Medical Coder Practice Test

Clinical Classification Systems 

1 A patient presents with CKD stage III, edema and hypertension. The correct ICD-10 CM codes for this chart are:

a. N18.3, I10, R60.9

b. N18.9, I10, R60.9

c. N18.3, I12.9

d. N18.9, I12.9, R60.9

Incorrect. Please choose another answer.

Per ICD-10CM guidelines, do not code signs and symptoms. Edema is a symptom of both hypertension and CKD. ICD-10CM guidelines state there is a causal relationship assumed between CKD and hypertension unless the provider specifically states that the hypertension is not related to the CKD, giving this patient hypertensive chronic kidney disease instead of regular hypertension.

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2 A patient presents with hematemesis and is diagnosed with esophagitis. The provider states that the hematemesis is due to erosion in the esophagus. Assign the correct ICD-10-CM codes.

a. K22.4

b. K92.0, K20.91

c. K22.11

d. K20.91

Incorrect. Please choose another answer.

The coder will look up erosion, then esophagus, then with bleeding in the alphabetic index. The hematemesis is not coded separately, since it is a sign and symptom of the esophageal erosion and included in the statement "with bleeding." (Coding Clinic May 2023).

3 A 42-year-old female, who is a new patient, presents with foul-smelling urine, frequency, flank pain and fever for 4 days. Patient denies nausea and headache. Patient is not sexually active and is a non-smoker. The provider performs the following exam in addition to patient's height, weight and blood pressure check:

General: Well-developed, well nourished, in no acute distress
Ears: external ears normal, TM bilaterally intact
Neck: Supple, no thyromegaly
Extremities: No edema
Cardiovascular: RRR, no bruits
Lungs: Clear to auscultation

The patient is prescribed ciprofloxacin and given a diagnosis of acute cystitis without hematuria. The correct coding for this encounter, using 1997 E/M guidelines is:

a. 99202, N30.00

b. 99203, N30.00, R30.0

c. 99202, N39.0

d. 99203, N39.0, R30.0

Incorrect. Please choose another answer.

1997 E/M guidelines state that the provider must reach 12 bullet points for a detailed level of exam. Although the patient's chart has a detailed history and moderate medical decision making, the provider only reached 11 bullet points, making this level a 99202. N39.0 is not the most specific code for this chart.

4 A patient presents to the operating room with chronic pelvic pain and left renal vein impingement. The surgeon performs a renal to ovarian vein transposition to relieve the pressure. What is the correct code assignment?

a. 34520

b. 37799

c. 33771

d. 58825

Incorrect. Please choose another answer.

37799 Unlisted procedure, vascular surgery, would be the correct code assignment for this procedure. There is currently no listed CPT code that accurately describes this service, so the coder must assign the unlisted CPT code. (CPT Assistant, March 2023).

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5 A patient presents with a cyst at the base of his tailbone. It is swollen and painful for the patient to sit down. The provider drapes the patient in the usual fashion, administers lidocaine and uses a scalpel to excise the 2cm cyst and a subcutaneous extension, rinses it with sterile saline, performs an intermediate repair of the wound with a layered closure. The correct CPT code assignment for this procedure is:

a. 10080, 12001-59

b. 10081

c. 11771

d. 11770, 12031-59

Incorrect. Please choose another answer.

The provider performs an excision, not an incision, completely removing the cyst. The excision is intermediate because it involves subcutaneous extensions and the repair is included with the procedure.

6 A patient is placed under general anesthesia for an emergency surgery due to a severe brain bleed and receives a craniotomy. The patient's blood pressure has also spiked drastically and is declared in a hypertensive emergency. Which anesthesia codes would be billed?

a. 00211

b. 00216

c. 00211, 99140

d. 00216, 99140, 99140

Incorrect. Please choose another answer.

The coder would code for the craniotomy with evacuation of the hematoma plus the emergency surgery add-on code. Per CPT assistant, a second add-on code for the hypertensive emergency would not be billed.

