Advanced Coding and Reimbursement Question
Bank
Course Introduction
Advanced Coding and Reimbursement delves into complex principles and practices surrounding medical coding systems and healthcare reimbursement methodologies. This course covers advanced application of ICD-10-CM/PCS, CPT, and HCPCS code sets, along with detailed instruction in regulatory guidelines affecting billing processes. Students will analyze case studies to navigate coding scenarios and insurance claim submissions for various healthcare settings. Emphasis is placed on compliance, auditing, payer requirements, denial management, and the integration of coding with electronic health records. Upon completion, students will be prepared to interpret and apply advanced coding techniques to maximize revenue integrity and ensure accurate reimbursement in a dynamic healthcare environment.
Recommended Textbook
ICD 10 CM PCS Coding Theory and Practice 2016 Edition 1st Edition by Karla R. Lovaasen
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27 Chapters
1674 Verified Questions
1674 Flashcards
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Chapter 1: The Rationale for and History of Coding
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46 Verified Questions
46 Flashcards
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Sample Questions
Q1) Medical coding
A)Has more than 100,000 members and was started in 1981
B)Translating diagnoses and procedures into numbers for the purposes of statistically capturing data
C)Grouping like items together for easy storage and retrieval
D)To maintain credentials,coders must earn these
E)Published by the College of American Pathologists,the most up-to-date system of nomenclature
F)The current coding classification system in use in the United States
Answer: B
Q2) Nomenclature of diseases was first developed in the United States around ____.
A)1893
B)1958
C)1928
D)1898
Answer: C
Q3) ICD-10-CM can be updated _________ times each year.
Answer: 2 two
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Page 3
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39 Verified Questions
39 Flashcards
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Sample Questions
Q1) GERD
A)Centers for Medicare and Medicaid Services
B)Temperature,pulse,and respiration
C)Uniform Hospital Discharge Data Set
D)Gastroesophageal reflux disease
Answer: D
Q2) UHDDS
A)Centers for Medicare and Medicaid Services
B)Temperature,pulse,and respiration
C)Uniform Hospital Discharge Data Set
D)Gastroesophageal reflux disease
Answer: C
Q3) A query should contain all of the following items EXCEPT ____.
A)date of service
B)amount of increased reimbursement due to query
C)patient name
D)area for provider signature
Answer: B
Q4) When coding a record,where is one of the best places to begin?
Answer: The discharge summary if available.
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Chapter 3: ICD-10-Cm Format and Conventions
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39 Verified Questions
39 Flashcards
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Sample Questions
Q1) The term "with" in the code title requires documentation of what?
Answer: That both conditions linked by the term "with" must be present and documented for this code to be assigned
Q2) What are the two tables found in the Alphabetic Index in ICD-10-CM?
Answer: Neoplasm Table and the Table of Drugs and Chemicals
Q3) In ICD-10-CM,the final character of a code assignment can never be a letter.
A)True
B)False
Answer: False
Q4) "Diseases of the skin and subcutaneous tissue (L00-L99)" represents a ____.
A)chapter
B)section
C)category
D)subcategory
Answer: A
Q5) In ICD-10-CM,there is an additional index for the External Causes of Injury.
A)True
B)False
Answer: True
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Chapter 4: Basic Steps of Coding
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39 Flashcards
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Sample Questions
Q1) In the discharge summary,a physician lists the __________ that were evaluated and treated and any procedures that were performed.
Q2) The main term is ____.
A)always identified in italics
B)a review of the patient's hospital course
C)a term identifying disease conditions or injuries
D)a word found in parentheses that enclose explanatory information that does NOT affect the code
Q3) A coder must always remember that,once a term is located in the Alphabetic Index,the code must be verified in the Tabular List.
A)True
B)False
Q4) When evaluating an ER record,a coder should look for the ____.
A)diagnosis
B)chief complaint
C)probable diagnosis
D)differential diagnosis
Q5) What is the subterm in "esophageal reflux"?
Q6) What is the subterm in "aspiration pneumonia"?
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Chapter 5: General Coding Guidelines for Diagnosis
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27 Verified Questions
27 Flashcards
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Sample Questions
Q1) What is the diagnosis code(s) for acute and chronic respiratory failure?
Q2) Principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.
