Ciox Aetna 2019 Mra Hcc Guidelines

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| By Samirpatel0862
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Samirpatel0862
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Quizzes Created: 1 | Total Attempts: 218
| Attempts: 218
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  • 1/19 Questions

    Visit dos is 02/02/2019 and provider signature on 06/28/2019. (electronically singed by xyz M.D on 06-28-2019) is this statement is going under as __?

    • No valid provider signature ( EMR sign issue)
    • Valid Provider signature ( Completed EMR sign) 
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About This Quiz

This quiz covers the 2019 MRA HCC Guidelines for CIOX Aetna, focusing on coding standards, medication linkage, and condition assessments.

Ciox Aetna 2019 Mra Hcc Guidelines - Quiz

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  • 2. 

    PMH: - HX of DM, HTN, HLD. Code the Note. All are the chronic condition found under the CIOX Cross walk.

    • Z86.39, I10, E78.5

    • I10, E78.5

    • E11.9 with Chronic no support found, I10,E785.

    Correct Answer
    A. E11.9 with Chronic no support found, I10,E785.
    Explanation
    The correct answer is "E11.9 with Chronic no support found, I10,E785." This is because the patient has a history of diabetes (E11.9) and chronic conditions such as hypertension (I10) and hyperlipidemia (E78.5). The other options either do not include all of the chronic conditions or do not accurately code the note.

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  • 3. 

    Chronic condition  which are present under the CC will be coded directly submittal without requiring any kind of  MEAT/TEMPER or support  in the visit? 

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false because even though chronic conditions may be present under the CC, they still require MEAT/TEMPER or support in the visit to be coded correctly for submittal. Chronic conditions cannot be coded directly without any additional information or documentation.

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  • 4. 

    Patient past medical History of condition is HTN, HLD, CKD, DM, GERD, OA, RA, Dementia, Ulcer. Can we code the Chronic condition from above mention list? or we going to skip those condition as it is marked as HX (History of ) condition without any kind of Support/MEAT/TEMPER?

    • Skip It as it is marked as HX of Statement without any Support. No evidence is present that condition is Active or not. 

    • Code the condition as it is mention under the  past medical history of , We have guideline that chronic condition from PMH go as valid directly no required any support. 

    Correct Answer
    A. Code the condition as it is mention under the  past medical history of , We have guideline that chronic condition from PMH go as valid directly no required any support. 
    Explanation
    The correct answer is to code the condition as it is mentioned under the past medical history. This is because there is a guideline that states chronic conditions from the past medical history can be coded directly without requiring any additional support. In this case, the patient's past medical history includes conditions such as HTN, HLD, CKD, DM, GERD, OA, RA, Dementia, and Ulcer, which can all be coded as chronic conditions. There is no evidence present to indicate whether these conditions are active or not, so they should be coded based on the past medical history alone.

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  • 5. 

     EYE report Note – Patient is here for the Eye exam. OS: - No PDR present    OU: - Positive for ARND, +1 NC. OD: - No DR present. Assessment: - PVD – I73.9, Vitreous hemorrhage, Hypertensive Retinopathy. It is valid to code I73.9 from Above case? True or False ?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    False. The correct answer is False because the given information does not provide enough evidence to support the coding of I73.9 (Peripheral vascular disease, unspecified) in this case. The assessment mentions PVD (presumably peripheral vascular disease), but the specific type or cause is not specified. Therefore, it is not valid to code I73.9 based on the given information.

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  • 6. 

    What is the Project scope for the CIOX Aetna 2019 MRA  ?

    • 2017-18 & 2019 till date, HCC, Rxhcc One  per year HCC coding rule.

    • 2019 till date with HCC and Rx HCC, Each Visit  HCC coding rule.

    • 2018-2019 till date , HCC and Rx HCC. Each Visit HCC coding rule.

    • None of above 

    Correct Answer
    A. 2018-2019 till date , HCC and Rx HCC. Each Visit HCC coding rule.
  • 7. 

    Type 1 -insulin dependent diabetes mellitus  is mention under the assessment . So, it is valid to code it as  E10.9 and Z79.4, If provider not document insulin under the medication list not in the entire visit.  Is this statement being true or false ?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false. Even if the provider does not document insulin under the medication list during the entire visit, it is still valid to code Type 1 - insulin dependent diabetes mellitus as E10.9 and Z79.4 if it is mentioned under the assessment. The lack of documentation in the medication list does not invalidate the coding.

