RHIT Domain 4 Exam Questions with Verified Solutions Latest Version 2025

RHIT Domain 4 Exam Questions with Verified Solutions Latest Version 2025 A coder might find which of the following on a patient's problem list if the medication list contains the drug Procardia? a. Esophagitis b. Hypertension c. Schizophrenia d. AIDS - Answers b Procardia is an antianginal, antihypertensive, calcium channel blocker that is used to treat stable angina pectoris, vasospastic angina, and hypertension (Schraffenberger and Palkie 2017, Appendix I, 16). From the information provided in this table, what percentage will the facility be paid for procedure 25500? Billing Number Status Indicator CPT/HCPCS APC 998323 V 998323 T 998323 X 998323 S 998323 S a. 0% b. 50% c. 75% d. 100% - Answers d Procedure 22550 has a "T" status indicator, which indicates that it is a significant procedure and multiple procedure reductions will apply. In this case, there is only one CPT procedure code that is a status "T" indicator, so 100 percent of the fee-based APC will be paid (Casto and Forrestal 2015, 175). The sum of a hospital's relative DRG weights for a year was 15,192, and the hospital had 10,471 discharges for the year. Given this information, what would be the hospital's case-mix index for that year? a. 0.689 b. 0.689 × 100 c. 1.45 × 100 d. 1.45 - Answers d The weight of each diagnosis-related group (DRG) is multiplied by the number of discharges for that DRG to arrive at the total weight for each DRG—in this situation 15,192. The total weights are summed and divided by the number of total discharges to arrive at the case-mix index for a hospital: 15,192 / 10,471 = 1.45 (Horton 2016b, 401). A Staghorn calculus of the left renal pelvis was treated earlier in the week by lithotripsy and is now removed via a percutaneous nephrostomy tube. What is the root operation performed for this procedure? a. Destruction b. Extirpation c. Extraction d. Fragmentation - Answers b The root operation extirpation is defined as taking or cutting out solid material from a body part. The matter may have been broken into pieces during the lithotripsy previous to this encounter, but at this time the pieces of the calculus are being removed (Kuehn and Jorwic 2017, 86). 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 - Answers c Colonoscopy includes examining the transverse colon. Proctosigmoidoscopy involves examining the rectum and sigmoid colon. Sigmoidoscopy involves examining the rectum, sigmoid colon, and may include portions of the descending colon (Smith 2017, 121). A physician orders a chest x-ray for an office patient who presents with fever, productive cough, and shortness of breath. The physician indicates in the progress notes: "Rule out pneumonia." What should the coder report for the visit when the results have not yet been received? a. Pneumonia b. Fever, cough, shortness of breath c. Cough, shortness of breath d. Pneumonia, cough, shortness of breath, fever - Answers b Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when a physician qualifies a diagnostic statement as "possible," "probable," "suspected," "questionable," "rule out," or "working diagnosis," or other similar terms indicating uncertainty (Schraffenberger and Palkie 2017, 102). When multiple burns are present, the first sequenced diagnosis is the: a. Burn that is treated surgically b. Burn that is closest to the head c. Highest-degree burn d. Burn that is treated first - Answers c Treatment and anatomic location are not factors in the sequencing of burn conditions. Code all burns with the highest degree of burn sequenced first (Schraffenberger and Palkie 2017, 584). Assign the correct CPT code for the following procedure: Revision of the pacemaker skin pocket. a. 33223, Relocation of skin pocket for implantable defibrillator b. 33210, Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) c. 33212, Insertion of pacemaker pulse generator only; with existing single lead d. 33222, Relocation of skin pocket for pacemaker - Answers d Begin with the main term Revision; pacemaker site; chest (Kuehn 2017, 22, 24). What is the term that means evaluating the appropriateness of the setting for the healthcare service and the level of service? a. Coordination of service benefits b. Community rating c. Outcomes assessment d. Utilization review - Answers d Utilization review assesses the appropriateness of the setting for the healthcare service in the continuum of care and the level of service. Also factored in are patients' severity of illness and other medical conditions and illnesses (Casto and Forrestal 2015, 100). What is the name of the process to determine whether medical care provided to a specific patient is necessary according to pre-established objective screening criteria at time frames specified? a. Case management b. Continuum of care c. Quality improvement d. Utilization review - Answers d Utilization review is the process to determine if medical care meets objective screening criteria (Sayles and Gordon 2016, 27). A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. Which of the following would be the correct coding and sequencing for this case? a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina c. Gastroenteritis; abdominal pain; angina d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina - Answers b The principal diagnosis is designated and defined as the condition established after study chiefly responsible for occasioning the admission of the patient to the hospital for care. The abdominal pain would not be coded as it is a symptom of the gastroenteritis (Schraffenberger and Palkie 2017, 91). The coding supervisor has compiled a report on the number of coding errors made each day by the coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an average of five errors per day, and Bob and Susan each make an average of two errors per day. Given this information, what immediate action should the coding supervisor take? a. Counsel Tim and Jane because they have the highest error rates. b. Encourage Tim and Jane to get additional training. c. Provide Bob and Susan with incentive pay for a low coding error rate. d. Take no action because not enough information is given to make a judgment. - Answers d The error rates are not comparable because there is no data about the number of records coded during the period by each coder (Schraffenberger and Kuehn 2011, 319-320). Dr. Green discharged 30 patients from Medicine Service during the month of August. The table above presents the number of patients discharged by MS-DRG. Calculate the CMI for Dr. Green. a. 32.219 b. 30 c. 1.074 d. 2.3055 - Answers c When calculating case mix using MS-DRGs, the case-mix index (CMI) is the average relative weight of all cases treated at a given facility or by a given physician, which reflects the resource intensity or clinical severity of a specific group in relation to the other groups in the classification system. The calculation for this data set is 32.219/30 = 1.074 (Gordon and Gordon 2016a, 441). When coding a benign neoplasm of skin of the left eyelid, which of the following codes should be used? D23 Other benign neoplasms of skin Includes: benign neoplasm of hair follicles benign neoplasm of sebaceous glands benign neoplasm of sweat glands Excludes1: benign lipomatous neoplasm of skin (D17.0-D17.3) melanocytic nevi (D22.-) D23.0 Other benign neoplasm of skin of lip Excludes1: benign neoplasm of vermilion border of lip (D10.0)