THE CODING EDGE® ARCHIVES

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Procedure Practice 07/15/00 - Feature Articles 07/15/00
   

Procedure Practice 07/15/00:
Coding Recommendations
 

Below you can find the answers to our Multiple Choice Coding Quiz. If you disagree with us or have other comments, please send an e-mail to codingedge@lagunamedsys.com.   

Please understand, however, that we cannot answer inquiries
unless they relate directly to our published material.

 

Multiple Choice Coding Quiz Answers

1. A coder is confused by the documentation provided for a shoulder MRI. The coder should:
  1. Ask the HIM director what to do.
     
  2. Assign the "best guess" diagnosis code.
     
  3. Query the physician.
     
2. If a patient is seen for a reason other than disease or injury, the coder should:
  1. Demand a diagnosis that can be coded from the physician's office.
     
  2. Assign the appropriate V-code to report the patient encounter.
     
  3. Assign the appropriate E-code to report the patient encounter.
     
3. All of the following services are reimbursed under the APC system except:
  1. Ambulance services
     
  2. Outpatient surgical services
     
  3. Emergency Department services
     
4. Epigastric pain was documented as the reason for a gallbladder ultrasound that was interpreted by the radiologist as showing multiple gallstones. The principal diagnosis for this service is:
  1. Epigastric pain
     
  2. Cholelithiasis
     
  3. Radiological exam not elsewhere classified
     
5. The OCE contains how many individual edits, excluding the new CCI edits?
  1. 56
     
  2. 19,000
     
  3. 42
     
6. A healthy 55-year-old male underwent flexible sigmoidoscopy to rule out rectal cancer. The coder should:
  1. Explain to the physician that this is an unnecessary service and the hospital will lose money on it.
     
  2. Assign a code for rectal bleeding since the insurance company won't pay the claim without a diagnosis.
     
  3. Assign a code to indicate that the service was a screening procedure.
     
7. All the following statements about APC's are true except:
  1. All services submitted on a single bill will be rolled into one APC payment.
     
  2. A payment rate is set for each APC.
     
  3. Each CPT/HCPCS code in the APC system has a status indicator that determines the reimbursement method.
     
8. Medicare local coverage decisions are based upon:
  1. OPPS
     
  2. HCFA
     
  3. LMRP
     
9. The guiding principle for correct coding is:
  1. Code based upon the available physician documentation.
     
  2. Code based upon the information the insurance carrier needs to pay the bill.
     
  3. Code the way the physician tells you to .
     
10. The OCE contains code edits for all the following except:
  1. Noncovered services
     
  2. Comprehensive codes
     
  3. Beneficiary copayments
     
11. If a Medicare claim is returned to a hospital with the disposition of "claim rejection," the facility can:
  1. Correct the problem and resubmit the bill.
     
  2. Cannot do anything-Medicare will not cover the service.
     
  3. Demand that the patient pay the entire amount of the bill.
     
12. Coders should understand how to use CPT modifiers because:
  1. They can append a modifier to any CPT code that Medicare rejects to get the bill paid.
     
  2. Certain modifiers may be added when appropriate to over-ride CCI edits and clarify the services provided.
     
  3. The OCE and CCI edits do not screen for modifier usage.
     

  

  

Procedure Practice 07/15/00 - Feature Articles 07/15/00
 

Bibliography - References:
AdminaStar Federal web site http://www.astar-federal.com
Coding Clinic for ICD-9-CM, American Hospital Association, 1st quarter 2000.
CPT Assistant, American Medical Association, April 1999
Department of Health and Human Services web site http://www.hhs.gov/proorg/oas/reports/region1/
Hallam, Kristen. "Lawmakers Define Medical Necessity." Modern Healthcare, 29, no. 10 (1999)
Health Care Financing Administration, Medicare Policy Manual, ICD-9-CM Official Outpatient Coding Guidelines
Office of Inspector General's Compliance Program Guidance for Hospitals, OIG web site http://www.hhs.gov/prororg/oig
MEDPAC (Medicare Payment Advisory Committee) web site http://www.medpac.gov
National Technical Information Service web site http://www.ntis.gov   		Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.