7 A 7-year-old child presents for a series of vaccines. The patient receives MMR and DTaP and counseling on vaccines. The correct CPT code assignment for this procedure is:

a. 90460, 90461

b. 90471, 90472

c. 90460, 90461x5

d. 90460x2, 90461x4

Incorrect. Please choose another answer.

Pediatric vaccines with counseling are coded per component. Each first component of a vaccine (Measles and Diphtheria in this case) are coded as one unit of 90460. Each additional component to the vaccine (mumps, rubella, tetanus and acellular pertussis) receive another 90461 for an additional component code.

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8 How should an internal presacral abscess and an intra-abdominal abscess be coded when the patient's history includes complex continuing diverticulitis that caused a sigmoid colectomy resulting in an end colostomy, and repeated pelvic abscesses?

a. K68.19, K65.1

b. K57.30, K65.1, Z93.3

c. K68.19, K65.1, K57.20, Z93.3

d. K68.19, K65.1, K57.20, K57.30, Z93.3

Incorrect. Please choose another answer.

According to Coding Clinic, K89.19 is assigned for the internal presacral abscess. K65.1 is for the intra-abdominal abscess. Then we have K57.20 for the diverticulitis, which is coded "with abscess" since these conditions can be coded as linked in absence of provider documentation due to the "with" in the alphabetic index. Finally, we have colostomy status.

9 ICD-10 codes are used:

a. as procedure codes

b. in DRGs

c. as diagnosis codes

d. All of the above

Incorrect. Please choose another answer.

ICD-10 PCS are used as procedure codes for inpatient visits. DRGs use similar ICD-10CM weights for facility reimbursement and ICD-10CM are used as diagnosis codes for all healthcare settings.

10 For urosepsis, a coder must:

a. Use the code for severe sepsis

b. Use the code for sepsis with organ dysfunction

c. Query the provider

d. Code first localized sepsis

Incorrect. Please choose another answer.

According to ICD-10CM guidelines, urosepsis is a nonspecific term and has no tabular position. The provider must be queried for clarification.

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Confidentiality and Privacy 

11 Stacey finds a particularly scandalous story told in the patient's medical record, filled with plot twists and jealous neighbors and occasional commentary on the situation by the patient's physician. She calls her supervisor over to see the drastic outcome (and the reason the patient is in the hospital). Is this allowed, per HIPAA?

a. Yes, because both Stacey and her supervisor work for a covered entity.

b. Yes, because it is necessary to access this information for coding purposes.

c. No, because it violates the Security Rule.

d. No, because it violates the Privacy Rule.

Incorrect. Please choose another answer.

This disclosure violates the minimum necessary part of the HIPAA Privacy rule which states that employees must only access the minimum amount of protected health information necessary to do their jobs. Stacey calling her supervisor to look at the chart is not necessary to do either of their jobs.

12 Which of the following organizations are not a covered entity under HIPAA?

a. Health plans

b. Billing companies

c. Nursing home

d. Clearinghouse

Incorrect. Please choose another answer.

Billing companies are not covered entities, but business associates. Business associates must agree via contract to not disclose private information, and may have sub-contractors who also agree to protect your information, but covered entities only involve anyone who sends electronic health information.

Clinical Classification Systems 

13 A patient comes into the office with white fuzzy patches on their tongue and is diagnosed with oral hairy leukoplakia. The provider runs a test for HIV and notates that the patient has HIV in the chart, but does not have a positive lab test yet. The patient is a smoker. What is the correct sequencing of these ICD-10 codes?

a. B20, K13.3, F17.200

b. K13.3, R75, Z87.891

c. B20, K13.3, Z87.891

d. K13.3, Z21, F17.200

Incorrect. Please choose another answer.

