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A patient is admitted from the emergency department (ED) with a diagnosis of weakness and anemia. After admission and further treatment with packed red blood cells (PRBC), GI consult, and endoscopy, the physician includes the following diagnoses in the discharge summary: anemia, suspected bleeding gastric ulcer, and GERD. What would be the most appropriate principle diagnosis?
A. Bleeding gastric ulcer B. Anemia C. GERD D. Weakness - ANSWER>>A. Bleeding gastric ulcer
A patient is admitted with new-onset seizures. Head CT reveals a mass in the occipital region. The physician documents possible brain tumor, and the patient is transferred to another hospital for further workup. What would be the most appropriate principal diagnosis based upon this documentation?
A. Seizure B. Neoplasm of occipital region C. Head mass D. Head tumor - ANSWER>>B. Neoplasm of occipital region
A hospital's base rate or blended rate is:
- Calculated annually
- Dependent upon indirect costs for graduate medical education and new technology
- Adjusted based upon number of low-income patients cared for
- Not adjusted based upon capital expenses
A. 1 and 2 B. 2 and 3 C. 1,2, and 3 D. 1,2,3, and 4 - ANSWER>>C. 1,2, and 3
- Calculated annually
- Dependent upon indirect costs for graduate medical education and new technology
- Adjusted based upon number of low-income patients cared for
The final MS-DRG assigned to a patient's medical record should:
A. Reflect the amount of time the physician spent with the patient B. Depend upon the patient's length of stay C. Be assigned by the physician D. Reflect the severity of illness (SOI) and resource consumption of the patient's care - ANSWER>>D. Reflect the severity of illness (SOI) and resource consumption of the patient's care
A patient is admitted from the emergency department with the diagnosis of acute respiratory failure due to overdose of pain medication and an aspiration pneumonia. What is the principal diagnosis?
A. Acute respiratory failure B. Aspiration pneumonia C. Poisoning D. Adverse effect of medication - ANSWER>>C. Poisoning
A patient is admitted with pneumonia, stage 1 chronic renal failure, chronic anemia, and COPD, While hospitalized the patient receives IV antibiotics,
B. Acute renal failure C. Abdominal pain D. Metastatic neoplasm of the colon - ANSWER>>A. Colon cancer
Accurate documentation should:
- Include identification of the patient's SOI
- Identify conditions that are present on admission
- Support medical necessity
A. 1 and 2 B. 2 and 3 C. 1 and 3 D. 1,2, and 3 - ANSWER>>D. 1,2, and 3
- Include identification of the patient's SOI
- Identify conditions that are present on admission
- Support medical necessity
A patient with a history of metastatic lung cancer is directly admitted from the doctor's office with a diagnosis of anemia secondary to chemotherapy. The patient receives two units of PRBCs and is discharged. What is the most appropriate principal diagnosis?
A. Respiratory neoplasm B. Anemia C. Admission for chemotherapy D. Admission for blood transfusion - ANSWER>>B. Anemia
A patient is admitted from the ED with rectal bleeding secondary to Coumadin toxicity. The physician documents that the patient had a recent increase in Coumadin dosage due to low PT/PTT. The patient also has a history of COPD and CHF. What is the most appropriate principal diagnosis?
A. GI hemorrhage B. Coumadin toxicity C. COPD D. CHF - ANSWER>>A. GI hemorrhage
A patient comes to the ED with fever, chills, and knee pain. Documentation states that the patient's admission is for knee prosthesis removal due to infection. What is the principal diagnosis? (Do not include the procedure)
A. Fever B. Sepsis C. Infected knee prosthesis D. Knee pain - ANSWER>>C. Infected knee prosthesis
A patient is admitted with pain in the lower extremity. The physician documents cellulitis due to septic joint. X-ray indicates possible osteomyelitis. What is the principal diagnosis?
A. Pain B. Cellulitis C. Osteomyelitis D. Septic joint - ANSWER>>D. Septic joint
Which guideline provides the direction for the correct assignment of the principal diagnosis?
