Deck 5: Coded Data

Question 1

Which organization is NOT one of the four Cooperating Parties for the ICD-10-CM?

A) American Medical Association (AMA)
B) Centers for Medicare and Medicaid Services (CMS)
C) National Center for Health Statistics (NCHS)
D) The Joint Commission (TJC)

Answer 1

American Medical Association (AMA)

Question 2

Which is NOT a common use of coded data?

A) Reimbursement
B) Compliance
C) Scheduling
D) Research

Answer 2

Scheduling

Question 3

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the:

A) reporting of diagnosis data to the National Center for Health Statistics (NCHS).
B) adoption and use of ICD-10-CM.
C) use of the EHR with point-of-care data capture.
D) use of certain codes in electronic transmissions.

Answer 3

use of certain codes in electronic transmissions.

Question 4

Why is electronic data interchange (EDI) beneficial?

A) computers can exchange information without human intervention
B) information can only be "read" by the recipient
C) messages contain unique identifiers that cannot be duplicated
D) it works across reimbursement and clinical platforms

Question 5

What is Accredited Standards Committee (ASC) X12 Version 5010?

A) The code set used in inpatient settings for diagnoses
B) the electronic data interchange (EDI) standard used for electronic versions of the Uniform Bill
C) the name of the latest standard for transactions and code sets
D) the form used to assign procedure codes in ambulatory care

Question 6

Current Procedure Terminology (CPT) is a

A) code set
B) electronic data interchange (EDI)
C) computer language
D) reference manual

Question 7

Current code sets under the Health Insurance Portability and Accountability Act (HIPAA) include all of the following, EXCEPT:

A) SNOMED CT.
B) National Drug Codes.
C) HCPCS and CPT-4.
D) ICD-10-CM and ICD-CM-PCS.

Question 8

A health care organization numbers its site locations not by geographic area or function, but by the order in which the sites were opened. For example, the head office is 001, the primary care physician group practice is 002, the urgent care office on the east side of town is 003, the imaging center is 004, and the urgent care office on the west side of town is 005. What type of coding system is this?

A) map
B) nomenclature
C) classification
D) taxonomy

Question 9

A list of preferred terms and their meanings is a

A) clinical vocabulary
B) nomenclature
C) data dictionary
D) taxonomy

Question 10

Tracking codes to determine the volume of cases seen at the facility is a _____________ use of coded data.

A) outcomes measurement
B) research
C) reimbursement
D) resource utilization

Question 11

The way a code set is organized is its

A) clinical vocabulary
B) nomenclature
C) data dictionary
D) taxonomy

Question 12

0D5N4ZZ Destruction of Sigmoid Colon, Perc Endo Approach, is an example of a code from which code set?

A) ICD-9-PCS
B) ICD-10-PCS
C) SNOMED CT
D) DSM-IV

Question 13

The second character of the code 0DJ86ZZ indicates which of the following?

A) Root Operation
B) Device
C) Body System
D) Approach

Question 14

The 5th character of the code 0DJ76ZZ indicates which of the following?

A) Location
B) Device
C) Body System
D) Approach

Question 15

An example of a CPT-4 (Health Care Common Procedure Coding System [HCPCS] Level 1) code is:

A) C1715
B) 0DJD8ZZ
C) 4557003
D) 43251

Question 16

The first three characters of an ICD-10-CM code represent the code:

A) etiology.
B) severity.
C) category.
D) anatomic site.

Question 17

The NDC code for one 28-tablet bottle of the chronic hepatitis medication Harvoni, made by Gilead Sciences, is 61958-1801-1. The number "61958" is the

A) labeler code
B) product code
C) packaging code
D) batch code

Question 18

Which code set is alphanumeric?

A) ICD-10-PCS
B) NDC
C) CPT-4, Category 1
D) SNOMED CT

Question 19

Which organization does NOT develop, report, or maintain a classification and/or code set for health care purposes?

A) The Joint Commission.
B) the AMA.
C) the American Psychiatric Association (APA).
D) the International Health Terminology Standards Development Organization (IHTSDO).

Question 20

Which statement about SNOMED CT is false?

