Medical Ethics, Legal, and Regulatory Issues CH7

Question 1

Current procedural terminology (CPT) codes are used to:
a) communicate between providers
b) communicate with insurance companies
c) provide legal documentation
d) inform patients regarding their health care

Answer 1

b) The purpose of CPT codes is to communicate with insurance companies, or “third-party payers,” regarding health care services rendered.

Question 2

CPT has a direct impact on:
a) clinical certification
b) presenting evidence in court
c) patient feedback
d) reimbursement

Answer 2

d) Coding, be it proper or improper, directly affects the reimbursement that the practice gets from third-party payers.

Question 3

A procedure might carry a different charge, depending on who performs it. This may
mean that the procedure code needs an additional code called a(n):

a) service number
b) qualifier
c) modifier
d) HIPAA code

Answer 3

c) Modifiers provide more explicit information about a procedure. Thus, a modifier might
be called for when a procedure carries an additional element, such as being performed by a technician or by a mid-level practitioner.

Question 4

The International Classification of Diseases (ICD) codes of nuclear cataract 366.16
and astigmatism 367.21 are examples of:
a) AMA codes
b) procedure codes
c) diagnosis codes
d) encounter codes

Answer 4

c) ICD codes are numeric codes that identify disorders, diseases, conditions, etc. The current edition is 9 (ie, ICD-9), but version 10 is already in use and will eventually be mandatory (ie, ICD-10).

Question 5

A reviewer is looking over an encounter form for a patient visit to your practice to make
sure that diagnosis codes and procedure codes match up. Which of the following would
be marked as unacceptable?

a) CPT: incise and drain ICD: chalazion
b) CPT: epilation ICD: trichiasis
c) CPT: probe and irrigation ICD: cataract
d) CPT: biopsy ICD: lesion of the eyelid

Answer 5

c) It is vital that procedure codes have an appropriate diagnosis code to justify them. One would expect a CPT code indicating that a probe and irrigation had been done would be
coupled with a diagnosis code of nasolacrimal duct obstruction (or some other associated
lacrimal problem).

Question 6

A patient who had a blepharoplasty is upset because now she has dry eyes. The court
determined that the patient was not told about this risk prior to surgery. This is an
example of:
a) failure to disclose
b) breach of promise
c) failure to perform
d) intentional harm

Answer 6

a) “Failure to disclose” occurs when a patient has not been informed about the risks of a
particular procedure. This “duty of disclosure” is part of the informed consent process. See
the section titled Informed Consent

Question 7

A patient who is moving to another state has stopped by the office requesting his
records. He would like you to hand over the chart so he can take it with him. Your
response to this is to:

a) make copies for the office and give him the original
b) tell the patient you will mail the original to his new provider
c) give the patient lab work reports from his chart
d) make copies for the patient and keep the original for the office

Answer 7

d) The physical chart belongs to the practice; the information belongs to the patient. That
means that choices a, b, and c are incorrect. Of course, prior to providing the copies, you
must get a signed release of information form. Some clinics have further rules that govern
how medical records are to be handled.

Question 8

Which of the following is a legal regulation?

a) An eye care practitioner must fit any patient who desires it with contact lenses.
b) The patient who has a refractive eye exam must be provided with a copy of the glasses
prescription.
c) A prescription for glasses is only good for 6 months.
d) K readings must be included on every glasses prescription in case the patient decides to get contact lenses.

Answer 8

b) A patient has a right to a copy of the glasses prescription. The expiration of glasses prescriptions varies from state to state, but the minimum will be 1 year

Question 9

An ophthalmic assistant who measures a patient’s refractive error and then writes the
patient a glasses prescription, where the physician does not see the patient or review
the record, is:

a) breaking the law
b) violating patient privacy
c) doing the patient a favor
d) in accordance with current practice

Answer 9

a) The procedure described is a refraction, which involves clinical judgment allowed only
to a licensed professional. A technician who performs refractions is practicing medicine
without a license, which is illegal. Ophthalmic technicians may, however, perform
refractometry, where the refractive error is measured but the prescribing/clinical judgment is left to the licensed practitioner.

