CCA Mock Examination 60 Questions

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CCA Mock Examination 60 Questions - Quiz

A mock examination is designed to give you a clear view of what to expect when the final exam is upon us. How ready do you think you are when it comes to actually sitting for the mock exam? Take up the CCA mock examination quiz below with 60 questions and find out.


Questions and Answers
  • 1. 

    The physician's office note states: "counseling visit, 15 minutes counseling in follow-up with a patient newly diagnosed with diabetes." If the physician reports code 99214, which piece of documentation is missing to substantiate this code?

    • A.

      Chief complaint

    • B.

      History

    • C.

      Exam

    • D.

      Total length of visit

    Correct Answer
    D. Total length of visit
    Explanation
    In order to use time as a factor in determining the appropriate E&M code, the total time spent with the patient as well as the amount of time spent in counseling must be recorded.

    * Note: The 3 R's of Consultation codes - Rendering, Report, Request

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  • 2. 

    A marked loss of bone density and increase in bone porosity is

    • A.

      Lumbago

    • B.

      Osteoarthritis

    • C.

      Spondylitis

    • D.

      Osteoporosis

    Correct Answer
    D. Osteoporosis
    Explanation
    Osteoporosis is a condition characterized by a marked loss of bone density and an increase in bone porosity. This means that the bones become weaker and more prone to fractures. Lumbago refers to lower back pain, osteoarthritis is a degenerative joint disease, and spondylitis is inflammation of the vertebrae. None of these conditions specifically involve a loss of bone density and increased porosity, making osteoporosis the correct answer.

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  • 3. 

    In order to correctly code a hernia repair, the coder needs to know all of the following except:

    • A.

      Type of hernia

    • B.

      Whether the hernia is strangulated or incarcerated

    • C.

      Age of the patient

    • D.

      Whether the patient is obese or not

    Correct Answer
    D. Whether the patient is obese or not
    Explanation
    The coder needs to know the type of hernia, whether the hernia is strangulated or incarcerated, and the age of the patient in order to correctly code a hernia repair. However, the patient's obesity status is not a factor that affects the coding for hernia repair procedures.

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  • 4. 

    Hysteroscopy with D&C and polypectomy. Provide the appropriate CPT code(s). 58100 Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) 58120 Dilation and curettae, diagnostic and/or therapeutic (nonobstetrical) 58555 Hysteroscopy, diagnostic (separate procedure) 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C 58563 Hysteroscopy, surgical: with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)

    • A.

      58563

    • B.

      58558

    • C.

      58120, 58100, 58555

    • D.

      58558, 58120

    Correct Answer
    B. 58558
    Explanation
    The correct answer is 58558 because it specifically mentions hysteroscopy with sampling (biopsy) of the endometrium and/or polypectomy, with or without D&C. This code accurately represents the procedure described in the question.

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  • 5. 

    The blood disorder in which red blood cells lack of the normal ability to produce hemoglobin is called

    • A.

      Aplastic anemia

    • B.

      Hemolytic anemia

    • C.

      Pernicious anemia

    • D.

      Thalassemia

    Correct Answer
    D. Thalassemia
    Explanation
    Thalassemia is a blood disorder characterized by the reduced production of hemoglobin, the protein responsible for carrying oxygen in red blood cells. This condition leads to anemia, as the red blood cells lack the normal ability to produce sufficient hemoglobin. Aplastic anemia refers to a condition where the bone marrow does not produce enough new blood cells, hemolytic anemia is caused by the destruction of red blood cells, and pernicious anemia is a type of anemia caused by a deficiency in vitamin B12.

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  • 6. 

    Newborn infant born with cleft palate 749.20 Cleft palate with cleft lip, unspecified V30.00 Single liveborn, born in hospital, without mention of c-section 27.54 Repair of cleft lip 27.62 Correction of cleft palate

    • A.

      749.20; 27.54; 27.62

    • B.

      749.20

    • C.

      V30.00; 749.20

    • D.

      V30.00

    Correct Answer
    C. V30.00; 749.20
    Explanation
    The correct answer is V30.00; 749.20. This answer includes both the code for the newborn infant born in the hospital without a mention of a C-section (V30.00) and the code for cleft palate with cleft lip, unspecified (749.20). This accurately represents the situation of a newborn infant born with a cleft palate and lip in a hospital setting.

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  • 7. 

    If any part of a combination code was not "present on admission" (POA) assign the POA  indicator of:

    • A.

      "Y"

    • B.

      "U"

    • C.

      "W"

    • D.

      "N"

    Correct Answer
    D. "N"
    Explanation
    The correct answer is "N" because if any part of a combination code was not "present on admission" (POA), it means that the condition or problem was not present at the time of admission. Therefore, the POA indicator should be assigned as "N" to indicate that the condition was not present on admission.

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  • 8. 

    ???????? Lumbar laminectomy (one segment) for decompression of spinal cord. Provide appropriate CPT code(s). 62263 Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (including contrast when administered), multiple adhesiolysis sessions; 2 or more days 63005 Laminectomy, with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy (eg, spinal stenosis), one or two vertebral segments; lumbar except for spondylolisthesis 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial  facetectomy, foraminotomy, and/or excision of herniated intervertebral disk including open and endoscopically-assisted approaches; one interspace, lumbar 63170 Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic or thoracolumbar

    • A.

      63005

    • B.

      62263

    • C.

      63170

    • D.

      63030

    Correct Answer
    A. 63005
    Explanation
    The correct answer is 63005 because it specifically mentions "laminectomy" and "decompression of spinal cord" without any additional procedures such as facetectomy or foraminotomy. The other codes listed involve different procedures or additional components that are not mentioned in the question.