According to chapter guidelines, if a patient is seen for an HIV-related condition, (which oral hairy leukoplakia is), then B20 is coded first, then the complications. Only the provider's statement that the patient has HIV is needed, not a positive lab test. F17.200 is to be assigned when the provider documents "smoker", but gives no further clarification (AHA: 2016, 1Q, 36)

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14 A 25-year-old patient is 27 weeks and 6 days pregnant. The patient is experiencing dysuria and blood in her urine. She is diagnosed with acute cystitis. What is the correct coding of this patient's chart?

a. N30.01, Z33.1

b. O23.32, N39.0, Z3A.27

c. O23.12, N30.01, Z3A.27

d. N30.00, Z33.1

Incorrect. Please choose another answer.

Cystitis is an infection of the bladder. The provider must specifically state that the infection or condition is not affecting the pregnancy for an incidental code. The patient is experiencing blood in her urine, which gives us the hematuria portion of the diagnosis.

15 A patient comes in after her pressure cooker has exploded and covered her face with boiling soup. She was luckily wearing a sweater which protected her arms. She has partial-thickness burns covering her entire face. What is the correct CPT code to be assigned as the hospital removes chicken, celery and burnt tissue from her face and places dressings on it?

a. 16020, 97597-59

b. 11011

c. 16025

d. 97597

Incorrect. Please choose another answer.

16025 covers whole face burns and includes debridement.

16 A 2-year-old child had their humerus fractured by a falling dresser and requires anesthesia to repair the break because they will not hold still for a reduction. The procedure billed is 24505. What anesthesia service is reported?

a. 01730 P1

b. 01742 P1, 99100

c. 01744 P1

d. 01756 P1, 99100

Incorrect. Please choose another answer.

Anesthesia for all closed procedures on humerus and elbow. The 99100 code is only used for patients under 1 year old or over 70 years old. 01744 is for open procedures, not closed.

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Confidentiality and Privacy 

17 The Breach Notification Rule, found in the ______ Rule of HIPAA, states that when _____ individuals have had their confidential data exposed and the covered entity has outdated contact information for them, that the covered entity must_____ for ______ days.

a. Security Rule, less than 200 individuals but more than 5, post a notice in the newspaper for 180 days

b. Omnibus Rule, less than 500 individuals but more than 10, post a notice on their website for 90 days

c. Security Rule, 500 or more individuals, post a notice on their website and create a radio ad for 60 days

d. Privacy Rule, 5 or more individuals, post a notice on their website, in the lobby and send postcards with information at least 3 times over 90 days.

Incorrect. Please choose another answer.

The Omnibus Rule established HITECH and the AARA of 2009 and finalized the Breach Notification Rule, mandating that covered entities who have more than 10 individuals with outdated contact information involved in a data breach must be notified by posting a notice on their website or creating a local ad in the newspaper. For breaches over 500 individuals, major news outlets must be contacted and the Secretary of HHS immediately.

18 Sally calls the coding department to contest the duplicate procedures that her adult sister received while admitted to an inpatient mental health facility. Sally has her sister's date of birth, her name but not her ID number. She says her sister is too depressed to advocate for herself and Sally just wants the charges reviewed. What do you do?

a. Tell Sally you'll review her sister's chart while she was hospitalized and process a corrected claim if needed.

b. Tell Sally you're sorry, but her sister must call when she gets out of the hospital, HIPAA does not allow you to speak to Sally without her sister's written consent.

c. Tell Sally her sister's patient ID number so she can better advocate for her sister in other departments

d. Tell Sally that according to HIPAA she must obtain her sister's written consent in order to discuss any protected health information with her and give her the fax number where she can send the written release.

Incorrect. Please choose another answer.

HIPAA Privacy Rule Section 164.510(b)(3) allows providers to discuss PHI with family members if they determine it is in the patient's best interest for coordination of treatment or payment, unless the patient has expressed wishes that their information is not shared with family.

19 You need a second opinion on coding a chart from your Coding Manager, who does not have access to the patient's records. You decide to e-mail a screenshot of the chart to the Coding Manager. What steps must you take to ensure that the patient's data is protected in your email?

a. Create a confidentiality notice in your email, asking an unintended recipient to delete the information

b. Follow all company guidelines to encrypt your email

c. Remove patient's name, date of birth, insurance ID#, SSN, address and patient number before emailing

d. All of the above

Incorrect. Please choose another answer.