A. Probable/possible conditions should always be assigned over a symptom diagnosis B. Always code the most severe condition as principal C. The coder can link the symptom to the most appropriate condition
Which of the following are included in chapter-specific guidelines for the coding of HIV?
- ICD-10 code B20 should be sequenced as principal diagnosis in all cases
- ICD-10 code B20 should only be assigned in confirmed cases of HIV
- HIV status must be confirmed by a blood test
- ICD-10 code B20, if sequenced as a secondary diagnosis, qualifies as an MCC
- Coding is specific to the reason for admission
A. 1,2, and 3 B. 1,3, and 5 C. 2,3, and 4 D. 2,4, and 5 - ANSWER>>D. 2,4, and 5
- ICD-10 code B20 should only be assigned in confirmed cases of HIV
- ICD-10 code B20, if sequenced as a secondary diagnosis, qualifies as an MCC
- Coding is specific to the reason for admission
Appropriate sequencing for a patient with urinary tract infection (UTI), pneumonia, and sepsis, all present on admission, recognizes that:
A. The systemic infection is always sequenced as principal diagnosis B. The systemic infection is always sequenced as secondary diagnosis C. The ICD-10 code for SIRS should be sequenced as principal diagnosis D. Documented organ failure is necessary before one can code sepsis - ANSWER>>A. The systemic infection is always sequenced as principal diagnosis
A patient is admitted with back pain documented as secondary to metastatic colon cancer. During the hospitalization, the patient undergoes a bone scan and the physician documents new bone metastasis of the spine. An oncology consult is completed and radiation therapy is recommended. The patient refuses further care, receives pain control, and is then discharged to hospice. The principal diagnosis is:
A. Metastatic colon cancer B. Pain C. Bone metastasis D. Palliative care - ANSWER>>C. Bone metastasis
When coding a medical record that includes diabetes and manifestations of diabetes, it is important to remember that specificity of coding for diabetes is dependent upon:
- Documentation of Type 1 or Type 2 diabetes
- Documentation of whether the diabetes is controlled
- Documentation of the patient's blood sugar levels
- Documentation of any manifestations of the diabetes
A. 1,2, and 3 B. 1,2, and 4 C. 1 and 4 D. 2 and 4 - ANSWER>>C. 1 and 4
- Documentation of Type 1 or Type 2 diabetes
- Documentation of any manifestations of the diabetes
A late effect of a condition is defined as:
A. A condition that develops within a year of the original condition B. A condition that always occurs C. A condition that remains or develops after conclusion of the acute phase of an illness/injury D. A condition that occurs as a complication of surgery - ANSWER>>C. A condition that remains or develops after conclusion of the acute phase of an illness/injury
Concurrent queries should be designed to clarify:
- Ambiguous, inconsistent, and incomplete documentation
- The clinical significance of abnormal test results
- The specificity or degree of severity of a condition
- Conditions that were present on admission
A. 1 and 3 B. 1,2, and 3 C, 1,2, and 4 D. 1,2,3, and 4 - ANSWER>>D. 1,2,3, and 4
- Ambiguous, inconsistent, and incomplete documentation
- The clinical significance of abnormal test results
- The specificity or degree of severity of a condition
- Conditions that were present on admission
When formulating a credible clinical query for a physician, which of the following information should a CDI specialist incorporate?
A. Medical history of the patient, past medications, and current medications B. Risk factors of a condition, signs and symptoms of a condition, and treatment C. Treatment plan for the admission D. Possible DRG choices for the physician to review - ANSWER>>B. Risk factors of a condition, signs and symptoms of a condition, and treatment
Policies and procedures that spell out a concurrent query process are important to:
A. Ensure that retrospective queries do not occur B. Stipulate conformance to AHIMA guidelines C. Identify conditions for when and how a query will be formulated
D. Prevent the need for coding audits - ANSWER>>C. Identify conditions for when and how a query will be formulated
Metabolic encephalopathy is:
A. Treated by correcting the underlying condition B. Caused by trauma to the head C. A minor comorbid condition D. Usually the principal diagnosis - ANSWER>>A. Treated by correcting the underlying condition
A patient is admitted with new-onset severe headache, visual changes, difficulty swallowing, and hypertension (HTN). Clinically, which of the diagnoses below would best explain these symptoms?
