Question 1

The 5th character of the code 0DJ76ZZ indicates which of the following?

Accepted Answer

A)   Location
B)   Device
C)   Body System
D)   Approach

Question 2

What is the lowest level of medical complexity represented by CPT E/M codes?

Accepted Answer

A)   straightforward
B)   problem-focused
C)   low complexity
D)   detailed

Question 3

Which code set is alphanumeric?

Accepted Answer

A)   ICD-10-PCS
B)   NDC
C)   CPT-4, Category 1
D)   SNOMED CT

Question 4

Why is electronic data interchange (EDI)  beneficial?

Accepted Answer

A)   computers can exchange information without human intervention
B)   information can only be "read" by the recipient
C)   messages contain unique identifiers that cannot be duplicated
D)   it works across reimbursement and clinical platforms

Question 5

Tracking codes to determine the volume of cases seen at the facility is a _____________ use of coded data.

Accepted Answer

A)   outcomes measurement
B)   research
C)   reimbursement
D)   resource utilization

Question 6

Which statement about SNOMED CT is false?

Accepted Answer

A)   it can assign codes from free text
B)   it makes systems interoperable across countries and languages
C)   there is a one-to-one translation between SNOMED CT and ICD-10-CM
D)   it has the potential to be useful during patient care, rather than after

Question 7

In which case would a CDI physician champion be involved?

Accepted Answer

A)   a provider and a clinical documentation improvement specialist disagree on what should be included in the plan of care
B)   a nurse is slow to input progress notes
C)   a coder adds complications and comorbidities that are unsupported by documentation
D)   a provider will not authenticate his verbal orders in a timely manner

Question 8

The Health Insurance Portability and Accountability Act (HIPAA)  of 1996 required the:

Accepted Answer

A)   reporting of diagnosis data to the National Center for Health Statistics (NCHS) .
B)   adoption and use of ICD-10-CM.
C)   use of the EHR with point-of-care data capture.
D)   use of certain codes in electronic transmissions.

Question 9

The _________ axis of an ICD-O-3 code indicates the site of a neoplasm in the body.

Accepted Answer

A)   morphology
B)   oncology
C)   topography
D)   pathology C

Question 10

____________ occurs when the coding results in the MS-DRG that most accurately represents the facility's utilization of resources, on the basis of the diagnoses and procedures, and is completely substantiated by documentation.

Accepted Answer

A)   Maximization
B)   Validity
C)   Optimization
D)   Compliance C

Question 11

An example of a CPT-4 (Health Care Common Procedure Coding System [HCPCS] Level 1)  code is:

Accepted Answer

A)   C1715
B)   0DJD8ZZ
C)   4557003
D)   43251

Question 12

The auditor was reviewing the hospital bills and noticed that for several cases billed to a commercial payer the DRG assignment, based on the MS-DRG description of the DRG code, did not match the diagnosis/procedure codes. One possible reason for this is:

Accepted Answer

A)   the coder made an error assigning the DRG.
B)   the grouper isn't working properly.
C)   that payer uses a different DRG than Medicare.
D)   the MS-DRG description is incorrect. C

Question 13

Which organization is NOT one of the four Cooperating Parties for the ICD-10-CM?

Accepted Answer

A)   American Medical Association (AM
A)  
B)   Centers for Medicare and Medicaid Services (CMS) 
C)   National Center for Health Statistics (NCHS) 
D)   The Joint Commission (TJ
C)

Question 14

It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must:

Accepted Answer

A)   follow all software prompts that will add a "cc" code. The software program is written so that the coder does not have to review the medical record.
B)   use coding software to sequence the best principal diagnosis for the highest reimbursement.
C)   code and sequence according to the documentation in the medical record, using the software to optimize the coding.
D)   adjust the principle diagnosis as needed to achieve the right DRG for the patient's needs.

Question 15

Why are coding audits performed by payers insufficient for determining coding accuracy?