HIPAA HITECH requires that covered entities take reasonable action to protect electronically transmitted information. Removing protected health information, encrypting email and creating confidentiality notices are a multi-layered security approach that is best-practice to prevent breaches of data.

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Reimbursement Methodologies 

20 Facility payments are based on:

a. Fee schedules

b. ICD-10 PCS codes

c. IPPS using DRGs

d. RVUs and conversion factors

Incorrect. Please choose another answer.

The Inpatient Prospective Payment System drives value-based care by paying inpatient stays based on DRGs (Diagnosis-Related Group(s)) which are groups of diagnoses with similar weights in order to determine "how much" a patient's stay ought to cost. These drivers force hospitals to work to be most efficient in their use of resources to come in under what they will be paid in order to avoid losing money.

21 Conversion factors:

a. Are based on how difficult a procedure is

b. Depend on the level of education a provider has

c. Are based on locality

d. None of the above

Incorrect. Please choose another answer.

RVUs are based off work for each HCPCS. RVUs are multiplied by Geographic Practice Cost Indices (GPCI), which account for physician work, cost of malpractice and practice expenses. A conversion factor, which is a national number that changes annually, is multiplied by the sum of RVUs that are multiplied by the GPCI to calculate payment for professional fee schedules.

22 Pressure ulcers, catheter-associated urinary tract infections, falls and head trauma, DVTs and pulmonary embolisms are all examples of:

a. DRGs that should have a POA indicator

b. Hospital-acquired conditions that will not be reimbursed

c. Part of similar weight DRGs

d. Complications that must be coded to receive full reimbursement

Incorrect. Please choose another answer.

The HAC-POA (Hospital acquired condition, present on admission) program was created by the Deficit Reduction Act of 2005--any of these conditions which are not present on admission and could have reasonably been prevented by following accepted standards of care will not be reimbursed. Usually, adding the DRG weight would have increased the facility's reimbursement, but this forces hospitals to avoid hospital acquired conditions, rather than profit from them.

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23 Relative Value Units are:

a. Different for each locality

b. A weight for procedure codes

c. Multiplied with conversion factors

d. All of the above

Incorrect. Please choose another answer.

RVUs multiplied by conversion factor gives you the amount payable for a provider's fee schedule.

24 Medicare pays Skilled Nursing Facilities with a prospective payment system. Reimbursement is based on:

a. Reasonable costs

b. Per Diem

c. Based on DRGs

d. Episode of care

Incorrect. Please choose another answer.

The Balanced Budget Act mandated that SNF-PPS be paid per diem for all costs, which is based on a case-mix of diagnoses.

25 For Medicare's OPPS, payment status indicator C indicates that the HCPCS is:

a. More complicated than usual, requiring increased reimbursement

b. Part of a series of concurrent procedures that will be performed together

c. Only performed in inpatient settings

d. Performed by the Chief surgeon, requiring increased reimbursement.

Incorrect. Please choose another answer.

Payment status indicator C indicates that the HCPCS is only performed in an in-patient setting.

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26 Risk Adjustment payment involves payments between which of the following entities?

a. Third-party insurance and Provider

b. Medicaid and Provider

c. Medicare and Provider

d. Medicare, Medicaid and Third-party insurance

Incorrect. Please choose another answer.

Medicare and Medicaid both reimburse third-party insurance companies for providing the management of their claims. Third-party insurance companies are paid off their "Risk Score" where the severity of their patients' illnesses are ranked and submitted for reimbursement.

27 Which of the following circumstances would indicate a payment over the usual IPPS (Inpatient Prospective Payment System) reimbursement amount?

a. Increased Federal Opening Payment

b. Highly Weighted DRG

c. Outlier Costs

d. Marginal Cost Factor

Incorrect. Please choose another answer.

Outlier costs would cause the IPPS payment to be driven up. Examples of outliers might include an experimental and costly treatment to save a patient's life. These may be reimbursed on a case-by-case basis.

