CCS EXAM Questions with preceding Answers, Questions Bank. 100% Accurate

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CCS EXAM Questions with preceding Answers, Questions Bank. 100% Accurate aplastic anemia - ✔✔-The type of anemia caused by a failure of the bone marrow to produce red blood cells is CPT/HC... PCS codes - ✔✔-The APC payment system is based on what coding system(s)? the third-degree burn only - ✔✔-In the diagnosis "first-, second-, and third-degree burns of the chest wall," a code is required for K80.10, I66.9, Z53.09 - ✔✔-6) Patient is admitted for elective cholecystectomy for treatment of chronic cholecystitis with cholelithiasis. Prior to administration of general anesthesia, patient suffers cerebral thrombosis. Surgery is subsequently canceled. Code and sequence the coding using the following codes. J96.00, I50.1, 5A1935Z - ✔✔-Patient was admitted from the nursing home in acute respiratory failure due to congestive heart failure. Chest X-ray also showed acute pulmonary edema. Patient was intubated and placed on mechanical ventilation for less than 24 hours and expired the day after admission. (Code diagnoses using ICD-10-CM and procedures using ICD-PCS.) laboratory information system - ✔✔-You have been asked to give an example of a clinical information system. Which one of the following would you cite? whether the patient is obese - ✔✔-In order to correctly code a hernia repair, the coder needs to know all of the following EXCEPT natural language processing - ✔✔-You have been hired to work with a computer-assisted coding initiative. The technology you will be working with is the sympathetic system and the parasympathetic system - ✔✔-The autonomic nervous system has two divisions. - 24 - ✔✔-A patient has major surgery and sees the surgeon 10 days later for an unrelated E/M service. Indicate the modifier that should be attached to the E/M code for the service provided. Holter monitor - ✔✔-Which diagnostic technique records the patient's heart rates and rhythms over a 24-hour period? 67108 - ✔✔-Repair of retinal detachment with vitrectomy. Chromosomal - ✔✔-Down's syndrome, Edwards' syndrome, and Patau syndrome are all examples of _________ defects. L97.219, L98.429, 0HBKXZZ, 0HB6XZZ, 0HR6X74 - ✔✔-John has chronic ulcers of the right calf and back. Both ulcers are excisionally debrided, and the ulcer of the back has a split-thickness skin graft, autologous. (Code the diagnoses using ICD-10-CM and procedures using ICD-10-PCS.) the Medicare administrative contractor (MAC) - ✔✔-CMS delegates its daily operations of the Medicare and Medicaid programs to revenue code - ✔✔-A four-digit code that describes a classification of a product or service provided to a patient is a reattachment - ✔✔-What is the root operation main term? Reattachment fourth finger National Provider Identifier (NPI) - ✔✔-This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms. cancer hospital - ✔✔-This type of hospital is considered excluded when it applies for, and receives, a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS). an initial inpatient consult and a subsequent hospital visit - ✔✔-The attending physician requests a consultation from a cardiologist. The cardiologist takes a detailed history, performs a detailed examination, and utilizes moderate medical decision making. The cardiologist orders diagnostic tests and prescribes medication. He documents his findings in the patient's medical record and communicates in writing with the attending physician. The following day the consultant visits the patient to evaluate the patient's response to the medication, to review results from the diagnostic tests, and to discuss treatment options. What codes should the consultant report for the two visits? 24 hours after admission or prior to surgery - ✔✔-You have been asked to recommend time-limited documentation standards for inclusion in the Medical Staff Bylaws, Rules, and Regulations. The committee documentation standards must meet the standards of both the Joint Commission and the Medicare Conditions of Participation. The standards for the history and physical exam documentation are discussed first. You advise them that the time period for completion of this report should be set at Digoxin - ✔✔-The patient is diagnosed with congestive heart failure. A drug of choice is use of prohibited or "dangerous" abbreviations - ✔✔-In the past, Joint Commission standards have focused on promoting the use of a facility-approved abbreviation list to be used by hospital care providers. With the advent of the Commission's national patient safety goals, the focus has shifted to the significant procedure - ✔✔-According to the UHDDS, a procedure that is surgical in nature, carries a procedural or anesthetic risk, or requires special training is defined as a fiscal year beginning October 1 - ✔✔-CMS adjusts the Medicare Severity DRGs and the reimbursement rates every replacement - ✔✔-What is the root operation main term? Total left knee replacement restriction - ✔✔-What is the root operation main term? Gastric lap band for treatment of morbid obesity dilation - ✔✔-What main term would be used? Percutaneous angioplasty right coronary artery using a balloon-tipped