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Medical Coding Exam System - Week 2 Day 3 Practice Exam Questions 173 - 208

173. Which data set was developed for collecting data on outpatients?

a. UHDDSb. Uniform Ambulatory Care Data Setc. Minimum Data Setd. Uniform Clinical Data Set

174. Review of patient services needed prior to the patient actually receiving these services iscalled:

a. retrospective reviewb. concurrent reviewc. prospective reviewd. discharge planning

175. Which of the following refers to the characteristic of data being defined at the correct level ofdetail?

a. accuracyb. consistencyc. integrityd. granularity

176. A Health Information Management department of a local hospital will experience a 20%increase in the number of discharges processed per day as the result of a merger with a smallerfacility. This 20% increase is projected as 120 additional records per day. The standard time forcoding a record is 15 minutes. Compute the number of FTEs required to handle this increasedvolume in coding based on an eight hour day.

a. 3.75b. 2.8c. 6.5d. 5.25

177. The extent to which data is within time parameters to be relevant refers to:

a. Relevancyb. Timelinessc. Currencyd. Granularity

178. What terms refers to accounts that are to be refunded to an insurer or a patient that ahealthcare facility has defined as uncollectible.

a. credit balancesb. accounts receivable

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c. late chargesd. bad debt

179. If administrators of a home health agency wanted to measure the outcomes of adult patientsreceiving their agency's services which tool would they use?

a. OASISb. HEDISc. ORYXd. QAI

180. In order to take part in the Medicare program, a hospital must be in compliance to asatisfactory degree with the standards for delivery of health care set forth in the:

a. Hospital medical staff bylawsb. Journal of the American Hospital Associationc. Joint Commissiond. Conditions of Participation

181. Most healthcare facilities use this type of screening criteria for utilization review purposes todetermine the need for inpatient services and justification for continued stay

a. severity of illness/intensity of service criteria (SI/IS)b. critical pathwaysc. Joint Commission defined and developed criteriad. HEDIS measures

182. Which of the following is a system in which the patient health record is kept in the sameorder on the nursing station and in the complete record?

a. reverse chronological orderb. universalc. integratedd. source‐oriented

183. You have been asked to define privacy. Which of the following definitions would you use?

a. The patient has the right to control everyone who reviews his or her medical record.b. The patient has rights regarding their individually identifiable health information.c. Access to medical record information has to be controlled by technical controls.d. Access to patient identifiable health information is available only to healthcare professionals.

184. A valid authorization for release of information contains

a. the name, agency, or institution to whom the information is to be providedb. the name of the hospital or provider who is releasing the medical informationc. the date and signature of the patient or their authorized representatived. all of the above

185. Which of the following would a coder would use to determine whether a service is


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considered medically necessary?

a. the American Hospital Association's Coding Clinicb. National Coverage Decisions (NCDs)c. the American Medical Association's CPT Assistantd. Correct Coding Initiatives

186. The APC payment system is based on what coding system(s)?

a. AMA's CPT codesb. CPT and ICD‐10‐CM diagnosis and procedure codesc. ICD‐10‐CM diagnosis and procedure codesd. CPT/ HCPCS codes

187. A coder in a hospital inpatient department sees a lab report in the patient's health recordthat supports the diagnosis of staph infection. However, there is no mention of the infection inthe physician's documentation. What should the coder do?

a. code as unspecified infectionb. query the physicianc. assign a code for the staph infectiond. don't code the staph infection at all

188. _______________________is a defect characterized by four anatomical abnormalitieswithin the heart that results in poorly oxygenated blood being pumped to the body.

a. atrial septal defectb. patent ductus arterioususc. Tetralogy of Fallotd. coarctation of the aorta

189. The process of attaching a HCPCS code to a procedure so that the code will automaticallybe included on the patient's bill is known as:

a. groupingb. hard codingc. soft codingd. mapping

190.This payment system replaced the customary, prevailing, and reasonable (CPR) chargepayment system for physician services provided to Medicare patients. It is based upon relativevalue units

a. Medicare fee scheduleb. pre‐certificationc. consolidated billingd. ancillary packaging

191. This prospective payment system has been adopted for use by many third party payers (i.e.,Medicaid) for reimbursement of outpatient visits. It is not the methodology used by Medicare.


