AHIMA RHIT STUDY GUIDE 2025/2026 QUESTIONS AND
SOLUTION RATED A+
✔✔The utilization manager's role is essential to:
a. Analyze the estimate of benefits (EOBs) received
b. Capture all relevant charges for the patient's account
c. Prevent denials for inappropriate levels of service
d. Verify the patient has insurance - ✔✔c. Prevent denials for inappropriate levels of
service
✔✔Local coverage determinations (LCD) describe when and under what circumstances
which of the following is met:
a. MACs
b. Medical necessity
c. NCDs
d. Proper administration of benefits - ✔✔b. Medical necessity
✔✔A physician correctly prescribes Coumadin. The patient takes the Coumadin as
prescribed but develops hematuria as a result of taking the medication. Which of the
following is the correct way to code this case?
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria; poisoning due to Coumadin
d. Hematuria; adverse reaction to Coumadin - ✔✔d. Hematuria; adverse reaction to
Coumadin
✔✔City Hospital's Revenue Cycle Management team has established the following
benchmarks: (1) The value of discharged not final billed cases should not exceed two
days of average daily revenue, and (2) AR days are not to exceed 60 days. The net
average daily revenue is $1,000,000. The following data indicate that City Hospital's
DNFB cases met its benchmarks:
a. 25 percent of the time
b. 50 percent of the time
c. 75 percent of the time
d. 100 percent of the time
Register - ✔✔b. 50 percent of the time
✔✔The hospital-acquired conditions provision of the Medicare PPS is an example of
which type of value-based purchasing system?
a. Paying for value
,b. Penalty based
c. Reward based
d. Penalty for value - ✔✔a. Paying for value
✔✔Unbundling refers to:
a. Use of a comprehensive code to appropriately maximize reimbursement
b. Use of multiple procedure codes when a comprehensive code is available
c. Combined billing for pre- and postsurgery physician services
d. Using the incorrect DRG code - ✔✔b. Use of multiple procedure codes when a
comprehensive code is available
✔✔A patient is scheduled for an outpatient colonoscopy, but due to a sudden drop in
blood pressure, the procedure is canceled just as the scope is introduced into the
rectum. Because of moderately severe mental retardation, the patient is given general
anesthetic prior to the procedure. How should this procedure be coded?
a. Assign the code for colonoscopy with modifier −74, Discontinued outpatient
procedure after anesthesia administration.
b. Assign the code for a colonoscopy with modifier −52, Reduced services.
c. Assign no code because no procedure was performed.
d. Assign an anesthesia code only. - ✔✔a. Assign the code for colonoscopy with
modifier −74, Discontinued outpatient procedure after anesthesia administration.
✔✔According to CPT, an endoscopy that is undertaken to the level of the midtransverse
colon would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy - ✔✔c. Colonoscopy
✔✔All of the following are steps in medical necessity and utilization review, except:
a. Initial clinical review
b. Peer clinical review
c. Access consideration
d. Appeals consideration - ✔✔c. Access consideration
✔✔When reporting an encounter for a patient who is HIV positive but has never had
any symptoms, the following code is assigned:
a. B20, Human immunodeficiency virus [HIV] disease
b. Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
c. R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV]
, d. Z20.6, Contact with and (suspected) exposure to human immunodeficiency virus
[HIV] - ✔✔b. Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
✔✔The coder assigned separate codes for individual tests when a combination code
exists. This is an example of which of the following?
a. Upcoding
b. Complex coding
c. Query
d. Unbundling - ✔✔d. Unbundling
✔✔When a service is not considered medically necessary based on the reason for
encounter, the patient should be provided with a(n) ________ indicating that Medicare
might not pay and that the patient might be responsible for the entire charge.
a. OIG
b. ABN
c. LOS
d. EOB - ✔✔b. ABN
✔✔Which of the following would be classified in ICD-10-CM with an external cause
code?
a. Echocardiogram
b. Fall from curb
c. Adenocarcinoma
d. Admission for plastic surgery - ✔✔b. Fall from curb
✔✔An alternative to the retrospective coding model is the __________ coding model in
which records are coded while the patient is still an inpatient.
a. Concurrent
b. Analytical
c. Prospective
d. Auxiliary - ✔✔a. Concurrent
✔✔If a patient has an excision of a malignant lesion of the skin, the CPT code is
determined by the body area from which the excision occurs and which of the following?
