Domain 1 – Clinical Classification Systems - Sample Questions

Task 1: Interpret healthcare data for code assignment

Question - A 55-year-old male is admitted with shortness of breath and diagnosed with acute exacerbation of COPD. The EHR also lists hypertension and diabetes. What should be assigned as the principal diagnosis?

Task 2: Incorporate clinical vocabularies and terminologies used in health information systems

Question - Which standardized clinical terminology supports interoperability and is commonly integrated into EHR systems to represent clinical concepts?

Task 3: Abstract pertinent information from medical records

Question - While reviewing a discharge summary, which type of information is typically abstracted for coding and clinical documentation improvement?

Task 4: Consult reference materials to facilitate code assignment

Question - If a coder encounters an unfamiliar procedure, what should be the first step to accurately assign the correct code?

Task 5: Apply inpatient coding guidelines

Question - How should inpatient coders handle a case where two conditions equally meet the criteria for principal diagnosis?

Task 6: Apply outpatient coding guidelines

Question - According to outpatient coding guidelines, how should suspected or probable diagnoses be handled in documentation?

Task 7: Apply physician coding guidelines

Question - A physician documents “possible pneumonia” in the progress note. How should this be handled according to physician coding standards?

Task 8: Assign inpatient codes

Question - Which coding classification is used to assign inpatient diagnoses in U.S. hospitals?

Task 9: Assign outpatient codes

Question - During an outpatient visit, a patient complains of knee pain due to a past sports injury. What should be the primary diagnosis coded?

Task 10: Assign physician codes

Question - What coding system should a physician use to report procedures performed during an office visit?

Task 11: Sequence codes according to healthcare setting

Question - In the outpatient setting, what is the guiding factor for sequencing diagnosis codes?

Domain 2 – Reimbursement Methodologies - Sample Questions

Task 1: Sequence codes for optimal reimbursement

Question - How does correct sequencing of diagnosis codes affect reimbursement for inpatient claims?

Task 2: Link diagnoses and CPT® codes according to payer specific guidelines

Question - What should a coder verify before linking a diagnosis to a CPT® code to ensure payer acceptance?

Task 3: Assign correct DRG

Question - What key elements determine the appropriate assignment of a Medicare Severity-Diagnosis Related Group (MS-DRG)?

Task 4: Assign correct APC

Question - Which outpatient grouping system is used by Medicare to determine payment rates for hospital outpatient services?

Task 5: Evaluate NCCI edits

Question - What is the purpose of National Correct Coding Initiative (NCCI) edits in outpatient claims?

Task 6: Reconcile NCCI edits

Question - What action should a coder take when a CPT® pair triggers an NCCI edit during outpatient coding?

Task 7: Validate medical necessity using LCD and NCD

Question - Which resources should a coder check to ensure that a test or procedure meets coverage criteria for Medicare beneficiaries?

Task 8: Submit claim forms

Question - What standardized form is typically used to submit outpatient services to insurance payers?

Task 9: Communicate with financial departments

Question - Why might a coding specialist need to collaborate with the finance department during the billing process?

Task 10: Evaluate claim denials

Question - What is a common reason for a claim denial related to diagnosis and procedure code mismatch?

Task 11: Respond to claim denials

Question - What information should be included in a coder’s appeal response when disputing a denied claim?

Task 12: Resubmit denied claim to the payer source

Question - What is the standard process for correcting and resubmitting a denied claim?

Task 13: Communicate with the physician to clarify documentation

Question - When documentation is unclear or ambiguous, what is the most appropriate action a coder should take?

Domain 3 – Health Records and Data Content - Sample Questions

Task 1: Retrieve medical records

Question - What system is most commonly used by HIM professionals to locate and retrieve electronic medical records?

Task 2: Assemble medical records according to healthcare setting

Question - What is a key consideration when organizing a patient’s record for a surgical setting versus an inpatient stay?