A) it can assign codes from free text
B) it makes systems interoperable across countries and languages
C) there is a one-to-one translation between SNOMED CT and ICD-10-CM
D) it has the potential to be useful during patient care, rather than after

Question 21

Which classification system is used to track neoplasms?

A) SNOMED CT
B) ICD-10-CM
C) ICD-O
D) CDT

Question 22

The _________ axis of an ICD-O-3 code indicates the site of a neoplasm in the body.

A) morphology
B) oncology
C) topography
D) pathology

Question 23

In an ICD-O-3 code, which part is the behavior code, indicating whether a tumor is malignant, benign, in situ, or uncertain?

A) the first four digits of the morphology axis
B) after the slash on the morphology axis
C) the letter character on the topographical axis
D) the numerical characters on the topographical axis

Question 24

Which is a requirement for a valid ICD-10-CM code?

A) has seven characters
B) begins with a letter character.
C) ends with a letter
D) has a dot

Question 25

A character value of X in the Qualifier position of certain ICD-10-PCS codes indicates a(n):

A) placeholder for the 7th character.
B) biopsy.
C) external approach.
D) device left in the body.

Question 26

In the third character of an ICD-10-PCS code, the main difference between the definitions of the Root Operations excision and resection is:

A) excision involves cutting out of or off, without replacement, all of a body part, while in a resection the body part is replaced.
B) excision involves cutting out of or off, with replacement, all of a body part; while in a resection all of a body part is cut off but no replaced.
C) excision involves cutting out of or off a portion of a body part; a resection involves cutting all of a body part out of or off.
D) excision involves cutting out of or off a portion of a body part, while a resection involves cutting out of or off all of a body part.

Question 27

Using the figure, which is the ICD-10-PCS code for an endoscopic colonoscopy?

A) ODJD8ZZ
B) ODJD7ZZ
C) ODJ68ZZ
D) ODJ67ZZ

Question 28

The auditor was reviewing the hospital bills and noticed that for several cases billed to a commercial payer the DRG assignment, based on the MS-DRG description of the DRG code, did not match the diagnosis/procedure codes. One possible reason for this is:

A) the coder made an error assigning the DRG.
B) the grouper isn't working properly.
C) that payer uses a different DRG than Medicare.
D) the MS-DRG description is incorrect.

Question 29

What is the lowest level of medical complexity represented by CPT E/M codes?

A) straightforward
B) problem-focused
C) low complexity
D) detailed

Question 30

Why might a coding manager automatically review and/or revise patients assigned to DRG 469 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC) or DRG 470 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC)?

A) The hospital might not be entitled to the reimbursement for these DRGs.
B) The federal government always reviews these DRGs for fraud and abuse.
C) There is something incorrect with the codes assigned and/or data when a patient is grouped into either of these DRGs.
D) These DRGs are on the OIG workplan this year.

Question 31

It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must:

A) follow all software prompts that will add a "cc" code. The software program is written so that the coder does not have to review the medical record.
B) use coding software to sequence the best principal diagnosis for the highest reimbursement.
C) code and sequence according to the documentation in the medical record, using the software to optimize the coding.
D) adjust the principle diagnosis as needed to achieve the right DRG for the patient's needs.

Question 32

What software checks ICD-10 codes for age conflicts, such as a newborn jaundice code assigned to a middle-aged man?

A) the Medicare Code Editor (MCE)
B) the grouper
C) the encoder
D) the I-MAGIC algorithm

Question 33

Where does the grouper search for a comorbidity or complication (CC) or major comorbidity or complication (MCC)?

A) principal diagnosis codes
B) secondary diagnosis codes
C) E/M codes
D) SNOMED CT codes

Question 34

Why does the presence of a hospital-acquired condition (HAC) result in lower reimbursement?

A) it is relatively easy to treat
B) it is usually owing to a poor lifestyle choice by the patient
C) it is considered by Medicare to be preventable
D) it occurs mostly in areas with a lower cost of living

Question 35

What trend in the case mix might trigger a CMS audit?

