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Medical Coding Exam System - Week 3 Day 1 Practice Exam Questions 281 - 322

281.These are financial protections to ensure that certain types of facilities (i.e., cancerhospitals and small rural hospitals) recoup all of their losses due to the differences in their APCpayments and the pre‐APC payments

a. limiting chargeb. indemnity insurancec. hold harmlessd. pass through

282. The ________________________________ refers to a statement sent to the patient toclarify which services were provided, amount billed and amount of payments made by the healthplan.

a. medicare summary noticeb. remittance advicec. healthcare claims transactiond. coordination of benefits

283. The prospective payment system used to reimburse Home Health Agencies for Medicarepatients utilizes data from

a. MDS (Minimum Data Set)b. OASIS (Outcome and Assessment Information Set)c. UHDDS (Uniform Hospital Discharge Data Set)d. UACDS (Uniform Ambulatory Core Data Set)

284. A Medicare patient has arthroscopic lysis of adhesions and shaving of the articularcartilage of the right knee. The codes are:

29884‐RT Arthroscopy, knee, surgical, with lysis of adhesions (separate procedure), right29877‐RT Arthroscopy, knee, surgical, debridement/shaving of articular cartilage, right

Comprehensive Codes: 29877

Component Codes: 20610, 27570, 29870, 29871, 29874, 29875, 29884The Medicare CCI (Correct Coding Initiative) edits indicate that code 29877 is not a componentcode for 29884, but code 29884 is a component code for 29877. The correct code(s) to bereported on this claim is (are)

a. 29884‐RT and 29877‐RTb. 29884‐RTc. 29877‐RTd. neither code

285. A discharge in which the patient was discharged from the inpatient rehabilitation facility andreturned within three calendar days is called a (an)

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a. interrupted stayb. transferc. per diemd. qualified discharge

286. Which of the terms below indicates that the claim has been released as complete forsubmission to the insurer for payment.

a. bill dropb. accounts receivablesc. bill holdd. concurrent review

287. A patient was seen by Dr. Zachary. The charge for the office visit was $125. The Medicarebeneficiary already met his deductible. The Medicare fee schedule amount is $100. Dr. Zacharydoes not accept assignment. The office manager will apply a practice termed as "balancebilling", which means that

a. the patient is financially liable for the Medicare fee schedule amountb. the patient is financially liable for charges in excess of the Medicare fee schedulec. the patient is not financially liable for any amountd. the patient is financially liable for the entire charge for the office visit

288. Under the RBRVS, each HCPCS/CPT code contains three (3) components, each havingassigned relative value units. These three (3) components are

a. geographic index, wage index, and cost of living indexb. fee‐for‐service, per diem payment, and capitationc. conversion factor, CMS weight, and hospital specific rated. physician work, practice expense, and malpractice insurance expense

289. The case mix management system that utilizes information from the minimum data set(MDS) in long‐term care settings is called

a. Diagnosis Related Groups (DRGs)b. Resource Based Relative Value System (RBRVS)c. Resource Utilization Groups (RUGs)d. Ambulatory Patient Classification (APCs)

290. All of the following elements are found in the charge description master, EXCEPT for

a. ICD‐10‐CM codeb. chargec. HCPCS/CPT coded. narrative description

291. Mitch was admitted directly from his physician's office for dehydration. Mitch hadgastroenteritis for several days prior to this illness that has resulted in dehydration and requiresintravenous hydration. Mitch also has chronic kidney disease and is at high risk for acute


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chronic kidney failure. Two days following admission Mitch develops acute renal failure. Mitchalso has hypertension. Provide appropriate ICD‐10‐CM diagnosis codes.

a. N17.9, I12.9, E86.0b. E86.0, N17.9, I12.9c. I12.0, E86.0d. E86.0, 586, N17.9, I10

292. A computer software program that assigns appropriate MS‐DRGs according to theinformation provided for each episode of care is called a(n)

a. encoderb. case‐mix analyzerc. grouperd. DRG creeper

293. Changes in case mix index (CMI) may be attributed to all of the following factors EXCEPT

a. changes in medical staff compositionb. changes in coding rulesc. changes in services offeredd. changes in coding productivity

294. The forth step in the MS‐DRG logic which is used to assign a case to a particular MSDRGis:

a. cases are further differentiated based on the presence or absence of complications/comorbidities (CCs) or major complications/co‐morbidities (MCCS).b. cases are divided into either a surgical partition or a medical partitionc. the principal diagnosis determines the MDC assignmentd. diagnoses and procedures are coded using ICD‐10‐CM

