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