A. Arteriosclerosis B. Cerebral edema secondary to a lesion in the brain C. Acute renal failure D. Lou Gehrig's disease - ANSWER>>B. Cerebral edema secondary to a lesion in the brain
An elderly gentleman with a history of COPD and HTN who uses home oxygen is admitted with complaints of dyspnea, rapid shallow breaths, and an oxygen saturation of 84% on 2L of oxygen. A non-rebreather mask is applied, and the patient receives IV solumedrol and breathing treatments. The physician documents in the progress notes "respiratory failure due to COPD versus pneumonia." Based upon this documentation, the principal diagnosis would be:
A. Dyspnea B. Pneumonia C. COPD D. Respiratory failure - ANSWER>>D. Respiratory failure
A. Malignant B. Transudative C. Exudative D. Serosanguinous - ANSWER>>C. Exudative
Clinical indicators of acute respiratory failure most commonly include:
- Use of accessory muscles
- Work of breathing
- Inability to speak more than a few words at a time
- Oxygen saturations below 95% on 2L oxygen
- Tachycardia
A. 1,2, and 3 B. 2,3, and 5 C. 3,4, and 5 D. 1,3, and 5 - ANSWER>>A. 1,2, and 3
- Use of accessory muscles
- Work of breathing
- Inability to speak more than a few words at a time
An elderly patient with a history of CAD, GERD, and HTN is admitted with chest pain. Pain was unrelieved with nitroglycerin at home. A GI cocktail is administered in the ED with relief. Cardiac workup is negative, and patient is scheduled for an EGD. The physician documents atypical chest pain. A concurrent query:
A. Is not necessary to code GERD as the principal diagnosis B. Would be needed to specify the cause of the chest pain C. Would not be necessary as chest pain is the principal diagnosis
D. Would be needed to specify the type of GERD - ANSWER>>B. Would be needed to specify the cause of the chest pain
A patient is admitted with syncope. Typical considerations for the underlying cause of syncope include:
A. Cardiac arrhythmia and fluid overload B. CHF and renal failure C. Diabetes, bradycardia, and dehydration D. Obesity and colon cancer - ANSWER>>C. Diabetes, bradycardia, and dehydration
When a patient's admission includes a reimbursable surgical procedure, assignment of the final MS-DRG will:
A. Always be in the same MDC as the principal medical diagnosis B. Always include a comorbid condition (CC/MCC) C. Depend on the patient's age D. Be driven by the surgical hierarchy established by CMS - ANSWER>>D. Be driven by the surgical hierarchy established by CMS
When concurrently formulating a query to clarify whether a patient has a gastrointestinal hemorrhage, it is important to assist the physician in understanding which of the following coding rules?
A. Active bleeding does not need to be visualized in an endoscopy; the physician impression can be documented and coded B. Bleeding must be visualized in order to code an active bleed C. A positive hemoccult is sufficient documentation to code GI hemorrhage D. The EGD report will be used to code the location of the GI hemorrhage - ANSWER>>A. Active bleeding does not need to be visualized in an endoscopy; the physician impression can be documented and coded
positive for white blood cells. Head CT is negative for acute changes. The patient is started on IV fluids and antibiotics. Labs after 2 liters of fluid are BUN 28 and creatinine 1.7. The physician documents the following impression list:
-Dehydration with pre-renal azotemia -UTI -CKD -AMS
Which of the following is an appropriate concurrent query?
A. Documentation indicates creatinine 2.4 on admission decreasing to 1.7 after 2 liters of fluid administered. Please clarify the condition you are monitoring and treating related to creatinine. Based upon presentation of altered mental status, are you also treating a CVA? B. Please specify the reason for the IV fluids C. Please specify the - ANSWER>>A. Documentation indicates creatinine 2.4 on admission decreasing to 1.7 after 2 liters of fluid administered. Please clarify the condition you are monitoring and treating related to creatinine. Based upon presentation of altered mental status, are you also treating a CVA?
