COC 2023 - FINAL EXAM QUESTIONS W/O CODES (SET 1) QUESTIONS WITH CORRECT ANSWERS

A choledochal cyst is a cyst originating from which structure? - Common bile duct A character's position can be understood as which type of classification that allows different specific values to be inserted into that space, and whose physical position remains stable? - Semi-independent A code from categories Q00-Q99 can be used until the patient reaches what age? Refer to ICD-10-CM guideline I.C.17. - • They can be used throughout the life of the patient unless it has been corrected . A condition where the thyroid is overactive is called: - Thyrotoxicosis A critical access hospital is: - Answer:A facility in a rural area used for hospital inpatient stays, inpatient rehabilitation and psychiatric services, which also offers emergency services Rationale: Medicare beneficiaries in rural areas can receive services from critical access hospitals. CAHs offer 24-hour emergency services seven days a week, hospital inpatient stays, inpatient rehabilitation, and psychiatric services. A cystourethroscopy is examination of what structures? - Bladder and urethra A dacryocystectomy describes: - Excision of the lacrimal sac A deficiency of cells in the blood is defined as: - Cytopenia A facility coder: - Must understand the complete revenue cycle process. Rationale: A facility coder must understand the complete revenue cycle process and the impact the coder's role in the overall success. A gonioscopy is an examination of what part of the eye: - Anterior chamber of the eye A hospital CDM contains the following information: - Department number, CPT®/HCPCS Level II code(s), charge, revenue code, inventory number, description of service Rationale: Typically, a CDM includes the department number/internal control/inventory number, description of services, revenue center (UB revenue code), CPT ®/HCPCS Level II (procedure codes), and charge for service. A hospital has an obligation to provide emergency services to a patient under what federal act? - Emergency Medical Treatment and Active Labor Act A Medicare patient is scheduled for a procedure Medicare deemed as statutorily excluded. The facility asks the patient to sign the ABN, but the patient refuses. The facility bills the patient for the service and the patient refuses to pay. Is the patient liable in this situation? - Yes If yes, why is the patient liable for the bill? When the statute excludes the service, an ABN is not necessary and refusal to sign the ABN does not exempt the patient from payment responsibility. A Medicare patient was to undergo a procedure based on a diagnosis that was not medically necessary for Medicare reimbursement. The surgery technician presented the ABN appropriately to the patient, but the patient refused to sign the ABN. The surgery technician documented on the ABN that the patient refused to sign. The technician asked the nurse to witness the patient's refusal to sign. The patient insisted on undergoing the procedure and the surgeon agreed to perform the service. Medicare denied the claim because the diagnosis did not support medical necessity for the service. What is the most appropriate action? - The hospital may bill the patient and collect the full amount of the bill. A Medicare secondary payer ensures: - Medicare payment for items or services is prohibited if payment can be paid by another payer under certain conditions. A meningioma is defined as: - Tumor of the meninges A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: - Prostate A patient arrives at the ED after being involved in an automobile accident. She has multiple lacerations, a contusion on her head, and a sprained ankle. The laceration repair and a level 3 ED visit are reported. Is a modifier necessary? If yes, why? - Yes. Modifier 25 is required on the ED visit to indicate it was separately identifiable from the laceration repair. A patient presented to the hospital outpatient pulmonary clinic for asthma follow-up. During the encounter, the physician performed an expanded problem focused history and exam with moderate decision making for this established patient. The documentation supported a low-level E/M for the facility. Later in the evening, the patient suffered an acute asthma attack and went to the ER in the same hospital for treatment. What modifier is used to indicate multiple E/M services occurred on the same date? - 27 A patient presents to the hospital-based clinic in her 15th week of pregnancy with cramping, cervix dilated to 2 cm, and a bulging amniotic sac. The physician confirms a spontaneous abortion is inevitable and decides to manage the patient expectantly with monitoring. How is this coded? - An appropriate E/M code A patient underwent a high cost procedure in urban Vermont. The charge for the procedure was $12,000. The procedure performed was a reconstruction of an elbow joint. The APC payment rate for this procedure is $3,450.00. Does this procedure qualify for an outlier payment? - NO If yes, what is the outlier payment? If no, why does it not qualify?;$12,000 x .454 = $5,448 (.426 = $5112);$3,450 x 1.75 = $6037.5;$4,325 + $3,775 = $8100 Total Exceeds A patient was brought into the ED following accident. The Pt suffered a humerus fracture, which required care and is reported with CPT 23620 (APC assignement of 5111 w/a status indictor of T). The Pt also suffered a break to the forearm and a cast was applied to provide support until th ePt could be seen by an orthopedic surgeon for potential surgery. The CPT code reported was 29075 (APC assignment of 5102 with a status indicator of T). How will the procedures be reimbursed under the OPPS? - 29075 (status indicator T) will be reimbursed 100%, 23620 (status indictor T) will be reduced by 50%) A patient was seen in the physician's office and was directly referred to Observation with atrial fibrillation. Decision was made to perform cardioversion (92960 status indicator S), but minutes before defibrillation, the patient went into normal sinus rhythm. After 3 hours in Observation the decision was then made to admit the patient for 2 days for monitoring to test the effectiveness of a new oral medication for atrial fibrillation. Report the CPT ® code(s) and ICD-10-CM code for the outpatient facility. - No outpatient facility charges are filed A pregnant patient presents to the ED with bleeding, cramping, and concerns of loss of tissue and material vaginally. On examination, the physician discovers an open cervical (os) with no products of conception seen. He tells the patient she has had an abortion. What type of abortion has occurred? - Spontaneous A procedure requiring the physician to cut down to the superficial fascia is documented as cutting down into the: - Hypodermis A projection is the path of the X-ray beam. If the projection is frong to back it would be: - Anteroposterior A Pt was admitted to the hospital with abdominal pain, nausea and vomiting, fever, and rule out acute pancreatitis. After extensive workup, no pancreatitis was found and the Pt was DC. What is the principle DX for this Pt? - Acute pancreatitis A routine ABN is appropriate for patients who return to the facility more than once. - False A septal dermatoplasty is: - Removal of diseased internasal mucosa and replacement with a graft A statement is sent to the patient as soon as: - Payments are posted and denials are resolved. Rationale: After the business office receives an explanation of benefits (EOB), the claim payment and contractual adjustments are posted and then a statement is mailed to the patient for the amount determined to be patient responsibility. A status indicator of S indicates: - The procedure is paid under OPPS and is not discounted. A surgeon performed a radical mastectomy on the right breast for a 42- year-old woman. The patient requested a permanent prosthesis in the recovery room. The surgeon decided to take the patient back to the operating room later that day and the prosthesis was inserted in the right breast. What modifier should the facility use? - 58 A surgeon places a self-retaining indwelling ureteral stent following a cystourethroscopic procedure. Later in the evening, due to complications, the patient returns to the OR for removal of the stent by the same surgeon. Select the appropriate modifier for the stent removal. - 78 A surgical procedure creating an opening into the jejunum is defined as a: - Jejunostomy A teaching physician's participation in the patient's care can be documented in the patient's medical chart by: - The physician, resident, or the nurse A type A emergency department includes: - Answer: 24-hours per day, seven days a week access for patient requiring immediate or urgent care Rationale: Type A Emergency Departments are open 24 hours per day, seven days per week for immediate, urgent, and emergent care. Abducens - Controls movement of the lateral rectus muscle of the eye, one of the six muscles of the eyeball Accessory - Responsible for shoulder movements, head rotation, swallowing, visceral move-ments, and voice production According to ICD-10-CM guildelines, when a Pt is seen for management of anemia due to malignancy, how is it reported? - The malignancy is reported first, followed by the code for anemia According to Medicare guidelines, dictated notes must be _________ by the physician before they are placed in the patient's chart. - According to Medicare guidelines, dictated notes must be _________ by the physician before they are placed in the patient's chart. According to the Conditions of Participation (CoP), medical records must be retained in their original or legally reproduced form for a period of at least: - Five years According to the ICD-10-CM guidelines, how is bilateral glaucoma of the same type and stage reported? - A bilateral code can be used to report the type of glaucoma and the stage of glaucoma. According to The Joint Commission's dangerous abbreviation list, which abbreviation is considered to be a dangerous abbreviation and why? - U; can be mistaken for cc.