Medical Billing and Coding Exam 2023 Solved 100%

According to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? a. complex b. intermediate c. not specified d. simple - Answer a. Complex A skin lesion is removed from a patient's cheek in the dermatologist's office. The dermatologist documents "skin lesion" in the health record. Prior to billing the pathology report returns with a diagnosis of basal cell carcinoma. Which of the following actions should the coding professional do for claim submission? a. Code skin lesion b. Code benign skin lesion c. Code basal cell carcinoma d. Query the dermatologist - Answer c. code basal cell carcinoma which of the following organizations is responsible for updating the procedure classification of ICD-10-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 - Answer b. Centers for Medicare and Medicaid Services [CMS] A patient is admitted with a history of prostate cancer and with mental confusion. The patient completed radiation therapy for prostatic carcinoma three years ago and is status post a radical resection of the prostate. A CT scan of the brain during the current admission reveals metastasis. Which of the following is the correct coding and sequencing for the current hospital stay? a. Metastatic carcinoma of the brain; carcinoma of the prostate; mental confusion b. Mental confusion; history of carcinoma of the prostate; admission for chemotherapy c. metastatic carcinoma of the brain, history of carcinoma of the prostate d. carcinoma of the prostate; metastatic carcinoma of the brain - Answer c. metastatic carcinoma of the brain, history of carcinoma of the prostate. What is the correct CPT code assignment for destruction of internal hemorrhoid's with use of infrared coagulation? a. 46255 b. 46930 c. 46260 d. 46945 - Answer b. 46930 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 d. -55 A female patient is admitted for stress incontinence. A urethral suspension is performed. Assign the correct ICD-10-CM diagnosis and/or procedure code[s]. a. N39.3, 0TJB8ZZ b. N23, 0TSD0ZZ c. N39.3, 0TSD0ZZ d. N23, 0TJB8ZZ - Answer c. N39.3, 0TSD0ZZ These codes are used to assign a diagnosis to a patient who is seeking health services, but is not necessarily sick. a. E codes b. V codes c. M codes d. C codes - Answer b. Z codes According to the UHDDS, which of the following is the definition of "other diagnoses"? a. is recorded in the patient record b. is documented by the attending physician c. receives clinical evaluation of therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and monitoring. d. is documented by at least physicians and nursing staff - Answer c. receives clinical evaluation of therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and monitoring. 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-10-CM code is a. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out b. R10.11, Esophageal pain c. K21.3, Gastrointestinal reflux d. R07.9. Chest pain NOS - Answer d. R07.9 Chest pain NOS Identify the diagnosis code[s] for melanoma of skin of shoulder a. C43.8. C43.60 b. C43.60 c. C43.9 d. C43.8 - Answer b. C43.60 Which of the following is NOT one of the purposes of ICD-10-CM? a. Classification of morbidity for statistical purposes b. Classification of mortality for statistical purposes c. Reporting of diagnoses by physicians d. Identification of the supplies, products, and services provided to patients - Answer d. Identification of the supplies, products, and services provided to patients. The patient was admitted to the outpatient department and had a bronchoscopy with bronchial brushing performed. a. 31622, 31640 b. 31622, 31623 c. 31623 d. 31625 - Answer c. 31623 The physician performs an exploratory laparotomy with bilateral salpingooophorectomy. What is the correct CPT code assignment for this procedure. a. 49000, 58940, 58700 b. 58940, 58720-50 c. 49000, 58720 d. 58720 - Answer d. 58720 Patient returns during a 90-day postoperative period from a ventral hernia repair, now complaining or eye pain. What modifier would a physician use with the Evaluation and Management code? a. -79, Unrelated procedure or service by the same physician during the postoperative period. b. -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. c. -21, Prolonged evaluation and management services d. -24, unrelated evaluation and management service by the same physician during a postoperative period. - Answer d. -24, Unrelated evaluation and management service by the same physician during a postoperative period. Which of the following ICD-10-CM codes classify environment events and circumstances as the cause of an injury, poisioning, or other adverse affect? a. Category codes b. T codes c. Subcategory codes d. V codes - Answer b. T