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  • 8. 

    Select the best option for the Rejection Reason for the coding from the Medical Record.

    • Face sheet/ cover sheet only in entire chart.

    • In competed notes no 2/3 key component are present no valid SOAP note present in ENTIRE record.

    • Labs/ Imaging reports only.

    • All of the Above.

    Correct Answer
    A. All of the Above.
    Explanation
    The correct answer is "All of the Above" because each option listed provides a valid reason for rejecting the coding from the Medical Record. The first option states that only a face sheet or cover sheet is present in the entire chart, which is insufficient documentation. The second option indicates that the completed notes do not have two or three key components and lack a valid SOAP note, which is also inadequate. The third option mentions that only labs or imaging reports are available, which is not comprehensive enough for proper coding. Therefore, all of these reasons justify rejecting the coding from the Medical Record.

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  • 9. 

    What is the chart rejection process please select the below suitable option?

    • Missing of patient second identifier in the visit.

    • A date of service is not mention clearly.

    • Entire record with the missing of the patient DOB and Miss match of the Patient First and last Name, Multiple patient data on valid SOAP format.

    • All of the Above.  

    Correct Answer
    A. All of the Above.  
    Explanation
    The correct answer is "All of the Above." This means that all of the options mentioned in the question are suitable explanations for the chart rejection process. The options include missing patient second identifier in the visit, unclear mention of date of service, missing patient DOB, mismatch of patient first and last name, and multiple patient data on valid SOAP format.

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  • 10. 

    Each discharge summary will be coded with the D/S dos only, And in between document will be coded with the A/D and D/S date range.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The explanation for the given correct answer is that each discharge summary is coded with the D/S dos (date of service) only, indicating the specific date when the patient was discharged. On the other hand, documents in between discharge summaries are coded with the A/D (admission/discharge) and D/S date range, which includes the dates of both admission and discharge. Therefore, the statement is true as it accurately describes the coding process for discharge summaries and other documents.

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  • 11. 

    Patient is here for the cardio f/u. his bp is normal. He is on calcium channel blocker for her heart disease. PMH/Pl: - HTN, Hyperlipidemia, Hypercholesterolemia, Hypertryglecridemia, ASCVD, DVT, GERD, CHF. Vitals normal PE: - Constitutional: - Smile face, alert and oriented. HENT – normal, Cardio- continue aspirin for CAD. RRR normal. Extremities: - Edema present. Assessment: - DVT before 2 weeks ago patient went to Ed that time. Cont. lab order for ECHO, Lipid profile. LDL 90, HDL110.

    • I10, E78.5, I2510,K219,I82409.

    • I119,i509,E785,I2510,K219,I82409

    • I110,E785,I509,I2510,K21.9

    • I110,I509,E78.2,I2510,K21.9,

    Correct Answer
    A. I110,I509,E78.2,I2510,K21.9,
    Explanation
    The correct answer is I110, I509, E78.2, I2510, K21.9. This answer represents the appropriate ICD-10 codes for the patient's conditions. I110 refers to essential hypertension, I509 refers to heart failure, E78.2 refers to hyperlipidemia, I2510 refers to atherosclerotic heart disease, and K21.9 refers to gastro-esophageal reflux disease. These codes accurately reflect the patient's medical history and current conditions as described in the clinical presentation.

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  • 12. 

    C.C - Patient is here for the cancer past surgery f/u. HPI – Mr Nanda is here for the f/u of the breast ca surgery f/u. here surgery for the Right breast ca – Lumpectomy was done before the 1 month ago. Now, she is here for the f/u. PE – All systems are normal. Assessment: - right sided breast cancer. Mammogram for the breast cancer is ordered. Cont. on Chemotherapy. Plan - NAD (No evidence for the disease is present). Electronically signed by XXRAI MD on current date.  Can we code BREAST CA as VALID or SKIP the condition ?

    • Code the Condition.

    • Do not Code, Skip the condition. 

