CCS EXAM PREPARATION, DOMAIN 4: REGULATORY COMPLIANCE QUESTIONS AND CORRECT VERIFIED ANSWERS

CCS EXAM PREPARATION, DOMAIN 4:
REGULATORY COMPLIANCE QUESTIONS
AND CORRECT VERIFIED ANSWERS
AfterA2consultingA2withA2aA2physician,A2aA2codingA2supervisorA2hasA2issuedA2anA2internalA2
policyA2statingA2thatA2allA2bedsideA2debridementA2beA2codedA2asA2excisional.A2IsA2thisA2an
A2ethicalA2practiceA2forA2aA2codingA2professionalA2toA2follow?A2WhyA2orA2whyA2not?


A.A2Yes,A2physicianA2guidanceA2providedA2basisA2forA2theA2policy.A2

B.A2Yes,A2codingA2professionalsA2mustA2followA2internalA2policiesA2ofA2theA2facilitiesA2wher
eA2theyA2areA2employed.A2

C.A2No,A2codingA2supervisorsA2cannotA2makeA2internalA2policiesA2withoutA2approvalA2ofA2a
dministration.A2

D.A2No,A2internalA2policiesA2cannotA2conflictA2withA2requirementsA2providedA2inA2codingA2g
uidelines,A2conventions,A2andA2soA2on.A2-A2Ans--
A2D.A2No,A2internalA2policiesA2cannotA2conflictA2withA2requirementsA2providedA2inA2codingA
2guidelines,A2conventions,A2andA2soA2on.


EthicalA2CodingA2GuidelineA21.2A2statesA2thatA2internalA2policiesA2mayA2notA2conflictA2with
A2theA2codingA2rules,A2conventions,A2guidelines,A2etc.A2ofA2theA2codingA2classificationsA2n
orA2withA2anyA2officialA2codingA2adviceA2(AHIMAA2HouseA2ofA2DelegatesA22016).

TheA2codingA2supervisorA2isA2concernedA2thatA2patientsA2diagnosedA2withA2carcinoidA2col
onA2tumorsA2wereA2miscodedA2asA2malignantA2duringA2theA2lastA2sixA2months.A2ToA2addre
ssA2thisA2situation,A2whatA2workA2processesA2couldA2beA2undertaken?

A.A2ObtainA2theA2casesA2ofA2carcinoidA2colonA2tumorsA2fromA2theA2cancerA2registry,A2obtai
nA2theA2casesA2ofA2malignantA2colonA2tumorsA2fromA2theA2billingA2system,A2importA2bothA2l
istsA2intoA2aA2spreadsheet,A2andA2compareA2them.A2TheA2casesA2inA2theA2cancerA2registry
A2butA2notA2codedA2asA2carcinoidA2inA2theA2billingA2systemA2areA2likelyA2malignantA2andA2s
houldA2beA2manuallyA2reviewed.A2

B.A2CompareA2theA2casesA2fromA2theA2chartA2completionA2softwareA2withA2theA2billingA2sof
tware.A2IdentifyA2theA2casesA2thatA2areA2notA2inA2theA2billingA2system.A2TheseA2casesA2sho
uldA2beA2manuallyA2reviewedA2toA2ensureA2theyA2areA2notA2carcinoidA2tumors.A2

C.A2ObtainA2theA2casesA2ofA2malignantA2colonA2tumorsA2fromA2bothA2theA2cancerA2registry
A2andA2theA2billingA2system;A2importA2bothA2listsA2intoA2aA2spreadsheetA2andA2compareA2th
em.A2IdentifyA2-A2Ans--
A2C.A2ObtainA2theA2casesA2ofA2malignantA2colonA2tumorsA2fromA2bothA2theA2cancerA2registr
yA2andA2theA2billingA2system;A2importA2bothA2listsA2intoA2aA2spreadsheetA2andA2compareA2t

,hem.A2IdentifyA2theA2casesA2thatA2areA2notA2inA2theA2tumorA2registryA2butA2areA2codedA2asA
2malignantA2inA2theA2billingA2system.A2TheseA2casesA2shouldA2beA2manuallyA2reviewedA2to
A2ensureA2theyA2areA2notA2carcinoidA2tumors.A2


TheA2diagnosticA2indexA2canA2beA2usedA2withA2theA2cancerA2registryA2dataA2toA2undertake
A2dataA2qualityA2analysisA2(JohnsA22020,A285).


TheA2patientA2wasA2admittedA2forA2prostateA2carcinoma.A2ThisA2wasA2treatedA2withA2radiat
ion.A2AA2memberA2ofA2theA2medicalA2staffA2whoA2wasA2notA2associatedA2withA2theA2patient'
sA2careA2requestsA2toA2seeA2theA2patient'sA2healthA2record.A2WhatA2shouldA2theA2codingA2
professionalA2do?

A.A2ProvideA2theA2recordA2toA2theA2physician.A2
B.A2ReportA2theA2incidentA2toA2hospitalA2security.A2
C.A2AskA2theA2physicianA2toA2comeA2backA2whenA2theA2supervisorA2getsA2back.A2
D.A2ExplainA2thatA2providingA2theA2recordA2wouldA2violateA2theA2privacyA2policyA2-A2Ans--
A2D.A2ExplainA2thatA2providingA2theA2recordA2wouldA2violateA2theA2privacyA2policy


ThisA2questionA2relatesA2toA2theA2need-to-
knowA2principle.A2TheA2medicalA2staffA2memberA2whoA2isA2notA2associatedA2withA2theA2pat
ient'sA2careA2doesA2notA2needA2toA2seeA2thatA2patient'sA2recordA2(HamiltonA22020,A2669-
670).

