemotherapy.)
Z51.11, C78.7, Z85.3
A patient is admitted for chemotherapy for treatment of liver metastasis from previous breast cancer. She had a mastectomy 4 months ago. Chemotherapy is given today.
Z51.11, C78.7, Z85.3
a patient is admitted for chemotherapy for treatment of breast cancer with liver metastasis. she had a mastectomy 4 months ago. chemotherapy is given today
Z51.11, C78.7, Z85.3
Which of the following BEST describes tuberculosis?
a chronic, systemic disease whose initial infection is in the lungs
There has been a significant increase in the number of cases and deaths from pertussis. Health care professionals attribute this disease trend to which of the following?
a decrease in the number of people immunized with TDaP
A pharyngeal culture is taken from a 13-year-old male patient presenting to the ER with fever, painful cervical lymph nodes, purulent tonsillar exudate, and difficulty swallowing. A blood agar culture plate shows complete hemolysis around Streptococcus pyogenes bacterial colonies. The patient is given a prescription for erythromycin. The diagnosis in this case is
a group A beta-hemolytic streptococcal throat infection.
what is an IDS?
a group of facilities that provide comprehensive medical care and services
Prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the chance of developing cancers. Which of the following would NOT be an identified risk factor for colorectal cancer?
a high-fiber diet
All of the following statements are true of MS-DRGs, EXCEPT
a patient claim may have multiple MS-DRGs.
When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital
absorbs the loss.
When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called
abuse
A patient with leukemia is admitted for chemotherapy 5 weeks after experiencing an acute mycardial infraction. How will the MI be coded?
acute MI with 5th digit 2- subsequent episode of care
An elevated serum amylase would be characteristic of
acute pancreatitis.
modifier-51
add-on codes
Established 42-year-old patient comes into your office to obtain vaccines required for his trip to Sri Lanka. The nurse injects intramuscularly the following vaccines: hepatitis A and B vaccines, cholera vaccine, and yellow fever vaccine. As the coding specialist, what would you report on the CMS 1500 form?
administration of two or more single vaccines; vaccine products for hepatitis A and B, cholera, and yellow fever
Which endocrine gland secretes epinephrine, which activates the "fight or flight" response and increases blood pressure and metabolism?
adrenal medulla
Of the following, which is a hospital-acquired condition (HAC)?
aire embolism
Which of the following conditions is typically treated with the insertion of a pacemaker?
all answers apply
Which of the following issues seems to be the main contributing factor to the rise of antibiotic-resistant bacterial organisms such as methicillin-resistant Staphylococcus aureus?
all answers apply
Children at higher risk for sudden infant death syndrome (SIDS) include those
all answers apply.
U.S. health care providers are concerned about a possible pandemic of avian flu because
all answers apply.
How can Graves' disease be treated?
all answers apply..
A 63-year-old patient with terminal pancreatic cancer has started palliative chemotherapy. Palliative means
alleviating or eliminating distressing symptoms of the disease.
Gas exchange in the lungs takes place at the
alveoli
A common contraceptive that is implanted in the uterus induces slight endometrial inflammation, which attracts neutrophils to the uterus. These neutrophils are toxic to sperm and prevent the fertilization of the ovum. This contraception is termed
an IUD.
a physician performed an outpatient surgical procedure on the eye orbit of a Medicare patient. Upon searching the CPT codes and consulting with the physician the coder is unable to find a code for the procedure. The coder should assign:
an unlisted procedure code located in the eye and ocular adnexa section
A bee stung little Bobby. He experiences itching, erythema, and respiratory distress caused by laryngeal edema and vascular collapse. In the emergency room where he is given an epinephrine injection, Bobby is diagnosed with
anaphylactic shock.
A severe allergic reaction that can be life-threatening, due to a swollen throat, difficulty breathing, rash, and dizziness that must be treated with injectable epinephrine is termed
anaphylaxis
Under APCs, payment status indicator "X" means
ancillary services.
how often are the medicare fee schedule updated?
annually
The opposing interaction of two drugs in which one decreases or cancels out the effects of the other is termed a
antagonistic effect.