295. The first step in the MS‐DRG logic which is used to assign a case to a particular MS‐DRGis:

a. cases are further differentiated based on the presence or absence of complications/comorbidities (CCs) or major complications/co‐morbidities (MCCs)b. cases are divided into either a surgical partition or a medical partitionc. the principal diagnosis determines the MDC assignmentd. diagnoses and procedures are coded using ICD‐10‐CM

296. The hospital outpatient prospective payment system for Medicare applies to all of thefollowing, EXCEPT, for

a. physician reimbursement of observation servicesb. facility reimbursement for outpatient clinic visitsc. facility reimbursement for emergency department visitsd. facility reimbursement for hospital‐based outpatient surgery


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297. According to the Federal Register, the definition of a "new" patient when assigning a CPT Eval-uation and Management (medical visit) code to a Medicare hospital outpatient under the prospective payment system is a patient that has

a. not seen the physician within the last 3 yearsb. not seen the physician within the last 5 yearsc. not already been assigned a medical record numberd. never seen the physician before

298. What is the prospective payment system to hospitals for Medicare hospital outpatients called and when did it become effective.

a. APGs, October 1, 2000b. RBRVS, January 1, 2000c. APCs, August 1, 2000d. DRGs, October 1, 1983

299. A statement sent to the provider to explain payments made by third party payers is called.

a. remittance adviceb. advance beneficiary noticec. attestation statementd. acknowledgement notice

300. This means that the service or procedure is reasonable and necessary for the diagnosis or treatment of the illness or injury consistent with generally accepted standards of care.

a. peer reviewb. optimizationc. benchmarkingd. medical necessity

301. A patient initially consulted with Dr. Vasseur at the request of Dr. Meche, the patient'sprimary care physician. Dr. Vasseur examined the patient, prescribed medication, and orderedtests. Additional visits to Dr. Vasseur's office for continuing care would be assigned from whichE&M section?

a. office and other outpatient services, new patientb. office and other outpatient services, established patientc. office or other outpatient consultations, new or established patientd. confirmatory consultations, new or established patient

302. CMS delegates its daily operations of the Medicare and Medicaid programs to:

a. the office of Inspector Generalb. the PRO in each statec. the National Center for Vital and Health Statisticsd. Medicare administrative contractor (MAC)

303. The physician's office note states: "Counseling visit, 15 minutes counseling in follow‐up with


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a patient newly diagnosed with diabetes." If the physician reports code 99214, which piece ofdocumentation is missing to substantiate this code?

a. chief complaintb. historyc. examd. total length of visit

304. Urinary frequency, urgency, nocturia, incontinence and hesitancy are all symptoms of:

a. BPHb. end stage kidney diseasec. salpingitisd. genital prolapse

305. A PEG procedure would most likely be done to facilitate:

a. breathingb. eatingc. urinationd. none of the above

306. SNOMED‐CT is an example of a:

a. classification systemb. HIPAA code setc. medical nomenclatured. clinical terminology

307. Down's syndrome, Edward's syndrome and Patau's syndrome are all examples ofwhat type of defects:

a. musculoskeletalb. chromosomalc. genitourinary tractd. digestive system

308. The healthcare setting that most recently has begun being paid under a new Medicareprospective payment system is:

a. skilled nursing facilitiesb. acute care hospitalsc. psychiatric hospitalsd. home health agencies

309. Graves Disease

a. is an autoimmune diseaseb. most commonly affects malesc. usually can not be treated


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d. usually affects the elderly

310. Five to ten percent of the patients with an inherited defect of the BRCA1 or BRCA2 gene areat risk for developing

a. Brain carcinomab. Breast carcinomac. Bronchial carcinomad. None of the above

311. A patient with leukemia is admitted for chemotherapy five weeks after experiencing an acute myocardial infarction. How will the MI be coded?

a. MI with 5th digit 1 ‐ initial episode of careb. MI with 5th digit 2 ‐ subsequent episode of carec. History of MId. Chronic MI

312. The nursing staff would most likely use which of the following to facilitate aggregation of data for comparison at local, regional, national and international levels.

a. READ codesb. ABC codesc. SPECIALIST Lexicond. LOINC

313. The Level I (CPT) codes of the HCPCS coding system are maintained by the:

a. American Medical Association b. American Hospital Association c. local fiscal intermediaryd. Centers for Medicare and Medicaid Services

314. A patient is admitted with shortness of breath and hemoptysis. A chest X‐ray revealed patchy infiltrates in the left lung and possible pneumonia. On the third day of hospitalization a bron-choscopy with biopsy was done which revealed a small cell carcinoma of the left upper lobe of the lung. A metastatic lesion in the brain was detected and the patient was started on radiation to the brain. The principal diagnosis is the

a. metastatic brain carcinoma b. small cell lung carcinoma c. hemoptysisd. pneumonia

315. A patient has a total abdominal hysterectomy with bilateral salpingectomy. The coder selected the following codes:

58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s) with or without removal of ovary(s) and 58700 Salpingectomy, complete or partial unilateral or bilateral (separate procedure) This type of coding would be referred to as


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a. global packageb. unbundling c. maximizing d. optimization

316. A patient develops difficulty during surgery and the physician discontinues the procedure. Iden-tify the modifier that may be reported by the physician to indicate that the procedure was discontin-ued.

a. ‐52 b. ‐53 c. ‐73 d. ‐74

317. A patient is seen by a surgeon who determines that an emergency procedure is necessary. Identify the modifier that may be reported to indicate that the decision to do surgery was made on this office visit.

a. ‐25 b. ‐55 c. ‐57 d. ‐58

318. Which of the following is coded as an adverse effect in ICD‐10‐CM?

a. Mental retardation due to intracranial abscessb. Rejection of transplanted kidneyc. Tinnitus due to allergic reaction after administration of ear dropsd. Non‐functioning pacemaker due to defective soldering

319. Jane Moore was admitted to the ambulatory care unit of the hospital for a planned cholecystec-tomy for cholelithiasis. Shortly before surgery, Jane developed tachycardia, and the surgery was canceled. After a thorough work‐up for the tachycardia, Jane was discharged. This outpatient ad-mission should be coded in the following sequence

a. Z code for canceled surgery, tachycardia, cholelithiasis b. Tachycardia, Z code for canceled surgery, cholelithiasis c. Cholelithiasis, Z code for canceled surgeryd. Cholelithiasis, Z code for canceled surgery, tachycardia

320. A nomenclature of codes and medical terms which provides standard terminology for reporting physicians' services for third party reimbursement is:

a. Current Medical Information and Terminology (CMIT). b. Current Procedural Terminology (CPT)c. Systematized Nomenclature of Pathology (SNOP)d. Diagnostic and Statistical Manual of Mental Disorders (DSM)

321. Acute respiratory failure due to congestive heart failure. Patient is placed on the ventilator for


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three days following insertion of endotracheal tube.

a. J96.00, I50.20, 5A1945Z, 0BH17EZ b. J96.00, I50.20, 5A1955Z, 0BH17EZ c. I50.20, J96.00, 5A1945Z, 0BH17EZ d. I50.20, J96.10, 5A1955Z, 0BH17EZ

322. Latent schizophrenia, chronic with acute exacerbation.

a. F20.81b. F20.5c. F20.89 d. F20.3


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Medical Coding Exam System - Week 3 Day 1Practice Exam Answers 281 - 322

281. c.

282. a.

283. b.

284. c. CPT code 29884 is an integral component of code 29877; therefore code 29884cannot be reported with code 29877 for this patient. Only code 2987

285. a.

286. a.

287. b.

288. d.

289. c.

290. a.

291. b.

292 c.

293. d.

294. a.

295. d.

296. a.

297. c. The definition of “new patient” in the CPT Code Book is “one who has not received anyprofessional services from the physician or another physician

298. c. The effective date in the Federal Register was July 1, 2000, but it was delayed untilAugust 1, 2000.

299. a.

300. d.

301. b. Consultation codes can no longer be coded when the physician has taken active part inthe continued care of the patient


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302. d. Medicare administrative contractor is the new name for the previously termed carriersand fiscal intermediaries.

303. d. In order to use time as a factor in determining the appropriate E&M code, the total timespent with the patient as well as the amount of time spent in counseling must be recorded.

304. a.

305. b.

306. d.

307. b.

308. c.

309. a.

310. b.

311. b.

312. b.

313. a.

314. B. The principal procedure is defined as the procedure performed for definitive treatment (rather than for diagnostic purposes) or one that was necessary to take care of the complication. If two or more procedures meet this definition, the one most related to the principal diagnosis is desig-nated as the principal procedure.

315. b.

316. b.

317. c.

318. c. Mental retardation is a late effect, rejection of the kidney is a complication, and non‐functioning pacemaker is a mechanical complication.

319. d. There are Z codes which indicate various reasons for canceled surgery. Review codes Z28.9, Z53.09, Z53.29, and Z53.8. As usual, the principal diagnosis is always the reason for admis-sion, in this case, the cholelithiasis. The contraindication (the tachycardia) should also be coded.

320. b.

321. a.

322. c.


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