UnderA2whichA2ofA2theA2followingA2circumstancesA2doesA2aA2healthcareA2entityA2loseA2aA2
potentialA2increaseA2inA2reimbursementA2whenA2aA2hospital-
acquiredA2conditionA2(HAC)A2isA2codedA2withoutA2aA2POAA2indicatorA2ofA2"Y"?
A.A2WhenA2theA2HACA2isA2theA2onlyA2CC/MCCA2onA2theA2account
B.A2WhenA2theA2HACA2isA2listedA2asA2theA2principalA2diagnosis
C.A2WhenA2theA2HACA2isA2codedA2alongA2withA2aA2surgicalA2procedure
D.A2WhenA2theA2HACA2isA2theA2onlyA2diagnosisA2listedA2-A2Ans--
A2A.A2WhenA2theA2HACA2isA2theA2onlyA2CC/MCCA2onA2theA2account


ItA2isA2onlyA2inA2theA2circumstanceA2whenA2theA2HACA2isA2theA2onlyA2CC/
MCCA2onA2theA2patient'sA2account,A2andA2doesA2notA2carryA2aA2POAA2indicatorA2ofA2Y,A2wi
llA2thereA2beA2aA2lossA2ofA2anA2opportunityA2toA2captureA2additionalA2reimbursementA2(Cas
toA2andA2WhiteA22021,A285).

ToA2correctA2anA2entryA2inA2aA2paper-basedA2medicalA2record,A2theA2providerA2should:
A.A2DrawA2aA2singleA2lineA2throughA2theA2error,A2addA2aA2noteA2explainingA2theA2error,A2init
ialA2andA2date,A2addA2theA2correctA2informationA2inA2chronologicalA2order
B.A2DrawA2aA2doubleA2lineA2throughA2theA2error,A2initialA2andA2date,A2addA2theA2reasonA2fo
rA2theA2correction
C.A2DrawA2aA2singleA2lineA2throughA2theA2error,A2andA2addA2theA2correctA2informationA2inA2
chronologicalA2order
D.A2DrawA2severalA2linesA2throughA2theA2error,A2obliterateA2theA2documentationA2asA2muc
hA2asA2possible,A2initialA2andA2date,A2addA2theA2correctA2informationA2inA2chronologicalA2or

, derA2-A2Ans--
A2A.A2DrawA2aA2singleA2lineA2throughA2theA2error,A2addA2aA2noteA2explainingA2theA2error,A2i
nitialA2andA2date,A2addA2theA2correctA2informationA2inA2chronologicalA2order

IfA2anA2errorA2isA2corrected,A2theA2healthcareA2providerA2whoA2madeA2theA2errorA2shouldA2
drawA2aA2singleA2lineA2throughA2theA2error,A2addA2aA2noteA2explainingA2theA2error,A2initialA2
andA2dateA2it,A2andA2addA2theA2correctA2informationA2inA2chronologicalA2orderA2(SaylesA22
020,A278).A2Further,A2AHIMAA2principlesA2forA2healthA2recordA2documentationA2specifyA2th
eA2priorA2statementA2asA2theA2properA2methodA2forA2correctingA2anA2errorA2inA2theA2paper-
basedA2recordsA2inA2orderA2toA2maintainA2aA2legallyA2soundA2record.A2ThisA2processA2isA2b
asedA2onA2theA2ASTMA2andA2HL7A2standardsA2forA2errorA2correctionA2(AHIMAA2e-
HIMA2WorkA2GroupA2onA2MaintainingA2theA2LegalA2EHRA22005).

MostA2hospitalsA2requireA2aA2medicalA2recordA2toA2beA2completedA2within:
A.A25A2days
B.A210A2days
C.A27A2days
D.A230A2daysA2-A2Ans--A2D.A230A2days

TheA2MedicareA2ConditionsA2ofA2ParticipationA2andA2theA2JointA2CommissionA2requireA2th
atA2theA2medicalA2recordA2isA2completedA2noA2laterA2thanA230A2daysA2followingA2discharge
A2ofA2theA2patientA2(BricknerA22020,A297).


WhatA2isA2theA2termA2usedA2whenA2protectedA2healthA2informationA2hasA2beenA2disclosed
A2inappropriately?
A.A2Exposure
B.A2Breach
C.A2Violation
D.A2InfractionA2-A2Ans--A2B.A2Breach

UnderA2HITECH,A2whenA2thereA2hasA2beenA2unauthorizedA2accessA2orA2disclosureA2ofA2p
rotectedA2healthA2information,A2aA2breachA2isA2foundA2toA2haveA2occurredA2(Rinehart-
ThompsonA22017b,A2250-251).

TheA2minimumA2necessaryA2requirementA2wouldA2applyA2inA2whichA2ofA2theA2followingA2sc
enarios?
A.A2WhenA2disclosureA2isA2toA2theA2secretaryA2ofA2HHSA2forA2investigation
B.A2WhenA2disclosureA2isA2requiredA2byA2law
C.A2WhenA2disclosureA2isA2forA2payment
D.A2WhenA2disclosureA2isA2madeA2toA2theA2personalA2representativeA2ofA2theA2individualA2
-A2Ans--A2C.A2WhenA2disclosureA2isA2forA2payment

DisclosuresA2madeA2forA2paymentA2fallA2underA2theA2minimumA2necessaryA2doctrine,A2whi
leA2inA2theA2otherA2circumstancesA2listed,A2theA2minimumA2necessaryA2standardA2doesA2n
otA2applyA2(Rinehart-ThompsonA22017a,A2232-233).