ICD-10

Question 1

When coding a visit for pain in neoplastic disease, which code is first?

Answer 1

Pain comes 1st when the reason for the encounter is documented as ‘pain control’ or ‘pain management’.

Question 2

Is code Z79.4, long term use of insulin, required for a type 1 diabetic?

Answer 2

No, type 1 patients are insulin dependent.

Question 3

What does intractable epilepsy mean?

Answer 3

Poorly controlled with medication

Question 4

Can acute respiratory failure be a primary diagnosis with another acute diagnosis if it is clear the respiratory failure was responsible for the patient being admitted?

Answer 4

Yes

Question 5

How many codes are used for a transplant complication? (aka a malignant neoplasm of a transplanted organ)

Answer 5

3. Transplant complication: Assign 1st the appropriate code from category T86.-, Complications of transplanted organs and tissue, followed by code C80.2, Malignant neoplasm associated with transplanted organ. Use an additional code for the specific malignancy.

Question 6

Is there a causal relationship between hypertension and heart and/or kidney involvement?

Answer 6

Yes, unless documented as ‘unrelated’, in which case, document as separate.

Question 7

Does NSTEMI get coded as a STEMI?

Answer 7

Yes, If a type 1 NSTEMI evolves to STEMI, assign the STEMI code. If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI,

Question 8

When unspecified, what is the side with default dominance for a cerebral infarction?

Answer 8

Right

Question 9

When unspecified, what is the default type of diabetes?

Answer 9

Type 2

Question 10

Does the use of insulin mean a patient is type 1 diabetic?

Answer 10

No

Question 11

Is there a presumed causal relationship between CKD and hypertension?

Answer 11

Yes

Question 12

When treatment is directed at secondary cancer, is primary or secondary reported 1st?

Answer 12

Secondary

Question 13

Can uncertain diagnosis such as probably, suspected, questionable, rule out or working diagnosis be coded?

Answer 13

No

Question 14

When is dehydration sequenced first?

Answer 14

When the encounter is for mgmt of dehydration due to the malignancy or therapy, or a combination of both, and only the dehydration is being treated.

Question 15

Unstageable and unspecified pressure ulcers are the same.

Answer 15

False. Documentation must state unstageable

Question 16

If a patient is admitted with a pressure ulcer at one stage and it evolves to another, should you utilize the highest stage documented?

Answer 16

No, you have to use the code for the stage at admission and another for highest stage documented.

Question 17

Can BMI and Ulcer staging be coded based on ancillary provider documentation?

Answer 17

Yes, so long as the associated diagnosis is documented by the patient’s provider.

Question 18

For rheumatoid arthritis at the upper and lower end of the bone, do you code for the bone or the joint?

Answer 18

Bone

Question 19

Category M81 is for osteoporosis patients with or without a current pathological fracture?

Answer 19

Without a current pathological fracture. Utilize Z code for history of healed osteoporosis fracture.

Question 20

Category Z3A does not apply to which three scenarios?

Answer 20

1. Abortions
2. Elective terminations
3. Postpartum conditions

Question 21

True or false, codes for chapter 15 should only be utilized on the mother?

Answer 21

Correct. Do not utilize chapter 15 codes on the newborn.

Question 22

When a pregnant patient is admitted with a complication do you code the trimester in which it occurred or current trimester?

Answer 22

Trimester it occurred

Question 23

When are codes that describe symptoms and signs appropriate?

Answer 23

When a definitive diagnosis has not been established.

Question 24

Lack of ability to move one’s limbs or inability to ambulate due to extreme debility is what type of quadaplegia

Answer 24

Functional (R53.2) as opposed to neurologic or injury

Question 25

Code for adverse effect when the prescription was properly taken and administered?

Answer 25

True

Question 26

Code first abuse and neglect?

Answer 26

True

Question 27

Code first poisoning followed by manifestation?

Answer 27

True

Question 28

Should superficial injuries to same site be coded?

Answer 28

No

Question 29

When can ultrasonic guidance be reported more than once?

Answer 29

If two forms of guidance are used

Question 30

How do you choose the appropriate injection CPT code?

Answer 30

Must have the anatomy, site and number of injections, along with the drug and dosage.

Question 31

Can a radiology code be coded in addition to injection with ultrasound guidance?

Answer 31

No

Question 32

Is documenting ‘Negative’ for PSFH sufficient?

Answer 32

No. There must be a statement of what is negative.

Question 33

Is a modifier needed if the service is outside the 10 day global period?

Answer 33

No

Question 34

The provider documents a brief HPI (location and duration); pertinent ROS (allergies); and complete PFSH (past and social). Expanded problem focused, problem focused complete or; comprehensive

Answer 34

expanded problem focused

Question 35

When a physician is banned from participating in any Federal or State health care program by the OIG under the Exclusion Statute (42 U.S.C. § 1320a-7), what is the minimum term of exclusion that can be applied?

Answer 35

5 Years

Question 36

A Qui Tam Relator may receive what type of award for bringing a case in which the government intervenes?

Answer 36

15-25 percent of the money recovered

Question 37

When utilizing templates to document in a medical record, what documentation must be included in the template?

Answer 37

Elaboration on abnormal findings

Question 38

What program was established by HIPAA to combat fraud and abuse committed against all health plans, both public and private?

Answer 38

Health Care Fraud and Abuse Control Program

Question 39

A way to indicate that a discussion between the patient and the provider took place about a patient’s condition and the treatment options available, to allow the patient an opportunity to ask questions and make an informed choice on his or her plan of treatment.

Answer 39

Informed consent

Question 40

What is appropriate to document in a radiology report for contrast material used in a radiologic study?

Answer 40

The type and amount of contrast used, along with the route of administration is documented.

Question 41

Each provider involved in a surgical case is expected to document the portion of the surgical procedure they performed with the exception of?

Answer 41

Assistant surgeon

Question 42

When a correction is made in an electronic health record, what must exist?

Answer 42

Reliable means to clearly identify the original content and the modified content.

Question 43

True or False, clinical documentation improvement efforts are performed on a prospective basis?

Answer 43

True

Question 44

Which system is given credit for the exam component when a provider documents “no appreciable edema in the ankles?”

