mixed
The following codes were submitted to a private insurance company for reimbursement for an established patient with insulin dependent diabetes mellitus who was seen in the office. The patient had a blood test to check his glycosylated hemoglobin. (A1C) Level and a detailed history and physical examination (level 4 Evaluation and Management service) for circulatory problems. Diagnosis code: D51.0 (pernicious anemia) CPT 99214 level 4 established patient EM service CPT 83036 glycosylated (A1C) hemoglobin. This insurance claim would most likely be denied due to which of the following reasons?
A. Upcoding
B. Lack of appropriate HCPCS code
C. Lack of demonstrating medical necessity
D. Lack of appropriate modifier
E. Unbundling of charges
C. Lack of demonstrating medical necessity.
Diagnosis Code D51.0 (Pernicious Anemia) is not a direct match to the patient’s insulin-dependent diabetes mellitus, and it doesn't support the need for the A1C test in the context of diabetes management, unless there's a medically documented reason that justifies it. The insurance company may deny the claim if they feel the tests and services provided are not medically necessary for the patient’s condition.
The process of tapping the body to detect signs of disease is known as which of the following?
A. Palpation
B. Mensuration
C. Auscultation
D. Inspection
E. Percussion
E. Percussion
Percussion is the process of tapping on the body, typically with fingers or a small instrument, to detect signs of disease. This method helps in identifying abnormalities such as fluid in the lungs or air in the abdomen.
Which of the following is the serous membrane that lines the abdomen and covers the viscera?
A. Pleura
B. Meninges
C. Pericardium
D. Perineum
E. Peritoneum
E. Peritoneum.
The peritoneum is the serous membrane that lines the abdominal cavity and covers the internal organs (viscera) within it. It provides support to the organs and helps reduce friction between them.
Which of the following is the time frame in which a Mantoux (PPD) TB test should be read?
A. 2 to 6 hours
B. 7 to 12 hours
C. 13 to 24 hours
D. 25 to 36 hours
E. 48 to 72 hours
E. 48 to 72 hours
E. 48 to 72 hours.
A Mantoux (PPD) Tuberculosis (TB) test should be read 48 to 72 hours after administration. During this time, a healthcare provider will assess the site of injection for any signs of a reaction, such as redness or induration (swelling or firmness), which helps determine whether the person has been exposed to TB
Which of the following urine tests requires special cleansing of the external genitalia during collection?
A. Midstream urine
B. Random urine
C. 24-hour urine
D. First morning urine
A. Midstream urine
Midstream urine collection requires special cleansing of the external genitalia to reduce the risk of contamination from bacteria or debris in the genital area. The patient is instructed to clean the area before collecting the urine midstream, meaning they start urinating into the toilet and then collect the sample during the middle of the urination process.
Which of the following should be the first action of the medical assistant if a patient sitting on the examination table complains of feeling faint?
A. Assist the patient to a supine position
B. Place a pillow behind the patient's back
C. Have the patient move to a comfortable chair with a straight back for support
D. Offer the patient a drink of cool water
E. Administer oxygen
A. Assist the patient to a supine position
If a patient complains of feeling faint, the first priority is to help prevent a fainting episode (syncope) by improving blood flow to the brain. Assisting the patient to a supine position (lying down on their back) helps increase blood circulation to the brain, which can prevent or alleviate fainting.
Which of the following best describes the care of instruments when performing chemical disinfection?
A. Rinse instruments in hot water containing bleach prior to chemical disinfection.
B. Dry instruments prior to placing in the chemical solution.
C. Immerse only the tips of the instruments in the solution
D. Place the chemical solution and instruments in an open container
E. Line the container with sterile gauze before adding instruments.
B. Dry instruments prior to placing in the chemical solution.
This answer refers to the correct procedure for chemical disinfection when using disinfecting solutions. Typically, after cleaning instruments, you should dry them before placing them into a chemical disinfectant. Excess moisture can dilute the disinfectant or interfere with its effectiveness, so it's important to dry instruments thoroughly beforehand.
Which of the following best describes a condition resulting in a sudden discharge of electrical activity in the brain?
A. Bell's palsy
B. Alzheimer's disease
C. Epilepsy
D. Parkinson's disease
E. Herpes zoster
C. Epilepsy
Epilepsy is a neurological disorder characterized by sudden, abnormal electrical activity in the brain, which can lead to seizures. These seizures result from the excessive electrical discharge of neurons and can vary in severity and presentation.
Which of the following factors must exist to constitute a lawful emergency pertaining to consent?
A. The patient is a paraplegic and refuses care following a head contusion sustained in an automobile accident.
B. The patient reports being involved in a bicycle accident and appears to have a fractured femur.
C. The patient is intoxicated and is threatening suicide
D. The patient is a minor who has a broken arm and is admitting to recent use of illegal street drugs.
E. An adult patient has sustained significant blood loss postoperatively and refuses a blood transfusion.
C. The patient is intoxicated and is threatening suicide.
The patient is intoxicated and threatening suicide, which typically would be considered an emergency. The intoxication could impair the patient's ability to give informed consent, and the suicide threat presents an imminent risk to life. In this case, healthcare providers are often allowed to intervene without the patient's consent under emergency medical laws, particularly if the patient is unable to make decisions due to their mental state or intoxication.
