CCS EXAM PREPARATION, DOMAIN 4:
REGULATORY COMPLIANCE CORRECT
100%
After consulting with a physician, a coding supervisor has issued an internal policy
stating that all bedside debridement be coded as excisional. Is this an ethical practice
for a coding professional to follow? Why or why not?
A. Yes, physician guidance provided basis for the policy.
B. Yes, coding professionals must follow internal policies of the facilities where they are
employed.
C. No, coding supervisors cannot make internal policies without approval of
administration.
D. No, internal policies cannot conflict with requirements provided in coding guidelines,
conventions, and so on. - ANSWER D. No, internal policies cannot conflict with
requirements provided in coding guidelines, conventions, and so on.
Ethical Coding Guideline 1.2 states that internal policies may not conflict with the coding
rules, conventions, guidelines, etc. of the coding classifications nor with any official
coding advice (AHIMA House of Delegates 2016).
The coding supervisor is concerned that patients diagnosed with carcinoid colon tumors
were miscoded as malignant during the last six months. To address this situation, what
work processes could be undertaken?
A. Obtain the cases of carcinoid colon tumors from the cancer registry, obtain the cases
of malignant colon tumors from the billing system, import both lists into a spreadsheet,
and compare them. The cases in the cancer registry but not coded as carcinoid in the
billing system are likely malignant and should be manually reviewed.
B. Compare the cases from the chart completion software with the billing software.
Identify the cases that are not in the billing system. These cases should be manually
reviewed to ensure they are not carcinoid tumors.
C. Obtain the cases of malignant colon tumors from both the cancer registry and the
billing system; import both lists into a spreadsheet and compare them. Identify -
ANSWER C. Obtain the cases of malignant colon tumors from both the cancer registry
and the billing system; import both lists into a spreadsheet and compare them. Identify
the cases that are not in the tumor registry but are coded as malignant in the billing
,system. These cases should be manually reviewed to ensure they are not carcinoid
tumors.
The diagnostic index can be used with the cancer registry data to undertake data quality
analysis (Johns 2020, 85).
The patient was admitted for prostate carcinoma. This was treated with radiation. A
member of the medical staff who was not associated with the patient's care requests to
see the patient's health record. What should the coding professional do?
A. Provide the record to the physician.
B. Report the incident to hospital security.
C. Ask the physician to come back when the supervisor gets back.
D. Explain that providing the record would violate the privacy policy - ANSWER D.
Explain that providing the record would violate the privacy policy
This question relates to the need-to-know principle. The medical staff member who is
not associated with the patient's care does not need to see that patient's record
(Hamilton 2020, 669-670).
Under which of the following circumstances does a healthcare entity lose a potential
increase in reimbursement when a hospital-acquired condition (HAC) is coded without a
POA indicator of "Y"?
A. When the HAC is the only CC/MCC on the account
B. When the HAC is listed as the principal diagnosis
C. When the HAC is coded along with a surgical procedure
D. When the HAC is the only diagnosis listed - ANSWER A. When the HAC is the only
CC/MCC on the account
It is only in the circumstance when the HAC is the only CC/MCC on the patient's
account, and does not carry a POA indicator of Y, will there be a loss of an opportunity
to capture additional reimbursement (Casto and White 2021, 85).
To correct an entry in a paper-based medical record, the provider should:
A. Draw a single line through the error, add a note explaining the error, initial and date,
add the correct information in chronological order
B. Draw a double line through the error, initial and date, add the reason for the
correction
C. Draw a single line through the error, and add the correct information in chronological
order
D. Draw several lines through the error, obliterate the documentation as much as
possible, initial and date, add the correct information in chronological order - ANSWER
A. Draw a single line through the error, add a note explaining the error, initial and date,
add the correct information in chronological order
, If an error is corrected, the healthcare provider who made the error should draw a single
line through the error, add a note explaining the error, initial and date it, and add the
correct information in chronological order (Sayles 2020, 78). Further, AHIMA principles
for health record documentation specify the prior statement as the proper method for
correcting an error in the paper-based records in order to maintain a legally sound
record. This process is based on the ASTM and HL7 standards for error correction
(AHIMA e-HIM Work Group on Maintaining the Legal EHR 2005).
Most hospitals require a medical record to be completed within:
A. 5 days
B. 10 days
C. 7 days
D. 30 days - ANSWER D. 30 days
The Medicare Conditions of Participation and the Joint Commission require that the
medical record is completed no later than 30 days following discharge of the patient
(Brickner 2020, 97).
What is the term used when protected health information has been disclosed
inappropriately?
A. Exposure
B. Breach
C. Violation
D. Infraction - ANSWER B. Breach
Under HITECH, when there has been unauthorized access or disclosure of protected
health information, a breach is found to have occurred (Rinehart-Thompson 2017b, 250-
251).
The minimum necessary requirement would apply in which of the following scenarios?
A. When disclosure is to the secretary of HHS for investigation
B. When disclosure is required by law
C. When disclosure is for payment
D. When disclosure is made to the personal representative of the individual - ANSWER
C. When disclosure is for payment
Disclosures made for payment fall under the minimum necessary doctrine, while in the
other circumstances listed, the minimum necessary standard does not apply (Rinehart-
Thompson 2017a, 232-233).
According to the UHDDS, section III, the definition of other diagnoses is all conditions
that:
A. Coexist at the time of admission, that develop subsequently, or that affect the
treatment received or the length of stay.