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a. ASCs (Ambulatory Surgery Centers)b. APGs (Ambulatory Patient Groups)c. DRGs (Diagnosis Related Groups)d. APCs (Ambulatory Payment Classification)

192. In order to correctly code a hernia repair, the coder needs to know all of the followingexcept:

a. type of herniab. whether the hernia is strangulated or incarceratedc. age of the patientd. whether the patient is obese or not

193. The _______________is the most commonly used severity‐of‐illness system in the U.S.A

a. Adjusted Clinical Group (ACG) systemb. Medical outcomes studyc. Atlas Systemd. National Association of Children's Hospitals and Related Institutions

194. The practice of using a code that results in a higher payment to the provider than the codethat more accurately reflects the service provided is known as:

a. unbundlingb. upcodingc. optimizingd. ICD‐10‐CM creep

195. A PAR physician is one who:

a. can bill 115% above the Medicare Fee Scheduleb. signs an agreement to participate in the Medicare program and agrees to accept whateverMedicare pays for a provider or servicec. receives 5% less than other non‐PAR physiciansd. submits claim forms using ICD‐10‐CM procedure codes

196. The discharge diagnosis for this inpatient encounter is "rule out myocardial infarction." Thecoder would assign:

a. a code for a myocardial infarctionb. a code for the patient's symptomsc. a code for an impending myocardial infarctiond. no code for this condition

197. A snapshot of a current process that identifies potential areas for change in a process is:

a. process improvement studyb. data quality reviewc. benchmarking study


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d. work‐imaging study

198. A document which acknowledges patient responsibility for payment if Medicare denies theclaim is a(n):

a. explanation of benefitsb. remittance advicec. advance beneficiary noticed. CMS‐1500 claim form

199. A 35‐ year‐old non‐Medicare patient hyper‐extends his right thumb while at work. Thephysician provides a splint for the thumb. How is the splint coded?

a. 29075‐F5b. 29280‐RTc. A4570‐RTd. S8450‐F5

200. The type of anemia caused by a failure of the bone marrow to produce red blood cells is:

a. acute blood loss anemiab. sickle cell anemiac. iron deficiency anemiad. aplastic anemia

201. This is a patient classification system that expands the CMS DRGs into four distinct sub-classes, which are: minor, moderate, major, and extreme. These subclasses address the patient's severity of illness

a. Case Mix Groups (CMGs)b. Adjusted Clinical Groups (ACGs) c. Case Mix Index (CMI)d. All Patient Refined Diagnosis Related Groups (APR‐DRGs)

202. These are assigned to every HCPCS/ CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid

a. geographic practice cost indicesb. major diagnostic categoriesc. minimum data setd. payment status indicator

203. A service provided by a physician whose opinion or advice regarding evaluation and/ or man-agement of a specific problem is requested by another physician is referred to as

a. a referralb. a consultationc. risk factor interventiond. concurrent care


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204. A patient is admitted to your hospital 6 weeks post myocardial infarction with severe chest pains. The correct code would be

a. I25.89 Chronic MI b. I23.8 Acute MI c. I25.2 Old MId. I20.8 Angina

205. In ICD‐10‐CM when an exploratory laparotomy is performed followed by a therapeutic proce-dure, the coder lists

a. therapeutic procedure first, exploratory laparotomy secondb. exploratory laparotomy, therapeutic procedure, closure of woundc. therapeutic procedure onlyd. exploratory laparotomy first, therapeutic procedure second

206. A physician excises a 3.1 cm malignant lesion of the scalp which requires full thickness graft from the thigh to the scalp. In CPT, which of the following procedures should be coded?