28 Which of the following is the condition established after study to be chiefly responsible for the patient's admission to the hospital and drives the payment the hospital will receive?

a. First-Listed Diagnosis

b. Principal Diagnosis

c. Primary Diagnosis

d. Reason for Encounter

Incorrect. Please choose another answer.

The principal Diagnosis is the condition established after study to be chiefly responsible for the patient's admission to the hospital as defined by the Uniform Hospital Discharge Data Set (UHDDS). The principal diagnosis drives the DRG and then the payment for the hospital.

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29 Medicare reimburses on GPCI as part of the calculation for the Medicare Physician Fee Schedule (MPFS). The GPCI is multiplied by the RVU to determine pricing amounts. What is the GPCI?

a. Global Patient Care Index

b. Graduated Payment Care Initiative

c. Geographic Practice Cost Index

d. Generic Payment Cost Indicator

Incorrect. Please choose another answer.

The GPCI is the geographic practice cost index. This accounts for the cost of living in different areas, so a doctor in New York City would be reimbursed at a higher rate than a doctor in Kansas.

Health Records and Data Content 

30 CMS requires that the patient's history and physical be completed and documented in the patient's record:

a. Within 24 hours of admission or not greater than 30 days before admission

b. Immediately upon admission or not greater than 10 days before admission

c. Within 6 hours of admission or not greater than 15 days before admission

d. Within 3 hours of admission or not greater than 3 days before admission

Incorrect. Please choose another answer.

CMS conditions of participation require that the patient's history and physical be completed and documented within the patient's record within 24 hours of admission, but not greater than 30 days prior to admission.

31 These components create a patient's history:

a. Reason for Visit, History of Present Illness, Review of Symptoms, Prior History

b. Chief Complaint, History of Present Illness, Review of Systems, Past Family and Social History

c. Chronic conditions, History of Present Illness, Review of Symptoms, Reason for Visit, Surgical history

d. Chief Complaint, History of Present Illness, Review of Symptoms, Past Family and Social History

Incorrect. Please choose another answer.

CC, HPI, ROS and PFSH are the components of a patient history. ROS is performed to make sure the provider did not miss any relevant complaints and can be pulled from the HPI if needed.

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32 According to CMS, the provider's final authentication of the patient's health record must NOT be by:

a. Rubber stamp

b. Electronic signature verified by biometrics

c. Electronic signature verified by passcodes

d. Ink signatures in black ink

Incorrect. Please choose another answer.

Rubber stamps were prohibited by CMS in 2015 for provider authentication

33 An open-record review is when:

a. The patient's record, with PHI removed, is presented at a clinical documentation improvement session for providers

b. The patient's record is sent to CMS to be audited

c. When a qualitative analysis of the patient's record is done while the patient is in active treatment

d. When the patient is given a copy of their chart to ensure everything was documented accurately to the best of their knowledge

Incorrect. Please choose another answer.

An open-record review takes place when a qualitative analysis of the patient's record is done while the patient is in active treatment. The Joint Commission requires these reviews to ensure that documentation standards are met while the patient is still under care.

34 Which of the following is NOT a component of Personal Health Information

a. URL

b. Zip Code

c. License plate number

d. All of the above are PHI elements

Incorrect. Please choose another answer.

There are 18 unique identifiers protected by HIPAA. Only the first 3 digits of a patient's zip code is not PHI, as long as there are more than 20,000 people in the group that forms all zip codes. E.g. 123XX+123XY+123XZ have more than 20,000 people. Otherwise the zip code must be changed to 00000.

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35 Which of the following data sets must a home healthcare provider adhere to?

a. UHDDS

b. MDS

c. OASIS

d. DEEDS

Incorrect. Please choose another answer.

OASIS, the Outcome and Assessment Information Set, covers all data elements that home health organizations must collect and report to CMS (Centers for Medicare and Medicaid). This information includes patient's skin conditions, diagnoses, bowel status, cognitive patterns, mood and behavior, and medications.

36 Dr. Johns wants to make a correction to the patient's medical record from this morning. You advise him:

a. Since he has already signed off on the record, no changes can be made.

b. All changes must be outlined in bold type.

c. Original content must remain with a single strikethrough.

d. He can make changes, but must sign off on the chart again.

Incorrect. Please choose another answer.

The original content must remain, but providers must indicate the incorrect information with a single strikethrough and sign off on an addendum that contains the corrected information. This prevents the obliteration of the medical record, which in the case of malpractice might be considered spoilage of the evidence.

37 Where would you find this statement in the patient's medical record: "Continue Mounjaro. Increase dosage of metformin and continue to monitor."

a. Subjective

b. Objective

c. Prescriptions

d. Plan

Incorrect. Please choose another answer.

This statement would be found in the provider's plan for the patient's diagnosis. Subjective refers to the part of the patient's chart where the patient relays their symptoms. Objective is where the provider examines the patient. There is a prescription part of the EHR, but not generally included in the main section of the medical record, and the actual order for prescriptions would be found there.

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38 An electronic signature at the end of the provider's note which locks the health record is called:

a. Authentication

b. Auto-authentication

c. Verification

d. Validation

Incorrect. Please choose another answer.

Authentication is the process of signing off and locking the health record from further entries. Auto-authentication refers to dictated reports being signed off by the provider, since they have dictated the record in their own voice and a transcriptionist has simply transcribed what the physician already wrote.

Information Technologies 

39 What is the difference between an EHR and an EMR?

a. EHRs contain financial information while EMRs only contain clinical information.

b. EHRs are able to communicate with other systems, but EMRs are not.

c. EHRs contain images, while EMRs only contained electronic "paper" chart formats.

d. There is no difference between EHRs and EMRs. It's just a terminology difference.

Incorrect. Please choose another answer.

EHRs are defined by NAHIT as able to communicate and exchange data with multiple systems. EMRs do not have this capacity.

40 Which of the following standards are used to create standardized nomenclature within an electronic health record program?

a. ICD-10 CM

b. NADA PC

c. CTNS EHR

d. SNOMED CT

Incorrect. Please choose another answer.

Systemized Nomenclature of Medicine--Clinical Terminology (SNOMED CT) is the global standard for clinicians and is used to define terms in EHRs around the world.

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41 Implemented in 2012, what standard changed the way that PHI was submitted electronically?

a. ASC X12 5010

b. HL7 4010

c. SDLC 6040

d. HIPAA 2020

Incorrect. Please choose another answer.

Under Administrative Simplification, HIPAA standard 5010, using ASC X12, was created and implemented. HIPAA standard 4010 was no longer accepted as of June 30, 2012

42 Which of the following might a coder use on a daily basis to access health information?

a. Virtual Desktop Infrastructure

b. Virtual Public Network

c. Cloud Server

d. Intranet

Incorrect. Please choose another answer.

A coder might use a Virtual Desktop Infrastructure (VDI) to login to a "virtual machine," where the EHR is stored. Some healthcare organizations may choose to store their EHR virtually in order to create increased access across the country and prevent information from being screenshotted, copied, or otherwise misused.

43 Which of the following is a software tool that coders may use to find the appropriate diagnosis or procedure code?

a. CodePlus

b. Encoder

c. CodeFinder

d. Clincoder

Incorrect. Please choose another answer.

Coders use an encoder product to help them find codes. Encoders are virtual codebooks, sometimes logic-based, to help increase speed and accuracy of finding codes.

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44 What is the small piece of data that remembers you have visited a website called?

a. Cookie

b. Snack

c. Byte

d. Java

Incorrect. Please choose another answer.

A cookie tracks whether or not you've visited a website. Sometimes if you're having trouble accessing your encoder or EHR, you may need to clear your cookies and cache in order to reach the website.

45 An EHR stores all information about patients on an online database. This is an example of:

a. Privacy Breach

b. Cloud computing

c. Federally Qualified Healthcare Resource Network

d. Fast Healthcare Interoperability Resources

Incorrect. Please choose another answer.