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  • 9. 

    Chip is an unfortunate 35 year old who has been previously diagnosed with lung cancer. He has been receiving chemotherapy and radiation. He develops seizures and is admitted. Work up revealed metastasis of the lung cancer to the brain. Provide appropriate ICD-9-CM diagnosis codes. V10.11   Personal history of malignant neoplasm of the bronchus and lung V10.85   Personal history of malignant neoplasm of the brain 162.9     Malignant neoplasm of the bronchus/lung, unspecified site 191.9     Malignant neoplasm of the brain, unspecified 197.0     Secondary malignant neoplasm of the lung 198.3     Secondary malignant neoplasm of the brain and spinal cord 780.39   Other convulsions (seizures, not otherwise specified)

    • A.

      780.39, 191.9, 197.0, V10.11

    • B.

      780.39, 198.3, 162.9

    • C.

      780.39, V10.11, V10.85

    • D.

      198.3, 162.9, 780.39

    Correct Answer
    D. 198.3, 162.9, 780.39
    Explanation
    The correct answer is 198.3, 162.9, 780.39. This is because Chip has metastasis of lung cancer to the brain, which is coded as 198.3. He also has lung cancer, which is coded as 162.9. Lastly, he develops seizures, which are coded as 780.39.

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  • 10. 

    Urinary frequency, urgency, nocturia, incontinence and hesitancy are all symptoms of:

    • A.

      BPH

    • B.

      End stage kidney disease

    • C.

      Salpingitis

    • D.

      Genital prolapse

    Correct Answer
    A. BPH
    Explanation
    Urinary frequency, urgency, nocturia, incontinence, and hesitancy are all symptoms commonly associated with BPH, which stands for benign prostatic hyperplasia. BPH is a non-cancerous enlargement of the prostate gland, which can cause urinary problems by obstructing the flow of urine from the bladder. These symptoms occur because the enlarged prostate puts pressure on the urethra, leading to difficulties in emptying the bladder completely. While end stage kidney disease, salpingitis, and genital prolapse can also cause urinary symptoms, BPH is specifically known to be associated with this particular set of symptoms.

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  • 11. 

    What is the correct sequencing of the codes for a patient who is six weeks post mastectomy for carcinoma of the breast and is admitted for chemotherapy? 174.9  Malignant neoplasm of the female breast, unspecified site V10.3  Personal history of malignant neoplasm of breast V58.11 Encounter for antineoplastic chemotherapy V67.00  Follow-up examination following surgery, unspecified

    • A.

      V58.11, 174.9

    • B.

      V58.11, V10.3

    • C.

      V67.00, V58.11

    • D.

      V10.3

    Correct Answer
    A. V58.11, 174.9
    Explanation
    The correct sequencing of the codes for a patient who is six weeks post mastectomy for carcinoma of the breast and is admitted for chemotherapy is V58.11, 174.9. This is because V58.11 represents the encounter for antineoplastic chemotherapy, which is the reason for the admission. 174.9 represents the malignant neoplasm of the female breast, which is the condition being treated with chemotherapy.

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  • 12. 

    The physician listed the discharge diagnoses as congestive heart failure with acute pulmonary edema

    • A.

      The CHF only

    • B.

      The edema only

    • C.

      Both the CHF and the edema, sequence the CHF first

    • D.

      Both the CHF and the edema, sequence the edema first

    Correct Answer
    A. The CHF only
    Explanation
    The physician listed the discharge diagnoses as congestive heart failure with acute pulmonary edema. This means that the patient was diagnosed with congestive heart failure (CHF) and acute pulmonary edema. However, the question asks for the correct answer regarding the sequence of the diagnoses. The correct answer is "the CHF only" because it suggests that CHF should be sequenced first in the discharge diagnoses.

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  • 13. 

    The practice of using a code that results in a higher payment to the provider than the code that more accuratelyu reflects the service provided is known as:

    • A.

      Unbundling

    • B.

      Upcoding

    • C.

      Optimizing

    • D.

      Downcoding

    Correct Answer
    B. Upcoding
    Explanation
    Upcoding is the practice of using a code that results in a higher payment to the provider than the code that more accurately reflects the service provided. This can be done intentionally to increase reimbursement or to fraudulently bill for services that were not actually provided. Upcoding is considered fraudulent and is illegal.

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  • 14. 

    Male patient has been diagnosed with benign prostatic hypertrophy and undergoes a transurethral destruction of the prostate by radiofrequency thermotherapy. Provide appropriate ICD-9-CM and CPT codes. 600.00 Hypertrophy (benign of prostate) without urinary obstruction and other lower urinary tract symptoms (LUTS) 52601 Transurethral electrosurgical resection of prostate including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) 52648 Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transuteral transection of the prostate are including if performed.) 53850 Transurethral destruction of prostate tissue; by microwave thermotherapy 53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy

    • A.

      600.00, 52648

    • B.

      600.00, 53852

    • C.

      600.00, 52601

    • D.

      600.00, 53850

    Correct Answer
    B. 600.00, 53852
    Explanation
    The correct answer is 600.00, 53852. The patient has been diagnosed with benign prostatic hypertrophy, which is represented by the ICD-9-CM code 600.00. The procedure performed on the patient is transurethral destruction of prostate tissue using radiofrequency thermotherapy, which is represented by the CPT code 53852.

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  • 15. 

    The process of attaching a HCPCS code to a procedure so that the code will automatically be included on the patient's bill is known as:

    • A.

      Grouping

    • B.

