FREE Medical Coding (CMCS) MCQ Questions and Answers
What standard affected how PHI was reported electronically when implemented in 2012?
Explanation:
HIPAA Standard 5010 was developed and implemented utilizing ASC X12 as part of administrative simplification. As of June 30, 2012, HIPAA Classic 4010 was no longer approved.
What part of the following does not make up personal health information?
Explanation:
HIPAA protects eighteen different IDs. As long as there are more than 20,000 people in the group that makes up all zip codes, only the first three digits of a patient's zip code are considered to be PHI. For instance, 123XX+123XY+123XZ has over 20,000 individuals. Otherwise, you must modify the zip code to 00000.
Bases for facility payments include:
Explanation:
By paying inpatient stays based on DRGs (diagnosis-related groups), which are groups of diagnoses with similar weights to calculate "how much" a patient's stay ought to cost, the Inpatient Prospective Payment System promotes value-based treatment. To avoid losing money, these incentives compel hospitals to use resources as efficiently as possible to come in under what they will be paid.
Which of the following nomenclature standards is utilized in electronic health record software to produce standardized terminology?
Explanation:
The SNOMED CT standard, used to define terms in EHRs worldwide, is the systemized nomenclature of medicine—clinical terminology.
A patient is diagnosed with stage III CKD, hypertension, and edema. In this graphic, the appropriate ICD-10 CM codes are:
Explanation:
Per ICD-10CM guidelines, do not code signs and symptoms. Edema is a symptom of both hypertension and CKD. ICD-10CM guidelines state a casual relationship is assumed between CKD and hypertension unless the provider specifically says that the hypertension is not related to the CKD, giving this patient hypertensive chronic kidney disease instead of chronic hypertension.
A 7-year-old comes in for a round of shots. The patient is given DTaP, MMR, and vaccination advice. For this procedure, the appropriate CPT code is:
Explanation:
The components of pediatric vaccinations with counseling are coded separately. In this instance, measles and diphtheria are two vaccines whose first components are each recorded as one unit of 90460. Mumps, rubella, tetanus, and acellular pertussis are the extra components of the vaccination. Each earns a separate 90461 number.
Examples include pulmonary embolisms, DVTs, pressure ulcers, falls, head injuries, catheter-associated uTIs, and urinary tract infections.
Explanation:
The Deficit Reduction Act of 2005 established the HAC-POA (Hospital Acquired Condition, Present on Admission) program; any of these conditions that are not present on admission and could have reasonably been avoided by adhering to accepted standards of care would not be compensated. In most cases, increasing the DRG weight would have boosted the facility's compensation, but doing so drives hospitals to steer clear of HACs rather than make money off of them.