Accepted Answer

A)   the payer only checks records for the patients they have reimbursed
B)   the payer only performs targeted reviews on "problem" DRGs
C)   payers will only audit when there is a change in case mix
D)   payers are ultimately more interested in volume rather than accuracy

Question 16

Why might a coding manager automatically review and/or revise patients assigned to DRG 469 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC)  or DRG 470 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC) ?

Accepted Answer

A)   The hospital might not be entitled to the reimbursement for these DRGs.
B)   The federal government always reviews these DRGs for fraud and abuse.
C)   There is something incorrect with the codes assigned and/or data when a patient is grouped into either of these DRGs.
D)   These DRGs are on the OIG workplan this year.

Question 17

Which is an appropriate measure of the success of a clinical documentation improvement (CDI)  program?

Accepted Answer

A)   a more complex case mix
B)   higher reimbursements
C)   shorter average length of stay
D)   diagnosis documentation changes

Question 18

The NDC code for one 28-tablet bottle of the chronic hepatitis medication Harvoni, made by Gilead Sciences, is 61958-1801-1. The number "61958" is the

Accepted Answer

A)   labeler code
B)   product code
C)   packaging code
D)   batch code

Question 19

Using the figure, which is the ICD-10-PCS code for an endoscopic colonoscopy?

Accepted Answer

A)   ODJD8ZZ
B)   ODJD7ZZ
C)   ODJ68ZZ
D)   ODJ67ZZ

Question 20

Level _____________ of HCPCS is also known as Current Procedural Terminology (CPT).

Accepted Answer

The answer of Level _____________ of HCPCS is also known...

Exam 5: Coded Data

The 5th character of the code 0DJ76ZZ indicates which of the following?

Correct AnswerverifiedShow Answer

What is the lowest level of medical complexity represented by CPT E/M codes?

Correct AnswerverifiedShow Answer

Which code set is alphanumeric?

Correct AnswerverifiedShow Answer

Why is electronic data interchange (EDI) beneficial?

Correct AnswerverifiedShow Answer

Tracking codes to determine the volume of cases seen at the facility is a _____________ use of coded data.

Correct AnswerverifiedShow Answer

Which statement about SNOMED CT is false?

Correct AnswerverifiedShow Answer

In which case would a CDI physician champion be involved?

Correct AnswerverifiedShow Answer

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the:

Correct AnswerverifiedShow Answer

The _________ axis of an ICD-O-3 code indicates the site of a neoplasm in the body.

Correct AnswerverifiedC

____________ occurs when the coding results in the MS-DRG that most accurately represents the facility's utilization of resources, on the basis of the diagnoses and procedures, and is completely substantiated by documentation.

Correct AnswerverifiedC

An example of a CPT-4 (Health Care Common Procedure Coding System [HCPCS] Level 1) code is:

Correct AnswerverifiedShow Answer

The auditor was reviewing the hospital bills and noticed that for several cases billed to a commercial payer the DRG assignment, based on the MS-DRG description of the DRG code, did not match the diagnosis/procedure codes. One possible reason for this is:

Correct AnswerverifiedC

Which organization is NOT one of the four Cooperating Parties for the ICD-10-CM?

Correct AnswerverifiedShow Answer

It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must:

Correct AnswerverifiedShow Answer

Why are coding audits performed by payers insufficient for determining coding accuracy?

Correct AnswerverifiedShow Answer

Why might a coding manager automatically review and/or revise patients assigned to DRG 469 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC) or DRG 470 (MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC) ?

Correct AnswerverifiedShow Answer

Which is an appropriate measure of the success of a clinical documentation improvement (CDI) program?

Correct AnswerverifiedShow Answer

The NDC code for one 28-tablet bottle of the chronic hepatitis medication Harvoni, made by Gilead Sciences, is 61958-1801-1. The number "61958" is the

Correct AnswerverifiedShow Answer

Using the figure, which is the ICD-10-PCS code for an endoscopic colonoscopy?

Correct AnswerverifiedShow Answer

Level _____________ of HCPCS is also known as Current Procedural Terminology (CPT).

Correct AnswerverifiedShow Answer

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