John Smith presents to the emergency room at 1500 hours with a fever of 101 degrees F, which
he has had for the last three days. He was discharged six days ago following a colon resection.
X-rays show a bowel obstructi
...
John Smith presents to the emergency room at 1500 hours with a fever of 101 degrees F, which
he has had for the last three days. He was discharged six days ago following a colon resection.
X-rays show a bowel obstruction and the plan is for admission with inpatient surgery in the
morning.
a.The patient does not meet both severity of illness and intensity of service criteria.
b.The patient does meet both severity of illness and intensity of service criteria.
c.The patient meets intensity of service criteria but not severity of illness cri - Answer>>> b The
patient meets severity of illness with the persistent fever and intensity of service with the
inpatient-approved surgery scheduled within 24 hours of admission (Shaw and Carter 2014;
Shaw and Elliott 2012, 113, 120)
If a service is determined to be reasonable and necessary for the related diagnosis or treatment of
illness or injury, it is stated as being:
a.Needed for treatment
b.Medically justified
c.Non-covered
d.Medically necessary - Answer>>> d The determination that a service is reasonable and
necessary for the related diagnosis or treatment of illness or injury is determined to be medically
necessary (Shaw and Carter 2014; Malmgren and Solberg 2011, 462).
The coding manager at Community Hospital is seeing an increased number of physicians failing
to document the cause and effect of diabetes and its manifestations. Which of the following will
provide the most comprehensive solution to handle this documentation issue?
a.Have coders continue to query the attending physician for this documentation.
b.Present this information at the next medical staff meeting to inform physicians on
documentation standards and guidelines.
c.Do nothing because coding compliance guidelines do not allow any action.
d.Place all offending physicians on suspension if the documentation issues continue. -
Answer>>> b Present this information at the next medical staff meeting to inform physicians on
documentation standards and guidelines. The quality of the documentation entered in the health
record by providers can have major impacts on the ability of coding staff to perform their clinical
analyses and assign accurate codes. In this situation, the best solution would be to educate the
entire medical staff on their roles in the clinical documentation improvement process. Explaining
to them the documentation guidelines and what documentation is needed in the record to support
the more accurate coding of diabetes and its manifestations will reduce the need for coders to
continue to query for this clarification (Shaw and Carter 2014; Schraffenberger and Kuehn 2011,
285).
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