CCS EXAM practice questions 14th edition

Coding professionals at a physician group practice often collaborate on finding the appropriate diagnosis and procedure codes. They do not have access to an encoder, and the books they use are four years old. When they are uncertain about the code selection, they query the physicians. Based
on this information, is there anything unethical going on?

Yes. Coding professionals should have current books in order to assign appropriate codes.

A 30-year-old patient with acquired immunodeficiency syndrome (AIDS) is admitted for repair of inguinal hernia. The procedure performed was a right indirect inguinal herniorrhaphy via open approach. What is the principal diagnosis code for this scenario?

K40.90

Which of the following code sets are mandated under HIPAA?

Which of the following code sets are mandated under HIPAA?

A patient was admitted with chest pain and shortness of breath. Preliminary lab work indicated nonelevated troponin with LBBB noted on EKG. The patient developed a fever and chills, with an x-ray finding of an infiltrate in the left lung. Sputum culture identified Klebsiella. The patient slowly improved after antibiotics were administered. The final discharge diagnosis was listed as chest pain and the patient was sent home on piperacillin/tazobactam. A coding professional sent this query: Dr. Reynolds, based on the x-ray finding of lung infiltrate, sputum culture results positive for Klebsiella, and the discharge medication of piperacillin/tazobactam, can you identify the condition that was being treated? Is this a compliant query? Why or why not?

Yes, because clinical indicators are being provided without leading the provider to a response

Medically unlikely edits are used to identify which of the following?

Maximum units of service for a HCPCS code

A patient with acute respiratory failure, hypertension, and congestive heart failure is admitted for intubation and ventilation. The patient’s heart failure is stable on current medications. What are the correct diagnosis codes and sequencing?

I10          Essential (primary) hypertension

I11.0      Hypertensive heart disease with heart failure

I50.9      Heart failure, unspecified

J96.00    Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

J96.20    Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

J96.00, I11.0, I50.9

In 2000, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule on the outpatient prospective payment system (OPPS). The Final Rule:

Divided ambulatory services into fixed payment groups

Twin newborns are born prematurely at 32 weeks via cesarean section. The birth weight of twin A was 1,002g. Twin B was stillborn. Twin A was admitted to the nursery from the delivery room and had to be treated for jaundice due to ABO incompatibility. What codes should be assigned for twin A and what is the proper sequencing?

Z38.31, P07.14, P07.35, P55.1

A 75-year-old patient is admitted for a complex, ventral hernia repair. While in the hospital, the patient slips and falls, suffering a left hip fracture. Will the hip fracture be identified as part of the facility’s patient safety indicators (PSI)? Why or why not?

Yes, the hip fracture is a secondary diagnosis and will be part of the PSI.

Under HITECH, which group has the authority to initiate civil actions at the federal court level for citizens who were negatively impacted by a HIPAA violation?

State attorneys general

What admission source code would be used when a patient is admitted to the facility from home? Use the table below to answer.

Source Code Admission Source Definition

1 Non-Health Care Facility

2 Clinic

4 Transfer from Hospital

5 Transfer from Skilled or Intermediate Facility

6 Transfer from another Health Care Facility

7 Emergency Room

8 Court/Law Enforcement

E Transfer from Ambulatory Surgery

F Transfer from Hospice

1

A patient came from home and was seen in Hospital A’s emergency room and then transferred out to Hospital B. The admission source that Hospital B assigned was 1. Is this correct? Why or why not?

1 Non-Health Care Facility

2 Clinic

4 Transfer from Hospital

5 Transfer from Skilled or Intermediate Facility

6 Transfer from another Health Care Facility

7 Emergency Room

8 Court/Law Enforcement

E Transfer from Ambulatory Surgery

F Transfer from Hospice

No, the patient's arrival at Hospital B was from Hospital A so the admit source is 4.

