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Domain 4: Regulatory Compliance Exam 2024/2025 Questions With Completed & Verified Solutions.
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Domain 4: Regulatory Compliance Exam 2024/2025 Questions With Completed & Verified Solutions.
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Domain 4: Regulatory ComplianceAt work one day, Mary, who is an outpatient coding professional, overheard another outpatient
coder mention that whenever she has a chart to code with a procedure that she is unfamiliar
with, she assigns an unlisted CPT code. This allows her to keep up her productivity numbers
rather than taking time to research the procedure. What is Mary's ethical responsibility upon
learning this information?
a. None, as she is an outpatient coder and the Code of Ethics applies only to inpatient coders
b. None, because it is within coding guidelines to assign an unlisted CPT procedure code
c. Report this to her coding manager as the Code of Ethics requires coders to take steps to
correct unethical behavior of colleagues
d. Report this to the facility's risk manager in order to prevent claim denials
c. Report this to her coding manager as the Code of Ethics requires coders to take steps to
correct unethical behavior of colleagues
AHIMA's Standards of Ethical Coding (11.2) require that coding professionals take steps to
address the unethical behavior of colleagues
A patient has a principal diagnosis of pneumonia (J18.9) (MS-DRG 195). Which of the following
may legitimately change the coding of the pneumonia in accordance with the UHDDS and
relevant clinical documentation?
a. Sputum culture reflects growth of normal flora
b. Patient has a high fever
c. Patient is found to have dysphagia with aspiration
d. Patient has nonproductive cough
c. Patient is found to have dysphagia with aspiration
with documentation that links the pneumonia and aspiration, it changes the coding to aspiration
pneumonia and results in MS-DRG 179 RESPIRATORY INFECTIONS & INFLAMMATIONS
W/O CC/MCC, which has a weight of 0.8711 (CMS 2021d). This is in comparison to MS-DRG
195, SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC MDC: 04, which has a DRG weight of
0.6650 (CMS 2021d).
0:06
/
0:15
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Which of the following is found on the hospital-acquired condition list?
, a. Stage 4 pressure ulcer of the coccyx
b. Foreign body of the skin
c. Urinary tract infection
d. Diabetes
a. Stage 4 pressure ulcer of the coccyx
Stage 3 and 4 pressure ulcers fall on the CMS hospital-acquired conditions list
The patient was admitted for breast carcinoma in the right breast at two o'clock. This was
removed via lumpectomy. An axillary lymph node dissection, performed along with the
lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the patient's
neighbors, who works at the hospital, called the coding department to get the patient's diagnosis
because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy
d. Explain that discussing the case would violate the patient's right to privacy
Disclosing information without the patient's written consent violates the patient's right to privacy
A patient is admitted for pneumonia. Additionally, the physician has documented the patient has
a history of hypertension and diabetes, which require medication (Lisinopril and insulin) while in
the hospital, along with a history of migraines and repeated, recent falls. Which of the following
diagnoses does not meet the UHDDS definition of additional diagnoses?
a. I10
b. Z79.4
c. R29.6
d. G43.909
d. G43.909
G43.909 for migraines does not meet the UHDDS definition of additional diagnoses because it
pertains to a previous condition and is not currently under treatment like the hypertension and
diabetes. The insulin use and repeated falls impact the current stay and should be assigned as
additional diagnoses
Generally, data quality is defined as:
a. Ensuring the greatest amount of data possible is obtained from the medical record
b. Ensuring the accuracy and completeness of an organization's data
c. Ensuring accuracy of the data collected for the case-mix index
d. Ensuring the data for external reporting is optimized
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