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Medical |! Coding |! Midterm |! exam |!
with |! accurate |! detailed |! solutions
A |! major |! change |! took |! place |! in |! Medicare |! in |! ____ |! with |! the |! enactment |! of |! the |! Omnibus |! Budget |! Reconciliation |! Act. |! - |! Correct |! answer |! ✔ 1989 CMS |! - |! Correct |! answer |! ✔Centers |! for |! Medicare |! and |! Medicaid |! Services CMS |! handles |! the |! daily |! operation |! of |! the |! Medicare |! program |! through |! the |! use |! of |! ____ |! ____ |! ____, |! formerly |! Fiscal |! Intermediaries. |! - |! Correct |! answer |! ✔Medicare |! Administrative |! Contractors DHHS |! - |! Correct |! answer |! ✔Department |! of |! Health |! and |! Human |! Services For |! endoscopic |! procedures |! Medicare |! allows |! the |! full |! value |! of |! the |! highest |! valued |! endoscopy, |! plus |! the |! difference |! between |! the |! next |! highest |! endoscopy |! and |! the |! ____________________ |! endoscopy. |! - |! Correct |! answer |! ✔Highest Fraud |! is |! an |! intentional |! deception |! or |! misrepresentation |! that |! an |! individual |! knows |! to |! be |! false |! or |! does |! not |! believe |! to |! be |! true |! and |! makes |! knowing |! that |! the |! deception |! could |! result |! in |! some |! unauthorized |! benefit |! to |! himself/herself |! or |! some |! other |! person. |! T/F |! - |! Correct |! answer |! ✔True
If |! a |! QIO |! provider |! renders |! a |! covered |! service |! that |! costs |! $100 |! and |! bills |! Medicare |! for |! the |! service |! and |! Medicare |! allowed |! $58, |! the |! provider |! would |! bill |! this |! amount |! to |! the |! patient. |! - |! Correct |! answer |! ✔$ If |! a |! surgeon |! performs |! more |! than |! one |! procedure |! on |! the |! same |! patient |! on |! the |! same |! day, |! and |! discounts |! were |! made |! on |! all |! subsequent |! procedures, |! Medicare |! would |! pay |! what |! percentages |! for |! the |! first, |! second, |! third, |! fourth, |! and |! fifth |! procedures? |! - |! Correct |! answer |! ✔100%, |! 50%, |! 50%, |! 50%, |! 50% In |! the |! role |! as |! a |! medical |! coder, |! it |! is |! your |! responsibility |! to |! ensure |! that |! you |! code |! ____________________ |! and |! ____________________ |! to |! optimize |! reimbursement |! for |! services |! provided. |! (Separate |! your |! answers |! with |! a |! comma |! and |! a |! space.) |! - |! Correct |! answer |! ✔accurately, |! completely Kickbacks |! from |! patients |! are |! allowed |! under |! certain |! circumstances |! according |! to |! Medicare |! guidelines. |! T/F |! - |! Correct |! answer |! ✔False List |! the |! three |! components |! of |! the |! relative |! value |! unit. |! - |! Correct |! answer |! ✔1. |! Work
- |! Overhead
- |! Malpractice List |! the |! three |! goals |! of |! the |! Physician |! Payment |! Reform. |! - |! Correct |! answer |! ✔1. |! Decrease |! Medicare |! expenditures
- |! Redistribute |! physicians' |! payments |! more |! equitably
- |! Ensure |! quality |! health |! care |! at |! a |! reasonable |! rate
Medicare |! funds |! are |! collected |! by |! - |! Correct |! answer |! ✔Social |! Security |! Administration Medicare |! pays |! for |! what |! percentage |! of |! covered |! charges? |! - |! Correct |! answer |! ✔80% Medicare |! sets |! the |! payment |! level |! for |! assistant |! surgeons |! at |! a |! percentage |! of |! the |! fee |! schedule |! amount |! for |! the |! ____ |! surgical |! service. |! - |! Correct |! answer |! ✔Global Nationally, |! unit |! values |! have |! been |! assigned |! for |! each |! service |! by |! Medicare |! (CPT |! and |! HCPCS) |! and |! determined |! on |! the |! basis |! of |! the |! resources |! necessary |! for |! the |! physician's |! performance |! of |! the |! service. |! T/F |! - |! Correct |! answer |! ✔True OBRA |! - |! Correct |! answer |! ✔Omnibus |! Budget |! Reconciliation |! Act OIG |! - |! Correct |! answer |! ✔Office |! of |! the |! Inspector |! General Part |! B |! services |! are |! billed |! using |! - |! Correct |! answer |! ✔ICD-9-CM, |! CPT, |! HCPCS QIO |! - |! Correct |! answer |! ✔Quality |! Improvement |! Organizations The |! first |! nation |! to |! implement |! the |! world |! version |! of |! ICD-10 |! will |! be |! the |! United |! States. |! T/F |! - |! Correct |! answer |! ✔False