Treatment of acute renal failure may include:
- IV fluids
- Holding of diuretics
- Monitoring of intake and output
- Daily review of BUN and creatinine
A. 1 and 4 B. 3 and 4 C. 1,2, and 3 D. 1,2,3 and 4 - ANSWER>>D. 1,2,3 and 4
- IV fluids
- Holding of diuretics
- Monitoring of intake and output
- Daily review of BUN and creatinine
Aplastic anemia:
A. Is hereditary and can only be sequenced as the principal diagnosis B. Is defined as bone marrow failure causing a reduction in white blood cells, red blood cells, and platelets C. Is chronic and easily treated D. Qualifies as a minor comorbid condition (CC) - ANSWER>>B. Is defined as bone marrow failure causing a reduction in white blood cells, red blood cells, and platelets
A patient is admitted from a skilled nursing facility with a Foley catheter in place. Temp is 100.4, P 92, resp rate 22, BP 118/76. White blood cell count is 18.2. The admitting diagnostic list includes UTI due to a Foley, pneumonia, and infected decubitus ulcer of the right heel. What should a concurrent query be posed for?
A. Whether the UTI is secondary to the Foley catheter B. Osteomyelitis secondary to the infected ulcer C. Sepsis due to multifactoral infections, stage of the decubitus ulcer and specificity of the type of pneumonia D. No queries are needed - ANSWER>>C. Sepsis due to multifactorial infections, stage of the decubitus ulcer and specificity of the type of pneumonia
Which of the following are important metrics to monitor in evaluating CDI specialist productivity?
A. Hours worked and hospital case-mix index (CMI) B. Discharge rates and number of records coded
C. 2 and 3 D. 2 and 4 E. 3 and 4 - ANSWER>>B. 1 and 3
- One of the operating rooms sustained water sprinkler damage
- Three of five orthopedic surgeons were away at a national conference that month
A CDI team has a query rate of 55%, but the CMI has had only marginal improvement. Which of the following may explain this situation?
A. Data entry may not be accurate, causing a misrepresentation of MS-DRG shifts B. The physician response rate is high C. The physician agreement rate is high D. The CDI query rate is too high - ANSWER>>A. Data entry may not be accurate, causing a misrepresentation of MS-DRG shifts
CMS' Recovery Audit Program was designed to:
A. Detect improper coding B. Detect fraud of the Medicare system C. Serve as a method to track underpayments D. Identify improper payments in the Medicare system - ANSWER>>D. Identify improper payments in the Medicare system
When requesting medical records for review, Recovery Auditors:
A. Can request any record from any MDC B. Can only review the actual paper record C. Cannot request more than 200 records every 45 days D. Can only review records with a CC/MCC - ANSWER>>C. Cannot request more than 200 records every 45 days
In preparation for a recovery audit, a hospital may choose to implement an internal record review process. Records that would be important to review include:
A. Records with only one coded CC B. Records without a surgical procedure C. Records with long lengths of stay D. Records that were reviewed by a CDI specialist - ANSWER>>A. Records with only one coded CC
If a Recovery Auditor identifies a record that had improper payment, the hospital cannot:
A. Appeal the claim B. Agree with the decision and return the overpayment C. Submit a rebuttal letter D. Ask for a second review - ANSWER>>D. Ask for a second review
Which of the following types of health records are being targeted for review by the Recovery Audit Program?
A. Records with procedures that were performed in interventional radiology B. Records without additional comorbid conditions C. Records assigned with a single comorbid condition D. Records with comorbid conditions that are present on admission - ANSWER>>C. Records assigned with a single comorbid condition
Based upon medical necessity requirements, which of the following principal diagnoses is most likely to be denied?
A. Hypertension B. Healthcare-acquired pneumonia
