RHIT EXAM REVIEW DOMAIN 4 EXAM
QUESTIONS AND ANSWERS GRADED A+
2026
The accounts not selected for the billing report is a daily report used to track accounts that are:
a. Awaiting payment in accounts receivable
b. Paid at different rates
c. In bill hold or in error and awaiting billing
d. Pulled for quality review - ANS c. In bill hold or in error and awaiting billing
The accounts not selected for billing report is a daily report used to track the many reasons that
accounts may not be ready for billing. This report is also called the discharged not final billed
(DNFB) report. Accounts that have not met all facility-specified criteria for billing are held and
reported on this daily tracking list. Some accounts are held because the patient has not signed
the consents and authorizations required by the insurer. Still others are not billed because the
primary and secondary insurance benefits have not been confirmed .
Which of the following is a function of the outpatient code editor?
a. Validate the patient's age on a claim
b. Validate the patient's encounter number
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,c. Identify unbundling of codes
d. Identify cases that don't meet medical necessity - ANS c. Identify unbundling of codes
The latest version of the Medicare integrated outpatient code editor (OCE) should be installed
to review claims prior to releasing billed data to the Medicare program. OCE software contains
the National Correct Coding Initiative (NCCI) edits for Current Procedural Terminology (CPT). The
NCCI edits were created to evaluate the relationships between CPT codes on the bill and to
control improper coding leading to inappropriate payment and unbundling on the Part B claims.
They also identify component codes that were used instead of the appropriate comprehensive
code, as well as other types of coding errors.
A patient is admitted for the treatment of dehydration secondary to chemotherapy for primary
liver cancer. Intravenous (IV) fluids were administered to the patient. Which of the following
should be sequenced as the principal diagnosis?
a. Dehydration
b. Chemotherapy
c. Liver carcinoma
d. Complication of chemotherapy - ANS a. Dehydration
When the admission or encounter is for management of dehydration due to the malignancy and
only the dehydration is being treated, the dehydration is sequenced first, followed by the
code(s) for the malignancy.
The first step in an inpatient record review is to verify correct assignment of the:
a. Record sample
b. Coding procedures
c. Principal diagnosis
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
,d. MS-DRG - ANS c. Principal diagnosis
To begin the review, the coding supervisor checks the inpatient health record to ensure that the
diagnosis billed as principal meets the official Uniform Hospital Discharge Data Set (UHDDS)
definition for principal diagnosis. The principal diagnosis must have been a principal reason for
admission, and the patient received treatment or evaluation during the stay. When several
diagnoses meet all of those requirements, any of them could be selected as the principal
diagnosis.
A patient was seen in the emergency department for chest pain. It was suspected that the
patient may have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out
GERD." The correct ICD-10-CM diagnosis code is:
a. K21.9, Gastro-esophageal reflux disease without esophagitis
b. R07.9, Chest pain, unspecified
c. R10.11, Right upper quadrant pain
d. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out -
ANS b. R07.9, Chest pain, unspecified
Because this patient was seen only in the emergency department, he or she would be classified
as an outpatient. Diagnoses documented as "probable," "suspected," "questionable," "rule
out," or "working diagnosis" or other similar terms in the outpatient setting indicate uncertainty
and would not be coded as if existing. Rather, code the condition to the highest degree of
certainty for that encounter or visit, such as signs, symptoms, abnormal test results, or other
reason for the visit. In this case, unspecified chest pain would be coded.
A patient received a complete replacement of tunneled centrally inserted central venous
catheter with subcutaneous port; replacement performed through original access site (45-year-
old patient). Which of the following CPT codes would be most appropriate?
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
, 36578 - Replacement, catheter only, of central venous access device, with subcutaneous port or
pump, central or peripheral insertion site
36580 - Replacement, complete, on a non-tunneled centrally inserted central venous catheter,
without subcutaneous port or pump, through same venous access
36582 - Replacement, complete, of a tunneled centrally inserted central venous access device,
with subcutaneous port, through same venous access
36597 - Repositioning of previous placed central venous catheter under fluoroscopic guidance
a. 36578
b. 36580
c. 36582, 36597
d. 36582 - ANS d. 36582
A complete replacement of the entire device by the same venous access site is being
performed. It is a tunneled catheter inserted within the same venous access point. Code 36582
is the correct code.
A laparoscopic tubal ligation is undertaken. Which of the following is the correct CPT code
assignment?