Answer 44

Cardiovascular

Question 45

What modifier is appended to indicate a service is provided under the primary care exception without the presence of a teaching physician?

Answer 45

GE

Question 46

True or false, No matter how many tests are ordered/reviewed for labs, radiology and medicine each area only gets 1 point.

Answer 46

True

Question 47

True or false, When an excision (benign or malignant) is performed on the same site as an adjacent tissue transfer, only the adjacent tissue transfer is reported.

Answer 47

True

Question 48

Which modifier begins a new global period for unrelated procedure?

Answer 48

79

Question 49

Risk adjustment models are used to:

Answer 49

Determine projected costs of health care based on the condition(s) of patients.

Question 50

What does the abbreviation CDPS indicate?

Answer 50

Chronic Disability Payment System

Question 51

How often does CMS normalize risk scores and update the list of diagnosis codes for HCC coding?

Answer 51

Yearly

Question 52

Fee schedules for fee-for-service models are determined based on:

Answer 52

RVU’s

Question 53

Which components are used to determine RVUs?

Answer 53

Physician work
Practice expense
Malpractice insurance

Question 54

Which status indicator identifies procedures where the global concept does not apply?

Answer 54

XXX

Question 55

Which program was developed by CMS to review claims processing error rates?

Answer 55

CERT

Question 56

When is an ABN required?

Answer 56

When the procedure may not be covered for the patient’s condition.

Question 57

True or false, if STEMI converts to NSTEMI due to

thrombolytic therapy, it is still coded as STEMI.

Answer 57

True

Question 58

A patient is seen for his hypertension with stage 5 CKD and myocardial disease. The conditions are stable and he is told to continue with his medications. The myocardial disease is unrelated to the hypertension. What ICD-10-CM codes are reported?

Answer 58

I12.0, N18.5, I51.5
Instructional note under I12.0 indicates to use
additional code to identify the stage of the CKD. Code N18.5 is reported for stage 5 CKD. ICD-10-CM guideline, I.C.9.a.1 indicates if the documentation does not have a causal relationship between the hypertension and heart disease the conditions are coded separately. Look in the Alphabetic Index for Disease/myocardium, myocardial referring you to I51.5. Verify code selection in the Tabular List.

Question 59

When non-compliance is identified, what does the OIG recommended?

Answer 59

Take disciplinary action

document the date of the incident

name of reporting party

name of the person responsible for taking action
follow-up action taken

Question 60

When is incidental use and disclosure of PHI permitted?

Answer 60

When the covered entity has reasonable safeguards in place to ensure the information shared is being limited to the minimum necessary.

Question 61

Which one of the following options is a NOT a requirement for financial penalties to be mitigated in a federal False Claims Act case?

Answer 61

The person committing the violation decides to voluntarily opt out of the Medicare program.

Question 62

What is NOT a term used for a radiological view in a radiology report?

Answer 62

Prone

Question 63

What is appropriate to document in a radiology report for contrast material used in a radiologic study?

Answer 63

The type and amount of contrast used, along with the route of administration is documented.

Question 64

What is an action that results in unnecessary costs to a Federal health care program, either directly or indirectly

Answer 64

Abuse

Question 65

Which of the following is NOT supported as a linked condition from a documentation perspective in a medical record?

Answer 65

Diabetes and dermatitis

Question 66

What should the writing style of an audit report be?

Answer 66

Persuasive

Question 67

Which EMR feature is non-compliant with CMS?

Answer 67

Templates that allow the provider to de-select a prepopulated “normal” checkmark when the system is abnormal in the ROS

Question 68

What is NOT considered a purpose of documentation improvement programs?

Answer 68

Increase reimbursements

Question 69

Which is NOT an acceptable cause for query?

Answer 69

Signs and symptoms without a diagnosis

Question 70

The surgeon documents liver cancer, but the pathology report states angiosarcoma of liver. You:

Answer 70

Code the liver cancer as angiosarcoma, a primary liver cancer, based on the pathologist’s documentation.

Question 71

Patient has a history of a recent myocardial infarct and is admitted today with an ST elevation MI of the anterior wall. The flaw in this documentation from a coding standpoint:

Answer 71

The duration between the recent myocardial infarct and the current myocardial infarct will impact coding, so “recent” is insufficient documentation.

Question 72

Which term or phrase, when used between a manifestation and etiology, does NOT always show a causal relationship?

Answer 72

Likely

Question 73

Which is an example of poor documentation that is especially problematic as there is no “unspecified” code for the condition in ICD-10-CM?

Answer 73

Degenerative disc disease (DDD). Currently, ICD-10-CM does not provide a code for DDD when the site of the disc is not specified.

Question 74

Is it an acceptable practice to use a template that always documents a complete review of systems?

Answer 74

No. The extent of ROS performed and documented is dependent upon clinical judgment and the nature of the presenting problem(s).

Question 75

Which type of documentation can be used to report diagnoses under risk adjustment models?

Answer 75

Inpatient Admission Note

Question 76

What type of organization receives reimbursements based on quality metrics and reductions in the total cost of care for an assigned population of patients.

Answer 76

an Accountable Care Organization (ACO)

Question 77

What information should be documented to properly code hypertension in ICD-10-CM?

Answer 77

Level of control (controlled, uncontrolled, malignant)

Question 78

Which statement is TRUE for the use of a sign/symptom code with a definitive diagnosis code?

Answer 78

Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

Question 79

In the 2019 MIPS performance year, what percentage of the provider score will be determined based on the promoting interoperability category?

Answer 79

25%

Question 80

How is the cost category under MIPS going to be determined?

Answer 80

adjudicated claims data.

Question 81

Consider the following final diagnostic statement: Acute renal failure in patient with history of renal transplant. What advice would you give to the provider regarding whether this documentation is sufficient to document a kidney transplant complication.

Answer 81

ICD-10-CM Guideline I.C.19.g.3 states, “Codes that affect the function of the transplanted kidney, other than CKD, should be assigned a code from subcategory T86.1, Complications of transplanted organ, kidney, and a secondary code that identifies the complication.”

