CODING AND BILLING (RHIT DOMAIN 4) EXAMS
OF ADVANCED DATA ANALYSIS QUESTIONS AND
ANSWERS WITH RATIONALES
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon
would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy --CORRECT ANSWER--c
Colonoscopy includes examining the transverse colon. Proctosigmoidoscopy involves
examining the rectum and sigmoid colon. Sigmoidoscopy involves examining the rectum,
sigmoid colon, and may include portions of the descending colon (Smith 2017, 121).
A physician orders a chest x-ray for an office patient who presents with fever, productive
cough, and shortness of breath. The physician indicates in the progress notes: "Rule out
pneumonia." What should the coder report for the visit when the results have not yet been
received?
a. Pneumonia
b. Fever, cough, shortness of breath
c. Cough, shortness of breath
d. Pneumonia, cough, shortness of breath, fever --CORRECT ANSWER--b
Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when
a physician qualifies a diagnostic statement as "possible," "probable," "suspected,"
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,"questionable," "rule out," or "working diagnosis," or other similar terms indicating
uncertainty (Schraffenberger and Palkie 2017, 102).
When multiple burns are present, the first sequenced diagnosis is the:
a. Burn that is treated surgically
b. Burn that is closest to the head
c. Highest-degree burn
d. Burn that is treated first --CORRECT ANSWER--c
Treatment and anatomic location are not factors in the sequencing of burn conditions. Code
all burns with the highest degree of burn sequenced first (Schraffenberger and Palkie 2017,
584).
Assign the correct CPT code for the following procedure: Revision of the pacemaker skin
pocket.
a. 33223, Relocation of skin pocket for implantable defibrillator
b. 33210, Insertion or replacement of temporary transvenous single chamber cardiac
electrode or pacemaker catheter (separate procedure)
c. 33212, Insertion of pacemaker pulse generator only; with existing single lead
d. 33222, Relocation of skin pocket for pacemaker --CORRECT ANSWER--d
Begin with the main term Revision; pacemaker site; chest (Kuehn 2017, 22, 24).
What is the term that means evaluating the appropriateness of the setting for the healthcare
service and the level of service?
a. Coordination of service benefits
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,b. Community rating
c. Outcomes assessment
d. Utilization review --CORRECT ANSWER--d
Utilization review assesses the appropriateness of the setting for the healthcare service in the
continuum of care and the level of service. Also factored in are patients' severity of illness
and other medical conditions and illnesses (Casto and Forrestal 2015, 100).
A coder might find which of the following on a patient's problem list if the medication list
contains the drug Procardia?
a. Esophagitis
b. Hypertension
c. Schizophrenia
d. AIDS --CORRECT ANSWER--b
Procardia is an antianginal, antihypertensive, calcium channel blocker that is used to treat
stable angina pectoris, vasospastic angina, and hypertension (Schraffenberger and Palkie
2017, Appendix I, 16).
From the information provided in this table, what percentage will the facility be paid for
procedure 25500?
Billing Number Status Indicator CPT/HCPCS APC
998323 V 99285-25 0612
998323 T 25500 0044
998323 X 72050 0261
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, 998323 S 72128 0283
998323 S 70450 0283
a. 0%
b. 50%
c. 75%
d. 100% --CORRECT ANSWER--d
Procedure 22550 has a "T" status indicator, which indicates that it is a significant procedure
and multiple procedure reductions will apply. In this case, there is only one CPT procedure
code that is a status "T" indicator, so 100 percent of the fee-based APC will be paid (Casto
and Forrestal 2015, 175).
The sum of a hospital's relative DRG weights for a year was 15,192, and the hospital had
10,471 discharges for the year. Given this information, what would be the hospital's case-mix
index for that year?
a. 0.689
b. 0.689 × 100
c. 1.45 × 100
d. 1.45 --CORRECT ANSWER--d
The weight of each diagnosis-related group (DRG) is multiplied by the number of discharges
for that DRG to arrive at the total weight for each DRG—in this situation 15,192. The total
weights are summed and divided by the number of total discharges to arrive at the case-mix
index for a hospital: 15,,471 = 1.45 (Horton 2016b, 401).
