CCA review

In ICD-10-PCS, during post-CVA status, a speech assessment was performed to measure articulation and phonology using speech analysis.

F00Z9QZ

____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist.

Fraud -Fraud is the act of submitting claims with untrue information with the intent of collecting monies that have not been earned. This is the correct answer.

A 32-year-old female patient presents with right arm (dominant) paralysis due to childhood poliomyelitis.

G83.21, B91

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 diagnosed with psychogenic paroxysmal tachycardia.

I47.9, F54 -Paroxysmal tachycardia = I47.9 Psychological condition [psychogenic] effecting physical condition [tachycardia] = F54 See the notation beneath F54, "Code first the associated physical disorder."

Mitch was diagnosed by his physician as having dehydration. Mitch has had gastroenteritis for several days, which has resulted in dehydration and requires intravenous hydration. Mitch also has chronic kidney disease and is at high risk for acute on chronic kidney failure. Two days following admission, Mitch develops acute renal failure. Mitch also has hypertension. (Code the ICD-10-CM diagnoses.) E86.0Dehydration K52.9Noninfective gastroenteritis and colitis, unspecified I10Essential hypertension I12.9Hypertensive chronic kidney disease with stage I through stage IV chronic kidney disease, or unspecified chronic kidney disease I12.0Hypertensive chronic kidney disease with stage V chronic kidney disease or end-stage renal disease N17.9Acute kidney failure, unspecified N18.9Chronic kidney disease, unspecified N19Renal failure, unspecified

K52.9, I12.9, N18.9, N17.9

Dr. Mathews performed surgery on Nathan Weston to remove his gallbladder, after he was diagnosed with cholelithiasis with cholecystitis. Report this condition with: K80.61Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction K80.65Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction K80.10Calculus of gallbladder with chronic cholecystitis without obstruction K80.70Calculus of gallbladder and bile duct without cholecystitis without obstruction

K80.10

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)

The Quality Payment Program was implemented as part of ________.

MACRA

You are the office manager at a large group practice. One of the physicians at your practice has asked you to research and supply her with information about the legislation signed into law in 2015 which required the removal of social security numbers from all Medicare cards. You will provide this inquisitive physician with a fact sheet concerning this legislation:

Medicare Access and CHIP Reauthorization Act (MACRA) -The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015. As part of this legislation, MACRA requires the removal of social security numbers from all Medicare cards to better protect private health care and financial information.

Baby boy Jones was born and found to have congenital pneumonia due to chlamydia. Report this condition with: A74.9Chlamydial infection, unspecified B97.88Other viral agents as the cause of diseases classified elsewhere J18.9Pneumonia, unspecified organism P23.0Congenital pneumonia due to viral agent P23.1Congenital pneumonia due to Chlamydia

P23.1 -Congenital pneumonia means the infant was infected by the pathogen [chlamydia] en utero.

A patient admitted with gross hematuria and benign prostatic hypertrophy.

R31.0, N40.0 -Gross hematuria = R31.0 Benign prostatic hypertrophy = N40.0 Without any cause-and-effect documented, these must be separately reported.

A woman has a Pap smear that detected cervical high-risk human papillomavirus (HPV). The DNA test was positive.

R87.810

Dr. Carter performed a hip replacement. The root operation term used for this ICD-10-PCS code is:

Replacement: putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part

A patient is admitted for intentional overdose of valium and acute respiratory failure with hypoxia.

T42.4x2A, J96.01 -Poisoning, valium [classified as benzodiazepine], by intentional self-harm, initial encounter = T42.4x2A Acute respiratory failure with hypoxia = J96.01

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.

A patient develops difficulty during surgery and the physician discontinues the procedure. Identify the modifier that may be reported by the physician to indicate that the procedure was discontinued.

-53 -Modifier -53 is appropriate in circumstances where the physician elects to terminate or discontinue a surgical or diagnostic procedure, usually because of a risk to the patient's well-being. This modifier should not be used to report the elective cancellation of a procedure prior to the patient's surgical preparation or prior to the induction of anesthesia.