Ingrid Anderson presents with a skin infection that began as a raised, itchy bump, resembling an insect bite. Within 1-2 days, it developed into a vesicle. Now it is a painless ulcer, about 2 cm in diameter, with a black necrotic area in the center. During the history, her doctor learns that she has recently returned from an overseas vacation that included a trip to a sheep farm and becomes concerned that she may have become infected with anthrax. He will prescribe an
antibiotic
One of the most common causes of peptic ulcer disease is the consumption of aspirin and NSAIDs. Another common cause is infection by Helicobacter pylori, and the usual treatment for this condition is use of
antibiotics
Diabetic microvascular disease occurs
as a direct result of elevated serum glucose.
When the body's immune system reverses itself and attacks the organs and tissues, this process is called
autoimmunity
the federal legislation that focused on healthcare fraud and abuse issues especially as they relate to penalties was the
balanced budget act of 1997
Which of the following is a risk factor involved in the etiology of gallstones?
being overweight
_________indicated that the claim has been release as complete for submission to the insurer for payment
bill drop
A pathological diagnosis of transitional cell carcinoma is made. The examined tissue was removed from the
bladder
In the Medical Surgical Section of ICD-10-PCS, the second character position represents which of the following?
body system
When a decubitus ulcer has progressed to a stage in which osteomyelitis is present, the ulcer has extended to the
bone
The etiology of aplastic anemia is
bone marrow failure.
Some immunizations, such as tetanus, require a second application to strengthen or "remind" the immune system in response to antigens. The subsequent injections are termed
booster shots
Pain is a symptom of which of the following conditions?
both first-degree burn (superficial) and second-degree burn (partial thickness)
A disease of the inner ear with fluid disruption in the semicircular canal that causes vertigo is
both labyrinthitis and Meniere's disease.
The most common type of vaginitis is
both yeast and protozoan.
O2 is carried in the blood
bound to hemoglobin
All of the following items are "packaged" under the Medicare ASC payments, EXCEPT for
brachytherapy.
Tracheostomy
bypass
Dr. Zambrano ordered a CEA test for Mr. Logan, a 67-year-old African American male patient. Dr. Zambrano may be considering a diagnosis of
cancer
The following type of hospital is considered excluded when it applies for, and receives, a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS).
cancer hospital
what is the term used in the insurance industry for the lump sum payment of a set dollar amount for each covered person on a specific health plan?
capitation
The process of cancer development, from exposure through the cellular changes of hyperplasia to neoplasia, is termed
carcinogenesis.
Cancer derived from epithelial tissue is classified as a(n)
carcinoma
The Phalen's wrist flexor test is a noninvasive method for diagnosing
carpal tunnel syndrome.
Diagnostic testing for meningitis usually involves
cerebrospinal fluid analysis.
Henrietta Dawson presents with a chief complaint of pain and weakness in her arms and neck. After an H and P and a review of diagnostic tests that include a myelogram, her doctor diagnoses a herniated nucleus pulposus at the _________ level of her spine.
cervical
Changes in case-mix index (CMI) may be attributed to all of the following factors EXCEPT
changes in coding productivity.
This process involves the gathering of charge documentation from all departments within the facility that have provided services to patients. The purpose is to make certain that all charges are entered into the billing system.
charge capturing
This information is the numerical identification of the service or supply. Each item has a unique number with a prefix that indicates the department number (the number assigned to a specific ancillary department) and an item number (the number assigned by the accounting department or the business office) for a specific procedure or service represented on the chargemaster.
charge/service code
In a hospital, a document that contains a computer-generated list of procedures, services, and supplies, along with their revenue codes and charges for each item, is known as a(n)
chargemaster
This is the amount the facility actually bills for the services it provides.
charges
Which of the following types of hospitals are excluded from the Medicare prospective payment system?
children's
Which of the following procedures would be performed for the removal of the gall bladder due to excessive gallstone formation?
cholecystectomy
Accounts receivable (A/R) refers to
claims for which money has not yet come in.
in a typical acute-care setting which revenue cycle are uses an internal auditing system (scrubber) to ensure that error-fee (clean claims) are submitted to third-party payers?
claims processing
Under APCs, payment status indicator "V" means
clinic or emergency department visit (medical visits).
John Palmer was in a car accident and sustained severe chest trauma resulting in a tension pneumothorax. Manifestations of this disorder include all of the following EXCEPT
clubbing
An 81-year-old male with arteriosclerosis and a long-standing history of taking Coumadin presents to his physician's office for his biweekly prothrombin time (PT) test. The PT test is one of the most common hemostasis tests used as a presurgery screening and monitoring Coumadin (warfarin) therapy. This test evaluates
coagulation of the blood.
