Deck 16: The Application of HCC Coding in a Physician Practice and Lessons Learned

Question 1

The purpose of HCC coding is to reflect the health of a ________________ accurately.

A) patient population
B) patient population with like resource consumption
C) Medicare beneficiary pool
D) select subgroup of a chronic population

Answer 1

A

Question 2

The volume of diagnosis codes that can be tracked is not limited to four or ____________ and must be submitted each calendar year.

A) 8
B) 9
C) 10
D) 11
E) 12

Answer 2

E

Question 3

____________________ include patient encounters that fall into two categories of exams: routine adult health exam with abnormal findings and routine adult health exam without abnormal findings.

A) Routine visits
B) Chronic Care visits
C) Diagnostic visits
D) Annual Wellness visits

Answer 3

D

Question 4

There are principles for documentation for Evaluation and Management (EM) services, and according to CMS, the nature and amount of physician work and documentation will vary based on:

A) the type or types of service provided.
B) the place of service.
C) the patient's status.
D) All of these are correct.

Question 5

All documentation is essential for ____________________ of the claims as the payers want to see documentation that is consistent, accurate, complete, and timely to cover the services that are being billed for by the provider.

A) accuracy
B) completeness
C) outcomes
D) reimbursement

Question 6

_________________________is a statement that describes in detail any symptom, problem, condition, or diagnosis that prompts the physician to ask the patient to return for a visit, or the reason the patient is in the physician's office for a visit.

A) Chief complaint
B) History of present illness
C) Review of systems
D) Medical decision-making

Question 7

______________________is a description of the patient's illness from the initial sign or symptom in previous encounters and to those symptoms that lead up to the present encounter for the patient.

A) Chief complaint
B) Discharge instructions
C) Review of systems
D) Medical decision-making
E) History of present illness

Question 8

______________________________ is where the physician, or other providers, take an inventory of the patient's body systems by questioning the patient on what things they may have been experiencing recently or have experienced in the past.

A) Review of systems
B) Chief complaint
C) Discharge instructions
D) Medical decision-making
E) History of present illness

Question 9

The components of _________________________________ are focused in three areas, which are a past history of a patient's illness and any treatment or surgical procedures that were done in the past.

A) past family and/or social history
B) chief complaint
C) review of systems
D) medical decision-making
E) history of present illness

Question 10

In HCC coding, all diagnoses are _____________________ to reflect the current status of the patient's chronic conditions.

A) drilled down
B) not uncomplicated
C) at the appropriate level
D) drilled down and at the appropriate level
E) drilled down, not uncomplicated, and at the appropriate level

Question 11

The assignment of ICD-10-CM codes are entirely based on ___________________, and the medical records must be authenticated.

A) the EHR
B) clinical documentation
C) reason for visit
D) all diagnostic tests ordered

Question 12

A practitioner should not use __________________ when describing a known active condition.

A) "due to"
B) "in remission"
C) "history of"
D) "cut and paste"

Question 13

A practitioner should not use "history of" when describing a condition that is:

A) in remission.
B) new.
C) chronic.
D) cut and paste.

Question 14

A practitioner should make sure that all documentation in the patient's medical record is unique to the encounter and not use:

A) "due to."
B) "in remission."
C) "history of."
D) "cut and paste."

Question 15

The risk scores are determined by the diagnosis codes that are captured during a primary care physician office visit.

Question 16

The HCC Model is comprised of approximately 9000 ICD-10 Codes that represent Chronic Diseases.

Question 17

In general, the documentation in a medical record in a paper format needs to be complete and legible.

Question 18

In general, if the patient has a below-the-knee amputation that is documented in the patient's chart, the coder should use code Z89.512 for Acquired Absence of Left Leg Below Knee.

Question 19

In coding the BMI, a coder can report the BMI without an accompanying weight-related diagnosis.

Question 20

When coding a record that consists of a chronic condition, such as CKD, the ICD-10-CM coding guidelines tell a coder that they can't assume a causal link between most systemic disorders that a patient may have and diabetes.

Question 21

If a patient has a history of a malignant neoplasm of the prostate, the coder should use a "Z" code showing this is a history and not actively being treated.