Health Care Reimbursement Chapter Review 9 High-Probability Questions & Detailed Answers

Health Care Reimbursement Chapter
Review 9

If a provider documents only COPD (chronic obstructive pulmonary disease), but

there is clinical evidence to support an exacerbation of COPD, what impact might

this have on clinical validation?


a. The case may be vulnerable to denial.


b. The medication administration records will be used to define the diagnosis.


c. The CDI specialist will require a concurrent review.


d. The working DRG will have to be updated. - Correct Answer ✔️✔️a. The

case may be vulnerable to denial


What is the relationship between an inpatient HIM coder and a CDI specialist?


a. The inpatient HIM coder uses the CDI worksheet to review concurrent health

records.


b. The inpatient HIM coder uses the CDI worksheet to update all responses to

queries.


c. The inpatient HIM coder documents the final DRG on the CDI worksheet.

, d. The inpatient HIM coder notes all physician queries on the CDI worksheet. -

Correct Answer ✔️✔️c. The inpatient HIM coder documents the final DRG

on the CDI worksheet.


Which of the following supports the seven characteristics of high-quality clinical

documentation?


a. provider notes


b. clinical evidence


c. ancillary reports


d. ICD-O-PCS coding - Correct Answer ✔️✔️b. clinical evidence


When the 2021 CPT evaluation and management guidelines for office and

outpatient visits changed, how did the role of CDI specialists change?


a. They had to track key elements of patient history.


b. They had to prepare providers and coders.


c. They had to ensure complete and timely submissions.


d. They had to indicate the amount of time needed with patients based on codes.

- Correct Answer ✔️✔️b. They had to prepare providers and coders.