Certified Medical Coding Specialist Communication & Stakeholder Relations 3 — Questions and Answers
Question 1: Which of the following best describes a compliant physician query?
- Leading the physician toward a specific diagnosis to maximize reimbursement
- Asking an open-ended question about unclear documentation without suggesting a specific answer (Correct answer)
- Informing the physician that the current code will result in a lower payment
- Requiring the physician to add diagnoses not mentioned in the record
Correct answer: Asking an open-ended question about unclear documentation without suggesting a specific answer
Compliant queries are open-ended, non-leading, and based solely on existing clinical documentation.
Question 2: When presenting coding audit findings to department leadership, a coder should:
- Share only findings that reflect positively on the department
- Present all findings objectively with data, trends, and recommended actions (Correct answer)
- Avoid mentioning specific physicians by name under any circumstance
- Summarize findings verbally only to avoid creating a paper trail
Correct answer: Present all findings objectively with data, trends, and recommended actions
Audit findings should be presented objectively with supporting data and actionable recommendations to drive improvement.
Question 3: A nurse practitioner claims she documented a condition that a coder cannot locate in the record. The coder should:
- Add the condition to the claim based on the NP's verbal statement
- Ask the NP to amend the medical record through the proper clinical amendment process (Correct answer)
- Code the condition as stated verbally to avoid conflict
- Ignore the discrepancy and submit the claim as-is
Correct answer: Ask the NP to amend the medical record through the proper clinical amendment process
Only properly documented and amended records can support coded diagnoses; verbal statements alone are insufficient.
Question 4: Which stakeholder is primarily responsible for ensuring clinical documentation supports the codes assigned?
- The insurance payer
- The medical coder
- The treating physician or provider (Correct answer)
- The hospital administrator
Correct answer: The treating physician or provider
The treating physician or provider bears primary responsibility for creating clinical documentation that accurately reflects the patient encounter.
Question 5: A coder receives pressure from a practice manager to upcode a procedure to increase reimbursement. The coder should:
- Comply to maintain a good working relationship
- Upcode but document the manager's request
- Refuse and report the request through the compliance hotline or chain of command (Correct answer)
- Ask the patient if they agree with the change
Correct answer: Refuse and report the request through the compliance hotline or chain of command
Upcoding is fraudulent; the coder must refuse and report the request through appropriate compliance channels.
Question 6: What does AHIMA's Standards of Ethical Coding require regarding communication with payers?
- Coders may omit diagnoses that could trigger audits
- Coders must report all codes that accurately reflect documented services (Correct answer)
- Coders should communicate only diagnoses that optimize reimbursement
- Coders should defer all payer communication to physicians
Correct answer: Coders must report all codes that accurately reflect documented services
AHIMA's ethical standards require that all codes accurately reflect the documented services, regardless of reimbursement impact.
Question 7: Effective interdepartmental communication in a coding department typically includes:
- Sharing patient PHI in unsecured emails for convenience
- Regular team meetings, written policies, and feedback loops with clinical staff (Correct answer)
- Limiting communication to formal written memos only
- Avoiding contact with clinicians to maintain objectivity
Correct answer: Regular team meetings, written policies, and feedback loops with clinical staff
Regular meetings, clear policies, and feedback loops with clinical staff support accuracy and continuous improvement in coding.
Certified Medical Coding Specialist Communication & Stakeholder Relations 3
Which of the following best describes a compliant physician query?