49320 - Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)
58662 - Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera,
or peritoneal surface by any method
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 4
QUESTIONS AND ANSWERS GRADED A+
2026
The accounts not selected for the billing report is a daily report used to track accounts that are:
a. Awaiting payment in accounts receivable
b. Paid at different rates
c. In bill hold or in error and awaiting billing
d. Pulled for quality review - ANS c. In bill hold or in error and awaiting billing
The accounts not selected for billing report is a daily report used to track the many reasons that
accounts may not be ready for billing. This report is also called the discharged not final billed
(DNFB) report. Accounts that have not met all facility-specified criteria for billing are held and
reported on this daily tracking list. Some accounts are held because the patient has not signed
the consents and authorizations required by the insurer. Still others are not billed because the
primary and secondary insurance benefits have not been confirmed .
Which of the following is a function of the outpatient code editor?
a. Validate the patient's age on a claim
b. Validate the patient's encounter number
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,c. Identify unbundling of codes
d. Identify cases that don't meet medical necessity - ANS c. Identify unbundling of codes
The latest version of the Medicare integrated outpatient code editor (OCE) should be installed
to review claims prior to releasing billed data to the Medicare program. OCE software contains
the National Correct Coding Initiative (NCCI) edits for Current Procedural Terminology (CPT). The
NCCI edits were created to evaluate the relationships between CPT codes on the bill and to
control improper coding leading to inappropriate payment and unbundling on the Part B claims.
They also identify component codes that were used instead of the appropriate comprehensive
code, as well as other types of coding errors.
A patient is admitted for the treatment of dehydration secondary to chemotherapy for primary
liver cancer. Intravenous (IV) fluids were administered to the patient. Which of the following
should be sequenced as the principal diagnosis?
a. Dehydration
b. Chemotherapy
c. Liver carcinoma
d. Complication of chemotherapy - ANS a. Dehydration
When the admission or encounter is for management of dehydration due to the malignancy and
only the dehydration is being treated, the dehydration is sequenced first, followed by the
code(s) for the malignancy.
The first step in an inpatient record review is to verify correct assignment of the:
a. Record sample
b. Coding procedures
c. Principal diagnosis
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
,d. MS-DRG - ANS c. Principal diagnosis
To begin the review, the coding supervisor checks the inpatient health record to ensure that the
diagnosis billed as principal meets the official Uniform Hospital Discharge Data Set (UHDDS)
definition for principal diagnosis. The principal diagnosis must have been a principal reason for
admission, and the patient received treatment or evaluation during the stay. When several
diagnoses meet all of those requirements, any of them could be selected as the principal
diagnosis.
A patient was seen in the emergency department for chest pain. It was suspected that the
patient may have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out
GERD." The correct ICD-10-CM diagnosis code is:
a. K21.9, Gastro-esophageal reflux disease without esophagitis
b. R07.9, Chest pain, unspecified
c. R10.11, Right upper quadrant pain
d. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out -
ANS b. R07.9, Chest pain, unspecified
Because this patient was seen only in the emergency department, he or she would be classified
as an outpatient. Diagnoses documented as "probable," "suspected," "questionable," "rule
out," or "working diagnosis" or other similar terms in the outpatient setting indicate uncertainty
and would not be coded as if existing. Rather, code the condition to the highest degree of
certainty for that encounter or visit, such as signs, symptoms, abnormal test results, or other
reason for the visit. In this case, unspecified chest pain would be coded.
A patient received a complete replacement of tunneled centrally inserted central venous
catheter with subcutaneous port; replacement performed through original access site (45-year-
old patient). Which of the following CPT codes would be most appropriate?
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
, 36578 - Replacement, catheter only, of central venous access device, with subcutaneous port or
pump, central or peripheral insertion site
36580 - Replacement, complete, on a non-tunneled centrally inserted central venous catheter,
without subcutaneous port or pump, through same venous access
36582 - Replacement, complete, of a tunneled centrally inserted central venous access device,
with subcutaneous port, through same venous access
36597 - Repositioning of previous placed central venous catheter under fluoroscopic guidance
a. 36578
b. 36580
c. 36582, 36597
d. 36582 - ANS d. 36582
A complete replacement of the entire device by the same venous access site is being
performed. It is a tunneled catheter inserted within the same venous access point. Code 36582
is the correct code.
A laparoscopic tubal ligation is undertaken. Which of the following is the correct CPT code
assignment?
49320 - Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)
58662 - Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera,
or peritoneal surface by any method
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 4
