Mr. Valdez arrives in the emergency department with complaints of shortness of breath and wheezing.

After study, he is found to have an exacerbation of COPD. He has a history of emphysema. ICD-10-CM
code(s) are:

A. R06.02, R06.2
B. J44.1
C. J44.1, J43.9
D. J43.9

Question 7
Ms. Gardose is a 75-year-old woman who presented to emergency department with sharp pain during
inhalation. The physician diagnosed her with pneumonia and flare up of COPD. Diagnosis code(s) to
report this patient’s condition are:

A. J44.0, J18.9
B. J44.0, J18.9, J44.1
C. J44.1, J18.9
D. J18.9

Question 8
What documentation indicates a “rupture” when coding for an endovascular repair?

A. Pseudoaneurysm
B. Chronic rupture
C. Dissection
D. Acute hemorrhage

Question 9
Code +34709 for placement of an extension may be assigned for which scenario?

A. An extension is placed in the common iliac artery.

B. A docking limb is placed in the common iliac artery.
C. An extension is placed in the external iliac artery.
D. A docking limb is placed in the external iliac artery.

Question 10
Which diagnostic test or procedure can be used to diagnose a patient with CVS?

A. Abdominal X-ray
B. Abdominal ultrasound
C. Upper GI endoscopy
D. None of the above
Question 11
What is the ICD-10-CM code for a diagnosis of “cyclic vomiting syndrome?”

A. R11.2
B. R11.12
C. G43.A0
D. G43.A1

Question 12
Payer policies follow the indications for the drugs and what has been approved by the:

A. FDA
B. CMS
C. OSHA
D. None of the above.

Question 13
A peer-to-peer prior authorization entails:

A. A discussion between the ordering provider and nurse practitioner

B. A discussion between the ordering provider and payer’s medical director or pharmacist
C. A discussion between two providers in the same office
D. A discussion between a pharmacist and pharmacy technician

Question 14
Guard against insurance and patient check payment theft by:

A. Using insurance company direct deposit options

B. Using bank check scanners in your office for depositing checks
C. Using a bank lock box to avoid checks coming to the office
D. All of the above

Question 15
What type of insurance plans do not include out-of-network benefits?

A. HMO/EPO
B. PPO
C. POS
D. Traditional
Question 16
You may want to consider being an out-of-network provider if all of your referrals come from the following
marketing sources:

A. Word of mouth
B. Other colleagues
C. Independent marketing
D. All of the above

Question 17
A patient presents to the urgent care after accidently cutting two fingers with a bagel knife. The laceration
on the index finger is 1 cm and the laceration on the middle finger is 2 cm. Simple repairs are performed
on each laceration with 5-0 nylon. How should you code these repairs?

A. 12001 x 2
B. 12001
C. 12002
D. 12042

Question 18
A patient presents with an abscess on his back that requires drainage. The procedure note indicates: I&D
of abscess - complicated. Area injected with 1% lidocaine, anesthesia achieved. Area incised with #11
blade, frank pus expressed approx. 5 mL. Abscess probed to break loculations and wound irrigated and
then packed with nugauze. Sterile dressing applied. How should you code?

A. 10040
B. 10061
C. 10060
D. 10180

Question 19
The patient is a 49-year-old woman who presents to the ER with an acute onset of pain in her right wrist
after falling while being chased by a dog. She fell onto an outstretched hand and struck it sharply against
her front doorstep. X-rays of her right hand and wrist confirm she sustained a Colles distal radius fracture.
The orthopedist on call places her in a short-arm cast and the visit is documented to Level 3.

A. 25600-RT, 99283-57
B. 25600-RT, 29075-59-RT, 99283-57
C. 25605-RT, 29075-51-RT, 99283-25
D. 25605-RT, 99283

Question 20
A 68-year-old, Medicare patient was woodworking in his basement workshop in his single-family home,
preparing a new finish to a coffee table. He lost his grip on a powered sander and suffered a crushing
injury into the capitate and hamate bones of his right wrist as well as a Gustilo-Anderson Type I open
fracture of the hamate body. In the hospital, an orthopedic surgeon performed a flexor tendon
decompression fasciotomy with extensive debridement of muscle, nerve tissue and bone as well as a 2-
bone carpectomy. An ORIF of the fracture was also done. The surgery took place in the hospital the day
after admission at Level 2 subsequent hospital care. This procedure was actually done in consult, but
Medicare does not pay for consultation CPT® codes. The patient is placed in an extension control cock-
up wrist splint. Code the encounter.

A. 25023-RT, 25628-51-RT, 25210-51-RT

B. 25023-RT, 25628-51-RT, 25210-51-RT x 2
C. 25023-RT, 11012-51, 25645-51-RT, 25210-51-RT x 2
D. 25023-RT, 25645-51-RT, 25210-51-RT x 2, 99232-57
Grade

You have failed 3 attempts. Please reread the publication and try in 1 hours.

View Rationale
Question 1
Atherosclerosis:

A. Is a significant risk factor for AAA

B. May cause muscle weakness in the legs
C. May cause tears in the inner layer of the aorta
D. Both a and b

View Rationale
Question 2
True or False: You can use a general diagnosis code (Z00.00) for an in-depth procedure test, such as
TSH screening panel.

A. True
B. False

View Rationale
Question 3
A patient presents to the urgent care after accidently cutting two fingers with a bagel knife. The laceration
on the index finger is 1 cm, and 2 cm on the middle finger. Simple repairs are performed on each
laceration with 5-0 nylon. Which is proper coding?

