Medical Billing/Medical Coding

ICD-10 codes are used:

a) as procedure codes

b) in DRGs

c) as diagnosis codes

d) all of the above

d) all of the above

For urosepsis, what should the coder do?

query the provider

Stacey finds a particularly scandalous story told in the patient's medical record, filled with plot twists and jealous neighbors and occasional commentary on the situation by the patient's physician. She calls her supervisor over to see the drastic outcome (and the reason the patient is in the hospital). Is this allowed, per HIPAA? Why or why not?

No, because it violates the Privacy rule

the HIPAA Privacy rule states that the employees must only access the __________ amount of protected health information necessary to do their jobs.

Minimum

Which of the following organizations are not a covered entity under HIPAA?

a) health plans

b) billing companies

c) nursing homes

d) clearinghouse

b) billing companies

Billing companies are not considered covered entities under HIPAA. Instead they are considered ________.

business entities

If a patient is seen for an HIV-related condition, then _______ is coded first, then the complications.

B20 Human immunodeficiency virus [HIV] disease

To use the code B20, does the document need to state that the patient tested positive for HIV?

No, only the provider’s statement that the patient has HIV is needed, not a positive lab test.

What icd-10-cm code is to be assigned when the provider documents “smoker”, but gives no further clarification?

F17.200 Nicotine dependence, unspecified, uncomplicated

ICD-10-CM guidelines state that there is a _______ relationship assumed between chronic kidney disease (CKD) and hypertension unless stated otherwise.

Causal

A patient presents to the operating room with chronic pelvic pain and left renal vein impingement. The surgeon performs a renal to ovarian transposition to relieve the pressure. What is the correct code assignment?

37799 Unlisted procedure, vascular surgery

True or false: when a physician excises a cyst and then repairs the wound, the repair is included in the the procedure for the cyst excision

True

The Breach Notification Rule, found in the Omnibus Rule of HIPAA states that when ______ individuals have had their confidential data exposed and the covered entity has outdated contact information for them, that the covered entity must ______ for ______ days

Less than 500 individuals but more than 10, post a notice on their website for 90 days

Sally calls the coding department to contest the duplicate procedures that her adult sister received while admitting to an inpatient mental health facility. Sally has her sister’s date of birth, her name, but not her ID number. She says her sister is too depressed to advocate for herself and Sally just wants the charges reviewed. Do you need written or oral consent from the sister first in order to talk to Sally?

No, under HIPAA, providers are allowed to discuss PHI with family members if they determine it is in the patient’s best interest for coordination of treatment or payment, unless the patient has expressed wishes that their info is not shared with family.

What are facility payments based on?

the Inpatient Prospective Payment System (IPPS) using Diagnosis-Related Group(s) (DRGs)

Will pressure ulcers, catheter-associated urinary tract infections, falls and head trauma, DVTs and pulmonary embolisms be reimbursed? Why or why not?

No because they are hospital-acquired conditions.

Relative Value Units (RVUs) are multiplied with ________, which gives you the amount payable for a provider’s fee schedule

Conversion factors

Medicare reimburses Skilled Nursing Facilities based on _______.

Per Diem

For Medicare’s OPPS (Outpatient Prospective Payment System), what does the payment status indicator C indicate?

The HCPCS is only performed in inpatient settings.

Risk Adjustment payment involves payments between these following entities

Medicare, Medicaid, and Third-party insurance

What is an outlier cost?

A hospital (either outpatient or inpatient) discharge or procedure that is more expensive than other similar cases

What circumstance would indicate a payment over the usual IPPS (Inpatient Prospective Payment System) reimbursement amount?

Outlier costs

What is the condition established after study to be chiefly responsible for patient’s admission to the hospital called?

Principal diagnosis

The term principal diagnosis is specifically used for ______ settings.

Inpatient

CMS requires that the patient’s history and physical be completed and documented in the patient’s record within ______ hours of admission or not greater than _____ days before admission.

24; 30

What components create a patient’s history?

Chief Complaint, History of Present Illness, Review of Systems, Past Family and Social History

______ were prohibited by CMS in 2015 for provider authentication

Rubber stamps

An _______ takes place when a qualitative analysis of the patient’s record is done while the patient is in active treatment.

Open-record review

_______ covers all data elements that home health organizations must collect and report to CMS. This information includes patient’s skin conditions, diagnoses, bowel status, cognitive patterns, mood and behavior, and medications.

OASIS

If a physician wants to make a correction to the patient’s medical record, what must he or she do in order to correctly make a correction to the medical record?

He or she must indicate the incorrect information with a single strikethrough and sign off on an addendum that contains the correct information

What is an electronic signature at the end of the provider’s note which locks the health record called?

Authentication

What is the difference between an EHR (Electronic Health Record) and an EMR (electronic medical record)?

EHRs are able to communicate with other systems, but EMRs are not

_________ is the global standard for clinicians and is used to define terms in EHRs (Electronic health records) around the world

Systemized Nomenclature of Medicine—Clinical Terminology (SNOMED CT)

Implemented in 2012, what standard changed the way that Protected Health Information (PHI) was submitted electronically?

ASC X12 5010

What might a coder use on a daily basis to access health information?

Virtual Desktop Infrastructure

_______ is storing a database online instead of a location. This is an EHR that stores all information about patients on an online database.

Cloud computing

Is the use of modifier -25 on a minor evaluation and management service that is coded with a related procedure an acceptable or fraudulent practice?

Fraudulent

Physician queries must be:

non-leading, not based on reimbursement, for the purpose of improving patient care and open-ended, or Yes/No questions.

_______ happens when a physician or another lab bills for services not performed directly by the credentialed providers often on behalf of a non-contracted healthcare partner.

pass-through billing

What is the best place to learn about the most up-to-date rules and regulations that have been recently passed concerning healthcare?

The Federal Register

According to the OIG-issued General Compliance Program Guidance effective November 2023, what should be included in the compliance committee charter for a small entity?

A statement of meeting frequency

Are consultations initiated by a patient of family reported using the consultation codes?

No

Which of the following conditions may be documented by a clinician other than the patient’s provider?

a) elevated blood pressure

b) obesity

c) laterality

d) nonpressure ulcer

c) laterality

When listing both CPT and HCPCS modifiers on a claim, which modifier do you list first?

The CPT modifier

The midsagittal plane refers to what part of the body?

The middle

What organ system does the spleen belong to?

Hemic and lymphatic

Teres is one of the six major _______ muscles

scapulohumeral

Which act applies to situations where health privacy and employer/employee relationships intersect?

Americans with Disabilities Act

Where is the rope like structure called the tunica vaginalis located?

The male reproductive system

What document should providers review every year to identify potential problems areas?

OIG Work Plan

What does the Excludes 1 note mean?

Not coded here

When coding the placement of a catheter in the right middle artery, should the case be coded where the line begins (the insertion) or where the line ends up?

Beginning

What services do wound exploration codes cover?

Exploration, including enlargement, debridement, removal of foreign bodies, minor vessel ligation, and repair

When must ABNs be signed?

Before the service or procedure is provided to the patient

Which one of the following is an example of a case in which a diabetes-related problem exists and the code for diabetes is never sequenced first?

if the patient has an underdose of insulin due to an insulin pump malfunction

The patient health status modifiers (P1-P6) always appear at the _____ of an anesthesiology modifier sequence.

End