Question 1

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

Accepted Answer

HCC (Hierarchical Condition Category) coding is used to accurately reflect the health status of a patient population, which helps in predicting healthcare costs and resource allocation.

Question 2

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

Accepted Answer

The correct answer is 12, indicating that the volume of diagnosis codes that can be tracked is not limited to four or twelve, implying that more than twelve diagnosis codes can be submitted each calendar year.

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.

Accepted Answer

Annual Wellness visits include routine adult health exams, which can be with or without abnormal findings.

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:

Accepted Answer

The nature and amount of physician work and documentation for Evaluation and Management (EM) services can indeed vary based on the type or types of service provided, the place of service, and the patient's status, according to CMS guidelines. This means that all of the options (A, B, and C) are correct, making D the correct choice.

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.

Accepted Answer

Reimbursement is the correct answer because payers require documentation to verify that the billed services were actually provided and are necessary, in order to reimburse the provider.

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.

Accepted Answer

The chief complaint is the primary reason a patient seeks medical attention, described in their own words, and it guides the focus of the healthcare visit.

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.

Accepted Answer

History of present illness (HPI) is a detailed narrative description of the patient's complaints and the evolution of their condition from the onset of symptoms to the present, including the timing, severity, and context of symptoms.

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.

Accepted Answer

The Review of Systems (ROS) is a systematic process where the healthcare provider asks the patient questions about their health and symptoms they might be experiencing across different body systems, to identify any issues that may need further evaluation or treatment.

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.

Accepted Answer

Past family and/or social history involves the patient's past medical history, including illnesses, treatments, and surgeries, as well as family medical history and social factors that may impact health.

Question 10

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

Accepted Answer

In HCC (Hierarchical Condition Category) coding, it's important to capture the full complexity of a patient's condition. This means diagnoses must be "drilled down" to the most specific level possible and coded "at the appropriate level" to accurately reflect the current status of the patient's chronic conditions.

Question 11

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

Accepted Answer

The assignment of ICD-10-CM codes is based on clinical documentation, as it provides the detailed information needed to accurately code the nature of the condition or diagnosis for which the patient is being treated.

Question 12

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

Accepted Answer

"History of" implies that the condition is no longer active, so it should not be used to describe a known active condition.

Question 13

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

Accepted Answer

A "history of" is used to describe a condition that is no longer present.

Question 14

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

Accepted Answer

Using "cut and paste" in medical documentation can lead to inaccuracies and non-unique entries, which can compromise patient care and documentation integrity.

Question 15

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

Accepted Answer

Risk scores are calculated based on diagnosis codes captured during healthcare encounters, including primary care physician office visits, which help in assessing a patient's health status and predicting healthcare costs.

Question 16

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

Accepted Answer

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.

Accepted Answer

Complete and legible documentation in a medical record, regardless of whether it's in paper format or electronic, is essential for ensuring accurate and efficient patient care, facilitating communication among healthcare providers, and meeting legal and regulatory requirements.

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.

Accepted Answer

The code Z89.512 is used to indicate the acquired absence of the left leg below the knee.

Question 19

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

Accepted Answer

According to coding guidelines, a BMI code should only be reported when there is an associated, documented weight-related diagnosis by the provider.

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.

Accepted Answer

The ICD-10-CM coding guidelines specify that there is a presumed cause-and-effect relationship between diabetes and certain chronic conditions, such as chronic kidney disease (CKD), and coders are instructed to code as such unless the documentation clearly states the conditions are unrelated.

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

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

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

____________________ 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.

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:

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.

_________________________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.

______________________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.

______________________________ 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.

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.

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

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

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

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

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

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

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

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

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.

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

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.