catheter to expand the vessel $200.00 - ✔✔-A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The non-PAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount the physician will receive is O80, Z37.0, Z30.2, 10E0XZZ, 0W8NXZZ, 0UL74ZZ - ✔✔-Vaginal delivery with episiotomy of full-term liveborn infant. Patient undergoes repair of delivery episiotomy and postdelivery elective vaginal endoscopic ligation of fallopian tubes bilaterally. (Code the diagnoses using ICD-10-CM and procedures using ICD-10-PCS.) be assigned when they affect the management of the mother - ✔✔-Codes from category O36, known or suspected fetal abnormality affecting the mother, should drugs - ✔✔-HCPCS codes beginning with the letter J represent __________________. drug products - ✔✔-NDC codes represent __________________. People over 65, People under 65 with certain disabilities, and ESRD - ✔✔-Medicare covers which of the following scenarios? Coordination of care - ✔✔-_________________________ means that providers work together to ensure that the patient receives the best care and providers in different locations are not duplicating care. Continuity of care - ✔✔-__________________ means that providers work toward the same treatment goal for the patient. The patient - ✔✔-The information the patient gives to the provider belongs to ____________________. Seven years - ✔✔-State laws require providers to keep medical records for patients discharged, no longer seen or deceased for a minimum period of _______________. Providers can simultaneously access the same patient's record - ✔✔-An advantage of an electronic health record is _________________. They may suffer financial distress - ✔✔-What is the major disadvantage for providers who do not participate with Medicare or Medicaid? Improve coordination and continuity of patient care - ✔✔-The federal government will pay Medicare and Medicaid participating providers to implement EHRs, because it will ________________________. Morbidity - ✔✔-_________________ is the term used to classify the presence of an illness, disease, or injury. Tabular List - ✔✔-A coder should never code inpatient procedures directly from the Alphabetic Index without cross-referencing the codes to the ____________________. Z codes - ✔✔-_______________ represent reasons for encounters, other than a disease, condition, or injury, with some exceptions. V-Y codes - ✔✔-__________________ provide additional information about the patient's injury or poisoning but do not represent the patient's actual condition. When a more specific code is not available - ✔✔-When should a coder assign an unspecified code? Malignant, uncertain whether primary or metastatic site - ✔✔-A morphology fifth-digit code of /9 means that the neoplasm is _________________. DSM-5 - ✔✔-The American Psychiatric Association created the ________________ to classify mental disorders and help diagnosis and research various mental conditions. Index to External Causes of Injury - ✔✔-The ______________________ section of the Alphabetic Index contains an alphabetical list of external causes of accidents and injuries, along with their corresponding V-Y codes. carryover line, body site, subterm - ✔✔-A main term may be one word or a phrase, but a main term is not a ______________. Follow the guidelines established by the NCHS and CMS when coding - ✔✔-The Health Insurance Portability and Accountability Act requires coders to _____________ MEDPAR - ✔✔-You need to analyze data on the types of care provided to Medicare patients in your geographic area by DRG. Which of the following would be most helpful? 52318 - ✔✔-Litholapaxy, 3 cm calculus Which code would it be? 50590= Lithotripsy, extracorporeal shock wave 52317= Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (< 2.5 cm) 52318= Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm) 52353= Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) patients (beneficiaries) - ✔✔-A Medicare Summary Notice (MSN) is sent to ________ as their EOB. 52234 - ✔✔-Patient presents to the operating room for fulguration of bladder tumors. The cystoscope was inserted and entered the urethra, which was normal. Bladder tumors measuring approximately 1.5 cm were removed. Which code would it be? 50957= Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy 51530= Cystotomy; for excision of bladder tumor 52214= Cystourethroscopy, with fulguration (including cyrosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands 52234= Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of small bladder tumor(s) (0.5 up to 2.0 cm) N = not present at the time of inpatient admission - ✔✔-A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism. The present on admission (POA) indicator is history, examination, and medical decision making - ✔✔-In assigning E/M codes, three key components are used. These are ancillary services - ✔✔-Under APCs, payment status indicator "X" means only the chest pain - ✔✔-A coworker complained of sudden onset of chest pain and went to the emergency room. A myocardial infarction was ruled out. You would code the interdisciplinary patient care plan - ✔✔-The special form that plays the central role in planning and providing care at nursing, psychiatric, and