A. 12001 x 2
B. 12001
C. 12002
D. 12042
 View Rationale
Question 4
A patient presents with an abscess on his back that requires drainage. The procedure note is: I&D of
abscess, complicated. Area injected with 1 percent lidocaine, anesthesia achieved. Area incised with #11
blade, frank pus expressed approx. 5 mL. Abscess probed to break loculations, wound is irrigated, and
then packed with Nu Gauze. Sterile dressing applied. Which code reports this procedure?

A. 10040
B. 10061
C. 10060
D. 10180

View Rationale
Question 5
A 9-year-old female presents to this office today with continued bed wetting. She is here with her mom,
who states the child has never been able to go through the night without wetting the bed. She has used
alarms, cutting off fluids at 6 p.m., and using bathroom before bed. Denies dysuria or frequency. Mom
states the urine is often dark. Which is the ICD-10-CM code to report this condition?

A. N39.4
B. N39.41
C. N39.44
D. N39.498

View Rationale
Question 6
A 27-year-old male presents for evaluation of left elbow pain. It started two weeks ago after picking up a
heavy box. There is no snapping or popping. Pain is aching, located on the left lateral elbow. It’s worse
with gripping. He has never experienced this pain before, and there are no alleviating/aggravating factors.
He has been putting heat on the area with short term relief. Proper diagnosis is:

A. M77.0
B. M77.02
C. M77.11
D. M77.12

View Rationale
Question 7
CMS changed the rule regarding teaching physicians re-documenting medical students’ physical
examinations because:

A. They want less documentation for auditors to review.

B. They want to reduce the reimbursement for E/M services.
C. They want to reduce administrative burdens for teaching physicians.
D. They intend to change evaluation and management CPT® codes in 2019.
 View Rationale
Question 8
Dr. Torrey is a teaching physician in a large metropolitan medical center. She has four medical students
attached to her services. Resident Dr. Colavito performed an E/M service in the pediatric clinic, carefully
documenting all encounter data in the EHR. The service was performed on 2/1/2018 at 9:30 a.m. Dr.
Torrey reviewed his work and agreed with the findings on 2/2/2018 at 10 a.m. Does this meet CMS’
requirements for billing E/M services?

A. Yes: The EHR automatically adds her name and date stamp.
B. No: The teaching physician must be present at the time the patient is examined.

View Rationale
Question 9
When coding an adverse effect for a drug that was correctly prescribed and properly administered, what
should be coded first?

A. The drug
B. The underlying condition treated
C. The side effect of the drug
D. The activity the patient was involved in when the drug was taken

View Rationale
Question 10
From a documentation standpoint, which is most useful in determining whether a patient has a true drug
allergy or just a drug intolerance?

A. The underlying condition treated

B. The place of occurrence
C. The activity the patient was involved in when the drug was taken
D. The reaction the patient experienced and the drug that caused the reaction

View Rationale
Question 11
OP-25 is the measure for Safe Surgery Checklist Use (outpatient). Which should be done to ensure
patient safety?

A. Mark the site of the body area to be operated on.

B. Confirm the patient’s identity before initiating the procedure.
C. Identify the allergy(ies) the patient has prior to initiating the procedure.
D. All of the above.

View Rationale
Question 12
A patient admitted for left hip replacement has a medical history of COPD, with hospitalization six months
ago due to acute exacerbation, diabetes with neuropathy, appendicitis s/p RT appendectomy 1997, and a
history of prostate cancer s/p TURP, radiation and chemotherapy, no NED and no medications noted.
Considering the importance of capturing comorbidities in the inpatient setting, which conditions should the
providers document and address as active conditions for accurate code reporting during this admission?

A. Appendicitis, COPD, and diabetic neuropathy

B. COPD and diabetic neuropathy
C. COPD with exacerbation and diabetic neuropathy
D. COPD, diabetic neuropathy, and prostate cancer

View Rationale
Question 13
Local Coverage Determinations (LCDs) are:

A. Applicable across the United States

B. Issued by CMS
C. Contain information about standards for “reasonable and necessary” items and services
D. Not enforceable by the Medicare administrative contractor (MAC)

View Rationale
Question 14
The Sessions and Brand memos are:

A. New policies on how the DOJ should proceed regarding agency guidance
B. Effective upon their date of issue
C. Applied to guidance documents such as LCDs, CMS’ Medicare manuals, and OIG
advisory opinions
D. All the above

View Rationale
Question 15
A progress note with one to three elements of HPI for a new patient office visit will result in an E/M level
no higher than:

A. 99203
B. 99214
C. 99202
D. 99213

View Rationale
Question 16
When comparing the review of systems and physical examination to the chief complaint and HPI in an
EHR, the auditor is looking for:
 A. A comprehensive level
B. A detailed level
C. The number of HPI elements
D. Agreement

View Rationale
Question 17
____________________ is an example of a disease interaction.

A. Hypertension and osteoporosis

B. PVD and CHF
C. Diabetes with macular degeneration
D. Diabetes and respirator dependence

View Rationale
Question 18
All Medicare Advantage plan members are assigned an RAF by which entity?

A. AMA
B. CMS
C. AARP
D. ACA

View Rationale
Question 19
A patient has a panniculectomy, as well as a coring out and relocation of the umbilicus. Which is correct
coding assignment for this surgery?

A. 15830
B. 15830, 14301, 14302
C. 15380, 15847
D. 15380, 15877

View Rationale
Question 20
UOD excludes all of the following, except:

A. Hospice member
B. Sickle cell disease patient
C. 18 years and older who received prescription opioids for 15 days or more during the
measurement year at a high dose
 D. Cancer patient
Grade