AHIMA CCA UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔11.
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. Given this information, what would be
the hospital's case-mix index for that year?
a. 0.689
b. 1.59
c. 1.45 × 100
d. 1.45 - ✔✔Correct Answer: D
The case-mix index is 1.45 for the total case-mix index of the hospital. An individual MS-
DRG case mix can be figured by multiplying the relative weight of each MS-DRG by the
number of discharges within that MS-DRG. This provides the total weight for each MS-
DRG. The sum of all total weights (15,192) divided by the sum of total patient
discharges (10,471) equals the case-mix index (Johns 2011, 324).
✔✔12.
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-
9-CM code is:
a. V71.7, Admission for suspected cardiovascular condition
b. 789.01, Esophageal pain
c. 530.81, Gastrointestinal reflux
d. 786.50, Chest pain NOS - ✔✔Correct Answer: D
Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are
used when a physician qualifies a diagnostic statement as "rule out" or other similar
terms indicating uncertainty. In the outpatient setting the condition qualified in that
statement should not be coded as if it existed. Rather, the condition should be coded to
the highest degree of certainty, such as the sign or symptom the patient exhibits. In this
case, assign the code 786.50, Chest pain NOS (Schraffenberger 2012, 339).
✔✔Identify the correct diagnosis code for lipoma of the face.
a. 214.1
,b. 213.0
c. 214.0
d. 214.9 - ✔✔Correct Answer: C
Index Lipoma, face. ICD-9-CM classifies neoplasms by system, organ, or site with the
exception of neoplasms of the lymphatic and hematopoietic system, malignant
melanomas of the skin, lipomas, common tumors of the bone, uterus, and ovary.
Because of these exceptions, the Alphabetic Index must first be checked to determine if
a code has been assigned for that specific histology type (Schraffenberger 2012, 99-
100).
✔✔The term minimum necessary means that healthcare providers and other covered
entities must limit use, access, and disclosure to the minimum necessary to:
a. Satisfy one's curiosity
b. Accomplish the intended purpose
c. Treat an individual
d. Perform research - ✔✔Correct Answer: B
The Privacy Rule introduced the standard of minimum necessary to limit the amount of
PHI used, disclosed, and requested. This means that healthcare providers and other
covered entities must limit uses, disclosures, and requests to only the amount needed
to accomplish the intended purpose (Johns 2011, 822).
✔✔AMBULATORY RECORD
To view this health record:
Click on the tabs above.
Scroll to the bottom of each document.
For your referance, the Coding Guidelines tab includes information from your
codebooks.
To answer the questions in this case:
Enter the appropriate codes in the boxes on the right.
Enter a DX code in every box.
Any necessary decimal point must be present and correctly placed.
Do not include spaces with your answer.
______________
,*Candidates will need to click on each tab to review the reports. Candidates will be
instructed on exactly how many codes are required. The key will be displayed as to
which codes are required, meaning Diagnosis or Procedure and how many. In this
sample question, the case requires 1 Diagnosis code and 1 Procedure code. If the
candidate gets both codes correct they will receive two (2) points. If they get one (1)
correct and one (1) incorrect they will receive 1 point. *If candida - ✔✔Case Studies
PDX 338.3 Neoplasm-related pain (acute) (chronic)
DX2 174.8 Malignant neoplasm of female breast, other specified sites
DX3 198.5 Secondary malignant neoplasm of bone and bone marrow
PP1 62362 Implantation or replacement of device for intrathecal or epidural drug
infusion; programmable pump, including preparation of pump, with or without
programming
Notes for Practice Outpatient Case—Patient 2
338.3 The patient is admitted for pain management due to metastatic cancer. If the
admission is for pain control related to, associated with, or due to, a malignancy, code
338.3 (Brown 2012, 163; Coding Clinic 2nd Quarter 2007, 13-14).
174.8, 198.5 The primary site and metastatic (secondary) sites should be coded (Brown
2012, 378-382).
62362 The reservoir is surgically placed and attached to a previously placed catheter
(CPT Assistant March 1997, 11).
(Garvin 2013, 54, 250.)
✔✔The number that has been proposed for use as a unique patient identification
number but is controversial because of confidentiality and privacy concerns is the:
a. Social security number
b. Unique physician identification number
c. Health record number
d. National provider identifier - ✔✔Correct Answer: A
It is generally agreed that social security numbers (SSNs) should not be used as
patient identifiers (Johns 2011, 387).
✔✔5.
What are four-digit ICD-9-CM diagnosis codes referred to as?
a. Category codes
b. Section codes
c. Subcategory codes
, d. Subclassification codes - ✔✔Correct Answer: C
Categories are divided into subcategories. At this level, four-digit code numbers are
used (Johns 2011, 240).
✔✔Identify the diagnosis code(s) for melanoma of skin of shoulder.
a. 172.8, 172.6
b. 172.6
c. 172.9
d. 172.8 - ✔✔Correct Answer: B
Index Melanoma (malignant), shoulder. Melanoma is considered a malignant neoplasm
and is referenced as such in the index of ICD-9-CM. The term "benign neoplasm" is
considered a growth that does not invade adjacent structures or spread to distant sites
but may displace or exert pressure on adjacent structures (Schraffenberger 2012, 94-
95).
✔✔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 - ✔✔Correct Answer: B
V codes are diagnosis codes and indicate a reason for healthcare encounter
(Schraffenberger 2012, 433).
✔✔A female patient is admitted for stress incontinence. A urethral suspension is
performed. Assign the correct ICD-9-CM diagnosis and/or procedure code(s).
a. 625.6, 57.32
b. 788.0, 59.5
c. 625.6, 59.5
SOLUTIONS RATED A+
✔✔11.