rehabilitation facilities is recovery audit contractors (RACs) - ✔✔-The _______________ are the organizations that contract with Medicare to perform reviews of medical records with the corresponding Medicare claims to detect and correct improper payments. the OIG's Work Plan - ✔✔-This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS's website. Fraud - ✔✔-____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist. authentication - ✔✔-Before a user is allowed to access protected health information, the system confirms that the patient is who he or she says he or she is. This is known as Never events or sentinel events - ✔✔-____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. de-identified health information - ✔✔-Which of the following can be released without consent or authorization? APR-DRGs - ✔✔-Based on CMS's DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as when the director of health records is acting in response to a subpoena duces tecum and takes the health record to court - ✔✔-Under which of the following conditions can an original paper-based patient health record be physically removed from the hospital? medical staff rules and regulations - ✔✔-You want to review the one document in your facility that will spell out the documentation requirements for patient records, designate the time frame for completion by the active medical staff, and indicate the penalties for failure to comply with these record standards. Your best resource will be quality measure reporting - ✔✔-The PQRS is a reporting system established by the federal government for physician practices that participate in Medicare for CARF manual - ✔✔-The best resource for checking out specific voluntary accreditation standards and guidelines for a rehabilitation facility is the Commission on Accreditation of Rehabilitation Facilities - ✔✔-What does CARF manual means? Corporate Integrity Agreement - ✔✔-When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a The ANSI ASC X12 837 is the claim/encounter format. It is important to note all X12 formats are messaging standards developed for the sole purpose of transmitting data between two entities referred to as trading partners in the HIPAA legislation - ✔✔-What is ANSI ASC X12N 837 format? 5 - ✔✔-The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of ____ years, unless state law specifies a longer period. Recovery Audit Contractors (RAC) - ✔✔-This initiative was instituted by the government to eliminate fraud and abuse and recover overpayments, and involves the use of ______________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government. abuse - ✔✔-When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called a series of core measures - ✔✔-Your hospital is required by the Joint Commission and CMS to participate in national benchmarking on specific disease entities for quality of care measurement. This required collection and reporting of disease-specific data is considered the Stark I Law - ✔✔-This law prohibits a physician from referring Medicare patients to clinical laboratory services where the doctor or a member of his family has a financial interest. Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity - ✔✔-What is the Stark I Law? Medicare administrative contractor (MAC) - ✔✔-CMS delegates its daily operations of the Medicare and Medicaid programs to the Federal Register - ✔✔-In determining your acute care facility's degree of compliance with prospective payment requirements for Medicare, the best resource to reference for recent certification standards is the required for reimbursement of certain patient groups - ✔✔-Accreditation by Joint Commission is a voluntary activity for a facility, and it is use CPOE for medication orders - ✔✔-Stage I of meaningful use focuses on data capture and sharing. Which of the following is included in the menu set of objectives for eligible hospitals in this stage? Computerized physician order entry, sometimes referred to as computerized provider order entry or computerized provider order management, is a process of electronic entry of medical practitioner instructions for the treatment of patients under his or her care - ✔✔-What does CPOE means? MDS - ✔✔-The federally mandated resident assessment instrument used in long-term care facilities consists of three basic components, including the new care area assessment, utilization guidelines, and the achieving meaningful use of EHRs - ✔✔-Engaging patients and their families in health care decisions is one of the core objectives for record-over-record method - ✔✔-The method of calculating errors in a coding audit that allows for benchmarking with other hospitals, and permits the reviewer to track errors by case type, is the trauma registry - ✔✔-The abstract completed on the patients in your hospital contains the following items: patient demographics, prehospital interventions, vital signs on admission, procedures and treatment prior to hospitalization, transport modality, and injury severity score. The hospital uses these data for its discrepancy between postoperative diagnosis by the surgeon and pathology diagnosis by the pathologist - ✔✔-Which of the following is least likely to be identified