malicious software - ANSWER-backdoor
A female patient is diagnosed with congestive heart failure. Which of the following will increase the MS-DRG
... [Show More] weight if present on admission?
Atrial fibrillation
Stage III pressure ulcer
Blood loss anemia
Coronary artery disease - ANSWER-Stage III pressure ulcer
MS-DRG 291 (weight = 01.5010) for congestive heart failure with stage III pressure ulcer would optimize the MS-DRG. MS-DRG 293 (weight = 0. 6756) is assigned for congestive heart failure alone, with atrial fibrillation, with blood loss anemia, and with coronary artery disease all remain the same (Medicare Grouper Version 29-10/11)
A 70-year-old patient was admitted with pneumonia. The history and physical documented that the patient has a history of diabetes, hypertension, and migraine headache about 10 years ago without recurrence. The patient was administered IV antibiotics, metformin, and Altace during the hospitalization. Which conditions would be reported at the time of discharge? - ANSWER-Pneumonia, diabetes, and hypertension
A patient is admitted for chest pain. The patient was stabilized and discharged. In a subsequent admission, the patient was admitted as an outpatient for a left heart catheterization, coronary arteriography using two catheters and left ventricular angiography. The patient was found to have arteriosclerotic heart disease. The patient has no history of cardiac surgery. The appropriate sequencing of ICD-9 and CPT codes for the outpatient catheterization would be:
411.1-Intermediate coronary syndrome (unstable angina)
413.9- Other and unspecified angina pectoris
414.00-Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01-Coronary atherosclerosis of native coronary artery
786.50-Chest pain, unspecified
93452-Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
93453-Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
93454-Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;
93458-with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed - ANSWER-414.01, 93458
Code 414.01 is assigned to show coronary artery disease in a native coronary artery and is used when a patient has coronary artery disease and no history of coronary bypass graft (CABG) surgery (Schraffenberger 2012, 190-192). Code 93458 includes intraprocedural injection(s) for left ventricular/left atrial angiography, imaging supervision, and interpretation when performed (AMA CPT Professional Edition 2013, Cardiac Catheterization Guidelines, 500-503).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon would be coded as a - ANSWER-colonoscopy
A chest x-ray done to evaluate a chronic cough revealed a asymptomatic compression fracture of a lumbar vertebrae. No further evaluation was undertaken. The coder should:
Not assign a code for an acute condition but assign a code for chronic compression fracture
Assign a code for pathologic lumbar compression fracture
Assign a code for acute traumatic vertebral fracture
Not assign a code for this condition - ANSWER-Not assign a code for this condition
Do not assign a code for this condition because this is a frequent condition in the elderly, is asymptomatic, and there is no documentation of treating the condition so it should not be coded (Brown 2012, 33).
A patient is admitted with hypotension due to dobutamine taken, administered, and prescribed correctly. How should this be coded? - ANSWER-Code 458.2, Iatrogenic hypotension, should be assigned to describe this condition. This code should be assigned when hypotension develops as a result of any type of medical care. Assign code E941.2, Sympathomimetics (adrenergics), to indicate that it is an adverse effect of the drug
MS-DRG assignment is based on information that includes - ANSWER-Diagnoses (principal and secondary); Surgical procedures (principal and secondary; Discharge disposition or status; Presence of major or other complications and comorbidities (MCC or CC as secondary diagnosis)
These elements are used to determine the MS-DRG) MS-DRG assignment goes through four steps: - ANSWER-Pre-MDC assignments, MDC determination, Medical/surgical determination, and refinement
If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body area from which the excision occurs and the - ANSWER-Diameter of the lesion as well as the margins excised as described in the operative report
The operative report should be reviewed for the body part involved with the lesion. The total size of the excised area, including margins, is needed for accurate coding. The pathology report typically provides the specimen size rather than the lesion or excised size. Because the specimen tends to shrink, this is not an accurate measurement according to the intent of the code assignment
The case-mix index for the information provided above is:
MS-DRG Weight Number of Patients
MS-DRG 193, Simple pneumonia and pleurisy age >17 w/ CC;
WEIGHT 3.0; # of patients 10
MS-DRG 195, Simple pneumonia without MCC or CC
2.0; 10
MS-DRG 192, Chronic obstructive pulmonary disease w/o CC
1.0; 10 - ANSWER-2.0
The case mix is defined as a methods of grouping patients. MS-DRGs are often used to determine case mix in hospitals. The case-mix index is the average MS-DRG weight based on the specific patient group and is determined by multiplying the DRG weights by the number of patients and then divided by the total number of patients: 30 + 20 + 10 = 60 / 30 = 2.0
