RHIT Domain 4 Practice Questions Verified Solutions
1. When analyzing changes in a hospital's Medicare case-mix index over time, what level of detail should
the analyst start with?
Answer: MS-DRG triples, pairs, and singles.
2. What is the term that means evaluating the appropriateness of the setting for the healthcare service
and the level of service?
Answer: Utilization review.
3. To determine if present on admission (POA) indicators for certain conditions are having a negative
impact on a hospital's Medicare reimbursement, which action would be best?
Answer: Identify all records for a period that have these indicators for these conditions and determine
whether or not additional documentation can be submitted to Medicare to increase reimbursement.
4. Which of the following could be considered a comorbid condition for a patient admitted with acute
lower abdominal pain and diagnosed with acute appendicitis?
Answer: Diabetes.
5. A coding audit shows that an inpatient coder is using multiple codes that describe individual
components of a procedure rather than using a single code that describes all the steps of the procedure
performed. What should be done in this case?
Answer: Counsel the coder and stop the practice immediately.
6. What are diagnosis-related groups (DRGs) organized into?
,Answer: Major diagnostic categories.
7. NCCI edits prevent improper payments in which of the following cases?
Answer: Incorrect code combinations are on the claim.
8. What is the basis for Medicare inpatient reimbursement levels?
Answer: MS-DRG calculated for the encounter.
9. Calculate the CMI for Dr. Green, who discharged 30 patients from Medicine Service during the month
of August, given the table presenting the number of patients discharged by MS-DRG.
Answer: Total Wt. Answers: 33.4466; Total patients: 30.
10. A physician query may not be appropriate in which of the following instances?
Answer: Acute respiratory failure in a patient whose lab report findings appear not to support this
diagnosis.
11. What codes would be assigned for a 54-year-old patient seen with a high fever, chest pain, and a
cough, with Gram stain showing staphylococcus and physician documentation of staphylococcal
pneumonia?
Answer: J15.20 Pneumonia due to staphylococcus, unspecified.
12. If a patient has an excision of a malignant lesion of the skin, how is the CPT code determined?
Answer: By body area from which the excision occurs and diameter of lesion as well as margins excised
as described in operative report.
, 13. The present on admission indicator is a requirement for:
Answer: Inpatient Medicare claims submitted by hospitals.
14. What would be the correct coding and sequencing for a patient admitted with nausea, vomiting, and
abdominal pain, with discharge summary indicating acute cholecystitis?
Answer: Acute cholecystitis; nausea; vomiting; abdominal pain.
15. What would be the correct coding and sequencing for a patient admitted with abdominal pain,
diarrhea, chronic obstructive pulmonary disease, and angina?
Answer: Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina
An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, Liguria, and elevated
WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending
physician documents “urosepsis.” How should this case be coded?
Code sepsis as the principal diagnosis with urinary tract infection due to E. Coli as a secondary diagnosis.
Code urinary tract infection with sepsis as the principal diagnosis.
Query the physician to ask if the patient has septicemia because of the symptomatology.
Query the physician to ask if the patient had septic shock so that this may be used as the principal
diagnosis.
Query the physician to ask if the patient has septicemia because of the symptomatology.
The practice of using a code that results in a higher payment to the provider than the code that actually
reflects the service or item provided is known as:
Unbundling
Billing for services not provided
Medically unnecessary services
Upcoding
1. When analyzing changes in a hospital's Medicare case-mix index over time, what level of detail should
the analyst start with?
Answer: MS-DRG triples, pairs, and singles.
2. What is the term that means evaluating the appropriateness of the setting for the healthcare service
and the level of service?
Answer: Utilization review.
3. To determine if present on admission (POA) indicators for certain conditions are having a negative
impact on a hospital's Medicare reimbursement, which action would be best?
Answer: Identify all records for a period that have these indicators for these conditions and determine
whether or not additional documentation can be submitted to Medicare to increase reimbursement.
4. Which of the following could be considered a comorbid condition for a patient admitted with acute
lower abdominal pain and diagnosed with acute appendicitis?
Answer: Diabetes.
5. A coding audit shows that an inpatient coder is using multiple codes that describe individual
components of a procedure rather than using a single code that describes all the steps of the procedure
performed. What should be done in this case?
Answer: Counsel the coder and stop the practice immediately.
6. What are diagnosis-related groups (DRGs) organized into?
,Answer: Major diagnostic categories.
7. NCCI edits prevent improper payments in which of the following cases?
Answer: Incorrect code combinations are on the claim.
8. What is the basis for Medicare inpatient reimbursement levels?
Answer: MS-DRG calculated for the encounter.
9. Calculate the CMI for Dr. Green, who discharged 30 patients from Medicine Service during the month
of August, given the table presenting the number of patients discharged by MS-DRG.
Answer: Total Wt. Answers: 33.4466; Total patients: 30.
10. A physician query may not be appropriate in which of the following instances?
Answer: Acute respiratory failure in a patient whose lab report findings appear not to support this
diagnosis.
11. What codes would be assigned for a 54-year-old patient seen with a high fever, chest pain, and a
cough, with Gram stain showing staphylococcus and physician documentation of staphylococcal
pneumonia?
Answer: J15.20 Pneumonia due to staphylococcus, unspecified.
12. If a patient has an excision of a malignant lesion of the skin, how is the CPT code determined?
Answer: By body area from which the excision occurs and diameter of lesion as well as margins excised
as described in operative report.
, 13. The present on admission indicator is a requirement for:
Answer: Inpatient Medicare claims submitted by hospitals.
14. What would be the correct coding and sequencing for a patient admitted with nausea, vomiting, and
abdominal pain, with discharge summary indicating acute cholecystitis?
Answer: Acute cholecystitis; nausea; vomiting; abdominal pain.
15. What would be the correct coding and sequencing for a patient admitted with abdominal pain,
diarrhea, chronic obstructive pulmonary disease, and angina?
Answer: Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina
An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, Liguria, and elevated
WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending
physician documents “urosepsis.” How should this case be coded?
Code sepsis as the principal diagnosis with urinary tract infection due to E. Coli as a secondary diagnosis.
Code urinary tract infection with sepsis as the principal diagnosis.
Query the physician to ask if the patient has septicemia because of the symptomatology.
Query the physician to ask if the patient had septic shock so that this may be used as the principal
diagnosis.
Query the physician to ask if the patient has septicemia because of the symptomatology.
The practice of using a code that results in a higher payment to the provider than the code that actually
reflects the service or item provided is known as:
Unbundling
Billing for services not provided
Medically unnecessary services
Upcoding