Code anesthesia for vaginal hysterectomy.

00944 -A code of 00944 is used for anesthesia provided to the patient for a vaginal hysterectomy procedure.

Code anesthesia for total hip replacement.

01214

In ICD-10-PCS, a percutaneous fascia transfer to cover defect of the right anterior neck

0JX43ZZ

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%

Under ASC PPSs, bilateral procedures are reimbursed at _______ of the payment rate for their group.

150%

Open I&D of a deep abscess of the cervical spine

22010

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 with laryngeal cancer has a tracheoesophageal fistula created and has a voicebox inserted.

31611

Patient is admitted with alcohol cirrhosis and has a TIPS procedure performed.

37182

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 been on the bone marrow transplant recipient list for 3 months. A perfect match was made, and the patient came in and received a peripheral stem cell transplant.

38240

Patient diagnosed with cystic hygroma of the axilla, which was excised

38550

Patient has been diagnosed with carcinoma of the vagina, and she has a radical vaginectomy with complete removal of the vaginal wall.

57111

Hysteroscopy with D&C and polypectomy

58558

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

Radial keratotomy

65771 -A code of 65771 should be used for the radial keratotomy procedure.

Correction of trichiasis by incision of lid margin

67830

Patient with chronic otitis media requiring transtympanic eustachian tube catheterization.

69799

Basic metabolic panel (calcium, total) and total bilirubin

80048, 82247

What code is used for a culture of embryos less than 4 days old?

89250

Huhner test and semen analysis

89300

Cardioversion of cardiac arrhythmia by external forces

92960

An office consultation is performed for a postmenopausal woman who is complaining of spotting in the past 6 months with right lower-quadrant tenderness. A detailed history and physical examination were performed with a low-complexity medical decision.

99243

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

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

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 -The principal diagnosis is the abscess of the liver, so that is reported first, followed by the pneumonia. Then, you need to report Y95 to identify that the pneumonia was "hospital-acquired."

ICD-10-CM utilizes a placeholder character. This is used as a fifth character placeholder at certain six-character codes to allow for future expansion. The placeholder character is

X

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 -Observation, head injury, ruled out = Z04.3 Minor laceration, forehead, initial encounter = S01.81xA See the notation at the top of the code category, Z04, "This category is to be used when a person without a diagnosis is suspected of having an abnormal condition, without signs or symptoms, which requires study, but, after examination and observation, is ruled-out. This category is also for use for administrative and legal observation status." Confirm this with Official Guidelines Section I.C. Chapter-Specific Coding Guidelines, 21.c.6) Observation.

The patient required an adjustment to the settings for her pacemaker, put in due to her atrial fibrillation. Dr. Jones was able to perform the adjustment in her office. The reason for this encounter is: Z95.0Presence of cardiac pacemaker Z45.02Encounter for adjustment and management of automatic implantable cardiac defibrillator Z45.018Encounter for adjustment and management of other part of cardiac pacemaker I48.1Persistent atrial fibrillation

Z45.018

At the request of one physician, a second physician provides advice regarding the evaluation and management of a specific problem. This is called

a consultation.

Your hospital is required by the Joint Commission and CMS to participate in national benchmarking on specific disease entities for quality of care measurement. This required collection and reporting of disease-specific data is considered

a series of core measures.

Under APCs, payment status indicator "X" means

ancillary services.

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. -Cutaneous anthrax is caused by the bacteria Bacillus anthracis, found in wild animals, as well as domestic stocks of cows, sheep, and goats. Because of its propensity to occur in sheep, it is sometimes called "woolsorter's disease." Since anthrax is caused by a bacterium, an antibiotic is the medication of choice since it destroys bacteria. The other medications listed would have no effect on the bacteria.

Many of the principles of forms design apply to both paper-based and computer-based systems. For example, the physical layout of the form and/or screen should be organized to match the way the information is requested. Facilities that are scanning and imaging paper records as part of a computer-based system must give careful consideration to

bar code placement. -Most facilities use bar-coded patient identification to ensure proper indexing into the imaging system. Placement of bar codes on the forms follow principles of forms design for continuity in item placement for visual identity. Consistency is important for a visual identity and style that you maintain throughout your form (and the rest of the forms you create in the future).