codes Identify the diagnosis code[s] for carcinoma in situ of vocal cord. a. D02.0 b C32.0 c. D49.1 d. D14.1 - Answer a. D02.0 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 - Answer d. Hematuria; adverse reaction to Coumadin Which volume of ICD-10-CM contains the numerical listing of codes that represent diseases and injuries? a. Volume 1 [Tab] b. Volume 2 [Index] c. Volume 3 [PCS] d. Volume 4 - Answer Volume 1 [Tab] Which of the following statements does NOT apply to ICD-10-CM? a. It can be used as the basis for epidemiological research b. it can be used in the evaluation of medical care planning for healthcare delivery systems. c. it can be used to facilitate date storage and retrieval d. it can be used to collect date about nursing care. - Answer d. It can be used to collect data about nursing care Assign the correct CPT code for the following procedure: Revision of the pacemaker skin pocket. a. 33223 b. 33210 c. 33212 d. 33222 - Answer d. 33222 a patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient subsequently develops respiratory failure. The patient undergoes intubation with ventilator management. Which of the following would be the correct sequencing and coding of this case. a. congestive heart failure, respiratory failure, ventilator management, intubation. b. Respiratory failure, intubation, ventilator management c. Respiratory failure, congestive heart failure, intubation, ventilator management. d. Shortness of breath, congestive heart failure, respiratory failure, ventilatory management. - Answer a. Congestive heart failure, respiratory failure, ventilator management, intubation. Which of the following ICD-10-CM codes are always alphanumeric? a. Category codes b. Procedure codes c. Subcategory codes d. Z codes - Answer Z codes A patient is admitted with spotting. She had been treated two weeks previously for a miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. She is treated with an aspiration dilation and curettage. Products of conception are found. Which of the following should be the principal diagnosis? a. miscarriage b. complications of spontaneous abortion with sepsis c. sepsis d. spontaneous abortion with sepsis - Answer a. miscarriage Identify the correct diagnosis code for lipoma of the face. a. D17.1 b. D16.4 c. D17.0 d. D17.9 - Answer D17.0 Reference codes 49491 through 195252 for inguinal hernia repair. Patient is 47 years old. What is the correct code for an initial inguinal herniorrhaphy for incarcerated hernia? a. 49496 b. 49501 c. 49507 d. 49521 - Answer c. 49507 An 80-year-old 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 has septic shock so that this may be used as the principal diagnosis - Answer c. Query the physician to ask if the patient has septicemia because of the symptomology. Which of the following is a standard terminology used to code medical procedures and services. a. CPT b. HCPCS c. ICD-10-CM d. SNOMED CT - Answer a. CPT A 65-year-old patient, with a history of lung cancer, is admitted to a healthcare facility with ataxia and syncope and a fractured arm as a result of falling. The patient undergoes a closed reduction of the fracture in the emergency department and undergoes a complete workup for metastatic carcinoma of the brain. The patient is found to have metastatic carcinoma of the lung to the brain and undergoes radiation therapy to the brain. Which of the following would be the principal diagnosis in this case. a. Ataxia b. Fractured arm c. metastatic carcinoma of the brain d. carcinoma of the lung - Answer c. metastatic carcinoma of the brain what is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions? a. 58555, 58559 b. 58559 c. 58559, 58740 d. 58555, 58559, 58740 - Answer b. 58559 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 c. Appeal What is the process that determines how a claim will be reimbursed based on the insurance benefit? a. Transaction b. Processing c. Adjudication d. Allowance - Answer c. Adjudication Medicare part D pays for: a. physician office visits b. Durable medical equipment c. inpatient hospital care d. prescription drugs - Answer d. prescription drugs Effective October 16, 2003, under the Administrative Simplification Compliance section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all healthcare providers must electronically submit claims to Medicare. Which is the electronic format for hospital technical fees? a. 837I b. 837P c. UB-04 d. 1500 - Answer a. 837I 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. What would be the hospital's case-mix index for that year? a. 0.689 b. 1.59 c. 1.45x100 d. 1.45 - Answer 1.45 What system assigns each service a value representing the true resources involved in producing it, including the time and intensity