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OF ADVANCED DATA ANALYSIS QUESTIONS AND
ANSWERS WITH RATIONALES
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon
would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy --CORRECT ANSWER--c
Colonoscopy includes examining the transverse colon. Proctosigmoidoscopy involves
examining the rectum and sigmoid colon. Sigmoidoscopy involves examining the rectum,
sigmoid colon, and may include portions of the descending colon (Smith 2017, 121).
A physician orders a chest x-ray for an office patient who presents with fever, productive
cough, and shortness of breath. The physician indicates in the progress notes: "Rule out
pneumonia." What should the coder report for the visit when the results have not yet been
received?
a. Pneumonia
b. Fever, cough, shortness of breath
c. Cough, shortness of breath
d. Pneumonia, cough, shortness of breath, fever --CORRECT ANSWER--b
Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when
a physician qualifies a diagnostic statement as "possible," "probable," "suspected,"
Page 1 of 82
,"questionable," "rule out," or "working diagnosis," or other similar terms indicating
uncertainty (Schraffenberger and Palkie 2017, 102).
When multiple burns are present, the first sequenced diagnosis is the:
a. Burn that is treated surgically
b. Burn that is closest to the head
c. Highest-degree burn
d. Burn that is treated first --CORRECT ANSWER--c
Treatment and anatomic location are not factors in the sequencing of burn conditions. Code
all burns with the highest degree of burn sequenced first (Schraffenberger and Palkie 2017,
584).
Assign the correct CPT code for the following procedure: Revision of the pacemaker skin
pocket.
a. 33223, Relocation of skin pocket for implantable defibrillator
b. 33210, Insertion or replacement of temporary transvenous single chamber cardiac
electrode or pacemaker catheter (separate procedure)
c. 33212, Insertion of pacemaker pulse generator only; with existing single lead
d. 33222, Relocation of skin pocket for pacemaker --CORRECT ANSWER--d
Begin with the main term Revision; pacemaker site; chest (Kuehn 2017, 22, 24).
What is the term that means evaluating the appropriateness of the setting for the healthcare
service and the level of service?
a. Coordination of service benefits
Page 2 of 82
,b. Community rating
c. Outcomes assessment
d. Utilization review --CORRECT ANSWER--d
Utilization review assesses the appropriateness of the setting for the healthcare service in the
continuum of care and the level of service. Also factored in are patients' severity of illness
and other medical conditions and illnesses (Casto and Forrestal 2015, 100).
A coder might find which of the following on a patient's problem list if the medication list
contains the drug Procardia?
a. Esophagitis
b. Hypertension
c. Schizophrenia
d. AIDS --CORRECT ANSWER--b
Procardia is an antianginal, antihypertensive, calcium channel blocker that is used to treat
stable angina pectoris, vasospastic angina, and hypertension (Schraffenberger and Palkie
2017, Appendix I, 16).
From the information provided in this table, what percentage will the facility be paid for
procedure 25500?
Billing Number Status Indicator CPT/HCPCS APC
998323 V 99285-25 0612
998323 T 25500 0044
998323 X 72050 0261
Page 3 of 82
, 998323 S 72128 0283
998323 S 70450 0283
a. 0%
b. 50%
c. 75%
d. 100% --CORRECT ANSWER--d
Procedure 22550 has a "T" status indicator, which indicates that it is a significant procedure
and multiple procedure reductions will apply. In this case, there is only one CPT procedure
code that is a status "T" indicator, so 100 percent of the fee-based APC will be paid (Casto
and Forrestal 2015, 175).
The sum of a hospital's relative DRG weights for a year was 15,192, and the hospital had
10,471 discharges for the year. Given this information, what would be the hospital's case-mix
index for that year?
a. 0.689
b. 0.689 × 100
c. 1.45 × 100
d. 1.45 --CORRECT ANSWER--d
The weight of each diagnosis-related group (DRG) is multiplied by the number of discharges
for that DRG to arrive at the total weight for each DRG—in this situation 15,192. The total
weights are summed and divided by the number of total discharges to arrive at the case-mix
index for a hospital: 15,,471 = 1.45 (Horton 2016b, 401).
Page 4 of 82