      Hard coding

    • C.

      Soft coding

    • D.

      Downcoding

    Correct Answer
    B. Hard coding
    Explanation
    Hard coding refers to the process of attaching a HCPCS code to a procedure so that the code will automatically be included on the patient's bill. This means that the code is pre-programmed into the billing system and does not require manual input each time the procedure is performed. Hard coding ensures consistency and accuracy in billing, as well as streamlining the billing process for healthcare providers.

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  • 16. 

    The patient sees a PAR provider and has a procedure performed after meeting the annual deductible. If the Medicare-approved amount is $200, how much is the patient's out-of-pocket expense?

    • A.

      $0

    • B.

      $20

    • C.

      $40

    • D.

      $100

    Correct Answer
    C. $40
    Explanation
    The patient's out-of-pocket expense is $40 because even though they have met their annual deductible, they still have to pay 20% of the Medicare-approved amount for the procedure. The Medicare-approved amount is $200, so 20% of that is $40.

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  • 17. 

    Patient has bilateral inguinal hernias, the left is indirect and the right is direct. He has repair of both hernias with mesh prosthesis. Provide appropriate ICD-9-CM diagnosis and procedure codes. 550.90  Inguinal without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) 550.91  Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified, recurrent 550.92  Inguinal hernia, without mention of obstruction or gangrene, bilateral (not specified as recurrent) 53.01  Other and open unilateral repair of direct inguinal hernia 53.16  Other and open bilateral repair of inguinal hernia, one direct and one indirect, with graft or prosthesis 

    • A.

      550.91, 550.92, 53.16

    • B.

      550.90, 53.01, 53.02

    • C.

      550.92, 53.16

    • D.

      550.92, 53.01, 53.02

    Correct Answer
    C. 550.92, 53.16
    Explanation
    The correct answer is 550.92, 53.16. The patient has bilateral inguinal hernias, with the left hernia being indirect and the right hernia being direct. The appropriate ICD-9-CM diagnosis code for this is 550.92, which represents inguinal hernia without mention of obstruction or gangrene, bilateral (not specified as recurrent). The procedure code for the repair of both hernias with mesh prosthesis is 53.16, which represents other and open bilateral repair of inguinal hernia, one direct and one indirect, with graft or prosthesis.

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  • 18. 

    A patient is seen in the emergency department following an accident. The physician documents that the wound required multiple layers and extensive undermining.  According to CPT definitions, this type of repair would be classified as:

    • A.

      Complex

    • B.

      Intermediate

    • C.

      Simple

    • D.

      Advancement flap

    Correct Answer
    A. Complex
    Explanation
    The physician's documentation states that the wound required multiple layers and extensive undermining. According to CPT definitions, this type of repair would be classified as complex. Complex repair involves extensive reconstruction or creation of a defect, requiring a more intricate and time-consuming procedure compared to simple or intermediate repairs.

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  • 19. 

    The patient was admitted due to increasing severe pain in his right arm, shoulder and neck for the past 6 weeks. MRI tests showed herniation of the C5-C6 disc. Patient underwent cervical laminotomy and diskectomy C5-C6 disc. The patient is currently being treated for COPD and CAD with a history of a PTCA. Provide appropriate ICD-9-CM diagnosis and procedure codes. 722.0      Displacement of cervical intervertebral disc without myelopathy 722.71    Intervertebral disc disorder with myelopathy, cervical region 492.8     Other emphysema 496         Chronic airway obstruction, not elsewhere classified 414.01    Coronary atheroscierosis of native coronary artery 414.00     Coronary atherosclerosis of unspecified type of vessel, native or graft V45.82     Percutaneous transluminal coronary angioplasty status 80,.51      Excision of intervertebral disc 03.09     Other exploration and decompression of spinal canal (Decompression, laminotomy) 

    • A.

      722.0, 492.8, 414.01, V45.82, 80.51

    • B.

      722.71, 496, 414.01, V45.82, 03.09, 80.51

    • C.

      722.71, 492.8, 414.00, 03.09, 80.51

    • D.

      722.0, 496, 414.01, V45.82, 80.51

    Correct Answer
    D. 722.0, 496, 414.01, V45.82, 80.51
    Explanation
    The correct answer is 722.0, 496, 414.01, V45.82, 80.51. The patient's symptoms and MRI results indicate a herniation of the C5-C6 disc, which is coded as 722.0. The patient is also being treated for COPD (496) and CAD (414.01), with a history of PTCA (V45.82). The patient underwent a cervical laminotomy and diskectomy (80.51) to address the disc herniation.

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  • 20. 

    Pathological fracture of the femur due to metastatic bone cancer. Patient has a history of lung cancer. Only the fracture is treated. Provide the appropriate ICD-9-CM diagnostic code(s). 162.9      Primary malignancy lung and bronchus, unspecified 198.5     Secondary malignancy bone and bone marrow 733.13   Pathologic fracture neck of femur 821.00   Traumatic fracture femur, unspecified part V10.11   Personal history malignant neoplasm lung and bronchus

    • A.

      198.5; 733.14; V10.11

    • B.

      733.14; 198.5; V10.11

    • C.

      821.00; 198.5; V10.11

    • D.

      821.00; 198.5; 162.9

    Correct Answer
    B. 733.14; 198.5; V10.11
    Explanation
    The correct answer is 733.14; 198.5; V10.11. This answer includes the appropriate ICD-9-CM codes for the patient's condition. 733.14 represents a pathologic fracture of the neck of the femur, which is the specific type of fracture the patient has. 198.5 represents a secondary malignancy of the bone and bone marrow, indicating that the fracture is due to metastatic bone cancer. V10.11 represents a personal history of malignant neoplasm of the lung and bronchus, indicating the patient's history of lung cancer.

