CDEO Chapter 3 Questions With Complete Solutions
1995 & 1997 E/M Guidelines Correct Answers An auditor
must know the most advantageous set of guidelines for that visit
Check the company compliance plan for specifications
1995 E/M Guidelines Correct Answers Expanded problem
focused- limited exam of 2-7 body areas or organ systems
Detailed- EXTENDED exam of 2-7 body areas or organ systems
*DOES NOT DEFINE HOW MANY ELEMENTS MUST BE
DOCUMENTED TO MEET THE REQUIREMENTS OF
LIMITED OR EXTENDED
auditors may gain clarity from their MAC or internal guidelines
to clarify the gray area to specify the differences
1997 E/M Guidelines Correct Answers * Expanded problem
focused - includes performance and dox of at least SIX
ELEMENTS identified by a bullet in one or more organ systems
or body areas
* Detailed- includes at least SIX ORGAN SYSTEMS or BODY
AREAS. For each system/area selected, performance and
documentation of at least two elements identified by a bullet is
expected. Alternatively, a detailed examination may include
performance and dox of at least twelve identified by a bullet (*)
in TWO or MORE organ systems or body areas
,31 U.S.C 3729 (a) 1 Examples Correct Answers 1. Falsifying a
medical chart notation
2. Submitting a cliams for services not performed, not requested,
or unnecessary
3. Submitting claims for expired drugs
4. Upcoding and/or unbundling services
5. Submitting claims for physician services performed by a non-
physician provider NPP without regard to incident-to-guidelines
3729.a.2 Correct Answers states a court may assess not less
than 2x the amount of damages the government sustains because
of the act of the person
42 CFR ss482.24 Correct Answers outlines the CoP for
medical record services
*conditions include that each patient should have a medical
record; medical records must be organized to allow for prompt
completion, filing, and retrieval; record must be retained for at
least 5 years; and, patient confidentiality should be protected
42 U.S.C 1320a-7 Correct Answers The Exclusions Statute
A query may be posed for which of the following reasons?
I. To improve the CPT payment
II. To clarify the reason for an order for physical therapy
III. To allow the coder to clarify the correct ICD-10-CM code to
be reported
, IV. To clarify if a patient has a manifestation of a chronic illness
V. To keep compliant documentation a priority for the provider
VI. To resolve obscure documentation Correct Answers It is
inappropriate to query a provider to improve reimbursement.
This may be the result of the query, but the goal of a query
should always be to sharpen the clinical documentation to
improve clinical outcomes.
Queries are written to improve documentation, and may be used
as an educational tool to improve physician documentation. A
query is meant to clarify the record so that the correct codes can
be abstracted. Clarifying the record may include determining if a
causal relationship exists between two conditions, so that the
causal relationship can be reported. Queries are also used to
resolve conflicting or obscure documentation.
A Qui Tam Relator may receive what type of award for bringing
a case in which the government intervenes? Correct Answers
15-25 percent of the money recovered
According to documentation, the patient has COPD,
hypertension, and CKD, and is hospitalized with a fever of 40 C.
The first-listed diagnosis in the discharge summary is ARF. The
query most pertinent to coding would ask: Correct Answers
What does the acronym ARF in your documentation represent?
This chart cannot be completed until the coder knows the
intended meaning of ARF, commonly used to abbreviate acute
1995 & 1997 E/M Guidelines Correct Answers An auditor
must know the most advantageous set of guidelines for that visit
Check the company compliance plan for specifications
1995 E/M Guidelines Correct Answers Expanded problem
focused- limited exam of 2-7 body areas or organ systems
Detailed- EXTENDED exam of 2-7 body areas or organ systems
*DOES NOT DEFINE HOW MANY ELEMENTS MUST BE
DOCUMENTED TO MEET THE REQUIREMENTS OF
LIMITED OR EXTENDED
auditors may gain clarity from their MAC or internal guidelines
to clarify the gray area to specify the differences
1997 E/M Guidelines Correct Answers * Expanded problem
focused - includes performance and dox of at least SIX
ELEMENTS identified by a bullet in one or more organ systems
or body areas
* Detailed- includes at least SIX ORGAN SYSTEMS or BODY
AREAS. For each system/area selected, performance and
documentation of at least two elements identified by a bullet is
expected. Alternatively, a detailed examination may include
performance and dox of at least twelve identified by a bullet (*)
in TWO or MORE organ systems or body areas
,31 U.S.C 3729 (a) 1 Examples Correct Answers 1. Falsifying a
medical chart notation
2. Submitting a cliams for services not performed, not requested,
or unnecessary
3. Submitting claims for expired drugs
4. Upcoding and/or unbundling services
5. Submitting claims for physician services performed by a non-
physician provider NPP without regard to incident-to-guidelines
3729.a.2 Correct Answers states a court may assess not less
than 2x the amount of damages the government sustains because
of the act of the person
42 CFR ss482.24 Correct Answers outlines the CoP for
medical record services
*conditions include that each patient should have a medical
record; medical records must be organized to allow for prompt
completion, filing, and retrieval; record must be retained for at
least 5 years; and, patient confidentiality should be protected
42 U.S.C 1320a-7 Correct Answers The Exclusions Statute
A query may be posed for which of the following reasons?
I. To improve the CPT payment
II. To clarify the reason for an order for physical therapy
III. To allow the coder to clarify the correct ICD-10-CM code to
be reported
, IV. To clarify if a patient has a manifestation of a chronic illness
V. To keep compliant documentation a priority for the provider
VI. To resolve obscure documentation Correct Answers It is
inappropriate to query a provider to improve reimbursement.
This may be the result of the query, but the goal of a query
should always be to sharpen the clinical documentation to
improve clinical outcomes.
Queries are written to improve documentation, and may be used
as an educational tool to improve physician documentation. A
query is meant to clarify the record so that the correct codes can
be abstracted. Clarifying the record may include determining if a
causal relationship exists between two conditions, so that the
causal relationship can be reported. Queries are also used to
resolve conflicting or obscure documentation.
A Qui Tam Relator may receive what type of award for bringing
a case in which the government intervenes? Correct Answers
15-25 percent of the money recovered
According to documentation, the patient has COPD,
hypertension, and CKD, and is hospitalized with a fever of 40 C.
The first-listed diagnosis in the discharge summary is ARF. The
query most pertinent to coding would ask: Correct Answers
What does the acronym ARF in your documentation represent?
This chart cannot be completed until the coder knows the
intended meaning of ARF, commonly used to abbreviate acute