75-year-old woman is admitted to the hospital after tripping and falling at home. She underwent an open reduction with internal fixation of the femur. Which of the following would be important to capture in addition to diagnostic codes? - ANSWER-E codes for Cause of Injury, Place of Occurrence, Activity, and Status
External cause of injury codes are used to provide information about how an injury occurred, the intent (intentional or unintentional), provide information about where the injury occurred, and the status of the person at the time the injury occurred. In the case of a person who seeks care for an injury or other health condition that resulted from an activity, or when an activity contributed to the injury or health condition, activity codes are used to describe the activity
During an ambulatory surgery visit for excision of a malignant melanoma of the right forearm, the attending surgeon listed history of benign breast cyst, history of hypertension currently on Tenormin, and a current hammer toe. Which conditions are to be coded? - ANSWER-Malignant melanoma of forearm, hypertension
Assign codes for malignant melanoma of forearm, hypertension. Code chronic conditions if they affect the patient's treatment. The hypertension was being treated with a current medication and for this reason the hypertension is coded
Chronic conditions must be _____ by physician - ANSWER-This is an example of a circumstance where the chronic condition must be verified. All secondary conditions must meet the UHDDS definitions
Determining medical necessity for outpatient services includes all the following - ANSWER-Local coverage determinations (LCDs)
National coverage determinations (NCDs)
Diagnoses linked to procedures by claims-processing software tests ensuring that the procedure is cross-referenced, or linked, correctly to an acceptable diagnosis code for that service
the fee schedule and the current National Correct Coding Initiatives edits. Other valuable resources are Medicare's Carrier Manual, Medicare's National Coverage Determinations Manual, and local coverage determinations (LCDs)
A patient was admitted to the emergency department with chest pain, and was diagnosed with aborted myocardial infarction with acute myocardial ischemia. There was no prior cardiac surgery. The cardiac enzymes were normal. The appropriate coding of the diagnosis for this case is: - ANSWER-411.81 Acute coronary occlusion without myocardial infarction
Patients with acute ischemic heart disease or acute myocardial ischemia does not always indicate an infarction. It is often possible to prevent infarction by means of surgery or the use of thrombolytic agents if the patient is treated promptly. If there is occlusion or thrombosis of the artery without infarction, code 411.81, Acute coronary occlusion without myocardial infarction, is assigned
A patient is admitted with spotting and fever. She is found to have been treated for a miscarriage (spontaneous abortion), which was resolved two weeks prior to this admission. She is treated with aspiration dilation and curettage and products of conception are found. She is found to be septic. Which of the following should be the principal diagnosis? - ANSWER-This patient was previously treated for the spontaneous abortion but the presence of the products of conception denotes that the abortion was not completed during the prior episode of care. Because of this and the fact that she now has sepsis, she is coded as having an incomplete spontaneous abortion with sepsis
Coding compliance policies should include - ANSWER-Facility-specific documentation requirements
Coding compliance policies serve as a guide to performing coding and billing functions and provide documentation of the organizations' intent to correctly report services. The policies should include facility-specific documentation requirements, payer regulations and policies, and contractual arrangements for coding consultants and outsourcing services. This information may be covered in payer/provider contracts or found in Medicare and Medicaid manuals and bulletins
Data warehousing to form clinical repositories is undertaken by merging insurance members' claims and clinical data. Data mining assists in all of the following except: - ANSWER-providing feedback to patients
Data mining is associated with data warehouses. Data mining is a process that identifies patterns and relationships by searching through large amounts of data. Because data warehouses contain large amounts of data, data mining processes are frequently used to systematically analyze these data. In healthcare, data mining is used to identify methods for cutting healthcare costs, suggest more appropriate medical treatments, and predict medical outcomes
If the principal diagnosis is an initial episode of an anterior wall myocardial infarction, which procedure will result in the highest DRG?
Mechanical ventilator
Insertion central venous catheter
Right heart cardiac catheterization
Transbronchial lung biopsy - ANSWER-Transbronchial lung biopsy
MS-DRG 264 (weight = 02.5580) for myocardial infarction with transbronchial lung biopsy would result in the highest reimbursement. MS-DRG 282 (weight = 0.7856) would be assigned for the myocardial infarction alone, and with insertion central venous catheter. MS-DRG 282 (weight = 0.7856) would be assigned for myocardial infarction with mechanical ventilator
A patient was diagnosed with L4-5 lumbar neuropathy and discogenic pain. The patient underwent an intradiscal electrothermal annuloplasty (IDET) in the radiology suite. What ICD-9-CM code should be used?