Task 3: Analyze medical records quantitatively for completeness

Question - Which of the following would be flagged during a quantitative analysis of a discharged patient’s chart?

Task 4: Analyze medical records qualitatively for deficiencies

Question - What type of deficiency might be found during a qualitative record review?

Task 5: Perform data abstraction

Question - What is the purpose of abstracting clinical data from a patient record?

Task 6: Request patient-specific documentation from other sources

Question - When should HIM staff request additional documentation from ancillary departments or external providers?

Task 7: Retrieve patient information from master patient index

Question - What key data elements are typically used to locate a patient in the master patient index (MPI)?

Task 8: Educate providers on health data standards

Question - Why is it important for providers to understand health data standards such as HL7 and LOINC?

Task 9: Generate reports for data analysis

Question - Which tool might an HIM professional use to generate statistical reports for performance improvement?

Domain 4 – Compliance - Sample Questions

Task 1: Identify discrepancies between coded data and supporting documentation

Question - What could be the consequence of assigning codes that do not match the documentation?

Task 2: Validate that codes assigned by provider or electronic systems are supported by proper documentation

Question - What is the recommended action if a CAC system assigns a code that isn’t supported by the progress note?

Task 3: Perform ethical coding

Question - Which of the following is a violation of the AHIMA Code of Ethics in coding practices?

Task 4: Clarify documentation through physician query

Question - In which case is a physician query appropriate during code assignment?

Task 5: Research latest coding changes

Question - What is the most reliable source for updates on ICD-10-CM and CPT® code changes?

Task 6: Implement latest coding changes

Question - What process ensures that all staff members are updated on annual coding guideline revisions?

Task 7: Update fee/charge ticket based on latest coding changes

Question - When is it necessary to revise a facility’s chargemaster?

Task 8: Educate providers on compliant coding

Question - What should a training session on compliant coding emphasize for physicians?

Task 9: Assist in preparing the organization for external audits

Question - What role does the coding department play in preparation for a RAC audit?

Domain 5 – Information Technologies - Sample Questions

Task 1: Navigate throughout the EHR

Question - What is one benefit of using standardized navigation templates within an EHR system?

Task 2: Utilize encoding and grouping software

Question - How does encoder software support the coding workflow?

Task 3: Utilize practice management and HIM systems

Question - Which function is commonly performed in a practice management system rather than in an EHR?

Task 4: Utilize CAC software that automatically assigns codes based on electronic text

Question - What is a potential risk of relying solely on CAC software for code assignment?

Task 5: Validate the codes assigned by CAC software

Question - Why is human validation still necessary even when using CAC tools?

Domain 6 – Confidentiality & Privacy - Sample Questions

Task 1: Ensure patient confidentiality

Question - What standard practice helps ensure patient information remains confidential?

Task 2: Educate healthcare staff on privacy and confidentiality issues

Question - What topic should be included in annual privacy training for clinical staff?

Task 3: Recognize and report privacy issues/violations

Question - What should an employee do upon witnessing a potential HIPAA violation?

Task 4: Maintain a secure work environment

Question - Which of the following helps maintain physical security of patient information in a healthcare setting?

Task 5: Utilize pass codes

Question - What is one best practice for creating and using login credentials in healthcare systems?

Task 6: Access only minimal necessary documents/information

Question - What is the guiding principle behind the “minimum necessary” rule in HIPAA?

Task 7: Release patient-specific data to authorized individuals

Question - What must be verified before releasing a patient’s medical record to an external requestor?

Task 8: Protect electronic documents through encryption

Question - What role does encryption play in maintaining EHR security?

Task 9: Transfer electronic documents through secure sites

Question - What is the most secure method to transmit protected health information (PHI) electronically?

Task 10: Retain confidential records appropriately

Question - How long must a covered entity retain medical records, according to HIPAA standards?

Task 11: Destroy confidential records appropriately

Question - Which of the following methods is considered HIPAA-compliant for destroying physical medical records?