The diagnosis is as follows: "Carcinoma of axillary lymph nodes and lungs, metastatic from breast." Given this which are the primary cancer site(s)?

breast -The primary cancer site is the breast.

The Phalen's wrist flexor test is a noninvasive method for diagnosing

carpal tunnel syndrome.

Which of the following procedures would be performed for the removal of the gall bladder due to excessive gallstone formation?

cholecystectomy -Cholecystectomy is a surgical procedure to remove the gallbladder, a pear-shaped organ that sits just below the liver on the upper right side of the abdomen; the gallbladder collects and stores bile, a digestive fluid produced in the liver.

The coding supervisor notices that the coders are routinely failing to code all possible diagnoses and procedures for a patient encounter. This indicates to the supervisor that there is a problem with

completeness

The utilization review coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. Which of the following utilization review activities is being performed?

continued stay review

In ICD-10-PCS, stopping of postoperative tonsillectomy hemorrhaging is coded to which root operation?

control

Jane believes new equipment will make her staff more efficient. The board has asked for an analysis of the cost of the equipment to be compared with the benefit to the facility. This mathematical process is known as a ________

cost-benefit analysis -Cost-benefit analysis is the evaluation to determine whether the value of something is greater than the cost of that item, or not

There are seven criteria for high-quality clinical documentation. All of these elements are included EXCEPT

covered (by third-party payer).

Identify the correct root operation term used in ICD-10-PCS for the following: Lysis of abdominal adhesions

destruction

Identify the correct root operation, used in ICD-10-PCS, for the following: Amputation first left toe

detachment

Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for

diagnostic and therapeutic services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services.

Identify the correct root operation term used in ICD-10-PCS for the following: Percutaneous angioplasty right coronary artery using a balloon-tipped catheter to expand the vessel

dilation

Joint Commission does not approve of auto authentication of entries in a health record. The primary objection to this practice is that

evidence cannot be provided that the physician actually reviewed and approved each report.

The first stage of alcoholic liver disease is

fatty liver -Fatty liver (steatosis) is the earliest stage of ALD and the most common alcohol-related liver disorder; approximately 35% of heavy drinkers develop alcoholic hepatitis, which can be mild or severe. Symptoms may include fever, jaundice, nausea, vomiting, abdominal pain, and tenderness.

In quality review activities, departments are directed to focus on clinical processes that are

high risk.

Scabies, a highly contagious condition that produces intense pruritus and a rash, is caused by

itch mites Scabies is caused by an infestation by the itch mite, Sarcoptes scabiei.

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.

Regarding hospital emergency department and hospital outpatient evaluation and management CPT code assignment, which statement is true? A) Each facility must use the same methodology used by physician coders based on the history, examination, and medical decision-making components. B) Each facility is accountable for developing and implementing its own methodology. C) Each facility must use acuity sheets with acuity levels and assign points for each service performed. D) The level of service codes reported by the facility must match those reported by the physician.

B) Each facility is accountable for developing and implementing its own methodology.

In ICD-10-PCS, ultrasound performed on patient, 28 weeks pregnant with twins to check positions of fetuses

BY4GZZZ

____________ is the most common type of skin cancer, and _________ is the most deadly type of skin cancer.

Basal cell carcinoma, malignant melanoma

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: C71.3Malignant neoplasm of parietal lobe C79.31Secondary malignant neoplasm of brain D33.0Benign neoplasm of brain, supratentorial D43.0Neoplasm of uncertain behavior of brain, supratentorial

C79.31

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 -CABG = coronary artery bypass graft: using a piece of a different vein, attached to the coronary artery above and below the blockage, to provide an alternate pathway for the blood to flow.

The APC payment system is based on what coding system(s)?

CPT/HCPCS codes -The APC payment system is based on CPT/HCPCS codes.

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

In creating a new form or computer view, the designer should be most driven by

needs of the users.