80.50, Excision, destruction and other repair of intervertebral disc, unspecified
04.2, Destruction of cranial and peripheral nerves
80.59, Other destruction of intervertebral disc
05.23, Lumbar sympathectomy - ANSWER-Assign code 80.59, Other destruction of intervertebral disc, for the procedure performed. IDET involves only the disc not the nerve root. IDET is done with thermal energy (heat) directed into the outer disc wall (annulus) and inner disc contents (nucleus) via a heating coil, decreasing the pressure inside the disc. Code 04.2, Destruction of cranial and peripheral nerves, would not be the correct code assignment, because it relates to the peripheral nerves
A virtual screening colonoscopy would be coded as - ANSWER-74263
CT colonography uses CT scanning to obtain an interior view of the colon (the large intestine) that is otherwise only seen with a more invasive procedure where an endoscope is inserted into the rectum
Most hospitals require a medical record is completed within - ANSWER-30 days
A patient is admitted to the hospital with shortness of breath and congestive heart failure and subsequently develops respiratory failure. The patient undergoes intubation with ventilator management. The correct coding and sequencing of the diagnoses in this case would be - ANSWER-Congestive heart failure, respiratory failure, ventilator management, intubation
An information system (IS) consists of - ANSWER-data, people, and work processes and a combination of hardware (machines and media), software (computer programs), and communication technology (computer networks) known as information technology (IT)
A patient is admitted with a high temperature, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient also has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." What is the next step for the coder? - ANSWER-Unfortunately, urosepsis is sometimes stated as the diagnosis even though the condition has progressed to a septicemia in which a localized urinary tract infection has entered the blood stream and become a generalized sepsis. The physician should be asked if the diagnosis of urosepsis is intended to mean (1) generalized sepsis (septicemia) caused by leakage of urine or toxic urine by products into the general vascular circulation, or (2) urine contaminated by bacteria, bacterial by products, or other toxic material but without other findings
Resistance - ANSWER-Coders should only use the V codes denoting resistance when the resistance is documented by the physician(s) involved
Ex:Reported because the resistant organism is documented in the discharge summary and laboratory reports. Furthermore, the patient tried erythromycin and needed to be changed to another antibiotic V09.2
The patient has been on insulin long term - ANSWER-V58.67
The Joint Commission considers what kind of management to be important for safe, quality care? - ANSWER-Information management
The goal of information management is to support decision making
Quality improvement organizations (QIOs) are responsible - ANSWER-Quality of care reviews due to complaints,Utilization Reviews for hospital requested higher weighted DRG payments,Review of Emergency Medical Treatment Active Labor Act cases
These activities are part of the claims review required by QIOs)
From the information provided, how many APCs would impact this patient's total reimbursement?
989323 V 99285-25 00616
989323 T 25500 00129
989323 X 72050 00261
989323 S 72128 08005
989323 N 70450 19937 - ANSWER-1
Payment status indicators that are assigned to an APC and indicate APC payment are G, H, K, P, R, S, T, U, X, and V. Status indicator N denotes that there is no specific payment for that APC because the procedure payment is included in another APC. There may be multiple APCs with the same or different payment status indicator per claim. In this case, all APCs impact payment except the one with status indicator N
During an admission for CHF a chest x-ray was done to evaluate for the presence of congestive heart failure (CHF). An asymptomatic hernia was also found for which no treatment or evaluation was done. What is the primary reason that the hernia should not be coded? - ANSWER-The hernia is an incidental finding.
A patient undergoes a colposcopy with endometrial biopsy. Which of the following is correct?
The colposcopy and endometrial biopsy are represented by a combination code.
Two codes would be used with modifier -59 appended.
Two codes would be used in accordance with 2013 CPT code revisions.
Only one code is used and it does not state that it includes endometrial biopsy specifically. - ANSWER-Two codes would be used in accordance with 2013 CPT code revisions.