A) an unusually high number of complex cases for a period of time
B) a large number of maternity and newborn cases
C) a decrease in MS-DRG complexity
D) fewer trauma patients

Question 36

A coder or group of coders is said to demonstrate ___________ when codes are consistently assigned for similar or identical cases.

A) reliability
B) validity
C) volume
D) compliance

Question 37

____________ occurs when the coding results in the MS-DRG that most accurately represents the facility's utilization of resources, on the basis of the diagnoses and procedures, and is completely substantiated by documentation.

A) Maximization
B) Validity
C) Optimization
D) Compliance

Question 38

Which is the best way for HIM department managers to determine if charts are being coded at the proper volume?

A) monitoring volume data from coders in the facility over time
B) assuming the coder's role for a day and counting completed charts
C) comparing the volume data in a facility with the same number of beds
D) comparing the volume data in a facility with the same EHR system

Question 39

How does computer-assisted coding (CAC) work?

A) the software scans specific free text and discrete data in the record and assigns codes
B) the coder looks up codes in a database
C) the provider selects codes from a drop-down menu
D) the software creates a diagnosis from vital signs, orders, and physician notes

Question 40

Who audits the coding of Medicare patient records?

A) The Joint Commission
B) Quality Improvement Organizations (QIOs)
C) the state Board of Health
D) the state attorney general

Question 41

Why are coding audits performed by payers insufficient for determining coding accuracy?

A) the payer only checks records for the patients they have reimbursed
B) the payer only performs targeted reviews on "problem" DRGs
C) payers will only audit when there is a change in case mix
D) payers are ultimately more interested in volume rather than accuracy

Question 42

An example of fraudulent and unethical coding is:

A) re-reviewing documentation after initial coding to search for a CC code or MCC code.
B) performing concurrent coding and questioning the physician about documentation prior to patient discharge.
C) assigning codes to the highest degree of specificity documented in the medical record.
D) following software prompts to add CC codes or MCC codes to obtain maximum reimbursement without ensuring corresponding, supporting documentation.

Question 43

You are an auditor reviewing a spreadsheet that shows all of the records for the year in which the patient was on a mechanical ventilator. You are reviewing these records because, in every case, the coder has assigned a procedure code indicating that the patient was on mechanical ventilation for over 96 hours. When queried, the coder remarked that the hospital gets a higher reimbursement for that code than for a lower number of hours. You should:

A) accept the coder's explanation, because it is up to the coder to decide what codes to assign to a case.
B) discuss the finding with the Health Information Management Director as a potential abuse or fraud issue.
C) change some of the procedure codes so at least some of them are under 96 hours.
D) ask the coder to re-review all of the records.

Question 44

The clinical documentation improvement specialist works to improve the specificity of patient documentation:

A) before the patient is admitted
B) during the patient's stay
C) after discharge
D) after a claim is denied

Question 45

In which case would a CDI physician champion be involved?

A) a provider and a clinical documentation improvement specialist disagree on what should be included in the plan of care
B) a nurse is slow to input progress notes
C) a coder adds complications and comorbidities that are unsupported by documentation
D) a provider will not authenticate his verbal orders in a timely manner

Question 46

Structured communication between a clinical documentation improvement (CDI) specialist and a physician is a

A) case mix
B) query
C) E/M code
D) coding compliance plan

Question 47

Which is an appropriate measure of the success of a clinical documentation improvement (CDI) program?

A) a more complex case mix
B) higher reimbursements
C) shorter average length of stay
D) diagnosis documentation changes

Question 48

Coding is the assignment of numeric or _____________ values to diagnosis and procedure descriptions.

Question 49

The law commonly known as ___________________ names standards for transactions and code sets, which are national standards for exchanging health information electronically.

Question 50

Level _____________ of HCPCS is also known as Current Procedural Terminology (CPT).

Question 51

CMS publishes non-patient-identifiable data compiled to provide information about a group called ____________ data that can be used to compare hospital performance.

Question 52

DSM-5 diagnoses are coded using the ICD-10- _______________ code set.

Question 53

The strength, dosage, and formulation of the drug are indicated by the ____________ code, the second segment of the NDC.

Question 54

The I- ________________ algorithm maps SNOMED CT codes to the more specific ICD-10-CM code set.