CALIFORNIA DRIVERS DMV PERMIT REAL

CALIFORNIA DRIVERS DMV PERMIT REAL

EXAM

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A patient was admitted with HIV and pneumocystic carini. The patient should have a principal

diagnosis in ICD-10 of:

a.AIDS b.Asymptomatic HIV c.Pneumonia d.Not enough information - ANSWER✔✔a If a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease followed by additional diagnosis codes for all reported HIV-related conditions (ICD-10-CM Official Guidelines for Coding and Reporting 2016a, 17).

APR-DRGs have levels (subclasses) of severity entitled:

a.Excessive, Major, Moderate, Minor b.Extreme, Major, Moderate, Minor c.Extreme, Major, Moderate, Minimal d.Excessive, Major - ANSWER✔✔b The APR-DRG system is distributed into levels (subclasses) similar to MS-DRGs. These levels are entitled Extreme, Major, Moderate, Minor (Hess 2015, 48) During an outpatient procedure for removal of a bladder cyst, the urologist accidentally tore the urethral sphincter requiring an observation stay. This should be assigned as the principal

diagnosis:

a.The reason for the outpatient surgery b.The reason for admission c.Either the reason for the outpatient surgery or the reason for admission 1 / 4

d.None of the above - ANSWER✔✔a When a patient presents for outpatient surgery and develops complications requiring admission to observation, code the reason for the surgery as the first reported diagnosis (reason for the encounter), followed by codes for the complications as secondary diagnoses (ICD-10-CM Official Guidelines for Coding and Reporting 2016a, 103).In 1990, 3M created which DRG system that several states use for Medicaid reimbursement and is also used by facilities to analyze some portion of the data for Medicare Quality Indicators.What is this system called?a.MS-DRGs b.AP-DRGs c.APR-DRGs d.CPT-DRGs - ANSWER✔✔c In 1990, 3M created APR-DRGs, which several states use for Medicaid reimbursement. APR-DRGs are used by facilities to analyze some portion of the data for Medicare Quality Indicators (Hess 2015, 48) A patient was admitted to an acute care facility with a temperature of 102 and atrial fibrillation.The chest x-ray reveals pneumonia with subsequent documentation by the physician of pneumonia in the progress notes and discharge summary. The patient was treated with oral antiarrhythmia medications and IV antibiotics. What is the principal diagnosis?a.Pneumonia b.Arrhythmia c.Atrial fibrillation d.Both a and c - ANSWER✔✔a The patient presented with clinical signs of Pneumonia along with treatment. The atrial fibrillation was a chronic condition that can be reported additionally (CMS 2016b).

The Cooperating Parties, which develop and approve ICD-10, include:

a.American Hospital Association (AHA) and American Health Information Management Association (AHIMA) b.American Hospital Association (AHA), American Health Information Management Association (AHIMA), and Centers for Disease Control (CDC) 2 / 4

c.American Hospital Association (AHA), American Health Information Management Association (AHIMA), and Centers for Medicare and Medicaid Services (CMS), and National Center for Health Statistics (NCHS) d.American Hospital Association (AHA), American Health Information Management Association (AHIMA), and the World Health Organization (WHO) - ANSWER✔✔c The cooperating parties developed and approved ICD-10-CM/PCS and include (4) organizations American Hospital Association (AHA), American Health Information Management Association (AHIMA), and Centers for Medicare and Medicaid Services (CMS), and National Center for Health Statistics (NCHS) (CMS 2016c).Mildred Smith was admitted to a nursing facility with the following information: "Patient is being admitted for Organic Brain Syndrome." Underneath the diagnosis, her medical information was listed along with a summary of the care already provided. This information is

documented on the:

a.Transfer record b.Release of information form c.Patient's rights acknowledgment form d.Admitting physical evaluation record - ANSWER✔✔a Transfer records are created whenever a patient is transferred from one facility to another. The transfer record contains a summary of the care provided in the facility from which the patient is being transferred as well as the reason for transfer. Transfer records are important to the continuum of care because they document communication between caregivers in multiple settings (Shaw and Carter 2014; Fahrenholz and Russo 2013, 225).A 65-year-old white male was admitted to the hospital on 1/15 complaining of abdominal pain.The attending physician requested an upper GI series and laboratory evaluation of CBC and UA.The x-ray revealed possible cholelithiasis and the UA showed an increased white blood cell count. The patient was taken to surgery for an exploratory laparoscopy and a ruptured appendix

was discovered. The chief complaint was:

a.Ruptured appendix b.Exploratory laparoscopy c.Abdominal pain 3 / 4

d.Cholelithiasis - ANSWER✔✔c The abdominal pain is the chief complaint and is the reason the patient presented/reason for visit (Shaw and Carter 2014; Fahrenholz and Russo 2013, 225).A patient arrived via ambulance to the emergency department following a motor vehicle accident. The patient sustained a fracture of the ankle, 3.0 cm superficial laceration of the left arm, 5.0 cm laceration of the scalp with exposure of the fascia, and a concussion. The patient received the following procedures: x-ray of the ankle that showed a bimalleolar ankle fracture requiring closed manipulative reduction and simple suturing of the arm laceration and layer closure of the scalp. Provide CPT codes for the procedures done in the emergency department for the facility bill.12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm 12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm 12032 Repair, intermediate, wound - ANSWER✔✔c The closed reduction of the fracture is coded first following principal procedure guidelines. The laceration repair is also coded. When more than one classification of wound repair is performed, all codes are reported with the code for the most complicated procedure listed first (Kuehn 2013, 26-27, 111-113).The appeal coordinator received a denial that stated: On presentation, patient had hemoglobin of 8.8 with blood in stool noted in physician office...patient sent as direct admission straight to hospital. The physician notes 11/05/14 states GI bleeding will consider transfusion 11/06/14.Note also states melenic stools and states hemoccult positive. Endoscopy report states - Acute Posthemorrhagic Anemia with iron deficiency anemia due to blood loss. "Multiple small angioectasias without bleeding were found in the second part of the duodenum. Red blood was found on the greater curvature of the stomach. Multiple small angioectasias with stigmata of recent bleeding were found in the gastric body. No active bleeding or clear which angioectasia are bleeding source." Multiple recently bleeding angioectasias in the stomach. Hemoglobin and hematocrit low on admission and decreased following admission at 8.8 to 8.2 and 27.8 to - ANSWER✔✔a The assignment of the code is appropriate. If the physician clearly documents the anemia is due to acute blood loss, code D62 Acute posthemorrhagic anemia should be assigned.Anemia due to chronic blood loss is coded to D50.0 Secondary to blood loss (chronic). The physician should always be queried if there is a lack of sufficient documentation. Never assume cause and effect relationship (AHA Fourth Quarter 1993, 34; ICD-10-CM Official Guidelines 2016b).

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