Question 82

Diabetic ulcers are staged by:

Answer 82

skin, fat layer (subcutaneous), muscle, and bone

Question 83

Query the provider, asking if there is a diagnosis to go with the weight loss strategy counseling that was performed.

Answer 83

Query the provider, asking if there is a diagnosis to go with the weight loss strategy counseling that was performed.

Question 84

A pathology report might show:

Answer 84

The histology of a breast biopsy specimen

Question 85

Are views required for a CT order?

Answer 85

No, only for x-rays

Question 86

When are HCC scores normalized by CMS?

Answer 86

Yearly

Question 87

The National Institute of Health identifies in its website conditions that are chronic and incurable, so any “past medical history” of these diseases would translate to a current history of these diseases.

Answer 87

Down syndrome
Parkinson’s disease
schizophrenia
sickle cell anemia

Question 88

Is alcoholic liver disease specific enough to code alcoholic cirrhosis?

Answer 88

Alcoholic liver disease is a nonspecific diagnosis, and correct coding would be K70.9, alcoholic liver disease unspecified. Instructional notes indicate that an additional code should be used to identify the presence or absence of alcohol abuse and dependency.

Question 89

Is it appropriate to assign code Y95, Nosocomial condition, for a documented healthcare acquired condition?

Answer 89

Yes

Question 90

What MIPS measure replaces PQRS?

Answer 90

Quality

Question 91

What is NOT an eligible providers (EPs) for Medicare under the MIPS Quality Payment Program?

Answer 91

Certified social workers

Question 92

When does the performance year begin for the Medicare Quality Payment Program?

Answer 92

January 1 and closes December 31

Question 93

A/P: Diabetic neuropathy, improved. Still having insomnia. Lyrica should help her with the sleeping; we will monitor how her BS responds to this new medicine.
Return to office in 4-5 weeks. For the documentation provided, what is the level of MDM?

Answer 93

Low: Diabetic neuropathy is an established problem to the provider that has improved from the last time the patient was seen and the insomnia is an established problem not stated as stable or uncontrolled (2 points), no data to review (0 points), and the level of risk is moderate for prescription drug management (Lyrica).

Question 94

What statement is TRUE regarding the use of modifier 25 with minor surgeries?

Answer 94

When a significant and separately identifiable E/M is performed on the same date as a minor surgery, modifier 25 can be appended to the E/M code.

Question 95

What documentation is required to support transitional care codes?

Answer 95

I. Communication with the patient within two business days of discharge.
II. Interview with home health agency to assess need for home care.
III. Medical decision making of moderate to high complexity

Question 96

What is adjuvant therapy for cancer?

Answer 96

Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy. Adjuvant therapy given before the main treatment is called neoadjuvant therapy.

Question 97

When a patient is diagnosed with multiple pressure ulcers on the same limb that are of different stages, how should this be reported?

Answer 97

Assign as many codes from category L89 as needed to identify all the pressure ulcers the patient has, if applicable.

Question 98

What is MPV (mean platelet volume) on a complete blood count measuring?

Answer 98

Size of platelets

Question 99

What indicators are considered part of the Quick Sepsis-related Organ Failure Assessment (qSOFA) Score:

Answer 99

respiratory rate of 22/min or greater
altered mentation
or systolic blood pressure of 100 mm Hg or less.

Question 100

Which EMR feature is non-compliant with CMS?

Answer 100

1. Templates that allow the provider to de-select a prepopulated “normal” checkmark when the system is abnormal in the ROS
2. EMRs that prepopulate results are not compliant, since the default indicates a system was reviewed when it may not have been.

Question 101

When providing CDI to a provider, does the message change depending on whether you are performing a prospective or retrospective audit?

Answer 101

Yes, because the auditor cannot ask leading questions regarding documentation before a claim is submitted.

Question 102

CDI programs can help with:

Answer 102

Team building

Question 103

The surgeon documents liver cancer, but the pathology report states angiosarcoma of liver. You:

Answer 103

Code the liver cancer as angiosarcoma, a primary liver cancer, based on the pathologist’s documentation.

Question 104

In reviewing the provider’s assessment the documentation states “lab tests reviewed: +K.” You correctly query:

Answer 104

Can you please address the patient’s potassium status in further detail?

Question 105

Which term or phrase, when used between a manifestation and etiology, does NOT always show a causal relationship?

Answer 105

Likely

Question 106

Which is an example of poor documentation that is especially problematic as there is no “unspecified” code for the condition in ICD-10-CM?

Answer 106

Degenerative disc disease (DDD)

Question 107

Which type of documentation can be used to report diagnoses under risk adjustment models?

Answer 107

Inpatient Admission Note

Question 108

Is it an acceptable practice to use a template that always documents a complete review of systems?

Answer 108

No. The extent of ROS performed and documented is dependent upon clinical judgment and the nature of the presenting problem(s).

Question 109

What type of payment does an ACO (Accountable Care Organization) receive?

Answer 109

An ACO receives a payment per member per month (PMPM) to deliver care coordination services.

Question 110

True or false: A patient with a RAF score of 3.09 will likely consume more health care in the coming year than a patient with a RAF score of 1.89.

Answer 110

True

Question 111

What must be documented to properly code hypertension

Answer 111

Level of control (controlled, uncontrolled, malignant)

Question 112

Which statement is TRUE for the use of a sign/symptom code with a definitive diagnosis code?

Answer 112

Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

Question 113

When would morbid obesity be considered clinically significant:

Answer 113

When documented by the provider

Question 114

Which code systems are NOT included in HEDIS?

Answer 114

APC

Question 115

What are not HEDIS measures?

Answer 115

1. Melanoma Screening

2. Psoriasis Screening

Question 116

In the 2019 MIPS performance year, what percentage of the provider score will be determined based on the promoting interoperability category?

Answer 116

25%

Question 117

In the 2019 MIPS performance year, what percentage of the provider score will be determined based on the improvement category?

Answer 117

15%

Question 118

How is the cost category under MIPS going to be determined?

Answer 118

Adjudicated claims

Question 119

In performing a retrospective review, should you advise this physician that he missed the opportunity to completely code all conditions if patient had a BKA in the past?

Answer 119

status code for the BKA is informative because the status may affect the course of treatment and its outcome.

