Free Medical Coding (CMCS) Trivia Questions and Answers — Questions and Answers
Question 1: The physician performs a cardiovascular treatment that the coder is unfamiliar with, and the procedure's name does not appear in the CPT index. What action should the developer take first in such a circumstance?
- Assign a similar cardiovascular procedure code
- Request that the medical professional look at the CPT codes in the cardiovascular area (Correct answer)
- Use an unlisted procedure code from the cardiovascular section
- Postpone coding the specific procedure until a code is established by the AMA
Correct answer: Request that the medical professional look at the CPT codes in the cardiovascular area
When a coder encounters an unfamiliar procedure not found in the CPT index, the first step should be to consult with the performing physician. The physician can provide more specific details about the procedure or even suggest relevant CPT codes, ensuring accurate coding based on clinical documentation. This collaborative approach helps avoid miscoding or using generic 'unlisted procedure' codes prematurely.
Question 2: The coding supervisor performs weekly quality checks to evaluate the precision of the coded data. Which of the following codes listed as the principal diagnostic is the sole code that can be assigned as the principal diagnosis?
- V71.1 Observation for suspected malignant neoplasm
- 321.2 Meningitis due to viruses, not else- where classified (Correct answer)
- E855.0 Accidental poisoning by anticonvulsant and anti-Parkinsonism drugs
- V27.0 Outcome of delivery, single liveborn
Correct answer: 321.2 Meningitis due to viruses, not else- where classified
The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. Of the given options, 'Meningitis due to viruses' represents a definitive diagnosis that would typically warrant inpatient admission and treatment. The other options are either observation codes, accidental poisoning (which might be a secondary diagnosis), or an outcome of delivery (which describes a state, not the primary reason for admission).
Question 3: To rule out pneumonia, a patient with a cough (symptom code: 786.2) was referred by his doctor to the outpatient department (486). The outcomes could have been better. <br> <br> Which of the following is the appropriate sequencing?
- 786.2 (Correct answer)
- V72.5; 786.2
- V72.5
- V72.5; 486
Correct answer: 786.2
For outpatient encounters, the primary diagnosis should be the condition, problem, or other reason for the encounter, as indicated by the physician. In this scenario, the patient presented with a cough (symptom code 786.2), and the purpose of the visit was to rule out pneumonia. Since the pneumonia was not confirmed, the symptom (cough) is the appropriate principal diagnosis for the outpatient visit.
Question 4: A patient with tachycardia and hypotension visited the emergency room. Upon investigation, it was discovered that the patient's condition was brought on by a tetanus toxoid shot given four hours earlier. <br> <br> Which of the following is the appropriate sequencing?
- Hypotension; tachycardia; and therapeutic use E code, tetanus toxoid (Correct answer)
- Hypotension; tachycardia; and accidental poisoning E code, tetanus toxoid
- Unspecified adverse reaction and undetermined cause E code, tetanus toxoid
- Poisoning due to tetanus toxoid and therapeutic use E code, tetanus toxoid
Correct answer: Hypotension; tachycardia; and therapeutic use E code, tetanus toxoid
When a patient experiences an adverse effect from a drug properly administered in a therapeutic setting, the adverse effect (e.g., hypotension, tachycardia) is sequenced first. An E-code from the 'Therapeutic use' category is then used to identify the drug causing the adverse effect. This sequencing accurately reflects that the patient's symptoms are the primary reason for the visit, and the drug was administered correctly but still caused an undesired reaction.
Question 5: You code charts for clients at a billing company. Because your team is two months behind schedule and needs to comply with the terms of your service line agreement in the contract with your client, your manager sends out claims that have not been professionally coded. However, they claim it is acceptable because the provider already coded the shares at the time of service, and the client does not want to pay for additional coding. Which of the following assertions is accurate?
- This is unacceptable since billing businesses are responsible for any fraudulent claims they submit, including under coding (Correct answer)
- This is acceptable because the supplier made the best effort while coding the claim and is therefore exempt from liability
- Most of the time, the suppliers under code their offerings, which saves the insurance company money and spares us effort
- Only over coding is fraudulent, so this is acceptable.
Correct answer: This is unacceptable since billing businesses are responsible for any fraudulent claims they submit, including under coding
Billing companies have a legal and ethical responsibility to submit accurate and compliant claims. Submitting claims that have not been professionally coded, even if the provider initially coded them, can lead to undercoding, overcoding, or incorrect coding, all of which are forms of fraud or abuse. The billing company is liable for the accuracy of claims they submit, regardless of who initially assigned the codes, and must ensure compliance with coding guidelines and regulations.
Question 6: Which of the subsequent statements is false:
- They were changing the code on a claim because the provider did not fulfill documentation standards
- Use modifier -59 to report a unique and distinct service that would otherwise be against NCCI policies
- All of the above are acceptable practices
- Modifier -25 is applied to a fair assessment and management service coded alongside a connected operation (Correct answer)
Correct answer: Modifier -25 is applied to a fair assessment and management service coded alongside a connected operation
Modifier -25 is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed by the same physician on the same day as another procedure or service. The key is 'separately identifiable' and 'significant,' meaning the E/M service went beyond the usual pre- or post-operative work associated with the procedure. Therefore, stating it's applied to a 'fair' assessment is inaccurate; it must be a distinct and medically necessary service.
Free Medical Coding (CMCS) Trivia Questions and Answers
The physician performs a cardiovascular treatment that the coder is unfamiliar with, and the procedure's name does not appear in the CPT index.
What action should the developer take first in such a circumstance?