A treatment for sensorineural hearing loss is
cochlear implants.
Mary Smith, a 48-year-old patient, is receiving an IV mixture of four different medications to treat stage two invasive ductal breast carcinoma. Each of the medications acts upon a different aspect of the cancer cells. This mixture is typically termed a(n)
cocktail
The correct coding initiative (CCI) edits contain a listing of coders under two columns titled "comprehensive codes" and "component codes". According to the CCI edits when a provider bills medicare for a procedure that appears in both columns for the same beneficiary on the same date of service
code only the comprehensive code
The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled "comprehensive codes" and "component codes." According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service,
code only the comprehensive code.
Most chief financial officers view the HIM department's most essential role in the revenue cycle management to be:
coding of the record
In reviewing the medical record of a patient admitted for a left herniorrhaphy the coder discovers an extremely low potassium level on the laboratory report. In examining the physician orders the coder notices that intravenous potassium was ordered. The physician has not listed any indication of an abnormal potassium level or any related condition on the discharge summary. The best course of action for the coder to take is to:
confer with the physician and ask him or her to list the condition as a final diagnosis if her or she considers the abnormal potassium level to be clinically significant
All of the following are examples of direct transmission of a disease EXCEPT
contaminated foods.
This is the difference between what is charged and what is paid.
contractual allowance
The causative organism for severe acute respiratory syndrome (SARS) is a
coronavirus
This accounting method attributes a dollar figure to every input required to provide a service.
cost accounting
There are seven criteria for high-quality clinical documentation. All of these elements are included EXCEPT
covered (by third-party payer).
A surgical procedure that cuts into the skull to drain blood from a subdural hematoma in order to decrease the intracranial pressure is termed a(n)
craniotomy
When a physician orders a liver panel, which of the following tests are NOT included?
creatinine
Creation of arteriovenous graft brachial artery left arm for hemodialysis
creation
A procedure performed with an instrument that freezes and destroys abnormal tissues (including seborrheic keratoses, basal cell carcinomas, and squamous cell carcinomas) is
cryosurgery
A sweat test was done on a patient with the following symptoms: frequent respiratory infections, chronic cough, and foul-smelling bloody stools. Which of the following diseases is probably suspected?
cystic fibrosis
in which situation could the use of case mix information be helpful?
deciding if a facility should open an urgent care center
in August of 2006 what decision was made by the office of Management and Budget that will impact hospital-based billing?
decision to implement UB-04 claim
What has been impacted by the correct coding initiative
defining of cases of upcoding and unbundling
Endometrial ablation of cervical polyps
destruction
the patient's account balance is displaying a negative balance. what should be the healthcare organization do to resolve this situation?
determine which payer overpaid and return the funds
the phrase "bad debt" refers to accounts that include money owed by the patient and are:
determined bt the facility to be uncollectible
A serum potassium level of 2.8 would indicate
diabetic ketoacidosis.
A common cardiac glycoside medication that increases the force of the cardiac contraction without increasing the oxygen consumption, thereby increasing the cardiac output is typically given to patients with heart failure. However, there is a very narrow therapeutic window between effectiveness and toxicity, and the patient must be monitored closely. This common cardiac medication is
digoxin
The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete. DNFB is an acronym for _____________.
discharged no final bill
The following services are excluded under the Hospital Outpatient Prospective Payment System (OPPS) Ambulatory Payment Classification (APC) methodology.
durable medical equipment
In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT
each service is paid based on the actual charges.
Impetigo can be
either spread through autoinoculation or caused by Streptococcus pyogenes.
Which of the following tubes conveys sperm from the seminal vesicle to the urethra?
ejaculatory duct
The computer-to-computer transfer of data between providers and third-party payers in a data format agreed upon by both parties is called
electronic data interchange (EDI).
Which step of the "chain of infection" is disrupted by eliminating the standing water in old tires, birdbaths, and empty buckets when combatting the Zika virus epidemic?
eliminating the reservoir
The category "Commercial payers" includes private health insurance companies and
employer-based group health insurers.
which of the following documents should be updated at least on an annual basis to incorporate ICD-9-CM and CPT code changes?
encounter form
Health plans that use ____________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient over a specific period of time for a particular reason.
episode of care (EOC)
under the Home Health Resource group (HHRG) guidelines how often must a patients care be recertified
every 60 days
Biopsy of left lower lobe of the lung
excision
Dr. Thomas performed a tonsillectomy on Peter. The approach, as reported in ICD-10-PCS, is:
external
Left common carotid endarterectomy, open
extraction
Removal deep left vein thrombosis
extripation
The first stage of alcoholic liver disease is
fatty liver.
A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is
financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.
a patient was seen by DR.Zachary. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The medicare fee schedule amount is $100. Dr Zachary does not accept assignment. the office manager will apply a practice termed as "balance billing" which means that the patient is :
financially liable for charges in excess of the Medicare fee schedule
CMS adjusts the Medicare Severity DRGs and the reimbursement rates every
fiscal year beginning October 1.
The facility's Medicare case-mix index has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding quality review should be performed?
focused audit
What common vitamin should be taken by pregnant women to substantially reduce the occurrence of neural tube defects, such as spina bifida, in a developing fetus?
folic acid
____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist.
fraud
In which brain lobe is the processing of emotions, intellect, and personality performed?
frontal
In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by the
geographic practice cost indices.
A bundled payment that covers all services from immediately prior to a surgical procedure through the appropriate post-procedure care period is known as __________.
global payment
which of the following apply to radiological and other procedures that include professional and technical components and are paid as a lump sum to be divided between physician and healthcare facility?
global payment
Clinical manifestations of this disease include polydipsia, polyuria, polyphagia, weight loss, and hyperglycemia. Which of the following tests would be ordered to confirm the disease?
glucose tolerance test
What is the name of the protein that gives breads, cereals, baked goods, and pasta their structure but can cause serious gastrointestinal complications when ingested by individuals with celiac disease?
gluten
A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n)
grouper
A 68-year-old female patient has no visible bleeding but remains anemic. Her physician is concerned about possible gastrointestinal bleeding. Which of the following tests might be ordered?
guaiac smear test
A cardiac condition where there is an abnormality in the way the electricity passes through the sinoatrial (SA) node and the atrioventricular (AV) node to generate a pulse or heartbeat is called
heart block.
Full-blown AIDS sets in as
helper T-cell concentrations decrease.
A 62-year-old female presents to her family doctor complaining of fatigue; constantly feeling cold, especially in her hands and feet; weakness; and pallor. O2 must be transported to the cells and exchanged with CO2, which is then transported back to the lungs to be expelled. A hematology laboratory test that evaluates the oxygen-carrying capacity of blood is referred to as a
hemoglobin determination.
The most common blood-borne infection in the United States is
hepatitis C.
Contributing factors of mental disorders include
heredity, stress, and trauma.
In general, excessive RBC breakdown could result in
high bilirubin levels.
These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments.
hold harmless
What prospective payment system reimburses the provider according to determined rates for a 60-day episode of care?
home health resource groups
The state of balance or normality that the human body continuously tries to attain is referred to as
homeostasis
A 28-year-old female presents to her general practitioner with morning nausea and vomiting, weight gain, and two missed menstrual cycles. The physician orders a pregnancy test. What chemical in the urine does this lab test detect?
human chorionic gonadotropin
use of a revised CMS-1500 (80/05) claims was required effective April 1, 2007 due to:
implementation of NPI
Mary Mulholland has diabetes. Her physician has told her about some factors that put her more at risk for infections. Which of the following factors would probably NOT be applicable?
increased blood supply
Which of the following is an effect of insulin?
increases glucose metabolism
State Medicaid programs are required to offer medical assistance for
individuals with qualified financial need.
Penicillin is effective in the treatment of all of the following diseases EXCEPT
influenza
The prospective payment system (PPS) requiring the use of DRGs for inpatient care was implemented in 1983. This PPS is used to manage the costs for
inpatient hospital stays.
Under APCs, payment status indicator "C" means
inpatient procedures/services.
This prospective payment system is for ____________________ and utilizes a Patient Assessment Instrument (PAI) to classify patients into case-mix groups (CMGs).
inpatient rehabilitation facilities
a discharge in which the patient was discharged from the inpatient rehabilitation facility and returned within 3 calendar days is called a
interrupted stay
When a patient is discharged from the inpatient rehabilitation facility and returns within three calendar days (prior to midnight on the third day) this is called a(n)
interrupted stay.