Question 10

The right of a patient to protection of his or her personal health information is a federal law known as:

a) Health Insurance Portability and Accountability Act (HIPAA)
b) Occupational Safety and Health Administration (OSHA)
c) Joint Commission on Accreditation of Health Care Organizations (JCAHO)
d) American Academy of Ophthalmology (AAO)

Answer 10

a) HIPAA establishes the rights of a patient to protection of his or her health information

Question 11

OSHA has developed laws regarding:

a) standards for safety lenses
b) eye protection in the workplace
c) privacy laws
d) scope of practice

Answer 11

b) OSHA deals with employee safety and has rules regarding eye protection in the workplace (such as safety goggles worn when assisting with laser surgery).

Question 12

Which of the following is true?

a) An eye care practitioner may charge a fee to release a patient’s glasses prescription.
b) An eye care practitioner may restrict eye exams only to those who agree to purchase
eyewear from the practice’s optical shop.
c) An eye care practitioner may refuse to release a patient’s glasses prescription until the patient has paid for the eye exam, if it is customary to require payment at the time of
service.
d) An eye care practitioner who has fit a patient for contacts may require that the patient buy the first year’s supply of lenses from the practitioner’s practice.

Answer 12

c) The FTC has determined that if it is customary to ask any patient to pay when services are rendered, then the prescription may be withheld until payment is made.5
The scenarios in the other answers are strictly forbidden

Question 13

The Federal Trade Commission (FTC) has regulations affecting all of the following
except:
a) the “intraocular lens implant rule”
b) advertising for refractive surgery
c) the “eyeglass rule”
d) the “contact lens rule”

Answer 13

a) For more information on marketing refractive surgery

Question 14

OSHA regulations regarding medical practices require all of the following except:

a) every new hire is to be trained in infection control practices
b) all contact lenses must be fit by a licensed eye care practitioner
c) the employer must provide personal protective equipment to employees
d) OSHA regulations must be posted in the workplace

Answer 14

b) OSHA does not legislate prescribing or dispensing of medical devices

Question 15

The “Red Flags Rule” was developed by the FTC in order to prevent:

a) employee injuries
b) identity theft
c) insurance fraud
d) sexual harassment in the workplace

Answer 15

b) The Red Flags Rule was developed by the FTC in order to detect identity theft. The rule
requires businesses (including medical practices) to develop a plan of identifying “relevant patterns, practices, and specific forms of activity—the ‘red flags’—that signal possible identity theft

Question 16

All the following are true regarding the Patient Protection and Affordable Care Act
(PPACA) except:

a) It affects insurance coverage for pre-existing conditions.
b) It is concerned with health insurance reform.
c) It enforces health care privacy laws.
d) It was signed into law by President Barack Obama.

Answer 16

c) PPACA does not deal with health care privacy. The other statements are true

Question 17

Quality assurance (QA) depends upon:

a) opinions of caregivers
b) patient compliance
c) being able to measure something
d) having favorable surgical results

Answer 17

c) QA requires that something be measured, regardless of whether the data come from a
patient survey, patient records, checklists, etc.

Question 18

Which of the following does not apply to QA?

a) One characteristic of QA is to minimize problems and poor outcomes.
b) One characteristic of QA is to identify procedures that need to be changed.
c) One characteristic of QA is to be a once-and-done procedure.
d) One characteristic of QA is that it can lead to better patient care

Answer 18

c) The intent of QA is to monitor routine procedures so that problems can be identified and corrected, resulting in better patient care. To be effective, QA is an ongoing process, not
something done once to qualify for a certification or to pass an inspection

Question 19

An example of data collected for QA purposes regarding outcomes would be:
a) employee turnover
b) visual acuity after cataract surgery
c) number of patients seen daily
d) number of referral patients

Answer 19

b) A formal QA program collects data that give an indication of the quality of the service
rendered in part by evaluating outcomes. Simply counting the number of patients does not really yield data that reflect quality. But, evaluating the postoperative vision of the practice’s cataract surgery patients helps monitor treatment outcome.

Question 20

Which of the following is true?

a) QA is the responsibility only of the practitioner.
b) QA helps hold health care workers accountable.
c) QA is only an issue if the practice is to be inspected.
d) QA is not concerned with access to health care.