B. Receive evaluation and are documented by the physician
REGULATORY COMPLIANCE CORRECT
100%
After consulting with a physician, a coding supervisor has issued an internal policy
stating that all bedside debridement be coded as excisional. Is this an ethical practice
for a coding professional to follow? Why or why not?
A. Yes, physician guidance provided basis for the policy.
B. Yes, coding professionals must follow internal policies of the facilities where they are
employed.
C. No, coding supervisors cannot make internal policies without approval of
administration.
D. No, internal policies cannot conflict with requirements provided in coding guidelines,
conventions, and so on. - ANSWER D. No, internal policies cannot conflict with
requirements provided in coding guidelines, conventions, and so on.
Ethical Coding Guideline 1.2 states that internal policies may not conflict with the coding
rules, conventions, guidelines, etc. of the coding classifications nor with any official
coding advice (AHIMA House of Delegates 2016).
The coding supervisor is concerned that patients diagnosed with carcinoid colon tumors
were miscoded as malignant during the last six months. To address this situation, what
work processes could be undertaken?
A. Obtain the cases of carcinoid colon tumors from the cancer registry, obtain the cases
of malignant colon tumors from the billing system, import both lists into a spreadsheet,
and compare them. The cases in the cancer registry but not coded as carcinoid in the
billing system are likely malignant and should be manually reviewed.
B. Compare the cases from the chart completion software with the billing software.
Identify the cases that are not in the billing system. These cases should be manually
reviewed to ensure they are not carcinoid tumors.
C. Obtain the cases of malignant colon tumors from both the cancer registry and the
billing system; import both lists into a spreadsheet and compare them. Identify -
ANSWER C. Obtain the cases of malignant colon tumors from both the cancer registry
and the billing system; import both lists into a spreadsheet and compare them. Identify
the cases that are not in the tumor registry but are coded as malignant in the billing
,system. These cases should be manually reviewed to ensure they are not carcinoid
tumors.
The diagnostic index can be used with the cancer registry data to undertake data quality
analysis (Johns 2020, 85).
The patient was admitted for prostate carcinoma. This was treated with radiation. A
member of the medical staff who was not associated with the patient's care requests to
see the patient's health record. What should the coding professional do?
A. Provide the record to the physician.
B. Report the incident to hospital security.
C. Ask the physician to come back when the supervisor gets back.
D. Explain that providing the record would violate the privacy policy - ANSWER D.
Explain that providing the record would violate the privacy policy
This question relates to the need-to-know principle. The medical staff member who is
not associated with the patient's care does not need to see that patient's record
(Hamilton 2020, 669-670).
Under which of the following circumstances does a healthcare entity lose a potential
increase in reimbursement when a hospital-acquired condition (HAC) is coded without a
POA indicator of "Y"?
A. When the HAC is the only CC/MCC on the account
B. When the HAC is listed as the principal diagnosis
C. When the HAC is coded along with a surgical procedure
D. When the HAC is the only diagnosis listed - ANSWER A. When the HAC is the only
CC/MCC on the account
It is only in the circumstance when the HAC is the only CC/MCC on the patient's
account, and does not carry a POA indicator of Y, will there be a loss of an opportunity
to capture additional reimbursement (Casto and White 2021, 85).
To correct an entry in a paper-based medical record, the provider should:
A. Draw a single line through the error, add a note explaining the error, initial and date,
add the correct information in chronological order
B. Draw a double line through the error, initial and date, add the reason for the
correction
C. Draw a single line through the error, and add the correct information in chronological
order
D. Draw several lines through the error, obliterate the documentation as much as
possible, initial and date, add the correct information in chronological order - ANSWER
A. Draw a single line through the error, add a note explaining the error, initial and date,
add the correct information in chronological order
, If an error is corrected, the healthcare provider who made the error should draw a single
line through the error, add a note explaining the error, initial and date it, and add the
correct information in chronological order (Sayles 2020, 78). Further, AHIMA principles
for health record documentation specify the prior statement as the proper method for
correcting an error in the paper-based records in order to maintain a legally sound
record. This process is based on the ASTM and HL7 standards for error correction
(AHIMA e-HIM Work Group on Maintaining the Legal EHR 2005).
Most hospitals require a medical record to be completed within:
A. 5 days
B. 10 days
C. 7 days
D. 30 days - ANSWER D. 30 days
The Medicare Conditions of Participation and the Joint Commission require that the
medical record is completed no later than 30 days following discharge of the patient
(Brickner 2020, 97).
What is the term used when protected health information has been disclosed
inappropriately?
A. Exposure
B. Breach
C. Violation
D. Infraction - ANSWER B. Breach
Under HITECH, when there has been unauthorized access or disclosure of protected
health information, a breach is found to have occurred (Rinehart-Thompson 2017b, 250-
251).
The minimum necessary requirement would apply in which of the following scenarios?
A. When disclosure is to the secretary of HHS for investigation
B. When disclosure is required by law
C. When disclosure is for payment
D. When disclosure is made to the personal representative of the individual - ANSWER
C. When disclosure is for payment
Disclosures made for payment fall under the minimum necessary doctrine, while in the
other circumstances listed, the minimum necessary standard does not apply (Rinehart-
Thompson 2017a, 232-233).
According to the UHDDS, section III, the definition of other diagnoses is all conditions
that:
A. Coexist at the time of admission, that develop subsequently, or that affect the
treatment received or the length of stay.
B. Receive evaluation and are documented by the physician