There |! are |! 18 |! chapters |! in |! the |! United |! States |! I-10. |! T/F |! - |! Correct |! answer |! ✔False I-10 |! is |! indexed |! in |! a |! similar |! manner |! as |! the |! I-9. |! T/F |! - |! Correct |! answer |! ✔True The |! codes |! in |! the |! I-10 |! are |! alphanumeric. |! T/F |! - |! Correct |! answer |! ✔True The |! acronym |! for |! the |! I-10 |! system |! that |! reports |! inpatient |! procedures |! is |! the |! - |! Correct |! answer |! ✔PCS This |! mapping |! system |! serves |! as |! a |! crosswalk |! from |! I-9 |! to |! I-10 |! and |! from |! I-10- I-9 |! - |! Correct |! answer |! ✔GEM's When |! more |! than |! one |! diagnosis |! is |! reported |! with |! one |! code, |! the |! code |! is |! this |! type |! of |! code |! - |! Correct |! answer |! ✔combination This |! organization |! developed |! and |! maintains |! the |! ICD-10 |! on |! a |! world-wide |! basis |! - |! Correct |! answer |! ✔WHO This |! type |! of |! code |! expanded |! the |! injury |! codes |! in |! the |! I-10 |! - |! Correct |! answer |! ✔activity The |! United |! States |! is |! scheduled |! to |! implement |! the |! use |! of |! ICD-10 |! on |! what |! date |! - |! Correct |! answer |! ✔October |! 1, |! 2015
An |! established |! patient |! is |! seen |! for |! migraines |! and |! seizures, |! to |! rule |! out |! the |! possibility |! of |! a |! brain |! tumor. |! ____________________ |! - |! Correct |! answer |! ✔migraines |! and |! seizures Established |! patient |! presents |! with |! chest |! pain. |! He |! has |! a |! history |! of |! previous |! myocardial |! infarction |! and |! coronary |! artery |! bypass |! surgery. |! - |! Correct |! answer |! ✔chest |! pain Established |! patient |! seen |! for |! redness |! and |! sensitivity |! to |! light |! in |! her |! right |! eye. |! The |! documentation |! states |! the |! diagnosis |! is |! iritis. |! ____________________ |! - |! Correct |! answer |! ✔iritis Initial |! office |! visit |! for |! patient |! with |! nausea |! and |! vomiting. |! Physician |! documented |! the |! nausea |! and |! vomiting |! were |! due |! to |! acute |! appendicitis. |! - |! Correct |! answer |! ✔acute |! appendicitis If |! the |! pre- |! and |! postoperative |! diagnosis |! are |! different, |! the |! preoperative |! diagnosis |! should be |! reported. |! T/F |! - |! Correct |! answer |! ✔False In |! the |! inpatient |! hospital |! setting, |! proable, |! suspected, |! and |! rule-out |! diagnoses |! cannot |! be |! reported |! by |! the |! facility |! as |! though |! the |! condition |! exists. |! T/F |! - |! Correct |! answer |! ✔False In |! the |! outpatient |! setting, |! a |! diagnosis |! that |! is |! documented |! as |! "rule |! out" |! should |! not |! be |! reported. |! T/F |! - |! Correct |! answer |! ✔True
Section |! IV |! of |! the |! Official |! Guidelines |! for |! Coding |! and |! Reporting |! applies |! to |! both |! the |! inpatient |! and |! outpatient |! settings. |! T/F |! - |! Correct |! answer |! ✔False The |! term |! "primary |! diagnosis" |! is |! the |! same |! as |! the |! first-listed |! diagnosis. |! T/F |!
- |! Correct |! answer |! ✔True A |! multigravida |! 48-year-old |! patient |! presents |! for |! routine |! prenatal |! visit, |! first |! trimester. |! No |! complications |! are |! noted. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔O09. Corneal |! ulcer |! with |! hypopyon |! of |! left |! eye. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔H16. Encounter |! for |! blood |! type |! testing |! prior |! to |! surgery. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔Z01. Exposure |! to |! German |! measles. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔Z20. Long-term |! (current) |! use |! of |! aspirin. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔Z79. Long-term |! (current) |! use |! of |! systemic |! steroids.
