Question 1

Explain the difference between upcoding and downcoding.

Accepted Answer

The answer of Explain the difference between upcoding and downcoding....

Question 2

A chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n):
A)problem-focused exam.
B)expanded problem-focused exam.
C)detailed exam.
D)comprehensive exam.

Accepted Answer

The answer of A chart that reports an exam involving...

Question 3

Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.

Accepted Answer

A) True 
 B)False

Question 4

Physician offices should audit their medical records to:
A)ensure compliance with HIPAA regulations.
B)determine the accuracy of the physician's documentation.
C)assess the completeness of the medical record.
D)all of the above.

Accepted Answer

The answer of Physician offices should audit their medical records...

Question 5

What is the difference between a prospective and a retrospective audit?

Accepted Answer

The answer of What is the difference between a prospective...

Question 6

If documentation in the patient chart supports a higher level of service than that coded, the error would be called:
A)upcoding.
B)downcoding.
C)bundling.
D)unbundling.

Accepted Answer

The answer of If documentation in the patient chart supports...

Question 7

The key elements in determining the level of evaluation and management (E/M) services include the extent of the history, physical exam, and medical decision making.

Accepted Answer

A) True 
 B)False

Question 8

Medicare can deny or downcode an evaluation and management (E/M) service if it feels that the service provided exceeds the patient's documented needs.

Accepted Answer

A) True 
 B)False

Question 9

In what ways are medical necessity for evaluation and management services expressed?

Accepted Answer

The answer of In what ways are medical necessity for...

Question 10

Time is considered the controlling factor for determining the level of evaluation and management (E/M) service if counseling with the patient or family members constitutes at least 50% of the encounter.

Accepted Answer

A) True 
 B)False

Question 11

Key components for selecting evaluation and management (E/M) codes include all of the following EXCEPT:
A)complexity of the diagnosis.
B)complexity of the medical decision making.
C)extent of the history documented.
D)extent of the exam documented.

Accepted Answer

The answer of Key components for selecting evaluation and management...

Question 12

If a physician who ordered a test personally reviews the results to supplement information from the physician who prepared the test report, the work would add to the level of the:
A)number of diagnoses or management options.
B)amount and/or complexity of data to be reviewed.
C)risk of significant complications, morbidity, and/or mortality.
D)all of the above.

Accepted Answer

The answer of If a physician who ordered a test...

Question 13

If a patient presents with a minimal problem and the physician performs a limited exam of the affected body area only, the exam would be reported as problem focused.

Accepted Answer

A) True 
 B)False

Question 14

If a patient complains of a dull ache in the left ear over the past 24 hours, he or she would be describing:
A)one history of present illness (HPI) element.
B)two HPI elements.
C)three HPI elements.
D)four HPI elements.

Accepted Answer

The answer of If a patient complains of a dull...

Question 15

A postpayment audit would verify:
A)date of service.
B)patient insurance identification number.
C)sign-in sheets and appointment scheduling practices.
D)patient insurance eligibility.

Accepted Answer

The answer of A postpayment audit would verify:
A)date of service.
B)patient...

Question 16

Types of medical records audits include all of the following EXCEPT:
A)accreditation audits.
B)certification audits.
C)external audits.
D)internal audits.

Accepted Answer

The answer of Types of medical records audits include all...

Question 17

In a patient's chart, a diagnosis:
A)must be explicitly stated.
B)can be stated or implied.
C)must be part of the history of present illness (HPI).
D)must be coded.

Accepted Answer

The answer of In a patient's chart, a diagnosis:
A)must be...

Question 18

A postpayment audit would verify all of the following EXCEPT:
A)the coder's skill and knowledge.
B)billing records.
C)patient progress notes.
D)laboratory results.

Accepted Answer

The answer of A postpayment audit would verify all of...

Question 19

An internal prospective audit would most likely be performed on:
A)all claims.
B)workers' compensation claims.
C)all evaluation and management (E/M) claims.
D)all Medicare claims.

Accepted Answer

The answer of An internal prospective audit would most likely...

Question 20

If a CPT code stated on a claim form represents a lower level of service than is documented in the medical record, the procedure has been downcoded.

Accepted Answer

A) True 
 B)False

Exam 10: Auditing

Explain the difference between upcoding and downcoding.

A chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n): A)problem-focused exam. B)expanded problem-focused exam. C)detailed exam. D)comprehensive exam.

Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.

Physician offices should audit their medical records to: A)ensure compliance with HIPAA regulations. B)determine the accuracy of the physician's documentation. C)assess the completeness of the medical record. D)all of the above.

What is the difference between a prospective and a retrospective audit?

If documentation in the patient chart supports a higher level of service than that coded, the error would be called: A)upcoding. B)downcoding. C)bundling. D)unbundling.

The key elements in determining the level of evaluation and management (E/M) services include the extent of the history, physical exam, and medical decision making.

Medicare can deny or downcode an evaluation and management (E/M) service if it feels that the service provided exceeds the patient's documented needs.

In what ways are medical necessity for evaluation and management services expressed?

Time is considered the controlling factor for determining the level of evaluation and management (E/M) service if counseling with the patient or family members constitutes at least 50% of the encounter.

Key components for selecting evaluation and management (E/M) codes include all of the following EXCEPT: A)complexity of the diagnosis. B)complexity of the medical decision making. C)extent of the history documented. D)extent of the exam documented.

If a patient presents with a minimal problem and the physician performs a limited exam of the affected body area only, the exam would be reported as problem focused.

If a patient complains of a dull ache in the left ear over the past 24 hours, he or she would be describing: A)one history of present illness (HPI) element. B)two HPI elements. C)three HPI elements. D)four HPI elements.

A postpayment audit would verify: A)date of service. B)patient insurance identification number. C)sign-in sheets and appointment scheduling practices. D)patient insurance eligibility.

Types of medical records audits include all of the following EXCEPT: A)accreditation audits. B)certification audits. C)external audits. D)internal audits.

In a patient's chart, a diagnosis: A)must be explicitly stated. B)can be stated or implied. C)must be part of the history of present illness (HPI). D)must be coded.

A postpayment audit would verify all of the following EXCEPT: A)the coder's skill and knowledge. B)billing records. C)patient progress notes. D)laboratory results.

An internal prospective audit would most likely be performed on: A)all claims. B)workers' compensation claims. C)all evaluation and management (E/M) claims. D)all Medicare claims.

If a CPT code stated on a claim form represents a lower level of service than is documented in the medical record, the procedure has been downcoded.