A)True
B)False
Q3) A(n) __________ code is a single code used to classify two diagnoses,a diagnosis with an associated secondary process,or a diagnosis with an associated complication.
Q4) In the inpatient setting,it is not acceptable to code diagnoses that have not yet been confirmed and are questionable or suspected.
A)True
B)False
Q5) A(n) ____ is a residual effect (condition produced) after the acute phase of an illness or injury has terminated.
A)combination effect
B)acute effect
C)sequela
D)chronic effect
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Chapter 6: General Coding Guidelines for Medical and Surgical Procedures
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173 Verified Questions
173 Flashcards
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Sample Questions
Q1) Alphabetic Index entry for gastric banding (stomach)
Q2) The body site for perirenal is peritoneum.
A)True
B)False
Q3) Therapeutic paracentesis of peritoneal cavity,percutaneous
Q4) Alphabetic Index entry for left kidney transplant
Q5) Freeing a body part from an abnormal physical constraint is called ____.
A)reposition
B)division
C)release
D)transfer
Q6) "Division" is the root operation in which the sole objective is separating a nontubular body part.
A)True
B)False
Q7) The approach for removal of a skin lesion is external.
A)True
B)False
Q8) Bone marrow biopsy taken from iliac bone,percutaneous Page 8
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Chapter 7: General Coding Guidelines for Other Medicaland
Surgical-Related Procedures and Ancillary Procedures
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107 Verified Questions
107 Flashcards
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Sample Questions
Q1) CT procedures are located in the nuclear medicine section. A)True
B)False
Q2) In ICD-10-PCS,abortion is defined as the spontaneous termination of a pregnancy.
A)True
B)False
Q3) Radionuclide is the second character in the nuclear medicine section.
A)True
B)False
Q4) Hypothermia procedure is a type of extracorporeal therapy.
A)True
B)False
Q5) Packing wound,abdomen wall
Q6) CPAP,48 hours
Q7) The first character value for substance abuse treatment is B. A)True
B)False
Q9) Educational counseling Page 10
Q8) Fitting of voice prosthesis using voice analysis equipment
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Page 11
Chapter 8: Symptoms,
Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes
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57 Verified Questions
57 Flashcards
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Sample Questions
Q1) Camp physical: __________
Q2) Encounter for admission examination for prisoner: __________
Q3) The patient was admitted for prophylactic breast removal.The patient has a strong family history of breast cancer and the patient has severe fibrocystic disease in both breasts,making breast examination difficult.The patient was taken to the OR,and a bilateral simple mastectomy was performed.The patient recovered with no problems.The pathology report showed no evidence of malignancy.Final Diagnosis: Family history of breast cancer;severe fibrocystic disease.Procedure: Bilateral simple mastectomy.
A)Z40.8,,N60.11,N60.12,0HTV0ZZ
B)Z40.01,Z80.3,N60.11,N60.12,0HTV0ZZ
C)Z40.01,Z80.3,N60.19,0HTT0ZZ,0HTU0ZZ
D)N60.11,N60.12,Z40.01,0HTT0ZZ,0HTU0ZZ
Q4) Retained metal fragment: __________
Q5) What does BMI stand for?
Q6) Patient has a cystostomy: __________
Q7) Urinary hesitancy due to enlarged prostate: __________
Q8) Positive Mantoux test: __________
Q9) Name one problem that can result from lack of documentation. Page 12
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Page 13
Chapter 9: Certain Infectious and Parasitic Diseases
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63 Verified Questions
63 Flashcards
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Sample Questions
Q1) According to the discharge summary,a patient is admitted with bacterial pneumonia.Three days after admission,the patient spikes a fever and is tachycardic with a WBC of 18,000.Blood cultures reveal staphylococcal sepsis.
Q2) Spread by sexual contact;men are more likely to have symptoms such as burning while urinating and discharge from the penis;treated with antibiotic A)SIRS
B)Bacteremia
C)Septicemia
D)Gonorrhea
E)Septic shock
F)Sepsis
Q3) Assign the code for infectious diarrhea.
Q4) A patient was admitted with difficulty swallowing and is HIV positive.An EGD was performed and revealed candidal esophagitis.Patient was treated and discharged home in stable condition.
Q5) Assign the code for Colorado tick fever.
Q6) Assign the code for bubonic plague.
Q7) Assign the code(s) for diaper rash due to candidiasis.
Q8) Category B20 is assigned for ____________________.
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Chapter 10: Neoplasms
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68 Verified Questions
68 Flashcards
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Sample Questions
Q1) Malignancy that originates in the bone marrow
A)Well differentiated
B)Sarcomas
C)Fibromas
D)Metastasis
E)Leukemias
F)Melanomas
G)Carcinomas
H)Undifferentiated
I)Myeloma
J)Grading
K)Primary site
L)Staging
M)Adenocarcinoma
Q2) ____ is the placement of radioactive material directly in or near the site of the cancer.
A)Chemotherapy
B)Radiation
C)Brachytherapy
D)Palliative procedure
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Page 15
Chapter 11: Diseases of the Blood and Blood-Forming
Organs and Certain Disorders Involving the Immune
Mechanism
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70 Verified Questions
70 Flashcards
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Sample Questions
Q1) A patient is admitted with neutropenic fever.Patient has been receiving chemotherapy for acute myeloid leukemia.No source of infection is identified,and it is thought that Patient's neutropenia is due to chemotherapy.Patient is discharged.
A)T45.1x5A,D70.2,R50.81,C92.02
B)R50.81,D70.1,T45.1x5A,C92.01
C)T45.1x1A,D70.1,C92.00
D)D70.1,R50.81,T45.1x5A,C92.00
Q2) A(n) ____________________ is a blood test used to evaluate your overall health and detects a variety of disorders.
Q3) Patient was seen in the clinic for desquamation of skin.He had a bone marrow transplant 2 months ago.The physician is treating him for acute graft versus host disease.
A)T86.01,D89.811
B)T86.09,D89.813
C)T86.09,D89.810,R23.4
D)T86.01,D89.810,R23.4
Q4) Coagulopathy due to chronic liver disease: __________
Q5) Plasmacytosis: __________
Q6) End-stage renal disease with erythropoietin-resistant anemia: __________ Page 16
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Page 17
Chapter 12: Endocrine, Nutritional, and Metabolic Diseases
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69 Verified Questions
69 Flashcards
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Sample Questions
Q1) Disorders of the thyroid are located in code categories ____.
A)E00-E07
B)E08-E013
C)E15-E16
D)E89
Q2) Diabetes mellitus with hypoglycemic coma: __________
Q3) When blood sugar becomes abnormally high,this is called ____.
A)hyperglycemia
B)hypoglycemia
C)hyperpituitarism
D)hypopituitarism
Q4) The ____ is responsible for the "fight or flight" response during stress.
A)adrenal cortex
B)thymus
C)pineal gland
D)adrenal medulla
Q5) Marasmus: __________
Q6) Hypothyroidism in patient who has had a previous thyroidectomy: __________
Q7) Iritis right eye due to diabetes,type 2,out of control: __________
Q8) TLS stands for ____________________.
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Chapter 13: Mental, Behavioral, and Neuro developmental Disorders
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72 Verified Questions
72 Flashcards
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Sample Questions
Q1) The most common type of intellectual disability is the mild type,which affects ____ of those who have intellectual disabilities.
A)20%
B)50%
C)85%
D)100%
Q2) Panic agoraphobia: __________
Q3) Adjustment insomnia: __________
Q4) A patient has a history of PTSD and arrives at the ER with extreme anxiety.The patient has been noncompliant with medications and recently has been under a great deal of stress and indicates suicidal ideation.The patient is admitted for monitoring and reinstitution of medications for exacerbation of chronic PTSD.
Q5) Major depressive disorder,recurrent,moderate: __________
Q6) Cirrhosis of liver due to alcohol dependence in remission: __________
Q7) Active Heller's syndrome: __________
Q8) An impaired mental state in which the perception of reality has become distorted is called ____________________.
Q9) Family disruption due to parent's divorce: __________ Page 19
Q10) Name one occurrence during birth that can cause intellectual disability.
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Page 20
Chapter
Eye and Adnexa,and Diseases of the Ear and Mastoid Process
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59 Verified Questions
59 Flashcards
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Sample Questions
Q1) The two parts of the peripheral nervous system are the ____________________ nervous system and the ____________________ nervous system.
Q2) Root operations are only found in ICD-10-PCS.
A)True
B)False
Q3) Bilateral vitreous floaters: __________
Q4) All of the following are symptoms of meningitis EXCEPT ____.
A)vomiting
B)sensitivity to darkness
C)headache
D)high fever
Q5) A patient was admitted for acute pain control after falling off a ladder and suffering two broken ribs on the right side.The patient was admitted for pain control.
A)S22.31xA,G89.11,W11xxxA
B)G89.18,S22.41xA,W11xxxA
C)G89.11,S22.41xA,W11.xxxA
D)S22.41xA,G89.18,W11xxxA
Q6) Pseudohole of the macula of the right eye: __________ Page 21
Q7) The spinal cord is located in the ____________________ foramen.
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Chapter 15: Diseases of the Circulatory System
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Sample Questions
Q1) Heart assist device
A)Z82.3
B)Z94.1
C)Z95.811
D)Z95.9
E)Z76.82
Q2) Atherectomy is the removal of plaque from the vessel.
A)True
B)False
Q3) Blood thinners (Coumadin,Plavix,Ticlid);rate control: calcium channel blockers: Cardizem,verapamil;beta blockers: atenolol,Lopressor,Inderal,digoxin,Lanoxin
A)Angina
B)Atrial fibrillation
C)Congestive heart failure
D)Hypertension
Q4) Deep vein thrombosis (DVT) is a blood clot that forms deep in a vein,usually in the leg or hip.
A)True
B)False
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Chapter 16: Diseases of the Respiratory System
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73 Verified Questions
73 Flashcards
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Sample Questions
Q1) A patient is admitted with hypoxemia and acute respiratory failure.The patient has COPD and is being treated for an acute exacerbation.The patient is intubated in the ER and is transferred to ICU and maintained on mechanical ventilation for 24 hours.The patient has a history of chronic diastolic congestive heart failure.
A)J96.01,J44.1,I50.32,5A1945Z,0BH17EZ
B)J96.00,J44.1,I50.30,5A1945Z,0BH17EZ
C)J44.1,J96.10,I50.31,5A1935Z,0BH17EZ
D)J96.01,J44.1,I50.9,5A1935Z
Q2) Which of the following is a symptom of pneumonia?
A)Fever
B)Cough
C)Chest pain
D)Rapid breathing
E)All of the above
Q3) Suspected H1N1 influenza: __________
Q4) The condition where fluid accumulates in the lungs is called ____________________.
Q5) Asthmatic bronchitis: __________
Q6) Cork handlers' disease: __________
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Chapter 17: Diseases of the Digestive System
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60 Verified Questions
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Sample Questions
Q1) Procedure performed to remove adhesions from the body
A)Nissen fundoplication
B)Herniorrhaphy
C)Appendectomy
D)Colostomy
E)Lysis of adhesions
F)PEG (percutaneous endoscopic gastrostomy)
G)TIPS (transjugular intrahepatic portosystemic shunt) procedure
H)Whipple procedure
Q2) Name one purpose of the small intestine.
Q3) Recurrent gangrenous inguinal hernia: __________
Q4) ____ means bright red in the stool.
A)Hematuria
B)Hematochezia
C)Hematemesis
D)None of the above
Q5) Assign the code for portal thrombophlebitis: __________
Q6) What is the abbreviation for esophagogastroduodenoscopy?
Q7) Lingua villosa nigra: __________
Q8) Appendicitis with abscess: __________
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Chapter 18: Diseases of the Skin and Subcutaneous Tissue
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Sample Questions
Q1) A type of dermatitis that includes inflammation of the lower legs associated with venous incompetence
A)Decubitus ulcer
B)Skin ulcers
C)Cellulitis
D)Stasis ulcer
E)Stasis dermatitis
F)Intertriginous dermatitis
G)Gangrene
H)Hives
I)Dermatitis
Q2) Dermatitis from gold ring: __________
Q3) Exfoliative dermatitis: __________
Q4) Patient has a pressure ulcer of the left ankle on admission,which is documented as a stage I and progresses to a stage III during the course of the stay.The patient is a paraplegic.