The |! Official |! Guidelines |! for |! Coding |! and |! Reporting |! are |! updated |! every |! year |! by |! CMS |! and |! AMA. |! T/F |! - |! Correct |! answer |! ✔False Aphasia |! and |! cognitive |! defects, |! as |! a |! result |! of |! nontraumatic |! intracranial |! hemorrhage. ICD-10-CM |! Codes:____________________, |! ____________________ |! - |! Correct |! answer |! ✔I69.220, |! I69. It |! is |! unacceptable |! to |! report |! an |! impending |! condition |! as |! if |! it |! exists |! in |! an |! outpatient |! facility. |! T/F |! - |! Correct |! answer |! ✔True Rubella |! meningoencephalitis. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔B06. A |! combination |! code |! is |! a |! single |! code |! used |! to |! classify: |! - |! Correct |! answer |! ✔two |! diagnoses, |! a |! diagnosis |! with |! an |! associated |! secondary |! process |! (manifestation), |! a |! diagnosis |! with |! an |! associated |! complication |! (all |! of |! the |! above). It |! is |! important |! to |! follow |! any |! cross-reference |! instructions |! in |! the |! Index |! of |! the |! I-10, |! such |! as |! see |! also. |! T/F |! - |! Correct |! answer |! ✔True Assign |! codes |! as |! directed |! in |! the |! Index, |! only |! after |! verifying |! the |! code |! in |! the |! Tabular. |! T/F |! - |! Correct |! answer |! ✔True Hypertensive |! heart |! disease |! NOS.
ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔I11. Primary |! hypertension. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔I The |! correct |! reporting |! for |! Staphylococcal |! pneumonia: |! - |! Correct |! answer |! ✔J15. Arteriosclerosis |! of |! native |! arteries |! of |! the |! left |! leg |! with |! gangrene. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔I70. A |! late |! effect |! is |! the |! residual |! effect |! after |! the |! acute |! phase |! of |! an |! illness |! or |! injury |! has |! passed. |! T/F |! - |! Correct |! answer |! ✔True Pseudocyst |! of |! the |! pancreas. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔K86. If |! there |! are |! separate |! codes |! for |! both |! the |! acute |! and |! chronic |! forms |! of |! a |! condition, |! the |! code |! for |! the |! chronic |! condition |! is |! sequenced |! first |! as |! long |! as |! both |! codes |! are |! listed |! at |! the |! same |! indentation |! level |! of |! the |! Index. |! T/F |! - |! Correct |! answer |! ✔False Acute |! and |! chronic |! systolic |! (congestive) |! heart |! failure. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔I50.
ICD-10-CM |! Codes:____________________, |! _____________________ |! - |! Correct |! answer |! ✔G89.11, |! S43.51xD The |! correct |! reporting |! for |! stage |! IV |! chronic |! kidney |! disease |! associated |! with |! diabetes |! mellitus, |! type |! 2:E11.22, |! N18.4 |! - |! Correct |! answer |! ✔E11.22, |! N18. Subsequent |! encounter |! for |! malunion |! of |! displaced |! fracture |! of |! shaft |! of |! the |! first |! metacarpal |! bone, |! right |! hand. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔S62.241P Acute |! and |! chronic |! prostatitis |! due |! to |! Escherichia |! coli |! bacterial |! infection. ICD-10-CM |! Codes: |! _________________, |! _________________, |! _______________ |! - |! Correct |! answer |! ✔N41.0, |! N41.1, |! B96. Systemic |! lupus |! erythematosus |! with |! associated |! endocarditis |! (M32.11) |! is |! an |! example |! of |! dual |! coding. |! T/F |! - |! Correct |! answer |! ✔False For |! bilateral |! sites, |! the |! final |! character |! of |! the |! codes |! in |! the |! I-10 |! always |! indicates |! laterality. |! T/F |! - |! Correct |! answer |! ✔False The |! correct |! reporting |! for |! a |! pathological |! fracture |! of |! the |! left |! femur, |! due |! to |! neoplastic |! bone |! disease |! initial |! encounter: |! - |! Correct |! answer |! ✔M84.552A, |! D49.
Each |! unique |! I-10 |! diagnosis |! code |! may |! be |! reported |! more |! than |! once |! for |! an |! encounter. |! T/F |! - |! Correct |! answer |! ✔False The |! correct |! reporting |! for |! acute |! cholecystitis |! with |! cholelithiasis |! with |! obstruction: |! - |! Correct |! answer |! ✔K80. Multiple |! codes |! are |! often |! required |! for |! late |! effects, |! complication |! codes, |! and |! obstetric |! codes. |! T/F |! - |! Correct |! answer |! ✔True Acute |! and |! chronic |! respiratory |! failure. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔J96. Right |! and |! left |! inguinal |! hernia. ICD-10-CM |! Code:____________________ |! - |! Correct |! answer |! ✔K40. The |! correct |! reporting |! for |! hypertensive |! heart |! failure: |! - |! Correct |! answer |! ✔I11. Chronic |! osteomyelitis |! with |! draining |! sinuses |! of |! right |! first |! toe |! due |! to |! Staphylococcus |! aureus. ICD-10-CM |! Codes:____________________, |! _____________________ |! - |! Correct |! answer |! ✔M86.471, |! B95.