Cloud computing is storing a database online instead of a location. Locations that store lots of data for a hospital may need to be very large in size, but moving data to the cloud frees up room in the hospital and also protects the data from external threats or unexpected weather events like a tornado or flooding.

Compliance 

46 You work at a billing company, coding charts for clients. Your manager sends out claims that have not been coded professionally because your team is 2 months behind and out of compliance with your service line agreement in the contract with your client, but says that it is okay because the provider has coded the claims at the time of service and the client does not want to pay for extra coding. Which of the following statements is true?

a. This is fine because the provider coded the claim to the best of their ability and therefore cannot be held liable.

b. Billing companies have liability for fraudulent claims that they submit, including undercoding, so this is not acceptable.

c. Only overcoding is fraudulent, so this is acceptable.

d. The providers mostly under-code their services, so it's really saving the insurance money and saving us work!

Incorrect. Please choose another answer.

The OIG states that billing companies who submit fraudulent claims (as well as the person who submitted them!) are just as responsible as the provider who rendered the services. Both undercoding and overcoding are examples of fraudulent claims, the claim submitted must accurately represent the services rendered.

47 Which of the following are considered fraudulent?

a. Use of modifier -59 to report a distinct and separate service that would otherwise be prohibited by NCCI guidelines.

b. Changing the code on a claim because the provider did not meet documentation standards.

c. Use of modifier -25 on a minor evaluation and management service that is coded with a related procedure.

d. All of the above are acceptable practices.

Incorrect. Please choose another answer.

Procedures include a minor evaluation and management service. If the patient complains of an abscess and an I&D is performed, only the procedure should be reported. If the patient comes in complaining of hypertension and an abscess is discovered, then it would be acceptable to report an evaluation and management service.

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48 Which of the following is an example of a compliant query to a physician:

a. 06/30: Dr. Brown, can you add documentation for the procedure you did on for Mrs. Parks 5/22? We've billed it out but I'm worried that there isn't enough documentation to support it. We know you did the procedure, but just need a little something extra!

b. 6/30: Dr. Brown, can you clarify in the patient's chart Mrs. Cramb's diagnosis for 6/27 given the positive rapid strep test that was uploaded?

c. 6/30 Dr. Pepper, can you add acute sinusitis (if that's what he had!) to Mr. Meltzer's record--all we have is nasal congestion, headache and malaise and I see you prescribed him antibiotics. Thanks!

d. 6/30 Dr. Pepper, I see that you gave Mr. Evans a diagnosis of unspecified loss of kidney function, but we would get paid a bit more if it were Chronic Kidney Disease, would that be an appropriate diagnosis to code for this patient?

Incorrect. Please choose another answer.

Physician queries must be non-leading, not based on reimbursement, for the purpose of improving patient care and open-ended, or Yes/No questions. Providers must not add documentation solely for the purpose of being reimbursed and it must be within a reasonable time frame.

49 Pass-through billing for laboratories occurs when:

a. A physician pays the lab for the services their patients receive.

b. A physician bills insurance on behalf of the lab for services for their patients.

c. A Federally Qualified Health Center bills insurance for the services it renders.

d. Certain drugs, biological items and devices are reimbursed outside of the ASC.

Incorrect. Please choose another answer.

Pass through billing (not pass through payments) happens when a physician or another lab bills for services not performed directly by the credentialed providers, often on behalf of a non-contracted healthcare partner. Many insurance companies and CMS (Centers for Medicare and Medicaid) have banned this procedure, requiring all billing providers to be directly contracted with the insurance company.

50 The best place to learn about the most up-to-date rules and regulations that have been recently passed concerning healthcare is:

a. AAPC's Magazine

b. AHIMA's Body of Knowledge

c. The Federal Register

d. CMS' main page

Incorrect. Please choose another answer.

The Federal Register provides the daily report of new legislation that has been proposed and then passed into final rules by the government. You can find all the latest updates as soon as they're published, with precise detail on the decisions that were made.

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