by a deficiency analysis technician? signs an agreement to participate in the Medicare program and agrees to accept whatever Medicare pays for a provider or service - ✔✔-A participating (PAR) physician is one who outcome measures - ✔✔-42) Patient mortality, infection and complication rates, adherence to living will requirements, adequate pain control, and other documentation that describe end results of care or a measurable change in the patient's health are examples of HAVEN (Home Assessment Validation and Entry) - ✔✔-Home Health Agencies (HHAs) utilize a data entry software system developed by the Centers for Medicare and Medicaid Services (CMS). This software is available to HHAs at no cost through the CMS website or on a CD-ROM. National Practitioner Data Bank - ✔✔-Before making recommendations to the Executive Committee regarding new physicians who have applied for active membership, the Credentials Committee must query the the end user's needs - ✔✔-When developing a data collection system, the most effective approach first considers marking the surgical site - ✔✔-As part of Joint Commission's National Patient Safety Goal initiative, acute care hospitals are now required to use a preoperative verification process to confirm the patient's true identity and to confirm that necessary documents such as X-rays or medical records are available. They must also develop and use a process for 20% - ✔✔-Under ASC-PPS, the patient is responsible for paying the coinsurance amount based upon ____ of the national median charge for the services rendered using established physician query protocols - ✔✔-There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by recovery audit contractors - ✔✔-Your job description includes working with agents who have been charged with detecting and correcting overpayments made to your hospital in the Medicare Fee for Service program. You will need to develop a professional relationship with qualitative review - ✔✔-During a retrospective review of Rose Hunter's inpatient health record, the health information clerk notes that on day 4 of hospitalization, there was one missed dose of insulin. What type of review is this clerk performing? clinical documentation improvement (CDI) - ✔✔-The hospital implemented an electronic query system to allow more effective communication with physicians and other health practitioners to improve clinical documentation in the patient record. This query system was implemented as part of a __________________________program. attending physician - ✔✔-Ultimate responsibility for the quality and completion of entries in patient health records belongs to the evidence cannot be provided that the physician actually reviewed and approved each report - ✔✔-Joint Commission does not approve of auto authentication of entries in a health record. The primary objection to this practice is that Office for Civil Rights - ✔✔-Currently, the enforcement of HIPAA Privacy and Security Rules is the responsibility of the $40 - ✔✔-The patient sees a participating (PAR) provider and has a procedure performed after meeting the annual deductible. If the Medicare-approved amount is $200, how much is the patient's out-ofpocket expense? Cancer Committee - ✔✔-The committee that is responsible for establishing the quality improvement priorities of the cancer program and for monitoring the effectiveness of quality improvement activities is the DNFB (discharged, not final billed) - ✔✔-To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report. Though this report has no standard title, it is often called the the presence or absence of such items as preoperative and postoperative diagnosis, description of findings, and specimens removed - ✔✔-The health care providers at your hospital do a very thorough job of periodic open record review to ensure the completeness of record documentation. A qualitative review of surgical records would likely include checking for documentation regarding code only the comprehensive code - ✔✔-The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled "comprehensive codes" and "component codes." According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service they should completeness - ✔✔-The coding supervisor notices that the coders are routinely failing to code all possible diagnoses and procedures for a patient encounter. This indicates to the supervisor that there is a problem with accession register - ✔✔-The Cancer Committee at your hospital requests a list of all patients entered into your cancer registry in the last year. This information would be obtained by checking the patient care outcomes - ✔✔-In compiling statistics to report the specific cause of death for all openheart surgery cases, the quality coordinator assists in documenting CPT codes - ✔✔-To gather statistics for surgical services provided on an outpatient basis, which of the following codes are needed? pathology report - ✔✔-In preparation for an EHR, you are working with a team conducting a total facility inventory of all forms currently used. You must name each form for bar coding and indexing into a document management system. The unnamed doc [Show More]

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