RHIT Exam Review Domain 4: Questions & Answers
The accounts not selected for the billing report is a daily report used to track accounts that are:
a. Awaiting payment in accounts receivable
b. Paid at different rates
c. In bill hold or in error and awaiting billing
d. Pulled for quality review - ANSWER:c. In bill hold or in error and awaiting billing
The accounts not selected for billing report is a daily report used to track the many reasons that accounts
may not be ready for billing. This report is also called the discharged not final billed (DNFB) report.
Accounts that have not met all facility-specified criteria for billing are held and reported on this daily
tracking list. Some accounts are held because the patient has not signed the consents and authorizations
required by the insurer. Still others are not billed because the primary and secondary insurance benefits
have not been confirmed .
Which of the following is a function of the outpatient code editor?
a. Validate the patient's age on a claim
b. Validate the patient's encounter number
c. Identify unbundling of codes
d. Identify cases that don't meet medical necessity - ANSWER:c. Identify unbundling of codes
The latest version of the Medicare integrated outpatient code editor (OCE) should be installed to review
claims prior to releasing billed data to the Medicare program. OCE software contains the National
Correct Coding Initiative (NCCI) edits for Current Procedural Terminology (CPT). The NCCI edits were
created to evaluate the relationships between CPT codes on the bill and to control improper coding
leading to inappropriate payment and unbundling on the Part B claims. They also identify component
codes that were used instead of the appropriate comprehensive code, as well as other types of coding
errors.
A patient is admitted for the treatment of dehydration secondary to chemotherapy for primary liver
cancer. Intravenous (IV) fluids were administered to the patient. Which of the following should be
sequenced as the principal diagnosis?
,a. Dehydration
b. Chemotherapy
c. Liver carcinoma
d. Complication of chemotherapy - ANSWER:a. Dehydration
When the admission or encounter is for management of dehydration due to the malignancy and only the
dehydration is being treated, the dehydration is sequenced first, followed by the code(s) for the
malignancy.
The first step in an inpatient record review is to verify correct assignment of the:
a. Record sample
b. Coding procedures
c. Principal diagnosis
d. MS-DRG - ANSWER:c. Principal diagnosis
To begin the review, the coding supervisor checks the inpatient health record to ensure that the
diagnosis billed as principal meets the official Uniform Hospital Discharge Data Set (UHDDS) definition
for principal diagnosis. The principal diagnosis must have been a principal reason for admission, and the
patient received treatment or evaluation during the stay. When several diagnoses meet all of those
requirements, any of them could be selected as the principal diagnosis.
A patient was seen in the emergency department for chest pain. It was suspected that the patient may
have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out GERD." The correct ICD-
10-CM diagnosis code is:
a. K21.9, Gastro-esophageal reflux disease without esophagitis
b. R07.9, Chest pain, unspecified
c. R10.11, Right upper quadrant pain
d. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out - ANSWER:b.
R07.9, Chest pain, unspecified
Because this patient was seen only in the emergency department, he or she would be classified as an
outpatient. Diagnoses documented as "probable," "suspected," "questionable," "rule out," or "working
diagnosis" or other similar terms in the outpatient setting indicate uncertainty and would not be coded
, as if existing. Rather, code the condition to the highest degree of certainty for that encounter or visit,
such as signs, symptoms, abnormal test results, or other reason for the visit. In this case, unspecified
chest pain would be coded.
A patient received a complete replacement of tunneled centrally inserted central venous catheter with
subcutaneous port; replacement performed through original access site (45-year-old patient). Which of
the following CPT codes would be most appropriate?
36578 - Replacement, catheter only, of central venous access device, with subcutaneous port or pump,
central or peripheral insertion site
36580 - Replacement, complete, on a non-tunneled centrally inserted central venous catheter, without
subcutaneous port or pump, through same venous access
36582 - Replacement, complete, of a tunneled centrally inserted central venous access device, with
subcutaneous port, through same venous access
36597 - Repositioning of previous placed central venous catheter under fluoroscopic guidance
a. 36578
b. 36580
c. 36582, 36597
d. 36582 - ANSWER:d. 36582
A complete replacement of the entire device by the same venous access site is being performed. It is a
tunneled catheter inserted within the same venous access point. Code 36582 is the correct code.
A laparoscopic tubal ligation is undertaken. Which of the following is the correct CPT code assignment?