Which of the organs listed below has endocrine and exocrine functions?

pancreas

In compiling statistics to report the specific cause of death for all open-heart surgery cases, the quality coordinator assists in documenting

patient care outcomes -Death is one of the patient care outcomes.

Using the SOAP style of documenting progress notes, choose the "subjective" statement from the following.

patient states low back pain is as severe as it was on admission

Identify the correct root operation term used in ICD-10-PCS for the following: The patient could not breathe on his own, so he was placed on a ventilator.

performance

The method of calculating errors in a coding audit that allows for benchmarking with other hospitals, and permits the reviewer to track errors by case type, is the

record-over-record method.

Most carbon dioxide is carried in the

red blood cells.

When the third-party payer returns a claim due to missing, inaccurate, or invalid information, this is called a

rejected claim.

Softening of the bone in children is termed ________.

rickets -Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency.

Discharge summary documentation must include

significant findings during hospitalization.

According to the UHDDS, a procedure that is surgical in nature, carries a procedural or anesthetic risk, or requires special training is defined as a

significant procedure.

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

When asked to explain how "review of systems" differs from "physical exam," you explain that the review of systems is used to document

subjective symptoms that the patient may have forgotten to mention or that may have seemed unimportant.

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

When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary neoplasm only -code the secondary neoplasm as the principal diagnosis. -the secondary neoplasm is coded as the principal diagnosis, and the primary neoplasm is coded as an additional diagnosis. -code the primary neoplasm as the principal diagnosis. -the primary neoplasm is coded as the principal diagnosis and the secondary neoplasm is coded as an additional diagnosis.

the secondary neoplasm is coded as the principal diagnosis, and the primary neoplasm is coded as an additional diagnosis. -See ICD-10-CM Official Guidelines 2018, Section 1.c.2, Treatment of secondary site: "When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present."

The information collected for your registry includes patient demographic information, diagnosis codes, functional status, and histocompatibility information. This type of registry is a

transplant registry.

Under which of the following conditions can an original paper-based patient health record be physically removed from the hospital?

when the director of health records is acting in response to a subpoena duces tecum and takes the health record to court

In ICD-10-PCS, stereotactic gamma beam radiosurgery performed on patient's right breast

DM21JZZ

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). -Discharged, not final billed (DNFB) is a list of funds that have been earned because the patient has been discharged; however, the final claim form has not yet been generated or submitted.

Four people were seen in your emergency department yesterday. Which one will be coded as a poisoning? Robert-diagnosed with digitalis intoxication Gary-had an allergic reaction to a dye administered for a pyelogram David-developed syncope after taking Contac pills with a double scotch Brian-had an idiosyncratic reaction between two properly administered prescription drugs

David -The condition should be coded as a poisoning when there is an interaction of an over-the-counter drug and alcohol. The other answer choices are adverse effects of a correctly administered prescription drug.

Which of the following statements is true? A) A surgical procedure may include one or more surgical operations. B) The terms surgical operation and surgical procedure are synonymous. C) The term surgical procedure is an incorrect term and should not be used. D) A surgical operation may include one or more surgical procedures.

D) A surgical operation may include one or more surgical procedures. -A surgical operation is one or more surgical procedures performed at one time for one patient using a common approach or for a common purpose.

A patient is admitted with acute respiratory failure with hypercapnia due to chronic asthmatic bronchitis with acute exacerbation. Treatment consisted of IV steroids.

J45.901, J96.02 -Chronic asthmatic bronchitis with acute exacerbation = J44.1 Acute respiratory failure with hypercapnia = J96.02 You can see that "chronic asthmatic bronchitis" is shown in the INCLUDES list beneath J44 code category. For sequencing, you must realize that the exacerbation of the asthmatic bronchitis was the underlying cause of the patient's respiratory failure. Therefore, J44.1 is sequenced first.

In assigning E/M codes, three key components are used. These are

In assigning E/M codes, three key components are used. These are -The key factors are history, examination, and medical decision making. Information about the three key factors should be documented in the patient's health record as well.

Which of the following is characteristic of Graves' disease?

It is an autoimmune disease.