Question 120

Which of the following would be reported as a history of breast cancer rather than active breast cancer?

Answer 120

1. Breast cancer, post mastectomy, on tamoxifen prophylaxis
2. Breast cancer, post mastectomy, now undergoing prophylactic contralateral mastectomy
3. Breast cancer, post mastectomy, undergoing chemotherapy for secondary bone cancer

Question 121

Consider the following final diagnostic statement: Acute renal failure in patient with history of renal transplant. What advice would you give to the provider regarding whether this documentation is sufficient to document a kidney transplant complication.

Answer 121

“Codes that affect the function of the transplanted kidney, other than CKD, should be assigned a code from subcategory T86.1, Complications of transplanted organ, kidney, and a secondary code that identifies the complication.”

Question 122

Diabetic ulcers are staged by:

Answer 122

The following on the patient’s leg(s): swelling, pain, tenderness, warm skin, red or discolored skin on the leg, veins you can see, tired legs.

Question 123

Should documentation of “rheumatoid arthritis/osteoarthritis” include whether it is differential or definitive diagnosis?

Answer 123

Yes

Question 124

What does the drug Namenda treat?

Answer 124

Dementia

Question 125

Does the use of an EHR template with macros with multiple choice options for signs and symptoms lead to cloning of the medical record?

Answer 125

No, the use of a template with macro options is permitted as long as the information entered is specific to the patient

Question 126

What information can be pulled forward from a previous encounter if the information is reviewed and updated?

Answer 126

A ROS and/or a PFSH obtained during an earlier encounter does not need to be re-recorded if there is evidence that the physician reviewed and updated the previous information

Question 127

Given the following definitions, which of the following is TRUE related to accurate diagnosis coding in risk adjusted payment models:
Definitions: PMPM = per member per month
MLR = medical loss ratio; the proportion of premium revenues spent on clinical services and quality improvement. MLR = total claims expense (healthcare costs) divided by premiums received (per member per month payments)

Answer 127

The monthly payment is based on a patient’s risk score, which is based on the patient’s overall health status. Health status is determined by the diagnosis codes determined by providers caring for patients. Accurate diagnosis coding is an accurate reflection of patient health status. The sicker the patient, the more healthcare costs are expected, and thus, a higher premium will be paid for the care of that patient

Question 128

True or False: Congestive heart failure can be managed but it cannot be cured.

Answer 128

True

Question 129

Which components are used to determine RVUs?

Answer 129

RVUs are configured using three components:

1. Physician work—time, skill, training, and intensity of service provided
2. Practice expense—reflects the cost of ancillary personnel, supplies, and office overhead
3. Professional liability/malpractice insurance

Question 130

Which of the following conditions, if listed under Past Medical History and documented nowhere else in the record, would create a clinical documentation improvement opportunity?
I. ALS
II Hodgkin lymphoma
III Acute bronchitis
IV Chronic bronchitis
V Autism
VI Hypothyroidism

Answer 130

1. Hodgkin lymphoma

2. Acute bronchitis

Question 131

True or False: aftercare Z codes should not be used for aftercare involving injuries or poisonings.

Answer 131

True

Question 132

Consider the following final diagnostic statement: CKD, Stage III in patient with history of renal transplant. What advice would you give to the provider regarding whether this documentation is sufficient to document a kidney transplant complication.

Answer 132

ICD-10-CM Coding Guideline I.C.14.a.2 states, “patients who have undergone kidney transplant may still have some form of CKD because the kidney transplant may not fully restore kidney function. Therefore, the presence of CKD alone does not constitute a transplant complication. Guideline I.C.19.g.3 states, “Code T86.1 should not be assigned for post kidney transplant patients who have CKD unless a transplant failure or rejection is documented.”

Question 133

True or False:
Coders cannot assign code F17.218 (nicotine dependence, cigarettes, with other nicotine induced disorders) unless the provider has documented a cause-and-effect relationship.

Answer 133

True

Question 134

Which diagnosis is exempt from reporting Z3A as an additional diagnosis?

Answer 134

Codes in category Z3A, Weeks of gestation are not applicable, and should not be assigned if the pregnancy is outside of the uterus, otherwise nonviable, or with abortive outcomes (categories O00-O08). Refer to ICD-10-CM coding guideline I.C.21.c.11.

Question 135

Which is a benefit for using EHRs?

Answer 135

Greater coordination of care

Question 136

Which MIPS measure replaces meaningful use?

Answer 136

Promoting Interoperability

Question 137

What age range does the HEDIS Breast Cancer Screening measure pertain to?

Answer 137

50-74

Question 138

Quality measure for a biopsy follow up requires:

Answer 138

The description for the biopsy follow up measure states “percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician.”

Question 139

Which of the following documentation deficiencies has a negative impact on patient outcomes?

Answer 139

Failure to advise the patient instructions for colonoscopy preparation.

Question 140

To protect your organization, when you query the provider you should:

Answer 140

Use your organization’s standardized form to ensure consistency.

Question 141

A: 1. Sleep apnea syndrome. Patient will be scheduled for sleep study.
2. Premenopausal bleeding. Patient does have a referral to a gynecologist.
3. Ptosis of bilateral eyelids. Surgical correction performed 2/14/15.
4. Rheumatoid arthritis/osteoarthritis, erosive, involving bilateral hands and back, doing OK.
Which of the following is an appropriate query for this note?

Answer 141

Can you please provide further clinical information regarding “rheumatoid arthritis/osteoarthritis” in this note? Is this a differential or definitive diagnosis?

Question 142

Drug to treat dementia

Answer 142

Namenda

Question 143

What does history mean from a coding perspective?

Answer 143

Some providers document history of to indicate the patient has the condition for a long period. From a coding perspective, it means the condition has resolved.

Question 144

Does the use of an EHR template with macros with multiple choice options for signs and symptoms lead to cloning of the medical record?

Answer 144

No, the use of a template with macro options is permitted as long as the information entered is specific to the patient.

Question 145

A code from subcategory R65.2 Severe sepsis is NOT assigned unless the documentation specifies either severe sepsis or what other condition?