Which of the following indicates the appropriate time to send the initial report for a workers' compensation case?
A. At the time the patient is discharged
B. Upon request of the insurance carrier
C. After establishment of the diagnosis
D. Upon request of the patient
E. Immediately after the first visit
E. Immediately after the first visit
In a workers' compensation case, the initial report is typically required immediately after the first visit. This report usually includes details about the patient's injury, symptoms, treatment plan, and the provider's assessment of the situation. It helps document the condition and is used for the claims process, often by the employer’s insurance carrier.
Which of the following is the cranial nerve primarily involved in blindness?
A. Trochlear
B. Oculomotor
C. Olfactory
D. Abducent
E. Optic
E. Optic
The optic nerve (cranial nerve II) is primarily responsible for transmitting visual information from the retina to the brain. Damage to the optic nerve can result in blindness or significant visual impairment, depending on the severity and location of the damage.
Which of the following steps should be taken for a patient who faints and slumps to the floor?
A. Keep the patient's head and shoulder flat and raise the legs
B. Place the patient in the sitting position
C. Roll the patient onto his right side
D. Roll the patient onto his abdomen to avoid aspiration
E. Place a pillow under the patient's head and shoulders, keeping the feet and legs flat.
A. Keep the patient's head and shoulder flat and raise the legs
When a patient faints and slumps to the floor, the goal is to improve blood flow to the brain. This can be achieved by positioning the patient with their head and shoulders flat, and raising the legs to encourage blood to flow back to the head and prevent fainting or help the patient recover more quickly.
Which of the following terms refers to a disease process that has no defined course and is of unknown origin?
A. Idiopathic
B. Etiologic
C. Symbiotic
D. Biologic
E. Diastolic
A. Idiopathic
Idiopathic refers to a disease or condition that has no known cause or origin. It means that the specific cause of the disease is not understood or has not been identified.
Laboratory results indicating an increase in the creatinine and blood urea nitrogen (BUN) levels are consistent with damage to which of the following body systems?
A. Nervous
B. Cardiovascular
C. Respiratory
D. Urinary
E. Integumentary
D. Urinary
Increased levels of creatinine and blood urea nitrogen (BUN) are often indicators of kidney dysfunction. These are waste products that are normally filtered by the kidneys, so elevated levels typically suggest that the kidneys are not functioning properly, which is a key part of the urinary system.
Which of the following is subjective information on a medical record?
A. Social history of smoking one pack a day
B. Palpable liver
C. Atrial fibrillation
D. Blood pressure of 120/74 mmHg
E. Cholesterol level of 155 mg/dL
A. Social history of smoking one pack a day
Subjective information refers to details provided by the patient based on their personal experience, feelings, or history, which cannot be directly measured or observed by the healthcare provider. In this case, the patient's self-reported social history of smoking is considered subjective, as it is based on their account.
Which of the following is a written document that names a person as a proxy responsible for making medical decisions on behalf of a patient who is unable to do so for himself/herself?
A. Durable power of attorney for health care
B. Organ donor card
C. Living will
D. Patient Bill of Rights
E. Do not resuscitate order
A. Durable power of attorney for health care.
A durable power of attorney for health care is a legal document that allows a person (the principal) to appoint someone else (the proxy or agent) to make medical decisions on their behalf in the event that they are unable to do so themselves due to illness, injury, or incapacity.
Which of the following is another term for "adipose"?
A. Fat
B. Lymph
C. Muscle
D. Skin
E. Tendon
A. Fat
"Adipose" refers to fat tissue, which is specialized for storing energy in the form of fat. It also provides insulation and cushioning for the body.
The criteria of establishing "duty owed, dereliction of duty, direct cause, and damages" are used in reference to which of the following situations?
A. Providing emergency treatment to a comatose patient.
B. Terminating a physician-patient contractual relationship
C. Proving negligence
D. Revoking a medical license
E. Keeping a patient on life support systems
C. Proving negligence
The criteria of duty owed, dereliction of duty, direct cause, and damages are essential components in proving negligence in a legal context. These elements help establish whether a healthcare provider or other professional failed in their duty to provide care, resulting in harm to the patient. Here's how each element breaks down:
Duty owed: The healthcare provider has a responsibility to provide a certain standard of care.
Dereliction of duty: The provider failed to meet that standard of care.
Direct cause: The provider’s failure directly caused harm to the patient.
Damages: The patient experienced harm or injury as a result.
Which of the following is objective information relating to a patient's health?
A. Ongoing pain in right lower quadrant
B. Absence of patellar reflex
C. Patient is feeling depressed
D. Dizziness with a headache
E. Intermittent left-sided chest pain
B. Absence of patellar reflex
Objective information refers to data that can be observed, measured, or tested by the healthcare provider, rather than reported by the patient. The absence of a patellar reflex is an observable clinical finding that can be tested during a physical examination and is therefore considered objective information.
Patients are most likely to remember instructions when the medical assistant uses which of the following education methods?
A. Medical terms are emphasized
B. The instructions are written
C. The most important information is saved for last
D. Detailed instructions are repeated several times on a video
E. Instructions are discussed at length face to face
B. The instructions are written
Patients are more likely to remember instructions when they are written down because written materials provide a tangible reference that patients can review later. This allows them to absorb the information at their own pace and reduces the risk of forgetting key details.