Which of the following is the most effective method for the prevention of influenza?
intramuscular injection vaccine
Sex-linked genetic diseases
involve a defect on a chromosome.
Under APCs, the payment status indicator "N" means that the payment
is packaged into the payment for other services.
This information provides a narrative name of the services provided. This information should be presented in a clear and concise manner. When possible, the narratives from the HCPCS/CPT book should be utilized.
item/service description
Portal hypertension can contribute to all of the following EXCEPT
kidney failure.
Rheumatoid arthritis typically affects the
knees and small joints of the hands and feet.
The least invasive restrictive gastric surgery used to reduce the size of the stomach to facilitate weight loss in obese patients is
laparoscopic gastric banding
In systemic circulation, which of the following vessels carries oxygenated blood?
left ventricle
Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT
lifetime reserve days are paid under Medicare Part B.
The hypothalamus and the thalamus are part of the
limbic system.
The drug commonly used to treat bipolar mood swings is
lithium carbonate.
The _____ is the largest solid organ of the body, but the ____ is the largest organ overall.
liver, skin
LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for
local coverage determinations and national coverage determinations.
which of the following types of care is not covered by medicare?
long-term care
Fractures occur in patients with osteoporosis due to
loss of bone mass.
Which one of the following is NOT a pathophysiological factor in anemia?
loss of spleen function
Which of the following conditions is NOT a predisposing risk associated with essential hypertension?
low dietary sodium intake
The key diagnostic finding for typical pneumonia is
lung consolidation on CXR.
Many bacterial diseases are transmitted directly from person to person. Which of the diseases listed next is a bacterial disease transmitted by way of a tick vector?
lyme disease
In which gender is the urethra significantly longer?
males
Which of the following cells produce histamine in a type I hypersensitivity reaction?
mast cells
Carpal tunnel syndrome is caused by entrapment of the
medial nerve.
Several recent studies suggest that this issue/condition is now the third leading cause of death in the United States, is responsible for at least 10% of all deaths in the United States, and is an underrecognized and therefore underreported cause of death in the United States. This issue/condition is
medical errors
The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is
medical necessity.
The prevention of illness through vaccination occurs due to the formation of
memory cells.
A 19-year-old college student, who lives on campus in a dormitory, is brought to the ER by his roommates, complaining of a severe headache, nuchal rigidity, fever, and photophobia. The ER physician performs an LP and orders a CSF analysis with a bacterial culture and sensitivity. The young man is admitted to the ICU with a provisional diagnosis of
meningitis due to Neisseria meningitidis-positive cerebrospinal fluid.
Photophobia or visual aura preceding a severe headache is characteristic of
migraines
Cervical cerclage is a procedure used to help prevent
miscarriage
Which valve is between the left atrium and left ventricle?
mitral
In the Radiation Section of ICD-10-PCS, the third character position represents which of the following?
modality
A standard surgical procedure used for the treatment of early-stage breast cancer involves the removal of the cancerous tumor, skin, breast tissue, areola, nipple, and most of the axillary lymph nodes but leaves the underlying chest muscles intact. This procedure is termed a(n)
modified radical mastectomy.
Which of the following autoimmune diseases affects tissues of the nervous system?
myasthenia gravis
Which of the following is a congenital condition that is the most severe neural tube defect?
myelomeningocele
Which of the following procedures is typically performed on children to facilitate the drainage of serous exudate behind the tympanic membrane in chronic otitis media?
myringotomy with tympanostomy tubes
Under Medicare Part B, all of the following statements are true and are applicable to nonparticipating physician providers, EXCEPT
nonparticipating providers have a higher fee schedule than that for participating providers.
Ligation right fallopian tube
occlusion
what agency oversees the investigation of cases under the false claims act?
office of inspector general
The MS-DRG (Medicare Severity-Diagnosis Related Group) system was designed to pay:
only one amount (group) of reimbursement per hospitalization
A surgical procedure that is performed to realign and stabilize a fractured femur with a rod and screws is referred to as a(n)
open reduction with internal fixation
APCs are groups of services that the OPPS will reimburse. Which one of the following services is not included in APCs?
organ transplantation
A radiological test for bone mineral density (BMD) is a useful diagnostic tool for diagnosing
osteoporosis
A stapedectomy is a common treatment for
otosclerosis