a. Full thickness skin graft to scalp onlyb. Excision of lesion; Full‐thickness skin graft to scalpc. Excision of lesion; Full‐thickness skin graft to scalp; Excision of skin from thighd. Code 15002 for surgical preparation of recipient site; Full‐thickness skin graft to scalp

207. A patient is admitted in alcohol withdrawal suffering from delirium tremens. The patient is a chronic alcoholic and cocaine addict. Which of the following is the principal diagnosis?

a. alcoholic withdrawal b. chronic alcoholism c. cocaine dependence d. delirium tremens

208. Code I11, Hypertensive Heart Disease would appropriately be used in which situation

a. Left heart failure with benign hypertensionb. Congestive heart failure; hypertensionc. Hypertensive cardiovascular disease with congestive heart failured. Cardiomegaly with hypertension


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Medical Coding Exam System - Week 2 Day 3 Practice Exam Answers 173 - 208

173. b. The UHDDS is a data set created to collect inpatient data. The Minimum Data Set isdata collected on long term care patients.

174. c. prospective review

175. d. Accuracy indicates that the data is validʼ consistency indicates that the data is reliableand the same across applications; integrity is the property that data are true to the source andhave not been altered or destroyed in an unauthorized manner.

176. a. To determine the number of employees needed for a specific job, first determine howmuch time the work requires. In this case we know we will have an additional 120 records perday, and each record will average about 15 minutes. To figure the amount of total time, multiply 120 X 15 = 1800 minutes. Compute this to hours by dividing by 60 (60 minutes in an hour):1800 / 60 = 30 hours. Based upon the eight hour day, divide: 30 hours by 8 = 3.75 FTEs.

177. b. Data must be relevant to the purpose for which it was collected. c. Currency refers todata that is still relevant to the time period selected. d. Granularity refers to the fact that datacannot be further subdivided.

178. d. Credit balances are the balances on an account that are to be refunded to an insurer ora patient. Accounts receivable refers to charges for patient services that a healthcare facility isawaiting payment. Late charges are charges that are posted to an account after the facility'sestablished billhold.

179. a. Outcome and Assessment Information Set (OASIS) contain core items of acomprehensive assessment for adult home care patient and form the basis for measuringpatient outcomes.

180. d. The Medicare regulations for participation in the federal Medicare program are namedthe Conditions of Participation.

181. a. Evaluation of need before admission and for continued stay use criteria that areperformed are referred to as Intensity of service/severity of illness criteria (IS/SI criteria)reviews. Utilization management uses IS/SI to effectively control resource utilization.

182. b. In traditional settings, the chart is kept in reverse chronological order while the patient isin the facility and changed to source‐oriented chronological order after discharge. Many facilitiesare now switching to the universal order for charts.

183. b.

184. d. A valid authorization for release of information needs information on who gets theinformation, who is releasing the information and the date and signature of the person who isauthorized to release that information


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185. b.

186. d. CPT/HCPCS codes

187. b.

188. c.

189. b.

190. a.

191. b.

192. d. whether the patient is obese or not

193. c. Atlas System 58

194. b.

195. b.

196. d. When a diagnosis is preceded by the phrase "rule out" in the inpatient setting, thecondition is coded as though it is confirmed

197. d.

198. c.

199. a.

200. d.

201. d.

202. d.

203. b.

204. b. An acute MI is considered to be anything under 8 weeks duration from the time of initial on-set. A chronic MI is considered anything over 8 weeks with symptoms. An old MI is considered any-thing over 8 weeks with NO symptoms.

205. c.

206. b.

207. d.


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208. c. In order to use category I11 (Hypertensive heart disease) there must be a cause and effect relationship shown between the hypertension and the heart condition. "With" does not show this re-lationship nor does the fact that both conditions are listed on the same chart. The term "hyperten-sive" indicates a cause and effect relationship.


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