a. Length of the lesion as described in the pathology report
b. Dimension of the specimen submitted as described in the pathology report
c. Width times the length of the lesion as described in the operative report
d. Diameter of the lesion as well as the margins excised as described in the operative
report - ✔✔d. Diameter of the lesion as well as the margins excised as described in the
operative report
SOLUTION RATED A+
✔✔The utilization manager's role is essential to:
a. Analyze the estimate of benefits (EOBs) received
b. Capture all relevant charges for the patient's account
c. Prevent denials for inappropriate levels of service
d. Verify the patient has insurance - ✔✔c. Prevent denials for inappropriate levels of
service
✔✔Local coverage determinations (LCD) describe when and under what circumstances
which of the following is met:
a. MACs
b. Medical necessity
c. NCDs
d. Proper administration of benefits - ✔✔b. Medical necessity
✔✔A physician correctly prescribes Coumadin. The patient takes the Coumadin as
prescribed but develops hematuria as a result of taking the medication. Which of the
following is the correct way to code this case?
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria; poisoning due to Coumadin
d. Hematuria; adverse reaction to Coumadin - ✔✔d. Hematuria; adverse reaction to
Coumadin
✔✔City Hospital's Revenue Cycle Management team has established the following
benchmarks: (1) The value of discharged not final billed cases should not exceed two
days of average daily revenue, and (2) AR days are not to exceed 60 days. The net
average daily revenue is $1,000,000. The following data indicate that City Hospital's
DNFB cases met its benchmarks:
a. 25 percent of the time
b. 50 percent of the time
c. 75 percent of the time
d. 100 percent of the time
Register - ✔✔b. 50 percent of the time
✔✔The hospital-acquired conditions provision of the Medicare PPS is an example of
which type of value-based purchasing system?
a. Paying for value
,b. Penalty based
c. Reward based
d. Penalty for value - ✔✔a. Paying for value
✔✔Unbundling refers to:
a. Use of a comprehensive code to appropriately maximize reimbursement
b. Use of multiple procedure codes when a comprehensive code is available
c. Combined billing for pre- and postsurgery physician services
d. Using the incorrect DRG code - ✔✔b. Use of multiple procedure codes when a
comprehensive code is available
✔✔A patient is scheduled for an outpatient colonoscopy, but due to a sudden drop in
blood pressure, the procedure is canceled just as the scope is introduced into the
rectum. Because of moderately severe mental retardation, the patient is given general
anesthetic prior to the procedure. How should this procedure be coded?
a. Assign the code for colonoscopy with modifier −74, Discontinued outpatient
procedure after anesthesia administration.
b. Assign the code for a colonoscopy with modifier −52, Reduced services.
c. Assign no code because no procedure was performed.
d. Assign an anesthesia code only. - ✔✔a. Assign the code for colonoscopy with
modifier −74, Discontinued outpatient procedure after anesthesia administration.
✔✔According to CPT, an endoscopy that is undertaken to the level of the midtransverse
colon would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy - ✔✔c. Colonoscopy
✔✔All of the following are steps in medical necessity and utilization review, except:
a. Initial clinical review
b. Peer clinical review
c. Access consideration
d. Appeals consideration - ✔✔c. Access consideration
✔✔When reporting an encounter for a patient who is HIV positive but has never had
any symptoms, the following code is assigned:
a. B20, Human immunodeficiency virus [HIV] disease
b. Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
c. R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV]
, d. Z20.6, Contact with and (suspected) exposure to human immunodeficiency virus
[HIV] - ✔✔b. Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
✔✔The coder assigned separate codes for individual tests when a combination code
exists. This is an example of which of the following?
a. Upcoding
b. Complex coding
c. Query
d. Unbundling - ✔✔d. Unbundling
✔✔When a service is not considered medically necessary based on the reason for
encounter, the patient should be provided with a(n) ________ indicating that Medicare
might not pay and that the patient might be responsible for the entire charge.
a. OIG
b. ABN
c. LOS
d. EOB - ✔✔b. ABN
✔✔Which of the following would be classified in ICD-10-CM with an external cause
code?
a. Echocardiogram
b. Fall from curb
c. Adenocarcinoma
d. Admission for plastic surgery - ✔✔b. Fall from curb
✔✔An alternative to the retrospective coding model is the __________ coding model in
which records are coded while the patient is still an inpatient.
a. Concurrent
b. Analytical
c. Prospective
d. Auxiliary - ✔✔a. Concurrent
✔✔If a patient has an excision of a malignant lesion of the skin, the CPT code is
determined by the body area from which the excision occurs and which of the following?
a. Length of the lesion as described in the pathology report
b. Dimension of the specimen submitted as described in the pathology report
c. Width times the length of the lesion as described in the operative report
d. Diameter of the lesion as well as the margins excised as described in the operative
report - ✔✔d. Diameter of the lesion as well as the margins excised as described in the
operative report