A)L97.309,G82.22
B)L89.523,G82.20
C)L97.319,G82.20
D)L89.511,L89.523,G82.22
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Chapter 19: Diseases of the Musculoskeletal System and Connective Tissue
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63 Verified Questions
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Sample Questions
Q1) Organ or tissue replaced by other means-right hip
A)Z87.39
B)Z82.61
C)Z82.69
D)Z96.641
E)Z89.512
F)Z13.828
G)Z13.820
Q2) The patient was admitted with disc herniation at L4-L5.The patient has failed conservative treatments such as physical therapy.NSAIDs and even steroid injections did not provide much relief.The patient was taken to surgery,and an open discectomy was performed.The patient recovered uneventfully and was discharged.Instructions were given to avoid lifting anything heavier than 10 pounds until after the post-operative clinic visit.Final Diagnosis: Herniated disc.Procedure: Discectomy (partial).
A)M51.27,0ST40ZZ
B)M51.06,0ST20ZZ
C)M51.25,0SB40ZZ
D)M51.26,0SB20ZZ
Q3) Ankylosis of right shoulder: __________
Page 27
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Chapter 20: Diseases of the Genitourinary System
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73 Verified Questions
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Sample Questions
Q1) Inflammation or infection of the breast
A)Urolithiasis
B)Nephrotic syndrome
C)Fistula
D)Prostatitis
E)Urinary tract infections (UTIs)
F)Hemodialysis
G)Endometritis
H)Renal colic
I)Mastitis
J)Acute renal failure
Q2) Mittelschmerz: __________
Q3) When the site is known,urinary tract infections are assigned codes based on the site of the infection.
A)True
B)False
Q4) Small kidneys,bilaterally: __________
Q5) Tight hymenal ring: __________
Q6) UTI stands for ____________________.
Q7) Priapism: __________
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Chapter 21: Pregnancy, Childbirth, and the Puerperium
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56 Verified Questions
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Sample Questions
Q1) 35 or older at date of delivery
A)Young obstetric patient
B)Antepartum
C)Primigravida
D)Puerperium
E)Gravid
F)Elderly OB patient
Q2) Patient comes to the hospital at 39 weeks with convulsions;baby is taken emergently by low cervical C-section: __________
Q3) Lupus nephritis in second trimester of pregnancy (20 weeks): __________
Q4) What is tested for in a female's urine sample to confirm that she is pregnant?
Q5) A woman pregnant at 43 weeks is still considered to be a term pregnancy.
A)True
B)False
Q6) Coding a normal pregnancy requires only three diagnostic codes and one or more procedure codes.
A)True
B)False
Q7) What is the Index term if the condition is affecting the labor?
Q8) In referring to a pregnant woman,what does antepartum mean?
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Chapter 22: Certain Conditions Originating in the Perinatal
Period and Congenital Malformations, deformations, and
Chromosomal Abnormalities
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Sample Questions
Q1) Congenital conditions are always present,well defined,and diagnosed at birth.
A)True
B)False
Q2) Vaginal delivery of infant with a birth weight of 4600 grams at 42 weeks;physician documents large for dates: __________
Q3) Child is seen in pediatrician's office.She has a diagnosis of Down syndrome with ADD,sleep apnea,and mild mental retardation.Her medications are reviewed and a suggestion is made to have a sleep study.
A)Q90.0,F70,G47.30,F90.8
B)Q90.0,F79,G47.39,F90.9
C)Q90.9,F70,G47.30,F90.0
D)Q90.9,F79,G47.39,F90.9
Q4) TNN (transitory tachypnea of newborn) means the infant ____.
A)retains lung fluid
B)is disoriented
C)dies shortly after birth
D)has a bowel movement in the womb during birth
E)none of the above are correct
Q5) Cesarean delivery at term of baby with TTN: __________ Page 30
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Chapter 23: Injuries and Certain Other Consequences of
External Cases and External Causes of Morbidity
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Sample Questions
Q1) In ICD-10-CM,there are more Instructional notes for the coder to also code any associated injuries.
A)True
B)False
Q2) Small piece of grass from mowing lawn at a single-family house stuck on right cornea.Grass was removed.Assign injury and procedure codes only.