The endometrial biopsy (58110) is an add-on code and there are specific directions in the CPT book to use this code in conjunction with the code for the colposcopy;
Documentation in the record reveals that a patient is admitted with an acute exacerbation of COPD (MS-DRG 192). A higher-paying DRG may be appropriate if documentation is present in the record at the time the decision was made to admit the patient that confirms a diagnosis associated with which of the following:
Angina was treated with nitroglycerin prn for chest pain
Atrial fibrillation and underwent a cardioversion while hospitalized
Blood gases of pO2 of 58, pCO2 of 55, pH of 7.32 upon admission and treated with intubation and mechanical ventilation for more than 96 hours
Anemia and was given a blood transfusion - ANSWER-Blood gases of pO2 of 58, pCO2 of 55, pH of 7.32 upon admission and treated with intubation and mechanical ventilation for more than 96 hours
The blood gas values of pO2 of 58, pCO2 of 55, pH of 7.32 reflect respiratory failure and the patient was treated in ICU with intubation and mechanical ventilation DRG: 0207, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS. The addition of procedure codes for the intubation and ventilation would move this to MS-DRG 207. The acute exacerbation of COPD with blood gas values of pO2 of 58, pCO2 of 55, pH of 7.32 reflects possible respiratory failure. The patient was treated with intubation and mechanical ventilation for more than 96 hours. MS-DRG 0207 is a correct reflection of the patient's severity illness and appropriate reimbursement resulting based on the documentation when compared to the MS-DRG associated with acute exacerbation of COPD (491.21), which is MS-DRG 192 (weight = 0.7081)
The outpatient code editor (OCE) has all of the following types of edits except:
Claim accuracy
Discharge date discrepancy
Assigning APCs to the claim
Age and sex edits - ANSWER-Discharge date discrepancy
The OCE has four basic functions: editing the data on the claims for accuracy, specifying the action the FI should taken when specific edits occur, assigning APCs to the claim (for hospital outpatient services), and determining payment-related conditions that require direct reference to HCPCS codes or modifiers. Routine edits for age and sex are done on all claims
Under HIPAA Standards for Code Sets, the sets of codes used to encode the diagnoses and procedures, data elements, and medical concepts must be used in: - ANSWER-electronic claims only
A patient is admitted to undergo a laparoscopic cholecystectomy. Following the insertion of the laparoscope into the abdominal cavity, the patient experienced a cardiac arrhythmia and the procedure was terminated. The patient experienced a potentially compensable event resulting in an incident report. Which department may request to see the patient's record?
Pediatrics
Risk Management
Surgical Supply
Dietary Services - ANSWER-Risk Management
he role of the risk manager is to collect and analyze information on actual losses and potential risks and to design systems that lessen potential losses in the future. An incident report is a structured tool used to collect data and information about any event not consistent with routine operational procedures
If a patient is admitted with pneumococcal pneumonia and pneumococcal sepsis, the coder should - ANSWER-Assign a code for the sepsis, pneumonia, and SIRS
According to the UHDDS, in order to assign a code for another diagnosis, documentation must be present that: - ANSWER-The condition was clinically evaluated or therapeutically treated, extended the length of hospital stay or increased nursing care and monitoring or care
For reporting purposes the definition for other diagnoses is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or extended length of hospital stay; or increased nursing care or monitoring
During a coronary artery bypass surgery, the patient underwent saphenous bypass grafts; from the aorta to the left anterior descending branch of the left main coronary artery, and the left posterior descending of the left main coronary artery. The patient also underwent a repositioning of the mammary artery to the right coronary artery. Choose the best description for this procedure.
Three aortocoronary grafts
Two aortocoronary grafts and one mammary-coronary graft
Two aortocoronary grafts and two saphenous bypass graft
Three aortocoronary grafts and one mammary-coronary graft - ANSWER-Two aortocoronary grafts and one mammary-coronary graft
It is rare for only one coronary artery to be bypassed, and it is also fairly common to perform both an internal mammary-coronary artery bypass and an aortocoronary bypass at the same operative episode
EM example - ANSWER-Calculate the evaluation and management code for the outpatient visit. *According to the mapping scenario; meds given are = 2 = 5 points, the history is problem focused = 10 points, the exam is extended problem focused = 15 points, the number of tests = 5 = 15 points, supplies = 1 fracture tray = 5 points. Total is 50 points
History of radiation therapy - ANSWER-V15.3
. A patient has an inpatient discharge with principal diagnosis of shoulder pain due to peptic ulcer vs. cholecystitis documented on the history and physical. Both are equally treated and well documented. A coder should:
Code whichever diagnosis pays more, if both are equally treated
Use a code from the Findings Abnormal category
Code to the most severe symptom
Code shoulder pain, peptic ulcer, cholecystitis - ANSWER-Code shoulder pain, peptic ulcer, cholecystitis
When a symptom is followed by contrasting or comparative diagnoses, the symptom is sequenced first. All the contrasting or comparative diagnosis should be coded as additional diagnoses
A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility. The patient has multiple sclerosis and hypertension. During the course of hospitalization a decubitus ulcer is found and debrided at the bedside by a physician. There is no typed operative report and no pathology report. The coder should: - ANSWER-Excisional debridement can be performed in the operating room, the emergency department, or at the bedside. Coders are encouraged to work with the physician and other healthcare providers to ensure that the documentation in the health record is very specific regarding the type of debridement performed. If there is any question as to whether the debridement is excisional or nonexcisional, the provider should be queried for clarification
Assign the correct codes for a laparoscopic cholecystectomy with percutaneous removal of common bile duct stones - ANSWER-51.23, Laparoscopic cholecystectomy
51.96, Percutaneous extraction of common duct stones
Health information exchanges facilitate - ANSWER-Seamless trans [Show Less]