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  • 21. 

    Total transcervical thymectomy. Provide appropriate CPT code(s). 60200     Excision of cyst or adenoma of thyroid, or transection of isthmus 60240     Thyroidectomy, total or complete 60520     Thymectomy, partial or total; transcervical approach (separate procedure) 60540     Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure)

    • A.

      60520

    • B.

      60540

    • C.

      60240

    • D.

      60200

    Correct Answer
    A. 60520
    Explanation
    The correct answer is 60520 because it specifically mentions "transcervical approach" which is the method used for the thymectomy procedure. The other codes listed are for different procedures such as excision of cyst or adenoma of thyroid, thyroidectomy, and adrenalectomy.

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  • 22. 

    The APC (Ambulatory Payment Classification) payment is based on what coding system(s)?

    • A.

      AMA's CPT codes

    • B.

      CPT and ICD-9-CM diagnosis and procedure codes

    • C.

      ICD-9-CM diagnosis and procedure codes

    • D.

      CPT/HCPCS codes

    Correct Answer
    D. CPT/HCPCS codes
    Explanation
    The APC payment is based on CPT/HCPCS codes. These codes are used to identify and classify medical procedures and services provided to patients. The CPT codes, developed by the American Medical Association (AMA), are used to report medical procedures and services. The HCPCS codes, on the other hand, are used to report supplies, equipment, and other non-physician services. Together, these codes provide a comprehensive system for coding and billing medical services, which is used to determine the payment for ambulatory services under the APC system.

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  • 23. 

    Which of the following could influence a facility's case mix?

    • A.

      Changes in DRG weights

    • B.

      Changes in the services offered by a facility

    • C.

      Accuracy of coding

    • D.

      All of the above

    Correct Answer
    D. All of the above
    Explanation
    All of the options listed could influence a facility's case mix. Changes in DRG weights can affect the reimbursement received for each case, potentially altering the types of cases a facility is willing to accept. Changes in the services offered by a facility can attract different types of patients and cases. The accuracy of coding is crucial in determining the appropriate DRG assignment, which in turn affects the case mix. Therefore, all of these factors can have an impact on a facility's case mix.

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  • 24. 

    Patient (inpatient) was admitted with chestpain. Doctor ordered EKG to rule out MI

    • A.

      A code for a myocardial infarction

    • B.

      A code for the patient's symptoms

    • C.

      A code for an impending myocardial infarction

    • D.

      No code for this condition

    Correct Answer
    A. A code for a myocardial infarction
    Explanation
    Always code the Rule Out (R/O) if it's Inpatient

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  • 25. 

    The type of anemia caused by a failure of the bone marrow to produce red blood cells is:

    • A.

      Acute blood loss anemia

    • B.

      Sickle cell anemia

    • C.

      Iron deficiency anemia

    • D.

      Aplastic anemia

    Correct Answer
    D. Aplastic anemia
    Explanation
    Aplastic anemia is a type of anemia caused by a failure of the bone marrow to produce enough red blood cells. In this condition, the bone marrow is unable to produce sufficient new blood cells, leading to a decrease in the number of red blood cells in the body. This can result in symptoms such as fatigue, weakness, and shortness of breath. Aplastic anemia can be caused by various factors, including certain medications, radiation therapy, and autoimmune disorders. Treatment options may include blood transfusions, medications to stimulate blood cell production, and bone marrow transplantation.

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  • 26. 

    Thirty-two year old female known HIV positive was admitted with lessions of the anterior trunk. Excisional biopsies of the skin lesions were positive for Kaposi's sarcoma. Further examination revealed thrush. Provide appropriate ICD-9-CM and CPT codes. 042     Human immunodeficiency virus (HIV) disease 176.0 Kaposi's sarcoma, skin 686.00    Pyoderma, unspecified 112.0     Candidiasis of mouth 528.9     Other and unspecified disease of the oral soft tissues 86.11     Biopsy of the skin and subcutaneous tissue 86.22     Excisional debridement of the skin and subcutaneous tissue (wound, infection or burn)

    • A.

      042, 686.00, 112.0, 86.22

    • B.

      042, 176.0, 112.0, 86.11

    • C.

      795.71, 176.0, 528.9, 86.11

    • D.

      795.71, 686.00, 528.9, 86.22

    Correct Answer
    B. 042, 176.0, 112.0, 86.11
    Explanation
    The appropriate ICD-9-CM and CPT codes for this patient's condition are 042 (HIV disease), 176.0 (Kaposi's sarcoma, skin), 112.0 (Candidiasis of mouth), and 86.11 (Biopsy of the skin and subcutaneous tissue). This is because the patient is known to be HIV positive, has skin lesions positive for Kaposi's sarcoma, and further examination revealed thrush. The CPT code 86.11 is used for the biopsy of the skin lesions.

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  • 27. 

    Aunt Elsie is brought to the hospital for increased confusion. She is subsequently diagnosed with Alzheimer's disease with dementia and cerebral atherosclerosis. Aunt Elsie is also treated for hypertension and hypothyroidism. Provide appropriate ICD-9-CM diagnosis codes. 244.9    Unspecified acquired hypothyroidism 294.10  Dementia in conditions classified elsewhere without behavioral disturbance (manifestation) 294.11  Dementia in conditions classified elsewhere with behavioral disturbance (manifestation) 331.0    Alzheimer's disease 401.9    Essential hypertension, unspecified benign or malignant 437.0   Cerebral atherosclerosis

    • A.

      437.0, 294.10, 244.9, 401.9

    • B.

      294.10, 401.9, 244.9

    • C.

      331.0, 244.9, 401.9, 294.11

    • D.

      331.0, 294.10, 437.0, 244.9, 401.9

    Correct Answer
    D. 331.0, 294.10, 437.0, 244.9, 401.9
    Explanation
    The correct answer is 331.0, 294.10, 437.0, 244.9, 401.9. This answer includes the appropriate ICD-9-CM diagnosis codes for Aunt Elsie's conditions. 331.0 represents Alzheimer's disease, 294.10 represents dementia in conditions classified elsewhere without behavioral disturbance, 437.0 represents cerebral atherosclerosis, 244.9 represents unspecified acquired hypothyroidism, and 401.9 represents essential hypertension. These codes accurately reflect Aunt Elsie's diagnoses and conditions.

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  • 28. 

    Which of the following is coded as an adverse effect in ICD-9-CM?

    • A.

      Tinnitus due to allergic reaction after administration of ear drops

    • B.

      Mental retardation due to intracranial abscess

    • C.

      Rejection of transplanted kidney

    • D.

      Non-functioning pacemaker due to defective soldering

    Correct Answer
    A. Tinnitus due to allergic reaction after administration of ear drops
    Explanation
    Tinnitus due to allergic reaction after administration of ear drops is coded as an adverse effect in ICD-9-CM because it involves an unintended and harmful response to a medication (ear drops) that causes a ringing sensation in the ears (tinnitus). Adverse effects are classified in ICD-9-CM to track and monitor the potential harm caused by medications and treatments.

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  • 29. 

    Patient was admitted for cholecystectomy with exploratory of common duct, when the abnormal cavity was entered extensive metastic malignancy involving the stomach and duodendum with primary neoplasm in the pancreas was found. The procedure was discontinued, and the operative wound was closed. The coder reports:

    • A.

      Therapeutic procedure first, exploratory laparotomy second

    • B.

      Exploratory laparotomy, therapeutic procedure, closure of wound

    • C.

      Exploratory laparotomy first, therapeutic procedure second

    • D.

      Exploratory laparotomy only

    Correct Answer
    D. Exploratory laparotomy only
    Explanation
    The correct answer is "exploratory laparotomy only" because the procedure was discontinued after the abnormal cavity was entered and the extensive metastatic malignancy was found. No therapeutic procedure was performed, and the operative wound was closed without further intervention. Therefore, the exploratory laparotomy was the only procedure performed.

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  • 30. 

    An eighty-nine-year-old male is admitted from a nursing home with confusion, hypotension, temperature of 103.5, and obvious dehydration. Blood cultures were negative; however, urine culture was positive for E. coli. Physician documents final diagnosis as septicemia, septic shock, UTI due to E. coli, and dehydration. 03.9     Septicemia, unspecified 041.4   E. Coli 246.51    Dehydration 298.9      Psychosis, unspecified 458.9      Hypotension, unspecified 599.0      UTI, site not specified 780.60    Fever, unspecified 785.52    Septic shock 995.92    Severe sepsis

    • A.

      599.0, 458.9, 041.4, 786.60, 276.51

    • B.

      038.9, 995.92, 785.52, 599.0, 041.4, 276.51

    • C.

      599.0, 038.9, 041.4, 276.51, 995.92

    • D.

      038.9, 276.51, 786.60, 041.4, 995.92

    Correct Answer
    B. 038.9, 995.92, 785.52, 599.0, 041.4, 276.51
    Explanation
    The correct answer is 038.9, 995.92, 785.52, 599.0, 041.4, 276.51. The patient's symptoms and diagnosis indicate that he is experiencing septicemia (038.9) and septic shock (785.52) due to a urinary tract infection (UTI) caused by E. coli (041.4). Additionally, the patient is also experiencing dehydration (276.51), as evidenced by the obvious dehydration and hypotension (458.9). The fever (599.0) is also a symptom of the infection. Therefore, these codes accurately represent the patient's condition.

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  • 31. 

    In the CPT coding system, when there is no code to properly represent the work performed by the provider, the coder must use this code

    • A.

      Not otherwise specified

    • B.

      Not elsewhere classifiable

    • C.

      Unlisted procedure

    • D.

      Miscellaneous code

    Correct Answer
    C. Unlisted procedure
    Explanation
    When there is no specific code available to accurately describe the work performed by the healthcare provider in the CPT coding system, the coder is required to use an "unlisted procedure" code. This code is used to indicate that the procedure or service performed does not have a designated code and requires further explanation or documentation. It allows for proper billing and reimbursement for services that do not have a specific code assigned to them.

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  • 32. 

    Diverticulitis large bowel with abscess; right hemicolectomy with colostomy performed. Provide appropriate ICD-9-CM diagnosis and procedure codes. 562.10 Diverticulosis of colon (without mention of hemorrhage) 562.11 Diverticulitis of colon (without mention of hemorrhage) 569.5 Abscess of intestine 45.73 Open and other right hemicolectomy 45.74 Open and other resection of transverse colon 46.03 Exteriorization of large intestine (loop colostomy) 46.10 Colostomy, not otherwise specified 46.11 Temporary colostomy

    • A.

      562.10; 45.74; 46.03

    • B.

      562.11; 45.73; 46.03

    • C.

      562.11; 569.5; 45.73; 46.10

    • D.

      562.11; 569.5; 45.73; 46.11

    Correct Answer
    C. 562.11; 569.5; 45.73; 46.10
    Explanation
    The correct answer is 562.11; 569.5; 45.73; 46.10. This is because the patient has diverticulitis of the colon with an abscess, which is represented by the diagnosis codes 562.11 and 569.5. The procedure codes indicate that an open right hemicolectomy was performed (45.73), followed by a resection of the transverse colon (45.74) and the exteriorization of the large intestine to create a loop colostomy (46.03). The final code, 46.10, indicates that a colostomy was performed, but it is not specified as temporary or permanent.

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  • 33. 

    A document which acknowledges patient responsibility for payment if Medicare denies the claim is a(n):

    • A.

      Explanation of benefits

    • B.

      Remittance advice

    • C.

      Advance beneficiary notice/form (ABN)

    • D.

      CMS-1500 claim form

    Correct Answer
    C. Advance beneficiary notice/form (ABN)
    Explanation
    An advance beneficiary notice/form (ABN) is a document that acknowledges patient responsibility for payment if Medicare denies the claim. This means that if Medicare does not cover the cost of the services or procedures mentioned in the claim, the patient will be responsible for paying for them. The ABN serves as a notification to the patient that they may have to bear the financial burden in such a scenario.

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  • 34. 

    Incomplete abortion complicated by excessive hemorrhage; dilation and curettage performed. Provide appropriate ICD-9-CM diagnosis and procedure codes. 285.1     Acute blood los anemia 634.11   Spontaneous abortion complicated by delayed or excessive hemorrhage, incomplete 634.12   Spontaneous abortion complicated by delayed or excessive hemorrhage, complete 634.91   Spontaneous abortion without complication, incomplete 69.02     Dilation and curettage following delivery or abortion 69.09     Other dilation and curettage

    • A.

      634.12; 69.09

    • B.

      634.12; 285.1; 69.09

    • C.

      634.11; 69.02

    • D.

      634.91; 69.02

    Correct Answer
    C. 634.11; 69.02
    Explanation
    The correct answer is 634.11; 69.02. This is because the patient had a spontaneous abortion complicated by delayed or excessive hemorrhage, which is represented by the code 634.11. Additionally, a dilation and curettage procedure was performed following the abortion, which is represented by the code 69.02.

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  • 35. 

    CMS delegates its daily operations of the Medicare and Medicaid programs to:

    • A.

      The office of Inspector General

    • B.

      The PRO in each state

    • C.

      The National Center for Vital and Health Statistics

    • D.

      Medicare administrative contractor (MAC)

    Correct Answer
    D. Medicare administrative contractor (MAC)
    Explanation
    CMS delegates its daily operations of the Medicare and Medicaid programs to Medicare administrative contractors (MACs). MACs are private companies that are contracted by CMS to process Medicare claims, handle provider enrollment, and conduct audits and investigations. They are responsible for ensuring that Medicare and Medicaid payments are made correctly and efficiently. The other options mentioned in the question, such as the office of Inspector General, the PRO in each state, and the National Center for Vital and Health Statistics, may have roles related to healthcare oversight and data management, but they do not have the primary responsibility for daily operations of the Medicare and Medicaid programs.

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  • 36. 

    Which diagnostic technique records the patient heart rates and rhythms over a 24-hour period?

    • A.

      Echocardiography

    • B.

      Electrocardiography

    • C.

      Holter monitor

    • D.

      Angiocardiography

    Correct Answer
    C. Holter monitor
    Explanation
    A Holter monitor is a diagnostic technique that records a patient's heart rates and rhythms over a 24-hour period. This device is a portable electrocardiography (ECG) machine that the patient wears and it continuously records the electrical activity of the heart. This allows doctors to analyze the heart's function and detect any abnormalities or irregularities in the heart rate or rhythm. Echocardiography, on the other hand, uses ultrasound waves to create images of the heart, while angiocardiography is an invasive procedure that involves injecting a contrast dye into the blood vessels to visualize the heart.

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  • 37. 

    _______________ is a defect characterized by four anatomical abnormalities within the heart that results in poorly oxygenated blood being pumped to the body.

    • A.

      Atrial septal defect

    • B.

      Patent ductus arteriousus

    • C.

      Tetralogy of fallot

    • D.

      Coarctation of the aorta

    Correct Answer
    C. Tetralogy of fallot
    Explanation
    Tetralogy of Fallot is a congenital heart defect that involves four anatomical abnormalities within the heart. These abnormalities include a ventricular septal defect (hole between the two lower chambers of the heart), pulmonary stenosis (narrowing of the pulmonary valve and artery), overriding aorta (aorta is positioned over the ventricular septal defect), and right ventricular hypertrophy (thickening of the right ventricle). These abnormalities result in poorly oxygenated blood being pumped to the body, leading to cyanosis (bluish discoloration of the skin).

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  • 38. 

    What is the term used to describe the adjusting of the dollar amount due from the patient or insurance company to reflect a zero balance due on the claim?

    • A.

      Authorization

    • B.

      Write-off

    • C.

      Rebill

    • D.

      Outstanding

    Correct Answer
    B. Write-off
    Explanation
    A write-off is the term used to describe the adjusting of the dollar amount due from the patient or insurance company to reflect a zero balance due on the claim. This means that the amount owed is no longer considered collectible and is removed from the accounts receivable. It is a way for healthcare providers to acknowledge that the debt will not be paid and to clear it from their financial records.

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  • 39. 

    HPV or human papilloma virus

    • A.

      Is caused by the spirochete Treponema pallidum

    • B.

      Is a vaginal inflammation that is caused by a protozoan parasite

    • C.

      Is also known as genital warts

    • D.

      Is characterized by painful urination and an abnormal discharge

    Correct Answer
    C. Is also known as genital warts
    Explanation
    HPV, or human papilloma virus, is a sexually transmitted infection that is also known as genital warts. This virus can cause the growth of warts on the genitals or surrounding areas. It is important to note that not all cases of HPV infection result in visible warts, as some strains of the virus can be asymptomatic. However, HPV is a common cause of genital warts and can also lead to more serious health issues, such as cervical cancer.

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  • 40. 

    Mitch was admitted directly from his physician's office for dehydration. Mitch had gastroenteritis for several days prior to this illness that has resulted in dehydration and requires intravenous hydration. Mitch also has chronic kidne disease and is at high risk for acute on chronic kidney failure. Two days following admission, Mitch develops acute renal failure. Mitch also has hypertension. Provide appropriate ICD-9-CM diagnosis codes. 276.51     Dehydration 401.9       Essential hypertension, unspecified benign or malignant 403.90     Hypertensive chronic kidney disease stage I through state IV, or unspecified benign or malignant 403.91     Hypertensive chronic kidney disease stage V or end-stage renal disease, unspecified benign or malignant 584.9       Acute kidney failure, unspecified

    • A.

      584.9, 403.90, 276.51

    • B.

      276.51, 584.9, 585.9, 403.90

    • C.

      403.91, 276.51

    • D.

      276.51, 586, 584.9, 401.9

    Correct Answer
    B. 276.51, 584.9, 585.9, 403.90
    Explanation
    Mitch was admitted for dehydration, which is represented by the code 276.51. However, two days following admission, he develops acute renal failure, indicated by the code 584.9. Mitch also has chronic kidney disease and hypertension, which are represented by the codes 403.90 and 401.9 respectively. Therefore, the appropriate ICD-9-CM diagnosis codes for Mitch's condition would be 276.51, 584.9, 403.90, and 401.9.

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  • 41. 

    John has chronic ulcers of the calf and back. Both ulcers are excisionally debrided and the ulcer of the back has a split thicknes skin graft. Provide appropriate ICD-9-CM diagnosis and procedure codes. 707.12    Ulcer of calf 707.8      Chronic ulcer of other specified sites 86.22      Excisional debridement of wound, infection, or burn 86.69      Skin graft

    • A.

      707.12, 707.8, 86.22, 86.22, 86.69

    • B.

      707.12, 707.8, 86.22

    • C.

      707.8, 86.22, 86.69

    • D.

      707.8, 86.22, 86.22, 86.69

    Correct Answer
    A. 707.12, 707.8, 86.22, 86.22, 86.69
    Explanation
    The correct answer is 707.12, 707.8, 86.22, 86.22, 86.69. The ICD-9-CM diagnosis codes 707.12 and 707.8 represent the chronic ulcers of the calf and back, respectively. The procedure codes 86.22 and 86.69 indicate the excisional debridement of the ulcers and the split-thickness skin graft performed on the back ulcer. The repetition of 86.22 in the answer indicates that the excisional debridement was performed twice, once on the calf ulcer and once on the back ulcer.

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  • 42. 

    Which of the following is the term describing a woman who has delivered one child?

    • A.

      Primipara

    • B.

      Primigravida

    • C.

      Nulligravida

    • D.

      Paragravida

    Correct Answer
    A. Primipara
    Explanation
    Primipara is the correct answer because it is the term used to describe a woman who has delivered one child. The prefix "primi-" means first, and "para" refers to the number of pregnancies that have reached 20 weeks or more, resulting in a live birth. Therefore, a primipara is a woman who has given birth to her first child.

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  • 43. 

    A patient initially consulted with Dr. Vasseur at the request of Dr. Meche, the patient's primary care physician. Dr. Vasseur examined the patient, prescribed edication, and ordered tests. Additional visits to Dr. Vasseur's office for continuing care would be assigned from which E&M section?

    • A.

      Office and other outpatient services, new patient

    • B.

      Office and other outpatient services, established patient

    • C.

      Office or other outpatient consultations, new or established patient

    • D.

      Confirmatory consultations, new or established patient

    Correct Answer
    B. Office and other outpatient services, established patient
    Explanation
    The patient initially consulted with Dr. Vasseur, indicating that they have an established relationship. Dr. Vasseur examined the patient, prescribed medication, and ordered tests, indicating that this is not a new patient visit but rather a continuation of care. Therefore, additional visits to Dr. Vasseur's office for continuing care would be assigned from the "office and other outpatient services, established patient" E&M section.

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  • 44. 

    Phacoemulsification of left cataract with IOL implant and subconjunctival injection. Provide appropriate ICD-9-CM and CPT codes. 366.9 Unspecified cataract 66940 Removal of lens material; extracapsular 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure) 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis, (one stage procedure) manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) 68200 Subconjunctival injection

    • A.

      366.9, 66940-LT

    • B.

      366.9, 66983, 68200

    • C.

      366.9, 66984-LT

    • D.

      366.9, 66984-LT, 68200-LT

    Correct Answer
    C. 366.9, 66984-LT
    Explanation
    The correct answer is 366.9, 66984-LT. This answer includes the appropriate ICD-9-CM code for unspecified cataract (366.9) and the CPT code for extracapsular cataract removal with insertion of intraocular lens prosthesis using a manual or mechanical technique (66984). The "LT" modifier indicates that the procedure was performed on the left eye. The subconjunctival injection (68200) is not included in the answer because it is not directly related to the phacoemulsification and IOL implant procedure.

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  • 45. 

    D&C for missed abortion, first trimester. Provide appropriate CPT code(s). 59820  Treatment of missed abortion, completed surgically; first trimester 59840  Induced abortion, by dilation and curettage 59850  Induced abortion, by one or more intra-amniotic injections, (amniocenthesis-injections) including hospital admission and visits, delivery of fetus and secundines 59855  Induced abortion, by one or more vaginal suppositories (eg, prostaglandin), with or without cervical dilation, (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines

    • A.

      59840

    • B.

      59850

    • C.

      59855

    • D.

      59820

    Correct Answer
    D. 59820
    Explanation
    The correct answer is 59820 because it specifically mentions "treatment of missed abortion, completed surgically" in the first trimester. This code accurately represents the procedure of dilation and curettage (D&C) for a missed abortion in the first trimester.

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  • 46. 

    A PAR physician is one who:

    • A.

      (no answer here)

    • B.

      Signs an agreement to participate in the Medicare program and agrees to accept whatever Medicare pays for a provider or service

    • C.

      Receives 5% less than other non-PAR physicians

    • D.

      Submits claim forms using ICD-9-CM procedure codes

    Correct Answer
    B. Signs an agreement to participate in the Medicare program and agrees to accept whatever Medicare pays for a provider or service
    Explanation
    A PAR physician is one who signs an agreement to participate in the Medicare program and agrees to accept whatever Medicare pays for a provider or service. This means that they are willing to be part of the Medicare program and will not charge patients more than what Medicare allows. They agree to accept the payment rates set by Medicare, which may be lower than what non-PAR physicians receive. It is not mentioned in the question that a PAR physician receives 5% less than other non-PAR physicians or that they submit claim forms using ICD-9-CM procedure codes.

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  • 47. 

    Chronic otitis media with bilateral myringotomy and tube insertion using local anesthesia. Provide appropriate ICD-9-CM and CPT codes. 381.00     Acute nonsuppurative otitis media, unspecified 381.05     Acute allergic mucoid otitis media 382.9       Unspecified otitis media 69400     Eustachian tube inflation, transnasal; with catheterization 69405     Eustachian tube catheterization, transtympanic 69420     Myringotomy including aspiration and/or eustachian tube inflation 69433     Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia

    • A.

      382.9, 69420, 69420

    • B.

      382.9, 69433, 69433

    • C.

      381.05, 69405, 69405

    • D.

      381.00, 69400, 69400

    Correct Answer
    B. 382.9, 69433, 69433
    Explanation
    The correct answer is 382.9, 69433, 69433. The patient has chronic otitis media, which is represented by the ICD-9-CM code 382.9. The procedure performed is myringotomy and tube insertion, which is represented by the CPT code 69433. The CPT code is repeated twice because the procedure is performed bilaterally.

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  • 48. 

    The ________________ are the organizations that contract with Medicare to perform reviews of medical records with the corresponding Medicare claim to detect and correct improper payments.

    • A.

      Atlas System

    • B.

      Medical outcomes study

    • C.

      Recovery Audit Contractors (RACs)

    • D.

      Adjusted Clinical Group (ACG) system

    Correct Answer
    C. Recovery Audit Contractors (RACs)
    Explanation
    Recovery Audit Contractors (RACs) are the organizations that contract with Medicare to perform reviews of medical records with the corresponding Medicare claim to detect and correct improper payments. RACs are responsible for identifying and recovering overpayments made to healthcare providers and preventing future improper payments. They conduct audits and reviews of medical records to ensure that the services provided were medically necessary and billed correctly. RACs play a crucial role in ensuring the integrity of the Medicare program and preventing fraud and abuse.

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  • 49. 

    Cesarean delivery with antepartum and postpartum care. Provide appropriate CPT code(s). 59400     Routine obstetric care, including antepartum care, vaginal delivery (with or without episiotomy and/or forcepts), and postpartum care 59510     Routine obstetric care including antepartum care, cesarean delivery, and postpartum care 59514     Cesarean delivery only 59610     Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care, after previous cesarean delivery

    • A.

      59610

    • B.

      59514

    • C.

      59400

    • D.

      59510

    Correct Answer
    D. 59510
    Explanation
    The correct answer is 59510 because it specifically mentions routine obstetric care, antepartum care, cesarean delivery, and postpartum care. This code accurately represents the scenario described in the question.

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  • 50. 

    The physician has documented the final diagnoses as: acute myocardial infarction, COPD, CHF, hypertension, atrial fibrillation and status-post cholecystectomy. The following conditions should be reported using ICD-9-CM diagnostic codes. 401.1     Hypertension, benign 401.9     Hypertension, unspecified 402.91   Hypertensive, heart disease, unspecified with heart failure 410.91   Acute myocardial infarction, unspecified site, initial episode of care 427.31   Atrial fibrillation 428.0     Congestive heart failure, unspecified 496        Chronic obstructive pulmonary disease V45.79   Acquired absence of organ

    • A.

      410.9, 496, 402.91, 427.31, V45.79

    • B.

      410.91, 496, 428.0, 401.9, 427.31

    • C.

      410.91, 496, 428.0, 401.9, 427.31, V45.79

    • D.

      410.91, 496, 428.0, 401.1, 427.31

    Correct Answer
    B. 410.91, 496, 428.0, 401.9, 427.31
    Explanation
    The correct answer includes the codes for acute myocardial infarction (410.91), chronic obstructive pulmonary disease (496), congestive heart failure (428.0), hypertension (401.9), and atrial fibrillation (427.31). These are the conditions that the physician has documented in the patient's final diagnoses.

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