Answer 20

b) A practice’s QA system helps to set minimum standards to which all in the clinic (not just the practitioner) are held. QA is generally focused on outcome (eg, vision after cataract surgery), the relationship of cost to benefit (eg, time, money, and effort put into patient care versus benefit to the patient), and access to care (eg, availability of the services needed by the patient). While a viable QA system may be required for certain clinical certifications, every practice needs to have such a system

Question 21

Your practice is developing a QA program. One area to be addressed is strabismus
surgery. Which of the following would not fit into the list of the logical assessments?

a) preoperative and postoperative prism measurements of the deviation
b) patient or parental survey of satisfaction with the process as a whole
c) data concerning postoperative complications
d) putting strategies into place that will prevent alterations to the process

Answer 21

d) One of the main goals of QA is to identify problems (which could be revealed by items
in answers a, b, and c) and implement the change that is needed to improve outcome.

Question 22

The standards that govern moral conduct, especially of a person/group with some
type of power in issues regarding conduct, rights, and actions is:

a) informed consent
b) patient rights
c) ethics
d) medicolegal code

Answer 22

c) Ethics are the standards that govern our personal and professional behavior. In medicine, these are the standards that help us make moral judgments regarding such things as how we treat our patients (both personally and medically), how we treat our peers, what kind of employee we are, and much more. It includes providing the best and most intelligent care of which we are capable and maintaining honest relationships with others.

Question 23

The basis for medical ethics is:
a) The Oath of Hammurabi
b) The Hippocratic Oath
c) The Mayflower Compact
d) The Constitution of the United States

Answer 23

b) Hippocrates lived in the fifth century BC. He was a Greek physician who held himself
to a strict code of behavior and quality of care, which included conduct, confidentiality, and
scope of practice. From this grew the concept of medical ethics, and the Hippocratic Oath
(which speaks to those same virtues) is named after him.

Question 24

You have just seated your patient and ask if she’s having any problems with her eyes.
She states that she would like to discuss that only with the physician. You explain your
role in gathering information and assure her of confidentiality, but she insists that she
will speak only to the doctor. You should:

a) explain that it is office policy that she speak to you first
b) offer to appoint her for another day when she may feel more cooperative
c) affirm her right to speak only to the physician and acquiesce
d) recommend that the physician dismiss her from the practice

Answer 24

c) It is the patient’s right to discuss her case with the physician only; be sure to document
in the chart that the patient has made this choice. You might ask if you can go ahead and do a “few tests” so that the doctor will have some information when she speaks to the patient, such as visual acuity, lensometry, pupil evaluation, slit-lamp evaluation, and
perhaps noncontact tonometry. Without a history, it is inadvisable to instill drops or perform any type of contact test (tonometry, Schirmer’s, etc). In addition, while the patient may not wish to discuss his or her eye problems, he or she may be willing to give other information about his or her history

Question 25

The physician is out of the office, and a patient comes by on his way to an optical shop.
He has broken his glasses and asks you to “test me for glasses” and give him a new,
updated prescription to take to the optician. For you, as an ophthalmic assistant, this
is a question of:
a) patient rights
b) scope of practice
c) confidentiality
d) moral obligation

Answer 25

b) “Scope of practice” relates to what you are allowed to do in the performance of your job.
Because ophthalmic/optometric technicians are not permitted to “refract” (ie, measure
refractive error and then apply clinical judgment to write the prescription), this request would be beyond your scope of practice

Question 26

Your new patient had cataract surgery at another practice in town 6 months ago and
is unhappy with her vision. She states that she was nearsighted before, but now she
cannot read anything up close without glasses. Your refractometric measurement of
the eye is +3.75 sphere for distance, with a +2.25 add for near. Which of the following
is a potentially libelous thing to say?

a) “You’re the second patient in a month from that practice who has this problem!”
b) “We’ll know more after Dr. Davis looks at you.”
c) “Unfortunately, measuring for the power of an implant is an inexact science.”
d) “Has the surgeon suggested anything that might help?”

Answer 26

a) The comment in answer a suggests that there is a problem with the surgeon, who has
made the same mistake twice in just a few weeks. Discussing another doctor, practice, or
even someone in your own clinic in a negative fashion is not good ethics…even if they are
at fault

Question 27

Which of the following does not carry with it the “duty to report?”
a) incompetence
b) child abuse
c) data collection
d) impaired eye care professional

Answer 27

c) In QA, data are collected and compared; there is no duty to report. Accusations of a
health care worker’s incompetence or impairment needs to be evaluated with caution, but evaluated nonetheless. And even the suspicion of child abuse must be reported.

Question 28

Which of the following is true regarding certifications for eye care paraprofessionals?

a) Certification is required in order to be employed.
b) Certification acknowledges that a person has attained specific professional standards.
c) Certification legally permits the individual to evaluate and interact with patients.
d) Certification is required in order to perform certain functions, such as refractions

Answer 28

b) Certification attests to a person’s ability to meet a specific professional standard. It is not
required in order to work in the field of eye care, but it is a statement to patients, to other
professionals, and to the community at large that a person has attained those standards. It
is not licensure, a legal instrument that allows the bearer certain privileges. It is not legal
for any eye care paraprofessional (certified or not) to “refract” patients. See answer 9

ANSWER 9: a) The procedure described is a refraction, which involves clinical judgment allowed only to a licensed professional. A technician who performs refractions is practicing medicine without a license, which is illegal. Ophthalmic technicians may, however, perform refractometry, where the refractive error is measured but the prescribing/clinical judgment is left to the licensed practitioner.

Question 29

Compliance with the American National Standards Institute (ANSI) standards is:

a) required by federal law
b) required by state statutes
c) relative to the type of industry involved
d) voluntary

Answer 29

d) Were you surprised to learn that compliance with ANSI standards is voluntary? It is!

Question 30

Which of the following is true regarding the ANSI standards concerning eyeglasses?

a) The ANSI standards apply only to prescription eyewear.
b) The ANSI standards designate allowable variance between the power of the lenses
ordered and the lenses dispensed.
c) The ANSI standards apply to safety lenses, but not to any type of lens coating.
d) The ANSI standards apply only to safety lenses and frames.

Answer 30

b) The ANSI standards allow for a slight amount of difference in lens power between the lenses ordered and those that are actually dispensed. The stronger the lens power, the
smaller the allowable variance.

Question 31

Which of the following is true regarding the ANSI standards concerning contact
lenses?

a) The ANSI standards apply to contact lens materials but not to care products.
b) The ANSI standards apply to rigid contact lenses, but not to soft contact lenses.
c) The ANSI standards dictate what information must appear on the contact lens label.
d) The ANSI standards do not mention disinfection of multiuse trial contact lenses

Answer 31

c) The ANSI standards detail specific information that must appear on the labels of contact lenses. In addition, the standards apply to contact lens materials, rigid and soft lenses, contact lens care products, and disinfection of multiuse trial sets.

Question 32

Regarding intraocular lens implants, which of the following is not covered by the
ANSI standards?

a) phakic IOLs
b) optical properties and biocompatibility
c) sterility and shelf-life
d) patient selection

Answer 32

d) The ANSI standards do not apply to patient selection

Question 33

At its most basic, the duty of a scribe is:
a) personal assistant to the practitioner
b) patient educator and advocate
c) coding and charting coordinator
d) patient flow coordinator

Answer 33

a) Scribing is essentially being the practitioner’s right hand. While the main duty may be documentation, the scribe also performs other duties at the physician’s discretion, including patient education, coordinating patient flow, and overseeing billing forms and chart work.

Question 34

Which of the following is not a function of scribing?

a) documenting what the practitioner tells the patient about his or her diagnosis
b) writing and signing a prescription for the patient’s glaucoma drops
c) remaining after the physician and teaching the patient how to do lid scrubs
d) recording exam findings as the doctor dictates them

Answer 34

b) A scribe may write out a prescription for medication as directed by the practitioner, but
may not sign it. A scribe generally documents the physician’s findings as dictated during
the patient exam and during the patient briefing. A scribe may also remain after the doctor has left the exam room, providing patient education as necessary