Answer 145

Associated acute organ dysfunction

Question 146

True or False: Providers treating patients with higher medical costs will receive higher PMPM (per member per month) premium payments if they are accurately coding medical conditions supported in the medical record that account for higher expected medical costs.

Answer 146

True

Question 147

These components are used to determine what?

1. Physician work—time, skill, training, and intensity of service provided
2. Practice expense—reflects the cost of ancillary personnel, supplies, and office overhead
3. Professional liability/malpractice insurance

Answer 147

RVU’s

Question 148

True or False: Aftercare Z codes should not be used to report aftercare involving injuries or poisonings.

Answer 148

True

Question 149

True or False: For many etiology and manifestation pairings, use one code that reports both diagnoses.

Answer 149

True

Question 150

True or False: A provider must document the causal link between cigarette dependence and a respiratory condition to report F17.218.

Answer 150

True

Question 151

What advice would you give a provider regarding documentation to support a kidney transplant complication?

Answer 151

The presence of CKD alone does not constitute a transplant complication. Guideline I.C.19.g.3 states, “Code T86.1 should not be assigned for post kidney transplant patients who have CKD unless a transplant failure or rejection is documented.”

Question 152

Which statement is TRUE regarding code F17.218 Nicotine dependence, cigarettes, with other nicotine induced disorders?

Answer 152

A provider must document the causal link between cigarette dependence and a respiratory condition to report F17.218.

Question 153

Is ectopic pregnancy exempt from reporting Z3A as an additional diagnosis?

Answer 153

Yes

Question 154

Which MIPS measure replaces meaningful use?

Answer 154

Promoting Interoperability

Question 155

What age range does the HEDIS Breast Cancer Screening measure pertain to?

Answer 155

50-74 years of age who had a mammogram to screen for breast cancer within the past 27 months.

Question 156

Quality measure for a biopsy follow up requires:

Answer 156

Biopsy results for new patients to be communicated to the patient and the referring provider.

Question 157

Which of the following would be considered sign(s) or symptom(s) for the diagnosis of pulmonary hypertension?
I. Bluish tint to lips
II. Enlarged jugular veins
III. Shortness of breath

Answer 157

All of the above are evidence of pulmonary hypertension. Lack of oxygen can cause a bluish tint to the lips and nail beds and shortness of breath, as blood backs up due to increased pressure, the jugular veins can enlarge.

Question 158

True or False: Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s).

Answer 158

True

Question 159

Ture or False; Documentation for BMI, Depth of Non-pressure ulcers, Pressure Ulcer Stages, Coma Scale, and NIH Stroke Scale For the Body Mass Index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale, and NIH stroke scale (NIHSS) codes, code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis).

Answer 159

True

Question 160

True or False: Aftercare Z codes should not be used to report aftercare involving injuries or poisonings.

Answer 160

True

Question 161

When ordering an CT of the abdomen, what must be documented in the order?
I. Number of views
II. Medically necessary indication for the test
III. With or without contrast
IV. Date the test was ordered

Answer 161

Medically necessary indication for the test

With or without contrast

Date the test was ordered

Question 162

A physician who specializes in elder care undergoes a CDI audit. Fifteen charts are found with the diagnosis of marasmus. Your correct response:

Answer 162

Display in your query the Index entry for marasmus and the codes and descriptions for E41 and R54. Ask for guidance on which to report.

Question 163

According to documentation, A 34-week gestation patient with diabetes delivers twins. Fetus A was delivered without complication, with APGARs of 8 and 8. Fetus B’s delivery was complicated by a knot in the umbilical cord, and his APGARs were 3 and 5. Which query is appropriate?

Answer 163

What type of diabetes did the patient have?

Question 164

The provider states that the patient is hypertensive and is interested in beginning a diet. He discusses weight loss strategies, but does not document that the patient is overweight, obese or morbidly obese. BMI documented in the vitals is 42, blood pressure 145/82. The patient receives a prescription for amlodipine. You:

Answer 164

Query the provider, asking if there is a diagnosis to go with the weight loss strategy counseling that was performed.

Question 165

As the provider was treating actinic keratoses of the patient’s face and neck with cryosurgery, the liquid nitrogen canister misfired, inadvertently burning the patient’s cheek. This wound is treated with ELA-Max. The provider documented that there were “no intraoperative complications.” You correctly:

Answer 165

Ask for clarification of what may be conflicting data.

You cannot report an intraoperative complication unless it is stated by the provider. The correct way to pose a query is to be non-leading. We cannot ask if the provider meant to document something.

Question 166

STARS Ratings are important because they:

Answer 166

Identify top performing health plans.

Question 167

True or False: Trigger point injections are reported based on the number of muscles injected, not the number of injections. Multiple units are not reported for multiple trigger point injections.

Answer 167

True

Question 168

What documentation is required to support transitional care codes?

Answer 168

1. Communication with the patient within two business days of discharge.
2. Medical decision making of moderate to high complexity

Question 169

True or False: Traumatic fractures can be coded for patients with osteoporosis.

Answer 169

The coding guidelines for coding fractures in patients with osteoporosis states “A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.”

Question 170

Acute renal failure in patient with history of renal transplant. What advice would you give to the provider regarding whether this documentation is sufficient to document a kidney transplant complication.

Answer 170

Conditions that affect the function of a transplanted kidney, other than CKD, can be established as kidney transplant complications. Acute renal failure would affect the function of the kidney transplant and it would be appropriate to assign a kidney transplant complication code.

Question 171

True or False: A provider must document the causal link between cigarette dependence and a respiratory condition to report F17.218.

Answer 171

True

Question 172

True or False: A CDI professional can determine services that should be reviewed that are performed by the practice based on services identified for audit in the OIG Workplan.

Answer 172

True

Question 173

A problem pertinent review of systems (ROS) reviews how many systems?

Answer 173

One

Question 174

An extended review of systems (ROS) reviews how many systems?

Answer 174

Two to nine

Question 175

A complete review of systems (ROS) review how many systems?

Answer 175

10 or more

Question 176

What type of Medical Decision Making (MDM) consists of minimal number of diagnosis (dx) or treatment (tx) options, minimal or no data, and minimal risk?

Answer 176

Straightforward

Question 177

What type of Medical Decision Making (MDM) consists of limited number of diagnosis (dx) or treatment (tx) options, limited data, and low risk?

Answer 177

Low

Question 178

What type of Medical Decision Making (MDM) consists of multiple diagnosis (dx) or treatment (tx) options, moderate data, and moderate risk?

Answer 178

Moderate

Question 179

What type of Medical Decision Making (MDM) consists of extensive diagnosis (dx) or treatment (tx) options, extensive data and high level of risk?

Answer 179

High

Question 180

For medical decision making (MDM), two of the three elements must be met. For example, if you have one established stable condition, three data points and low risk, the MDM would be what?

Answer 180

Low

Question 181

A brief HPI is when how many elements are documented?

Answer 181

1-3

Question 182

An extended HPI is when how many elements are documented?

Answer 182

4 or more OR if the patients statements are regarding the status of at least 3 chronic conditions.

Question 183

Modifier for increased procedural services?

Answer 183

22

Question 184

Modifier for Professional Service

Answer 184

26

Question 185

Modifier for Multiple Procedures

Answer 185

51

Question 186

Modifier for Decision for Surgery

Answer 186

57

Question 187

Modifier for Distinct Procedural Service

Answer 187

59

Question 188

True or false: When selecting and E/M based on time, the provider must document the total time spent as well as that more than 50% of that time was spent on counseling or coordinating care. The provider must also include what the physician counseled that patient on or what care was coordinated.

Answer 188

True

Question 189

If lesion removal is not sent for pathologic evaluation can you code for a biopsy?

Answer 189

No

Question 190

If the primary purpose of the procedure is diagnostic, to obtain tissue for histopathology examination and the procedure is intended to remove a lesion or the problematic portion of the lesion, it would be classified as what?

Answer 190

Removal

Question 191

Required documentation elements for a procedure include:

Answer 191

1. H&P and/or laboratory findings that support the medical need for the procedure
2. performance of the procedure by a physician
3. outcome and diagnosis supporting the procedure.

Question 192

Documentation of two days of service contain the exact same ROS, exam findings, and Assessment. Even though the HPI and Plan are separately identifiable, the use of an unaltered template creates what problem(s)

Answer 192

1. Conflicting documentation and unsupported diagnoses.
2. The apparent practice of dropping the active problem list into the assessment section of the note compounds the problem of unsupported diagnoses.

Question 193

If provider documents “smoker” is this considered a nicotine dependence?

Answer 193

Yes. In ICD-10-CM “smoker” refers you to see Dependence, drug, nicotine. F17.210 can be specified if the provider documents “cigarette smoker.”

Question 194

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) defines cerumen as impacted if one or more of the following conditions are present:

Answer 194

Cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition;

Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc;
Cerumen is associated with foul odor, infection, or dermatitis; or

Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills.

Question 195

What must a provider document to report an E/M code based on time?

Answer 195

The total time of the encounter and that more than 50% of the time was spent counseling or coordinating care.

The provider must include in the documentation the details of the counseling or coordination that was performed.

Question 196

A combination of drug therapies used for HIV treatment is referred to as highly active antiretroviral therapy (HAART). When documentation mentions HAART, but does not indicate a diagnosis of HIV can you code HIV?

Answer 196

No, the provider should be queried.

Question 197

True or False: A patient who is actively using nicotine patches or nicotine gum, or other substance to assist in smoking cessation, is dependent on nicotine.

Answer 197

True

Question 198

What is a disadvantage of the electronic health record with regard to CDI?

Answer 198

Over documentation

CDI is important for many reasons. Errors in the medical record can erode patient/provider trust (or worse). Widespread use of the EHR has allowed “over documentation,” cloned medical records, and other compliance failures to flourish. Digitized data and modern computing power allow payers to enforce compliance aggressively using audits, recoupments, and payment denials. You should assume that all clinical documentation will be scrutinized at some point.

Question 199

Compliance is achieved in medical record entries through the use of what?

Answer 199

Internal documentation guidelines

Question 200

What are examples of internal documentation guidelines for medical record entries?

Answer 200

Health risk factors must be identified

Documentation must support CPT and ICD-10 codes

Documentation must be clear why ancillary services are ordered

Question 201

What facility type must have a compliant plan of care from the ordering provider?

Answer 201

Home healthcare entities

Home healthcare entities: Obtaining a compliant plan of care from the ordering provider is vital: without it, services are not justified.

Question 202

A CDI program promotes continuity of care from one provider to another. What affect does this have on patient care?

Answer 202

Improve patient outcomes

Quality patient care is evident only if it is documented in the medical record. CMS documentation guidelines for E/M services include the least expected documentation to support an encounter. CDI promotes complete and accurate documentation that goes beyond coding and billing to include:

-Improve communication and dissemination of info between and across service providers
-Appropriate treatment, interventions and plan of care
-Improve goal setting and evaluation of care outcomes
Improve early detection of problems and changes in health status; and
-Provider “EVIDENCE” of excellent patient care.

Question 203

These are examples of what?

Improve goal setting and evaluation of care outcome

Improve early detection of problems and changes in health status

Provide the appropriate treatment, intervention, and plan of care

promotes complete and accurate documentation

Answer 203

examples of CDI going beyond coding a billing?

Question 204

What is the overarching objective of CDI?

Answer 204

Patient care

Question 205

A CDEO monitors coding and billing risk areas. What risk area would be a subject of an OIG investigation and audit?

Answer 205

Knowing misuse of provider identification numbers, which results in improper billing

Adhering to state, federal , and individual payer mandates is paramount; however, patient care is the overarching objective.

Question 206

What facility must update the patient care plan every 90 days for Medicare patients?

Answer 206

Comprehensive outpatient rehab centers

Comprehensive outpatient rehabilitation centers: The patient care plan must be accurate and updated every 90 days as required for Medicare Patients

Question 207

What is the provider’s best defense in any legal situation?

Answer 207

A well documented note

The details in a well-documented note are a provider’s best defense in any legal situation. If the record is deficient, there is no “evidence” to support a provider’s testimony.

Question 208

What program did HIPAA establish to combat FWA in public and private health plans?

Answer 208

Healthcare Fraud and Abuse Control Program

Question 209

Which forms are commonly found in a medical record?

