Free Medical Coding (CMCS) MCQ Questions and Answers — Questions and Answers
Question 1: A patient is diagnosed with stage III CKD, hypertension, and edema. In this graphic, the appropriate ICD-10 CM codes are:
- N18.9, I12.9, R60.9
- N18.3, I10, R60.9
- N18.9, I10, R60.9
- N18.3, I12.9 (Correct answer)
Correct answer: N18.3, I12.9
For a patient diagnosed with Stage III CKD and hypertension, the correct ICD-10-CM codes are N18.3 for Chronic kidney disease, stage 3, and I12.9 for Hypertensive chronic kidney disease with stage 1-4 chronic kidney disease, or unspecified. When hypertension and CKD are linked, the combination code I12.9 is used, which implicitly includes the hypertension. Edema (R60.9) would be coded if it's a separate symptom, but the question implies the primary diagnoses.
Question 2: 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:
- 90460, 90461x5
- 90460x2, 90461x4 (Correct answer)
- 90460, 90461
- 90471, 90472
Correct answer: 90460x2, 90461x4
CPT codes 90460 and 90461 are used for immunization administration with counseling for patients 18 years and younger. Code 90460 is for the first component of each vaccine, and 90461 is for each additional component. DTaP is a 3-component vaccine (Diphtheria, Tetanus, acellular Pertussis), and MMR is also a 3-component vaccine (Measles, Mumps, Rubella). Therefore, for DTaP, you would code one 90460 and two 90461s. For MMR, you would also code one 90460 and two 90461s, resulting in a total of two 90460s and four 90461s.
Question 3: Bases for facility payments include:
- IPPS using DRGs (Correct answer)
- RVUs and conversion factors
- Fee schedules
- ICD-10 PCS codes
Correct answer: IPPS using DRGs
The Inpatient Prospective Payment System (IPPS) using Diagnosis-Related Groups (DRGs) is the primary method for reimbursing hospitals for inpatient services provided to Medicare beneficiaries. Under this system, hospitals receive a fixed payment amount for each patient discharge, based on the patient's DRG, regardless of the actual costs incurred. This incentivizes hospitals to manage costs efficiently and promotes standardized care.
Question 4: Examples include pulmonary embolisms, DVTs, pressure ulcers, falls, head injuries, catheter-associated uTIs, and urinary tract infections.
- Part of similar weight DRGs
- DRGs that should have a POA indicator
- Complications that must be coded to receive full reimbursement
- Hospital-acquired conditions that will not be reimbursed (Correct answer)
Correct answer: Hospital-acquired conditions that will not be reimbursed
The conditions listed, such as pulmonary embolisms, DVTs, pressure ulcers, and catheter-associated UTIs, are examples of Hospital-Acquired Conditions (HACs) or 'Never Events.' Under Medicare's payment policies, hospitals generally will not receive additional reimbursement for treating these conditions if they were acquired during the patient's hospital stay. This policy aims to incentivize hospitals to improve patient safety and prevent these preventable complications.
Question 5: What part of the following does not make up personal health information?
- All of the above are PHI elements (Correct answer)
- License plate number
- Zip Code
- URL
Correct answer: All of the above are PHI elements
Protected Health Information (PHI) under HIPAA includes any individually identifiable health information, as well as demographic data that can be used to identify an individual. This encompasses a wide range of identifiers, including license plate numbers, zip codes, and URLs, in addition to more obvious health-related data. Any piece of information that could potentially link to a specific person's health record is considered PHI.
Question 6: What standard affected how PHI was reported electronically when implemented in 2012?
- SDLC 6040
- HIPAA 2020
- ASC X12 5010 (Correct answer)
- HL7 4010
Correct answer: ASC X12 5010
The ASC X12 5010 transaction standard was implemented in 2012 to replace the older 4010/4010A1 versions for electronic healthcare transactions, including claims submission. This standard significantly affected how Protected Health Information (PHI) was reported electronically, improving data accuracy, efficiency, and the ability to accommodate ICD-10 codes. It was a crucial step in modernizing healthcare data exchange and compliance.
Question 7: Which of the following nomenclature standards is utilized in electronic health record software to produce standardized terminology?
- SNOMED CT (Correct answer)
- CTNS EHR
- NADA PC
- ICD-10 CM
Correct answer: SNOMED CT
SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms) is a comprehensive, multilingual clinical terminology that provides a standardized way to represent clinical phrases and concepts. It is widely used in electronic health record (EHR) software to ensure consistent and precise documentation of patient information. This standardization facilitates data exchange, interoperability, and analysis across different healthcare systems.
Free Medical Coding (CMCS) MCQ Questions and Answers
A patient is diagnosed with stage III CKD, hypertension, and edema.
In this graphic, the appropriate ICD-10 CM codes are: