CCA Mock Examination 60 Questions

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.

Down's syndrome, Edward's syndrome, and Patau's syndrome are all examples of chromosomal defects. These conditions are caused by abnormalities in the number or structure of chromosomes. Down's syndrome is caused by an extra copy of chromosome 21, while Edward's syndrome is caused by an extra copy of chromosome 18, and Patau's syndrome is caused by an extra copy of chromosome 13. These chromosomal abnormalities can lead to a range of physical and intellectual disabilities.

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.

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.

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.

The Correct Coding Initiative aims to detect and prevent payment for improperly coded services. This means that it is designed to identify instances where services have been coded inaccurately or inappropriately, which could result in incorrect reimbursement. By implementing this initiative, the goal is to ensure that healthcare providers are coding services correctly and receiving accurate payment for the services they provide.

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.

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.

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.

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.

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.

The correct answer is only the chest pain. This is because a myocardial infarction (heart attack) was ruled out, meaning that the patient did not actually have a heart attack. Therefore, there is no need to code for the infarction or any related conditions. Instead, the focus should be on documenting and coding the symptom that the patient presented with, which in this case is chest pain.

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.

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.

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.

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.

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.

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.

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.

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.

A superbill form is used to record the patient's diagnoses and the services performed for a particular visit. It also includes codes (CPT, HCPCS, and ICD-9-CM) used specifically by that physician's office.

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.

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.

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.

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.

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.

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.

In this scenario, the primary neoplasm is the underlying cause of the patient's condition, but the treatment is focused on addressing the secondary neoplasm. Therefore, the secondary diagnosis is coded as the principal diagnosis because it is the reason for the patient's admission and the primary neoplasm is coded as an additional diagnosis to provide a complete picture of the patient's condition.

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.

The correct answer is 354.0, 64721. The patient has carpal tunnel syndrome and is undergoing a neuroplasty and/or transposition of the median nerve at the carpal tunnel. The ICD-9-CM code 354.0 represents carpal tunnel syndrome, and the CPT code 64721 represents the specific procedure being performed.

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.

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.

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).

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

Always code the Rule Out (R/O) if it's Inpatient

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.

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.

An incisional biopsy of the breast involves removing only a portion of the lesion for pathologic examination. This type of biopsy is typically done when the lesion is large or when it is not possible to remove the entire lesion. It is performed by making a small incision and taking a sample of tissue from the area of interest. This allows for a more targeted examination of the specific area of concern, providing valuable information for diagnosis and treatment planning.

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.

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.

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.