Answer 209

Release of information
Informed consent
Assignment of Benefits

Question 210

What is an example of a business associate function?

Answer 210

Data analysis
Benefit management
Claims processing

Question 211

Who is responsible to administer and enforce the standards set forth in the Privacy Rule?

Answer 211

OCR

Question 212

Criminal penalties are imposed if a person knowingly obtains or discloses individually identifiable health information in a way that violates the Privacy Rule. Penalties (prior to inflation) begin at:

Answer 212

$50k and up to 1 year imprisonment

Question 213

The Joint Commission published a standard for the appropriate use of medical abbreviations as well as a Do Not Use list. What abbreviation appears on the Do Not Use list?

Answer 213

IU

Question 214

Which level of government establishes Conditions of Participation (CoP) for Medicare?

Answer 214

Federal

Question 215

An operative report generally has four main sections. They are:

Answer 215

Header, indications for surgery, body and findings

Question 216

According to Medicare guidelines, the physician must sign dictated notes________?

Answer 216

Before they are placed in the patient’s chart

Question 217

What are the benefits of using a template?

Answer 217

complete collection of information

Customization to fit the patient and the condition

Question 218

According to CMS, which one of the examples below is an instance of fraud?

Answer 218

Billing for services at a higher level than provided or necessary

Question 219

According to COMS, which one of the examples below is an instance of abuse?

Answer 219

Failure to maintain adequate medical or financial records

Question 220

The False Claims Act originated in 1863 under what name?

Answer 220

Lincoln Law

Question 221

The False Claims Act refers to the person bringing a qui tam civil action as a _____.

Answer 221

Relator

Question 222

The common term for a relator is?

Answer 222

Whistleblower

Question 223

Under the Exclusion Statue, there are two types of exclusions. They are:

Answer 223

Mandatory and Permissive

Question 224

How is the OIG Work Plan useful for a CDEO professional?

Answer 224

To evaluate current documentation and provide feedback to providers on services identified as problematic areas in the OIG Work Plan

Question 225

How often is the OIG Workplan updated?

Answer 225

Monthly

Question 226

The OIG developed voluntary compliance plan guidance (CPG) for a variety of healthcare settlings. The CPG for individual and small group practices lists potential benefits of a compliance program. Which is NOT a benefit?

Answer 226

Increase in patient population

Question 227

In reviewing the provider assessment, the documentation states “lab tests reviewed: +k.” Which of the following is a compliant query?

Answer 227

Can you please address the patient’s potassium status in further detail?

Question 228

A 47-year old patient is seen by her provider for a cervical Pap smear. Her last Pap smear was three year prior. which HEDIS measure is most likely satisfied with this encounter?

Answer 228

Cervical Cancer Screening (CCS)

Question 229

Which of the following is NOT a category of MIPS?

Answer 229

Reimbursement

Question 230

MIPS category Promoting Interoperability continues to highlight the benefits of using EHRs. Which of the following is a benefit of using EHRs?

Answer 230

EHRs improve quality, safety, and efficacy of care.

Question 231

E-prescribing electronically transmits RX to a pharmacy. Which of the following is NOT a benefit of e-prescribing?

Answer 231

Eliminating the need for linking the medication to a disease

Question 232

Which of the following is NOT a HEDIS measure

Answer 232

Chronic Wound Management

Question 233

In risk adjustment, CMS adjusts risk scores to maintain an average risk score of 1.0. What is this called?

Answer 233

Normalization adjustment

Question 234

Which of the following are not taken into consideration in the risk adjustment payment methodology?

Answer 234

Family Medical History

Question 235

Which of the following is a benefit of risk adjustment?

Answer 235

Chronic conditions are likely to be addressed annually

Question 236

Which payment system utilizes RVUs

Answer 236

Fee-for service (FFS)

Question 237

What are NCCI edits

Answer 237

To indicate when a procedure is inclusive to another procedure

Question 238

Why are NCCI edits used?

Answer 238

To indicate when a procedure is inclusive to another procedure

Question 239

Pure risk-adjusted models rely solely on

Answer 239

ICD-10-CM codes

Question 240

The most recognized risk adjustment model is?

Answer 240

Medicare Hierarchal Condition Categories (HCC-C)

Question 241

When an office visit is performed that is separately identifiable from a minor surgery, which modifier is appended to the office visit?

Answer 241

modifier 25

Question 242

What type of information should a documentation specialist look for when modifier 22 is appended to a surgical procedure because the patient is obese?

Answer 242

Documentation should indicate how much longer the procedure took, or what work was above and beyond the normal work because the patient was obese.

Question 243

Modifiers XE, XS, XP and XU were developed to provide greater reporting specificity. These modifiers may be used in place of which modifier?

Answer 243

59

Question 244

A patient presents with acute bronchitis. The conditions listed below have been documented in the past medical history. Which of these conditions should the documentation specialist query the provider to see if they are chronic conditions that affect the current treatment?

Answer 244

COPD and Asthma

Question 245

A patient is admitted whit asymptomatic HIV status and toxoplasmosis. How is this reported?

Answer 245

B20

B58.9

Question 246

Which of the following is TRUE regarding a final diagnostic statement of cirrhosis of the liver?

Answer 246

The cause of the cirrhosis should be documented for accurate reporting.

Question 247

A patient is seen for a diabetic right foot ulcer, with skin breakdown and muscle necrosis. What codes are reported?

Answer 247

E11.621

L97.513

Question 248

A patient was given thrombolytic therapy for an acute myocardial infarction (AMI) of the anterolateral wall. What ICD-10-CM codes should be reported?

Answer 248

I21.09

Question 249

A 45 year old female visits her provider after having a biopsy on dense breast tissue. The provider documents evidence of cancer, lower outer quadrant of the right breast. What ICD-10 code is reported?

Answer 249

C50.511

Question 250

A 58 yr old patient sees the provider for confusion and loss of memory. The provider diagnoses the patient with early onset stages of Alzheimer’s disease with dementia. What ICD-10 code is reported?