A patient comes in with right upper quadrant pain, nausea, and vomiting. An x-ray confirms inflammation in the gallbladder. The patient has been dealing with episodes like this for the past six months. The final diagnosis in the discharge statement is appendicitis. What discrepancy is noted in this record?

The condition indicated is acute on chronic cholecystitis.

Encoders are not typically used in which healthcare setting?

Provider offices

While admitted for an exacerbation of COPD, a patient developed swelling in the lower legs and had increasing shortness of breath despite the COPD treatment. An echocardiogram was performed that showed an ejection fraction of 33 percent. A urinalysis showed albuminuria. Breathing treatments continued with the addition of Lasix to the medication regime. In the final diagnostic statement, the physician mentions only the COPD exacerbation. What is the query opportunity for this record?

Acute congestive heart failure

The electronic transactions and code sets standards are found under which part of HIPAA?

Administrative Simplification

Determining employee access to patient information should be based on what HIPAA principle?

Minimum necessary

A patient is being treated with psychotherapy for excessive worrying that they are not able to control. The condition affects the patient’s ability to concentrate at work. These symptoms would verify which of the following diagnoses?

Generalized anxiety disorder

Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture reflected in the progress notes as Staphylococcus aureus sepsis. What codes should be assigned?

T83.511A, A41.01

Authentication of health record entries means to:

Prove authorship of documents

Which of the following is a valid concern when a coding professional uses a computer-assisted coding (CAC) program?

Codes for conditions that have previously been resolved will be suggested

Generally, data quality is defined as which of the following?

Ensuring the accuracy and completeness of an organization's data

A payer’s policy does not cover tetanus injections when provided as a preventive service but will cover them when provided as a postinjury service. If the injection is provided in the emergency department, what part of the claim will need to be modified to indicate the injection was a postinjury service rather than a preventive service?

Revenue code

A condition is considered present on admission when it is:

A condition that occurs prior to an inpatient admission

A patient is scheduled for elective surgery for cataract removal of the left eye. The operative report indicates the surgery on the right eye is performed with the use of phacoemulsification and intraocular lens insertion. What discrepancy is noted in this documentation?

Laterality is not in agreement

Which of the following is considered a complication or comorbidity?

Hypokalemia

Dehydration

Hypernatremia

Fluid overload

Hypernatremia

A patient is admitted with metastatic carcinoma from breast to liver with previous bilateral mastectomy and no recurrence at the primary site. In the progress note of day three, the physician indicates that patient now has pneumonia and begins treatment with an antibiotic that will be continued on discharge. What is the proper coding and sequencing of this admission?

C78.7, J18.9, Z85.3, Z90.13

The use of the outpatient code editor (OCE) is designed to

Identify incomplete or incorrect claims

Which of the following is a prospective reimbursement methodology?

Case rate

Medicare severity diagnostic-related groups (MS-DRGs) and ambulatory patient classifications (APCs) are similar in that they are both:

Prospective payment systems

Compliant queries include which of the following?

Relevant clinical indicators

A bronchoscopy with multiple biopsies of the left bronchus was completed and revealed adenocarcinoma. What, if any, modifier should be added to the procedure code billed by the facility?

No modifiers should be reported

A patient is admitted with hemoptysis. A bronchoscopy with transbronchial biopsy of the lower lobe was undertaken that revealed squamous cell carcinoma of the right lung. Which conditions should be identified as present on admission?

C34.30             Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31             Malignant neoplasm of lower lobe, right bronchus or lung

P26.9               Unspecified pulmonary hemorrhage originating in the perinatal period

R04.2               Hemoptysis

C34.31

Medicare’s identification of medically necessary services is outlined in which of the following?

Local coverage determinations

A woman is admitted to the hospital for an exacerbation of COPD and mentions a lump she has noticed in her right breast. On the fourth day of her hospital stay, a biopsy is done of the breast lump and a diagnosis of ductal carcinoma is made. What is the POA assignment for the carcinoma?

