1.   A patient with noninsulin dependent diabetes mellitus is admitted to the hospital with pneumonia. The patient's sputum culture shows Group A streptococcus pneumonia.His admission blood glucose is 180. During the hospital stay, the patient's pneumonia is treated with parenteral antibiotics, and he is continued on his usual oral antidiabetic drug. On discharge, the physician documents "streptococcus pneumonia" and "diabetes" as the final diagnoses.  What is the correct coding and sequencing of the final diagnoses?

A. 482.31  Pneumonia, due to Streptococcus, Group A

     250.00  Diabetes mellitus without mention of complication, Type II

B. 486       Pneumonia, organism unspecified

     041.01  Streptococcus, Group A

     250.00  Diabetes mellitus without mention of complication, Type II

C. 482.31  Pneumonia, due to Streptococcus, Group A

     250.92  Diabetes mellitus, unspecified complication, Type II, uncontrolled

D. 041.01  Streptococcus, Group A

     250.00  Diabetes mellitus, unspecified complication, Type II

2. A patient is admitted to the hospital with the diagnosis of "chest pain, rule-out myocardial infarction."On day two of the patient's hospitalization, in addition to the physician's progress notes, what diagnostic test result would be reviewed by the coder to determine whether the patient actually had a myocardial infarction?

A. BUN

B. Chest x-ray

C. CPK isoenzymes

D. PT/PTT

3. Which of the following punctuation marks are used by ICD-9-CM to identify nonessential modifiers that have no effect on the assignment of a code?

A. braces

B. brackets

C. colons

D. parentheses

4. When coding multiple wound repairs using CPT, what action should the coder take?

A. Code all wound repairs, listing the most complex repair first on the claim.

B. Code only the most complex repair.

C. Code only the least complex repair.

D. Code all repairs of the same site using the code for the most complex repair.

5. If a patient is receiving hyperalimentation, the chart will contain an order for

A. liquid diet.

B. tube feeding

C. enteral nutrition.

D. parenteral nutrition.

6. A clinical monitoring criterion requiring a fasting plasma glucose concentration above 140 mg/dL would support a diagnosis of

A. parathyroidism.

B. hyperlipidemia.

C. diabetes mellitus.

D. diabetes insipidus.

7. Which of the following best describes rhabdomyoma?

A. malignant tumor of bone marrow

B. benign tumor of voluntary muscle

C. benign tumor of squamous epithelium

D. malignant tumor with lymph node metastasis

8. Which of the following is the correct coding and sequencing for a patient seen in the emergency department for coma due to accidental overdose of prescribed diazepam (Valium), a benzodiazepine-based tranquilizer?

A. 780.1     Coma

     969.4     Poisoning by benzodiazepine-based tranquilizer

     E853.2  Accidental poisoning by benzodiazepine-based tranquilizer

B. 969.4     Poisoning by benzodiazepine-based tranquilizer

     780.01   Coma

     E853.2  Accidental poisoning by benzodiazepine-based tranquilizer

C. 969.4     Poisoning by benzodiazepine-based tranquilizer

     780.01   Coma

     E939.4  Adverse effects in therapeutic use of benzodiazepine-based tranquilizer

D. 780.01   Coma

     969.4     Poisoning by benzodiazepine-based tranquilizer

      E850.3  Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents

9. A hospital employee is a patient in the hospital.   Which of the following individuals working at the hospital must have a written authorization from the patient prior to reviewing the medical record?

A. a respiratory therapist treating the patient

B. a representative from the human resource department

C. a physician consulting on the patient's case

D. a utilization review nurse

10. The following data regarding medication errors have been gathered:

Which of the following graphs would be most appropriate to show the effect of each type of error on the total number of errors?

A. histogram

B. pie chart

C. run chart

D. scatter diagram

11. Which of the following is a sentinel event?

A. a meal tray delivered late

B. average patient waiting time in the ER greater than 30 minutes

C. patient dies on the operating table while undergoing a tonsillectomy

D. infection due to an indwelling catheter

12. Given the following statistical data, what is the average daily census for adults and children at Community Hospital, a 275-bed hospital with 40 bassinets, in the month of January?

A. 226

B. 232

C. 252

D. 265

13. In a study of laboratory test delays, the data revealed the following:

     56% were related to improper labeling of the test requests

     30% were caused by phlebotomist error

     11% were caused by reporting errors

       3% were due to miscellaneous causes

Which graph would best illustrate the highest priorities for improvement?

A. run chart

B. pictograph

C. Pareto chart

D. scatter diagram

14. Where would a health information management professional find abstracting requirements for a cancer registry?

A. American Cancer Society

B. Medicare Conditions of Participation

C. Commission on Cancer of the American College of Surgeons

D. Joint Commission on Accreditation of Healthcare Organizations

15. A nursing home resident, who has been declared incompetent by the court, requires a gastric endoscopy.From whom would informed consent be obtained?

A. legal guardian

B. attending physician

C. administrator of the nursing home

D. judge who signed the incompetency order

16. Which of the following demonstrates the personal use of a health record?

A. A committee reviews a sample of surgical cases.

B. A physician requests a record for a study on cholecystectomies.

C. The Social Security Administration asks for verification of a birth date.

D. A health information management professional uses a record to compile statistics.

17. A patient is admitted on September 1, 2001, and discharged September 4, 2001. A signed release form dated August 8, 2001, is received for this admission.The release-of-information clerk should

A. honor the patient's authorization.

B. ask the physician for authorization.

C. obtain the patient's authorization dated after the discharge.

D. ask the hospital attorney for permission to release the records.

18. The Director of Nursing asks the health information management professional how often home healthcare treatment plans must be reviewed.What source would be used to answer this question?

A. Medicare Conditions of Participation

B. National Committee for Quality Assurance standards

C. American Association of Retired Persons' position statement

D. Commission on Accreditation of Rehabilitation Facilities' requirements

19. The quality manager in a health maintenance organization wishes to know the total number of enrollees that receive an annual influenza vaccination.This information would most likely be found in which of the following databases?

A. master patient index

B. claims management system

C. referral tracking system

D. provider profile

20. At City Hospital, records not complete within 30 days of discharge are considered delinquent. As of June 1, which physician had the greatest number of delinquent records?

A. A

B. B

C. C

D. D

21. The transcription supervisor could use which of the following performance measures to evaluate the competency of the staff?

A. percent of operative reports dictated within one hour of the procedure

B. percent of discharge summaries lacking a final diagnosis

C. number of emergency records that are handwritten by physicians

D. number of reports with misspelled medical terms

22. The standard for a coding section of a health information department is to code records within three days of discharge.The section meets the standard only 36 percent of the time.The section members have identified this situation as a target of their quality improvement efforts.Which of the following tools could the section use to identify potential reasons why the standard is not being met consistently?

A. cause and effect diagram

B. decision matrix

C. Pareto chart

D. scatter diagram

23. Which of the following is an example of a POLICY that is to be followed in a health information department?

A. Records of deceased patients are located in the pathology department.

B. Information will not be released from the medical record without authorization.

C. Verify receipt of all records of discharged patients.

D. Record the medical record number on each page of the record.

24. Even though it is difficult to evaluate the outcome of a training program, an effective evaluation method is to

A. develop training objectives.

B. ask the employee for feedback.

C. conduct a before-and-after comparison.

D. monitor employee performance after training.

25. To determine from a series of patient records which cases had documentation of abnormal leukocyte counts, the technician should review which of the following reports?

A. urinalysis

B. electrocardiography

C. pathology

D. hematology