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. Given this information, what would be
the hospital's case-mix index for that year?
a. 0.689
b. 1.59
c. 1.45 × 100
d. 1.45 - ✔✔Correct Answer: D
The case-mix index is 1.45 for the total case-mix index of the hospital. An individual MS-
DRG case mix can be figured by multiplying the relative weight of each MS-DRG by the
number of discharges within that MS-DRG. This provides the total weight for each MS-
DRG. The sum of all total weights (15,192) divided by the sum of total patient
discharges (10,471) equals the case-mix index (Johns 2011, 324).
✔✔12.
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-
9-CM code is:
a. V71.7, Admission for suspected cardiovascular condition
b. 789.01, Esophageal pain
c. 530.81, Gastrointestinal reflux
d. 786.50, Chest pain NOS - ✔✔Correct Answer: D
Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are
used when a physician qualifies a diagnostic statement as "rule out" or other similar
terms indicating uncertainty. In the outpatient setting the condition qualified in that
statement should not be coded as if it existed. Rather, the condition should be coded to
the highest degree of certainty, such as the sign or symptom the patient exhibits. In this
case, assign the code 786.50, Chest pain NOS (Schraffenberger 2012, 339).
✔✔Identify the correct diagnosis code for lipoma of the face.
a. 214.1
,b. 213.0
c. 214.0
d. 214.9 - ✔✔Correct Answer: C
Index Lipoma, face. ICD-9-CM classifies neoplasms by system, organ, or site with the
exception of neoplasms of the lymphatic and hematopoietic system, malignant
melanomas of the skin, lipomas, common tumors of the bone, uterus, and ovary.
Because of these exceptions, the Alphabetic Index must first be checked to determine if
a code has been assigned for that specific histology type (Schraffenberger 2012, 99-
100).
✔✔The term minimum necessary means that healthcare providers and other covered
entities must limit use, access, and disclosure to the minimum necessary to:
a. Satisfy one's curiosity
b. Accomplish the intended purpose
c. Treat an individual
d. Perform research - ✔✔Correct Answer: B
The Privacy Rule introduced the standard of minimum necessary to limit the amount of
PHI used, disclosed, and requested. This means that healthcare providers and other
covered entities must limit uses, disclosures, and requests to only the amount needed
to accomplish the intended purpose (Johns 2011, 822).
✔✔AMBULATORY RECORD
To view this health record:
Click on the tabs above.
Scroll to the bottom of each document.
For your referance, the Coding Guidelines tab includes information from your
codebooks.
To answer the questions in this case:
Enter the appropriate codes in the boxes on the right.
Enter a DX code in every box.
Any necessary decimal point must be present and correctly placed.
Do not include spaces with your answer.
______________
,*Candidates will need to click on each tab to review the reports. Candidates will be
instructed on exactly how many codes are required. The key will be displayed as to
which codes are required, meaning Diagnosis or Procedure and how many. In this
sample question, the case requires 1 Diagnosis code and 1 Procedure code. If the
candidate gets both codes correct they will receive two (2) points. If they get one (1)
correct and one (1) incorrect they will receive 1 point. *If candida - ✔✔Case Studies
PDX 338.3 Neoplasm-related pain (acute) (chronic)
DX2 174.8 Malignant neoplasm of female breast, other specified sites
DX3 198.5 Secondary malignant neoplasm of bone and bone marrow
PP1 62362 Implantation or replacement of device for intrathecal or epidural drug
infusion; programmable pump, including preparation of pump, with or without
programming
Notes for Practice Outpatient Case—Patient 2
338.3 The patient is admitted for pain management due to metastatic cancer. If the
admission is for pain control related to, associated with, or due to, a malignancy, code
338.3 (Brown 2012, 163; Coding Clinic 2nd Quarter 2007, 13-14).
174.8, 198.5 The primary site and metastatic (secondary) sites should be coded (Brown
2012, 378-382).
62362 The reservoir is surgically placed and attached to a previously placed catheter
(CPT Assistant March 1997, 11).
(Garvin 2013, 54, 250.)
✔✔The number that has been proposed for use as a unique patient identification
number but is controversial because of confidentiality and privacy concerns is the:
a. Social security number
b. Unique physician identification number
c. Health record number
d. National provider identifier - ✔✔Correct Answer: A
It is generally agreed that social security numbers (SSNs) should not be used as
patient identifiers (Johns 2011, 387).
✔✔5.
What are four-digit ICD-9-CM diagnosis codes referred to as?
a. Category codes
b. Section codes
c. Subcategory codes
, d. Subclassification codes - ✔✔Correct Answer: C
Categories are divided into subcategories. At this level, four-digit code numbers are
used (Johns 2011, 240).
✔✔Identify the diagnosis code(s) for melanoma of skin of shoulder.
a. 172.8, 172.6
b. 172.6
c. 172.9
d. 172.8 - ✔✔Correct Answer: B
Index Melanoma (malignant), shoulder. Melanoma is considered a malignant neoplasm
and is referenced as such in the index of ICD-9-CM. The term "benign neoplasm" is
considered a growth that does not invade adjacent structures or spread to distant sites
but may displace or exert pressure on adjacent structures (Schraffenberger 2012, 94-
95).
✔✔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 - ✔✔Correct Answer: B
V codes are diagnosis codes and indicate a reason for healthcare encounter
(Schraffenberger 2012, 433).
✔✔A female patient is admitted for stress incontinence. A urethral suspension is
performed. Assign the correct ICD-9-CM diagnosis and/or procedure code(s).
a. 625.6, 57.32
b. 788.0, 59.5
c. 625.6, 59.5