Y

A coding professional reviews an inpatient health record and finds that the principal diagnosis code will be assigned from Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified. What should the coding professional do?

Assign the sign/symptom code.

Which of the following is found on the hospital-acquired condition list?

Stage 4 pressure ulcer of the coccyx

At work one day, Mary, who is an outpatient coding professional, overheard another outpatient coding professional mention that whenever she has a chart to code with a procedure that she is unfamiliar with, she assigns an unlisted CPT code. This allows her to keep up her productivity numbers rather than taking time to research the procedure. What is Mary’s ethical responsibility upon learning this information?

Report this to her coding manager as the Code of Ethics requires coding professionals to take steps to correct unethical behavior of colleagues.

The patient was admitted for breast carcinoma in the right breast at two o’clock. This was removed via lumpectomy. An axillary lymph node dissection, performed along with the lumpectomy, identified one of seven lymph nodes positive for carcinoma. One of the patient’s neighbors, who works at the hospital, called the coding department to get the patient’s diagnosis because she is a cancer survivor herself. What should the coding professional do?

Refuse to provide any information

Current Procedural Terminology (CPT) defines a separate procedure as which of the following?

Procedure considered an integral part of a more major service

A patient had a normal pregnancy and delivery with loose nuchal cord. Delivery, with birth of liveborn male infant, was accomplished with an episiotomy and repair. The delivery room record states “no evidence of fetal problem.” What is the query opportunity for this record?

Weeks of gestation/trimester

A 59-year-old man is diagnosed with basal cell carcinoma of the eyelid. An excision of basal cell carcinoma of the left upper eyelid was performed with an excised diameter of 1.9 cm and single layer closure. What codes and modifiers should be assigned?

C44.1191, 11642-E1

A laparoscopic cholecystectomy was performed. What is the correct ICD-10-PCS code?

0FB40ZZ         Excision of gallbladder, open approach

0FB44ZZ         Excision of gallbladder, percutaneous endoscopic approach

0FT40ZZ          Resection of gallbladder, open approach

0FT44ZZ          Resection of gallbladder, percutaneous endoscopic approach

0FT44ZZ

A patient is admitted with fever and urinary burning. Urosepsis is suspected. The discharge diagnosis is Escherichia coli, urinary tract infection; sepsis ruled out. Which of the following represents the diagnoses to report for this encounter and the appropriate sequencing of the codes for those conditions?

Urinary tract infection, Escherichia coli

Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What codes should be assigned?

O30.003    Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

O30.009    Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester

O60.14X0   Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified

O60.14X1   Preterm labor third trimester with preterm delivery third trimester, fetus 1

O60.14X2   Preterm labor third trimester with preterm delivery third trimester, fetus 2

O80             Encounter for full-term uncomplicated delivery

Z3A.30        30 weeks gestation of pregnancy

Z37.0          Single live birth

Z37.2          Twins, both liveborn

O60.14X1, O60.14X2, O30.003, Z3A.30, Z37.2

A facility’s coding policy states that inpatients who undergo open reduction and internal fixation of a fractured femur should be routinely coded with blood loss anemia when there is intraoperative blood loss of 500 cc or more documented in the operative report and the patient has low hemoglobin. Is this correct or incorrect and why?

It is incorrect because the physician did not document the blood loss anemia in the progress notes.

A 64-year-old female was admitted with renal failure and discharged with renal failure and chronic hypertension. Can a coding professional properly assign codes with this information? Why or why not?

No, without knowing the type of renal failure, the proper coding and sequencing cannot be performed.

A patient comes in with right upper quadrant pain, nausea, and vomiting. An x-ray confirms inflammation in the gallbladder. The patient has been dealing with episodes like this for the past six months. The final diagnosis in the discharge statement is appendicitis.

A query should be issued to determine the diagnosis as it seems appendicitis is incorrect.

For a patient with a principal diagnosis of septicemia, reporting which of the following diagnoses will have the greatest impact on the MS-DRG?