A)T15.01xD,08C8XZZ
B)T15.01xA,08C8XZZ
C)T15.02xA,08C9XZZ
D)T15.02XD,08C9XZZ
Q3) Fractured both wrists;left distal radius and ulna,right distal ulnar fracture,initial encounter: __________
Q4) All of the following are symptoms of fat embolism syndrome EXCEPT ____.
A)tachycardia
B)elevated temperature
C)decreased temperature
D)hypoxemia
Q5) When a patient is unable to respond to people or to other stimuli,he or she is considered to have ____________________.
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Chapter 24: Burns, adverse Effects, and Poisonings
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Sample Questions
Q1) Active treatment of non-healing second-degree burn to right forearm due to hot iron while ironing (accidental): __________
Q2) Allergy other than to medicinal agents-peanuts
A)Z69.020
B)Z88.8
C)Z91.030
D)Z88.7
E)Z91.010
F)Z91.89
G)Z91.011
H)Z91.410
Q3) During hospital stay,in the patient's room,the nurse accidentally administered insulin,and this caused hypoglycemia;patient is not a diabetic,and no insulin was ordered: __________
Q4) Are healthcare providers required to report suspicion of abuse to the authorities?
Q5) The abbreviation OR stands for ____________________.
Q6) Sunburned chest: __________
Q7) Patient had an adverse reaction to Cipro: __________
Q8) Battered spouse syndrome: Confirmed abuse by her husband: __________
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Chapter 25: Complications of Surgical and Medical Care
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Sample Questions
Q1) Patient is admitted for treatment of primary liver cancer.Patient had a liver transplant 2 years ago.Patient has a past medical history of hypertension and COPD and is a former alcoholic,now in remission.Patient has been sober for 10 years.
A)T86.49,C80.2,C22.8,F10.20,Y83.0
B)T86.49,C80.2,C22.9,I10,J44.1,F10.20,Y83.0
C)C80.2,T86.49,C22.9,J44.1,F10.21,Y83.0
D)T86.49,C80.2,C22.8,I10,J44.9,F10.21,Y83.0
Q2) A patient comes to the hospital with acute appendicitis and is taken to the OR for an open appendectomy.During the course of the surgery,the liver is accidentally lacerated and repaired.The patient recovers without any ill effects.__________
Q3) Iatrogenic is a term used to signify that a condition is a result of treatment. A)True B)False
Q4) A patient comes to the hospital with chronic cholecystitis,and a laparoscopic cholecystectomy is performed.The patient's bowel function was slow to return,and on day 3 the patient developed a post-operative ileus.__________
Q5) How often are code Z94.0 and a T86.1- code used together?
Q6) What does DVT stand for?
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Chapter 26: Reimbursement Methodologies
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Sample Questions
Q1) A condition that arises during a patient's hospitalization and may lead to increased resource use is a ____.
A)comorbidity
B)complication
C)provisional diagnosis
D)morbidity
Q2) How do you calculate case-mix index?
Q3) Medicare has medical necessity guidelines that outline the criteria for what services are to be determined to be reasonable and necessary.
A)True
B)False
Q4) MS-DRG stands for __________.
Q5) A four-digit code that is used on the UB-04 to indicate a particular type of service is called a ____.
A)chargemaster
B)charge description number
C)department number
D)revenue code
Q6) Medicare is responsible for more than ___% of patients.
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Chapter 27: Out patient Coding
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Sample Questions
Q1) Patient had a laparoscopic cholecystectomy for cholelithiasis (gallbladder) in the ambulatory surgery suite.In the recovery room,the patient is found to have atrial fibrillation,and the surgeon decides to admit the patient for observation: __________
Q2) Patient with right carpal tunnel syndrome had an endoscopic carpal tunnel release:
Q3) When a patient comes to the hospital for outpatient surgery,what should a coder code as the first-listed diagnosis?
Q4) Counseling a diabetic regarding diet: __________
Q5) Chronic diseases treated on an ongoing basis can be coded only once,when the patient receives treatment and care for the condition.
A)True
B)False
Q6) What are ancillary service visits?
Q7) Patient goes to a physician's office with a complaint of low back pain.This patient is on medication for hypertension and hypercholesterolemia.During this visit,the patient's blood pressure is checked,and blood is drawn for cholesterol level: __________
Q8) What does AMA stand for?
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