RHIT Domain 4a: Questions & Answers
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 - 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
998323 S 72128 0283
998323 S 70450 0283
a. 0%
b. 50%
c. 75%
d. 100% - 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 - 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).
A Staghorn calculus of the left renal pelvis was treated earlier in the week by lithotripsy and is now
removed via a percutaneous nephrostomy tube. What is the root operation performed for this
procedure?
a. Destruction
b. Extirpation
c. Extraction
d. Fragmentation - ANSWER:b
The root operation extirpation is defined as taking or cutting out solid material from a body part. The
matter may have been broken into pieces during the lithotripsy previous to this encounter, but at this
time the pieces of the calculus are being removed (Kuehn and Jorwic 2017, 86).
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 - 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 - 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," "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 - 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 - 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
b. Community rating
c. Outcomes assessment
d. Utilization review - 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).
What is the name of the process to determine whether medical care provided to a specific patient is
necessary according to pre-established objective screening criteria at time frames specified?
a. Case management
b. Continuum of care
c. Quality improvement
d. Utilization review - ANSWER:d
Utilization review is the process to determine if medical care meets objective screening criteria (Sayles
and Gordon 2016, 27).
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious
gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. Which of the
following would be the correct coding and sequencing for this case?
a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina
b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina
c. Gastroenteritis; abdominal pain; angina
d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina - ANSWER:b
The principal diagnosis is designated and defined as the condition established after study chiefly
responsible for occasioning the admission of the patient to the hospital for care. The abdominal pain
would not be coded as it is a symptom of the gastroenteritis (Schraffenberger and Palkie 2017, 91).
The coding supervisor has compiled a report on the number of coding errors made each day by the
coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an
average of five errors per day, and Bob and Susan each make an average of two errors per day. Given this
information, what immediate action should the coding supervisor take?
a. Counsel Tim and Jane because they have the highest error rates.
b. Encourage Tim and Jane to get additional training.
c. Provide Bob and Susan with incentive pay for a low coding error rate.
d. Take no action because not enough information is given to make a judgment. - ANSWER:d
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 - 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
998323 S 72128 0283
998323 S 70450 0283
a. 0%
b. 50%
c. 75%
d. 100% - 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 - 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).
A Staghorn calculus of the left renal pelvis was treated earlier in the week by lithotripsy and is now
removed via a percutaneous nephrostomy tube. What is the root operation performed for this
procedure?
a. Destruction
b. Extirpation
c. Extraction
d. Fragmentation - ANSWER:b
The root operation extirpation is defined as taking or cutting out solid material from a body part. The
matter may have been broken into pieces during the lithotripsy previous to this encounter, but at this
time the pieces of the calculus are being removed (Kuehn and Jorwic 2017, 86).
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 - 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 - 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," "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 - 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 - 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
b. Community rating
c. Outcomes assessment
d. Utilization review - 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).
What is the name of the process to determine whether medical care provided to a specific patient is
necessary according to pre-established objective screening criteria at time frames specified?
a. Case management
b. Continuum of care
c. Quality improvement
d. Utilization review - ANSWER:d
Utilization review is the process to determine if medical care meets objective screening criteria (Sayles
and Gordon 2016, 27).
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious
gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. Which of the
following would be the correct coding and sequencing for this case?
a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina
b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina
c. Gastroenteritis; abdominal pain; angina
d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina - ANSWER:b
The principal diagnosis is designated and defined as the condition established after study chiefly
responsible for occasioning the admission of the patient to the hospital for care. The abdominal pain
would not be coded as it is a symptom of the gastroenteritis (Schraffenberger and Palkie 2017, 91).
The coding supervisor has compiled a report on the number of coding errors made each day by the
coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an
average of five errors per day, and Bob and Susan each make an average of two errors per day. Given this
information, what immediate action should the coding supervisor take?
a. Counsel Tim and Jane because they have the highest error rates.
b. Encourage Tim and Jane to get additional training.
c. Provide Bob and Susan with incentive pay for a low coding error rate.
d. Take no action because not enough information is given to make a judgment. - ANSWER:d