Acute respiratory failure

To accurately report wound closures with CPT codes, in addition to knowing the site and length of the closure, what other information is necessary?

The repair type: simple, intermediate, or complex

On day 10 of a month-long admission, an inpatient progress note states there is aa stage three pressure ulcer of the sacrum that requires debridement. The coding professional composes a query to determine if this condition was present on admission (POA) by asking the physician if the pressure ulcer listed in the progress note of day 10 was present on admission—yes or no? Is this a compliant query? Why or why not?

Yes. Yes/no queries may be used to established POA status.

A resident physician continually documents “CHF” without further clarification in patients’ medical records. What is the most likely rationale for this documentation practice?

The resident lacks knowledge regarding the need for further clarification

What is the process of collecting data elements from a source document?

Abstracting

If a patient is admitted with pneumococcal pneumonia and severe pneumococcal sepsis, what is the principal diagnosis?

Pneumococcal sepsis

A toddler comes into the hospital admitted from the ED with the following: shortness of breath, wheezing, runny nose, and positive RSV test. The final diagnosis was viral infection upon discharge three days later. What condition should the coding professional query for in this scenario?

Acute bronchiolitis

A patient was admitted to an acute-care facility with a temperature of 102 and atrial fibrillation. A chest x-ray reveals pneumonia with subsequent documentation by the physician of pneumonia in the progress notes and discharge summary. The patient was treated with oral antiarrhythmic
medications and IV antibiotics. What is the correct code sequence?

J18.9, I48.91

I48.91, J18.9

It does not matter which is used as the principal diagnosis.

Not enough information is present. Query the physician

J18.9, I48.91

On which of the following does Medicare inpatient reimbursement depend?

The correct designation of the principal diagnosis

When an organization is transitioning from paper to electronic health records, what source system can function as a bridge?

Electronic document management

A patient underwent a CABG ×2 from aorta to the right anterior descending and right obtuse, using the left greater saphenous vein that was harvested via an open approach. Cardiopulmonary bypass was utilized. The procedural coding and sequencing for the hospitalization would be:

021109W, 06BQ0ZZ, 5A1221Z

A patient is admitted for a cerebral infarction. Residual effects at discharge include aphasia and dysphagia. The patient developed acute diastolic congestive heart failure while admitted and was treated with Lasix in addition to being given Betapace for his long-standing hypertension. Which condition is considered a major complication?

Acute diastolic congestive heart failure

How often are National Correct Coding Initiative (NCCI) edits released?

Quarterly

A patient has a principal diagnosis of pneumonia (J18.9) (MS-DRG 195). Which of the following may legitimately change the coding of the pneumonia in accordance with the UHDDS and relevant clinical documentation?

Patient is found to have dysphagia with aspiration

A patient is admitted for pneumonia. Additionally, the physician has documented that the patient has a history of hypertension and diabetes, which require medication (lisinopril and insulin) while in the hospital, along with a history of migraines and repeated, recent falls. Which of the following diagnoses does not meet the UHDDS definition of additional diagnoses?

G43.909

A patient is admitted for a cerebral infarction. Residual effects at discharge include aphasia and dysphagia. The patient developed acute diastolic congestive heart failure while admitted and was treated with Lasix in addition to being given Betapace for his long-standing hypertension. Which condition meets the definition of comorbidity?

Hypertension

A patient is admitted to an acute-care facility with chest pain. The patient was awakened from sleep by the pain. This was the patient’s first experience with chest pain. The patient was given two nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the diagnosis of new onset unstable angina. Serial creatine phosphokinase was normal. Following a left cardiac catheterization with fluoroscopic angiogram of multiple coronary arteries with low osmolar contrast, the patient is found to have arteriosclerotic coronary artery disease. What ICD-10-CM and PCS codes should be assigned?

I25.110, 4A023N7, B2111ZZ