of work, the expenses of practice, and the risk of malpractice? a. DRGs b. RVUs c. CPT d. SVR - Answer b. RVUs The NCCI editing system used in processing OPPS claims is referred to as: a. Outpatient code editor [OCE] b. Outpatient national editor [ONE] c. Outpatient perspective payment editor [OPPE] d. Outpatient claims editor [OCE] - Answer a. Outpatient code editor [OCE] The goal of coding compliance programs is to prevent: a. Accusations of fraud and abuse b. Delays in claims processing c. Billing errors d. Inaccurate code assignments - Answer a. accusations of fraud and abuse Which of the following best describes the type of coding utilized when a CPT/HCPCS code is assigned directly through the charge description master for claim submission and bypasses the record review and code assignment by the facility coding staff? a. hard coding b. soft coding c. encoder coding d. natural- language processing coding - Answer a. hard coding the next generation of consumer-directed healthcare will be driven by a design where copayments are set based on the value of the clinical services rather than the traditional practices that focus only on costs of clinical services. What new design will focus on both the benefit and cost? a. Value-based insurance design [VBID] b. Cost-based reimbursement [CBR] c. Pay for performance design [PPD] d. Prospective payment system [PPS] - Answer a. Value-based insurance design [VBID] A denial of a claim is possible for all of the following reasons except: a. Not meeting medical necessity b. Billing too many units of a specific service c. Unbundling d. Approved pre-certification - Answer d. Approved pre-certification Medicaid is a government-sponsored healthcare insurance program that became effective in 1966 as Title 19 of the Social Security Act. Medicaid is administered by: a. The federal government b. The state government c. The federal and state government d. Third-party administrators - Answer c. The federal and state government What statement is NOT reflective of meeting medical necessity requirements? a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease. b. A service or supply provided that is not experimental, investigational, or cosmetic in purpose c. A service provided that is necessary for an appropriate to the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease, or its symptoms. d. A service provided solely for the convenience of the insured, the insured's family, or the provider. - Answer d. A service provided solely for the convenience of the insured, the insured's family or the provider. Diagnosis-related groups are organized into: a. case-mix classifications b. geographic practice cost indices c. major diagnostic categories d. resource-based relative values - Answer c. Major diagnostic categories Denials of outpatient claims are often generated from all of the following edits EXCEPT: a. NCCI [National Correct Coding Initiative] b. OCE [Outpatient code editor] c. OCE [ outpatient claims editor] d. National and local policies - Answer c. OCE [Outpatient claims editor] In processing a Medicare payment for outpatient radiology examinations, a hospital outpatient services department would receive payment under which of the following? a. DRGs b. HHRGs c. OASIS d. OPPS - Answer d. OPPS Which of the following would a health record technician use to perform the billing function for a physician's office? a. CMS-1500 b. UB-04 c. UB-92 d. CMS 1450 - Answer a. CMS-1500 Which of the following is NOT an essential data element for a healthcare insurance claim? a. Revenue code b. Procedure code c. Provider name d. Procedure name - Answer d. Procedure name Common errors that delay, rather than prevent, payment, include all of the following EXCEPT: a. Patient name or certificate number b. Claims out of sequence c. Illogical demographic data d. Inaccurate or deleted codes - Answer a. patient name or certificate number The MS-DRG system creates a hospital's case-mix index [types of categories of patients treated by the hospital] based on the relative weights of the MS-DRG. The case mix can be figured by multiplying the relative weight of each MS-DRG by the number of within that MS-DRG. a. Admissions b. Discharges c. CCs d. MCCs - Answer b. Discharges A health information technician is processing payments for hospital outpatients services to be reimbursed by Medicare for patient who had two physician visits, underwent examinations, clinical laboratory tests, and who received take-home surgical dressings. Which of the following services is reimbursed under the outpatient prospective payment system? a. Clinical laboratory tests b. Physician office visits c. Radiology examinations d. Take-home surgical dressings - Answer c. Radiology examinations