Answer 250

Hypertension and left ventricular failure

Question 251

Mary had DJD of the left knee and has been seeing her physician for several months. She tried physical therapy and NSAIDS without improvement of the pain. The MD recommends a corticosteroid injection for her chronic knee pain. An injection of Kenalog-40 is injected into her left knee. What ICD-10 codes are reported?

Answer 251

G89.29

M25.562

Question 252

A patient with a history of chronic bronchitis is seen for a productive cough and shortness of breath. The diagnosis is acute bronchitis. What are the ICD-10-CM codes for this condition?

Answer 252

J20.9

J42

Question 253

ICD-10 guidelines I.C.21.c.4 states, “Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence , and therefore may require continued monitoring.” Which of the following conditions, when documented in the past medical history, should a documentation query the provider regarding?

Answer 253

Dementia
Lung Cancer
Diabetes
Heart Failure

Question 254

A 26 yr old gravida 2 para 1 female has been spotting and has been on bed rest. She awoke this morning with severe cramping and bleeding. Her husband brought her to the hospital. After examination, it was determined she has an incomplete early spontaneous abortion. She is in the 12th week of her pregnancy. She was taken to the OR and a D&C was performed. There were no complications from the procedure. She will follow-up with me in the office. She has had four antepartum visits during her pregnancy.

Answer 254

O03.4

Question 255

The National Pressure Ulcer Advisory Panel defines the stages of pressure ulcers. What is a characteristic of a stage 3 pressure ulcer?

Answer 255

The ulcer has a crater-like appearance.

Question 256

A 65 yr old female sees her provider for constant pain in her right upper arm. She reports no trauma but has been cleaning her basement and moving boxes. The patient was previously diagnosed with postmenopausal osteoporosis and the provider is concerned she may have a fracture. The provider sends her to the outpatient radiology department for an x-ray which reveals a fracture of the right humerus. What ICD-10 code is reported?

Answer 256

M80.021A

Question 257

A 10 yr old girl complains of left arm pain after falling while playing on the playground at school. She was taken to Urgent care and the X-ray showed a Type 1 Salter-Harris fracture (physeal) of the lower end of the left humerus. What ICD-10 code is reported for the fracture?

Answer 257

S49.112A

Question 258

The definition and function of a ligament is:

Answer 258

A tough cord that connects bone to bone and provides stability to joints

Question 259

A 70 yr old male sees his provider for type 2 diabetes and chronic kidney disease. The kidney disease progressed to stage 5 last year and he has been on dialysis since then. What IC-10 code would be reported for the patient’s visit?

Answer 259

E11.22
N18.6
Z99.2

Question 260

A 35 yr old female patient is given morphine to control postop pain. She complains of nausea and confusion. This is an adverse effect of morphine and her medication is changed with relief of her symptoms. What ICD-10 codes are reported for the adverse effect?

Answer 260

R41.0
R11.0
T40.2X5

Question 261

Which one of the choices is a TRUE statement regarding external cause codes?

Answer 261

Report all external cause codes needed to explain the external causes.

Question 262

A 19 yr old female returns to her physician for her second HPV immunization. She tells the physician she’s recovering from bronchopneumonia due to H. influenzae. The physician feels it would be better to wait until she is fully recovered and chooses not to administer the second HPC immunization today. How would you report the immunization not carried out?

Answer 262

Z28.01

Question 263

According to the CMS E/M documentation guidelines for 1997, what exam component includes examination of the abdominal aorta?

Answer 263

Cardiovascular

Question 264

A ROS is an account of body systems obtained through a series of questions seeking to spot signs and/or symptoms that the patient may be experiencing or has experienced. If the provider documented “patient denies indigestion or nausea and vomiting.” what system is reviewed?

Answer 264

Gastrointestinal

Question 265

The biggest difference between the 1995 DG and 1997 DG is the:

Answer 265

Exam

Question 266

Using the 1995 DG, what level of exam would be reported for this documentation: History: Patient is being seen for a lingering cough. Exam: constitutional - temperature 97, heart rate 66, BP 128/65: Cardiovascular S1, S2 regular rate and rhythm: Lungs clear to auscultation bilaterally: Abdomen soft, nontender.

Answer 266

Expanded problem focused

Question 267

Medical decision making (MDM) is determined by which three elements?

Answer 267

Number of diagnoses and treatment options, amount and complexity of data, overall risks

Question 268

The patient was admitted to the local hospital with pneumonia. The admitting physician documented a detailed history, comprehensive exam and low MDM,. What E/M code is reported?

Answer 268

99211-AI

Question 269

A physician documents 170 minutes of critical care time. How would this be reported:

Answer 269

99291

99292 x 4

Question 270

The codes for removal of lesions are defined by the type of lesion, the anatomical location of the lesion and the lesion diameter. What would be reported for the excision of a 1.5 cm benign lesion of the right arm with simple closure?

Answer 270

11402

Question 271

A patient sees an orthopedist for left hip pain after falling at home. After examination and a review of XX-rays, it is determined the patient has a acetabular fracture of the left hip. The orthopedist admits the patient to the hospital and schedules surgery for the next day. What modifier is used on the E/M office visit code?

Answer 271

57

Question 272

A patient arrives at the ER after tripping and falling while carrying a glass bowl. She has lacerations on both arms. The ER physician performs repairs a 1.5 cm superficial laceration of the right forearm and a 2.0 cm superficial laceration of the left arm. There is also a 3.0 cm laceration of the left hand which is repaired with a layered closure. How are the repairs reported?

Answer 272

12042

12002-59

Question 273

The sequencing rules for sepsis or severe sepsis with a noninfectious process are dependent on

Answer 273

whether or not the conditions meet the definition of principal diagnosis. If sepsis or severe sepsis is documented as associated with a noninfectious condition and that condition meets the definition of a principal diagnosis, then you would code the noninfectious condition first followed by the code for the resulting infection.

Question 274

If a sepsis infection meets the definition of principal diagnosis, it should be sequenced

Answer 274

first, followed by the noninfectious condition.

Question 275

When both the associated noninfectious conditions and a sepsis infection meet the definition of principal diagnosis

Answer 275

then either may be assigned as a principal diagnosis. Refer to ICD-10-CM coding guideline I.C.1.d.6. The type of sepsis is not specified in the question reporting code A41.9.