    Correct Answer
    A. Do not Code, Skip the condition. 
    Explanation
    The correct answer is "Do not Code, Skip the condition." This is because the patient is not currently experiencing breast cancer symptoms or undergoing treatment. The assessment states that there is "No evidence for the disease present" and the plan does not mention any further treatment for breast cancer. Therefore, there is no need to code the condition at this time.

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  • 13. 

     He has suspected MI in 2000, As CIOX MI is fall under the Chronic list and Also, OLD MI is fall under the status condition code .So, It is valid to code it as I25.2, True or False ?

    • True

    • False

    Correct Answer
    A. False
  • 14. 

    For the Medication we can use WebMed But, Provider linkage for all the medication of the disease condition is required. is this statement is True or False ? 

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false because the correct name of the website is WebMD, not WebMed. Additionally, the statement suggests that Provider linkage is required for all medication of the disease condition, which is not accurate. Provider linkage may be helpful for certain medications or treatments, but it is not a requirement for all medications.

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  • 15. 

    Age related cataract is valid to Link with the DM?

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Age related cataract refers to the development of cataracts in older individuals due to the natural aging process. Diabetes mellitus (DM) is a chronic condition characterized by high blood sugar levels. Research has shown that individuals with diabetes are more likely to develop cataracts, including age related cataracts. This is because high blood sugar levels can cause changes in the lens of the eye, leading to the formation of cataracts. Therefore, age related cataract is validly linked with DM.

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  • 16. 

    C.C Patient appointment for the Injection. HPI: - patient for the Vitamin B injection. PMH: - HTN, CAD, HLD, CHF, Prior MI 1885. Vitals: - BP 180/90, Ht 120Cm, Wt 145 Lbs, BMI 39.9 PE: - Not recorded Procedure: - Vitamin B injection is administered on the patient left side of the thigh by IV route by Mohmmad Devlekar  RN. Electronically signed by Roket Baba M.D on 02-02-2019. Is this visit is valid to code or not ?

    • Yes , It is valid to code.

    • No, It is not valid to code.

    Correct Answer
    A. No, It is not valid to code.
    Explanation
    Based on the information provided, there is not enough documentation to support a valid code for this visit. The question mentions the patient's appointment for a Vitamin B injection, but there is no mention of any evaluation or management of the patient's condition. The history, physical examination, and vital signs are not recorded, which are important components for coding a visit. Additionally, there is no information about the medical necessity or reason for the injection. Without sufficient documentation, it is not valid to code this visit.

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  • 17. 

    Acute condition ( As per CIOX Cross walk list) I65.23 ( occlusion and stenosis of carotid artery Bilateral) is valid to code directly from the assessment with the provider attention.  True or false ?

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The explanation for the given correct answer is that according to the CIOX Crosswalk list, the code I65.23 (occlusion and stenosis of carotid artery bilateral) can be directly coded from the assessment with the provider's attention. This means that the code accurately represents the condition of occlusion and stenosis of the carotid artery on both sides and can be used without any additional documentation or clarification. Therefore, the statement "True" is correct.

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  • 18. 

    BMI = 40  or more then 40, Present under the vitals section is valid to code directly without requiring any extra support. Is this statement being true or false?

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false. A BMI of 40 or more may indicate obesity, but it does not automatically mean that the "Present" under the vitals section can be coded directly without any extra support. The coding process requires additional information and documentation to accurately code the condition.

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  • 19. 

    DOS:- 12/31/17 Patient is here for the change the medication for HTN. Patient also has High Chol. Patient suffering from the CKD stage 3 from past 2 years. PMH – HTN, CHF, DM, GERD Medication – Insulin pump, Tums (Prilosec Proton Pump inhi.), Lisinopril. Furosemide, Digoxin, Losartan. Assessment: - patient is stable on HTN, CHF, GERD and CKD stage 3 to 4. EMR singed by UUir E APN on 01/01/2018. Select appropriate option.

    • I13.0, N18.4, E11.22, K21.9, I50.9, Z79.4

    • I13.0, N18.3, E11.22, K21.9, I50.9, Z79.4

    • I13.0, N18.3, E11.22, K21.9, Z79.4

    • I13.0, N18.4, E11.22, K21.9, Z79.4

    • None of the above. 

    Correct Answer
    A. None of the above. 

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  • Current Version
  • Oct 28, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 03, 2019
    Quiz Created by
    Samirpatel0862
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