49320 - Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
58662 - Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or
peritoneal surface by any method
The accounts not selected for the billing report is a daily report used to track accounts that are:
a. Awaiting payment in accounts receivable
b. Paid at different rates
c. In bill hold or in error and awaiting billing
d. Pulled for quality review - ANSWER:c. In bill hold or in error and awaiting billing
The accounts not selected for billing report is a daily report used to track the many reasons that accounts
may not be ready for billing. This report is also called the discharged not final billed (DNFB) report.
Accounts that have not met all facility-specified criteria for billing are held and reported on this daily
tracking list. Some accounts are held because the patient has not signed the consents and authorizations
required by the insurer. Still others are not billed because the primary and secondary insurance benefits
have not been confirmed .
Which of the following is a function of the outpatient code editor?
a. Validate the patient's age on a claim
b. Validate the patient's encounter number
c. Identify unbundling of codes
d. Identify cases that don't meet medical necessity - ANSWER:c. Identify unbundling of codes
The latest version of the Medicare integrated outpatient code editor (OCE) should be installed to review
claims prior to releasing billed data to the Medicare program. OCE software contains the National
Correct Coding Initiative (NCCI) edits for Current Procedural Terminology (CPT). The NCCI edits were
created to evaluate the relationships between CPT codes on the bill and to control improper coding
leading to inappropriate payment and unbundling on the Part B claims. They also identify component
codes that were used instead of the appropriate comprehensive code, as well as other types of coding
errors.
A patient is admitted for the treatment of dehydration secondary to chemotherapy for primary liver
cancer. Intravenous (IV) fluids were administered to the patient. Which of the following should be
sequenced as the principal diagnosis?
,a. Dehydration
b. Chemotherapy
c. Liver carcinoma
d. Complication of chemotherapy - ANSWER:a. Dehydration
When the admission or encounter is for management of dehydration due to the malignancy and only the
dehydration is being treated, the dehydration is sequenced first, followed by the code(s) for the
malignancy.
The first step in an inpatient record review is to verify correct assignment of the:
a. Record sample
b. Coding procedures
c. Principal diagnosis
d. MS-DRG - ANSWER:c. Principal diagnosis
To begin the review, the coding supervisor checks the inpatient health record to ensure that the
diagnosis billed as principal meets the official Uniform Hospital Discharge Data Set (UHDDS) definition
for principal diagnosis. The principal diagnosis must have been a principal reason for admission, and the
patient received treatment or evaluation during the stay. When several diagnoses meet all of those
requirements, any of them could be selected as the principal diagnosis.
A patient was seen in the emergency department for chest pain. It was suspected that the patient may
have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out GERD." The correct ICD-
10-CM diagnosis code is:
a. K21.9, Gastro-esophageal reflux disease without esophagitis
b. R07.9, Chest pain, unspecified
c. R10.11, Right upper quadrant pain
d. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out - ANSWER:b.
R07.9, Chest pain, unspecified
Because this patient was seen only in the emergency department, he or she would be classified as an
outpatient. Diagnoses documented as "probable," "suspected," "questionable," "rule out," or "working
diagnosis" or other similar terms in the outpatient setting indicate uncertainty and would not be coded
, as if existing. Rather, code the condition to the highest degree of certainty for that encounter or visit,
such as signs, symptoms, abnormal test results, or other reason for the visit. In this case, unspecified
chest pain would be coded.
A patient received a complete replacement of tunneled centrally inserted central venous catheter with
subcutaneous port; replacement performed through original access site (45-year-old patient). Which of
the following CPT codes would be most appropriate?
36578 - Replacement, catheter only, of central venous access device, with subcutaneous port or pump,
central or peripheral insertion site
36580 - Replacement, complete, on a non-tunneled centrally inserted central venous catheter, without
subcutaneous port or pump, through same venous access
36582 - Replacement, complete, of a tunneled centrally inserted central venous access device, with
subcutaneous port, through same venous access
36597 - Repositioning of previous placed central venous catheter under fluoroscopic guidance
a. 36578
b. 36580
c. 36582, 36597
d. 36582 - ANSWER:d. 36582
A complete replacement of the entire device by the same venous access site is being performed. It is a
tunneled catheter inserted within the same venous access point. Code 36582 is the correct code.
A laparoscopic tubal ligation is undertaken. Which of the following is the correct CPT code assignment?
49320 - Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
58662 - Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or
peritoneal surface by any method
