QUESTION: 21

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?

Maintain the original billing as supported by documentation in the medical record
Evaluate the payer’s timeframe for billing and reasons for the physician's delayed response
Review the record to determine any potential data integrity impact and/or rebilling implications
Report the physician’s delayed response to the Ethics and Compliance Committee

Answer(s): C

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QUESTION: 22

A patient has a history of asthma and presents with complaints of fever, cough, general body aches, and lethargy. The patient’s child was recently diagnosed with influenza. Wheezing is heard on exam. The physician documents the diagnosis as asthma exacerbation and orders nebulizer treatments of Albuterol and a 5-day course of oral Prednisone. The clinical documentation integrity practitioner (CDIP) is unsure which signs and symptoms are inherent to asthma. Which reference resource should be used to obtain this information?

Physician’s Desk Reference
AMA CPT Assistant
The Merck Manual
Medical Dictionary

Answer(s): C

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QUESTION: 23

A patient falls off a ladder and undergoes a right femur procedure. Three weeks later, the patient returns to the hospital for removal of the external fixation device. The ICD-10-CM 7th character code value should indicate

initial
sequela
aftercare
subsequent

Answer(s): D

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QUESTION: 24

A clinical documentation integrity (CDI) program that is compliant with regulations from the facility’s payors results in

meeting external benchmarks
less risk from audits
need for more CDI staff
higher overall program cost

Answer(s): A

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QUESTION: 24

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