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1. Hospital-acquired condition pay provisions apply only to
A) inpatient psychiatric hospitals
B) long-term acute care hospitals
C) inpatient prospective payment system hospitals
D) critical access hospitals
2. A 100-year-old female presents to the emergency department with altered mental state and a 3-day history of productive cough, shortness of breath, and fever after a witnessed aspiration 3 days ago. The patient lives in custodial care at a nearby skilled nursing facility. Patient was treated with Augmentin at the facility without improvement. Exam is notable for Tc 38.9, blood pressure 142/78, respiratory rate 28, pulse 91. There is accessory muscle use with breathing.
Patient is moaning and disoriented but
otherwise the neurologic exam is nonfocal.
Labs notable for sodium 126, creatinine 0.5. white blood count 17.5, hemoglobin 13, platelet 200. venous blood gas 7.44/32/45/-3 Chest x-ray shows bilateral lower lobe infiltrates and dense right lower lobe consolidation.
Patient is placed on bilevel positive airway pressure and given vancomycin, pip/tazo, levofloxacin.
Discharge Diagnosis: health care associated pneumonia (HCAP), respiratory distress, altered mental status, low sodium Which list of diagnoses require a post-discharge query that will result in a more specific principal diagnosis with the highest level of severity of illness and risk of mortality?
A) Sepsis with acute hypoxemic respiratory failure, hyponatremia, pneumonia
B) Aspiration pneumonia, hyponatremia, septic encephalopathy, and sepsis with acute hypoxemic respiratory failure
C) Coma, stroke, HCAP, hypernatremia
D) Severe sepsis, hypernatremia, delirium, pneumonia
3. Which of the following is the definition of an Excludes 2 note in ICD-10-CM?
A) This is not a convention found in ICD-10-CM
B) Only one code can be assigned to completely describe the condition
C) Neither of the codes can be assigned
D) Two codes can be used together to completely describe the condition
4. Hospital policy states that physician responses to queries should be no longer than timely payer filing requirements. A physician responds to a query after the final bill has been submitted. How should administration respond in this situation?
A) Report the physician's delayed response to the Ethics and Compliance Committee
B) Evaluate the payer's timeframe for billing and reasons for the physician's delayed response
C) Review the record to determine any potential data integrity impact and/or rebilling implications
D) Maintain the original billing as supported by documentation in the medical record
5. A patient is admitted for chronic obstructive pulmonary disease (COPD) exacerbation. The patient is on 3L of home oxygen and is treated during admission with 3L of oxygen. The most appropriate action is to
A) query the provider to see if respiratory insufficiency is supported by the health record
B) query the provider to see if chronic respiratory failure is supported by the health record
C) query the provider to see if acute on chronic respiratory failure is supported by the health record
D) code the diagnoses of COPD exacerbation and chronic respiratory failure
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: B | Question # 3 Answer: D | Question # 4 Answer: C | Question # 5 Answer: C |
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