C808 Coding Quality

When did HCFA (now CMS) implemented the National Correct Coding Initiative for physician claims?

1996

A physician performed a total abdominal hysterectomy with bilateral salpingo-oophorectomy on his patient at a Community Hospital. HIs office billed the following:

58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); Salpingo-oophorectomy, complete or partial unilateral or bilateral (separate procedure)- Unbundled procedures.

Coding accuracy is best determined by:

A predefined audit processes.

The period of time between discharge and claim submission, which a facility defines by policy, is called the:

Bill hold

At Medical Center Hospital, HIM professionals are located in the nursing stations, where they are responsible for all aspects of health record processing. While the patient is in the facility, the HIM professional does a daily review of the record to ensure complete documentation. This approach is called a:

Concurrent review

A coding audit shows that an inpatient coder is using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case?

Counsel the coder to stop practice immediately.

The primary responsibility of a coder is to:

Ensure accuracy of coded data.

Community Hospital implemented a clinical document improvement (CDI) program six months ago. The goal of the program was to improve clinical documentation to support quality of care, data quality, and HIM coding accuracy. Which of the following would be best to ensure that everyone understands the importance of this program?

Include ancillary clinical staff and medical staff in the process.

Coding compliance programs focus on preventing accusations of fraud and abuse in healthcare. Which organization from the Department of Health and Human Services provides guidance for healthcare organizations in developing compliance programs?

Office of the Inspector General (OIG)

You are the coding manager and are completing a review of a new coder's work. The case facts are that the patient was treated in the emergency department for two forearm lacerations that were both repaired with simple closure. The new coder assigned one CPT code for the largest laceration. Which of the following would be the correct CPT code assignment for this case?

One CPT code adding the lengths of the lacerations together.

All of the following are goals for a clinical documentation improvement program EXCEPT:

Preventing billing for bundled services

Which of the following elements is found in a charge description master?

Procedure or service charge

Which of the following is the principal goal of internal auditing programs for billing and coding?

Protect providers from sanctions or fine.s

In reviewing a patient chart, the coder finds that the patient's chest x-ray is suggestive of chronic obstructive pulmonary disease (COPD). The attending physician mentions the x-ray finding in one progress note, but no medication, treatment, or further evaluation is provided. Which of the following actions should the coder take in this case?

Query the attending physician and ask him to validate a diagnosis based on the chest x-ray results.

A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient undergoes intubation with mechanical ventilation. The final diagnoses documented by the attending physician are: Congestive heart failure, mechanical ventilation, and intubation. Which of the following actions should the coder take in this case?

Query the attending physician as the reason for the intubation and mechanical ventilation to add as a secondary diagnosis.

An 80-year-old woman is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of E-coli per CC of urine. The attending physician documents "urosepsis". How should the coder proceed to code this case?

Query the physician to ask if the patient has septicemia because of the symptomatology.

Carolyn works as a coder in a hospital inpatient department. She sees a lab report in a patient's health record that is positive for staph infection. However, there is no mention of staph in the physician's documentation. What should the coder do?

Query the physician.

Which of the following is the definition of revenue cycle management?

The coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

Why is it important to have a CDI physician champion or advisor?

To allow for peer-to-peer physician communication and education.

The coder assigned separate codes for the individual tests when a combination code exists. This is an example of which of the following?

Unbundling

The practice of using a code that results in a higher payment to the provider than the code that actually reflects the service or item provided is known as:

Upcoding

A patient who was admitted for treatment of an interverbal disk injury developed a urinary tract infection and fever several days after undergoing surgery. In this situation the urinary tract infection would be classified as:

healthcare-associated infection