AHIMA CCA 2023/24: Practice Questions and Answers 100% Correct

1. Identify the CPT code for a 42-year-old diagnosed with ESRD who requires home dialysis for the month of April. a. 90965 b. 90964 c. 90966 d. 90970 - ANSWER-Correct Answer: C Dialysis, end-stage renal disease. Code 90966 is for end-stage renal disease (ESRD) related services for home dialysis per full month for patients 20 years of age and older (Smith 2012, 227). 2. Exceptions to the consent requirement include: a. Medical emergencies b. Provider discretion c. Implied consent d. Informed consent - ANSWER-Correct Answer: A The law permits a presumption of consent during emergency situations, regardless of whether the patient is an adult or minor (Brodnik et al. 2009, 99). 3. An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, 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 the coder proceed to code this case? a. Code sepsis as the principal diagnosis with urinary tract infection due to E. coli as secondary diagnosis. b. Code urinary tract infection with sepsis as the principal diagnosis. c. Query the physician to ask if the patient has septicemia because of the symptomatology. d. Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis. - ANSWER-Correct Answer: C The term "urosepsis" is a nonspecific term. If that is the only term documented, only code 599.0 should be assigned based on the default for the term in the ICD-9-CM index, in addition to the code for the causal organism, if known. Septicemia results from the entry of pathogens into the bloodstream. Symptoms include spiking fever, chills, and skin eruptions in the form of petechiae or purpura. Blood cultures are usually positive; however, a negative culture does not exclude the diagnosis of septicemia. Several other clinical indications and symptomology could indicate the diagnosis of septicemia. Only the physician can diagnose the condition based on clinical indications. Query the physician when the diagnosis is not clear to the coder (Schraffenberger 2012, 79-81, 251). 4. What is the correct CPT code assignment for destruction of internal hemorrhoids with use of infrared coagulation? a. 46255 b. 46930 c. 46260 d. 46945 - ANSWER-Correct Answer: B Index main term: Destruction, hemorrhoid, thermal. Thermal includes infrared coagulation (Kuehn 2012, 27, 163). 5. Identify the two-digit modifier that may be reported to indicate a physician performed the postoperative management of a patient, but another physician performed the surgical procedure. a. -22 b. -54 c. -32 d. -55 - ANSWER-Correct Answer: D Modifiers are appended to the code to provide more information or to alert the payer that a payment change is required. Modifier -55 is used to identify the physician provided only postoperative care services for a particular procedure (Kuehn 2012, 292, 295). 6. Which of the following organizations is responsible for updating the procedure classification of ICD-9-CM? a. Centers for Disease Control (CDC) b. Centers for Medicare and Medicaid Services (CMS) c. National Center for Health Statistics (NCHS) d. World Health Organization (WHO) - ANSWER-Correct Answer: B NCHS is responsible for updating the diagnosis classification (Volumes 1 and 2), and CMS is responsible for updating the procedure classification (Volume 3) (Johns 2011, 239). 7. Good encoding software should include ________ to ensure data quality. a. Edit checks b. Voice recognition c. Reimbursement technology d. Passwords - ANSWER-Correct Answer: A Good encoding software should include edit checks to ensure data quality (Johns 2011, 270). 8. Patient was admitted through the emergency department following a fall from a ladder while painting an interior room in his house. He had contusions of the scalp and face and an open fracture of the acetabulum. The fracture site was debrided and the fracture was reduced by open procedure with an external fixation device applied. Which is the correct code assignment? a. 808.1, E881.0, E849.0, 79.25, 78.15 b. 808.1, 920, E881.0, E849.0, E000.8, E013.9, 79.25, 78.15, 79.65 c. 808.0, E881.0, E000.8, E013.9, 79.35, 79.65 d. 808.1, E881.0, E849.0, E013.9, 79.25, 78.15, 79.65 - ANSWER-Correct Answer: B The fracture is the principal diagnosis, with the contusions as a secondary diagnosis. The fracture is what required the most treatment. Procedures for the reduction, debridement, and external fixation device would all need to be coded (Schraffenberger 2012, 354-355). 9. A request for reconsideration of a denied claim for insurance coverage for healthcare services is called a(n): a. Breach b. Exclusion c. Appeal d. Inclusion - ANSWER-Correct Answer: C An appeal is a request for consideration of denial of coverage for healthcare services of a claim (Casto and Layman 2011, 71). 10. Patient had a laparoscopic incisional herniorrhaphy for a recurrent reducible hernia. The repair included insertion of mesh. What is the correct code assignment? a. 49565 b. 49565, 49568 c. 49656 d. 49560, 49568 - ANSWER-Correct Answer: C Begin with the main term of Hernia repair; incisional. The fact that the hernia is recurrent, done via a laparoscope, and is reducible makes the choice 49656. Notice that the use of mesh is included in the code (Kuehn 2012, 27, 164-166). 11. The sum of a hospital's total relative DRG weights for a year was 15,192 and the hospital had 10,471 total discharges for the year. Given this information, what would be the hospital's case-mix index for that year? a. 0.689 b. 1.59 c. 1.45 × 100 d. 1.45 - ANSWER-Correct Answer: D The case-mix index is 1.45 for the total case-mix index of the hospital. An individual MS-DRG case mix can be figured by multiplying the relative weight of each MS-DRG by the number of discharges within that MS-DRG. This provides the total weight for each MS-DRG. The sum of all total weights (15,192) divided by the sum of total patient discharges (10,471) equals the case-mix index (Johns 2011, 324). 12. A patient is seen in the emergency department for chest pain. After evaluation of the patient it is suspected that the patient may have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out chest pain versus GERD." The correct ICD-9-CM code is: a. V71.7, Admission for suspected cardiovascular condition b. 789.01, Esophageal pain c. 530.81, Gastrointestinal reflux d. 786.50, Chest pain NOS - ANSWER-Correct Answer: D Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when a physician qualifies a diagnostic statement as "rule out" or other similar terms indicating uncertainty. In the outpatient setting the condition qualified in that statement should not be coded as if it existed. Rather, the condition should be coded to the highest degree of certainty, such as the sign or symptom the patient exhibits. In this case, assign the code 786.50, Chest pain NOS (Schraffenberger 2012, 339). Identify the correct diagnosis code for lipoma of the face. a. 214.1 b. 213.0 c. 214.0 d. 214.9 - ANSWER-Correct Answer: C Index Lipoma, face. ICD-9-CM classifies neoplasms by system, organ, or site with the exception of neoplasms of the lymphatic and hematopoietic system, malignant