RHIA Practice Questions

The CPT® code set makes a clear distinction between primary and secondary repairs. A primary repair is performed on an acute injury, whereas a secondary repair is performed for a failed primary repair or a chronic, neglected rupture. The question explicitly states the procedure is a "secondary Achilles tendon repair." CPT code 27654 is defined as "Repair, secondary, Achilles tendon, with or without graft." This code precisely describes the service rendered. The other options represent different types of procedures (primary repair, debridement) or are for unlisted procedures, which are inappropriate when a specific code is available.

A. 27599: This is an unlisted procedure code, which is only appropriate when a more specific CPT code does not exist for the service performed.

C. 27650: This code is for a primary repair of an acute Achilles tendon rupture, not a secondary repair as specified in the clinical scenario.

D. 27698: This code describes the debridement (cleaning) of tendons in the leg, not the definitive surgical repair of the Achilles tendon itself.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Section: Musculoskeletal System

Leg (Tibia and Fibula) and Ankle Joint

Repair

Revision

and/or Reconstruction Procedures. Codes 27650

27654.

2. Foley

K. L.

& Lovaasen

J. L. (2020). Conquering the RHIA & RHIT Exams. AHIMA Press. Chapter 6: Clinical Classification Systems

Procedural Coding. This text reinforces the principle of selecting the most specific code available that accurately reflects the physician's documentation

distinguishing between primary and secondary repairs.

3. LaTour

K. M.

& Eichenwald-Maki

S. (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. Chapter 12: Healthcare Reimbursement

Section on CPT Coding Principles. The text emphasizes the importance of precise code selection based on procedural details such as primary versus secondary intervention.

A Business Continuity Plan (BCP) is the formal organizational strategy for responding to an unplanned disruption of critical business functions. An unexpected EHR hardware failure is precisely this type of event. The BCP contains predefined procedures, often called downtime procedures, that guide staff on how to continue operations, such as patient care and documentation, using manual or alternative methods until the primary system is restored. Initiating the BCP ensures a coordinated and effective response to maintain patient safety and minimize operational impact during the three-hour outage.

A. An information system strategic plan is a long-term document that aligns technology initiatives with organizational goals, not a plan for immediate crisis response.

B. An implementation plan is a detailed project plan used for deploying a new information system, not for managing an outage of an existing one.

D. Project planning is a general process for managing a specific, time-bound endeavor with a defined scope, not the pre-established organizational plan for handling operational disruptions.

1. American Health Information Management Association (AHIMA). Health Information Management: Concepts

Principles

and Practice

6th ed. Chicago

IL: AHIMA Press

2020: Chapter 11

"Information Governance and Stewardship

" section on "Business Continuity

" explains that a BCP is essential for responding to disruptive incidents like system downtime to maintain operations.

2. Sayles

N. B.

& Trawick

M. H. Health Information Management Technology: An Applied Approach

6th ed. Chicago

IL: AHIMA Press

2020: Chapter 5

"Data Governance and Stewardship

" discusses business continuity as a key component of data stewardship

which includes planning for system downtime to ensure information availability.

3. National Institute of Standards and Technology (NIST). Special Publication 800-34 Rev. 1: Contingency Planning Guide for Federal Information Systems. May 2010: Section 2.2

"Contingency Planning

" details the development of plans to recover from system disruptions. This foundational guide is a key reference in health information management curricula for developing business continuity and disaster recovery plans.

The procedure described is the suture of two ulnar nerves. In the CPT codebook, the section for "Suture of Nerve (Neurorrhaphy)" provides specific codes for this procedure. CPT code 64836, "Suture of one nerve, hand or foot; ulnar motor," is the correct code for the primary procedure on the first nerve. Because a second ulnar nerve was also repaired during the same operative session, the add-on code 64837, "Suture of each additional nerve, hand or foot," must also be reported. This combination accurately reflects the repair of two distinct nerves.

A. 64837: This is an add-on code and cannot be reported by itself; it must accompany a primary procedure code.

B. 64892; 69990: Code 64892 describes a nerve graft, which is a different procedure from a direct suture. Code 69990 is for microsurgery, which was not documented.

D. 64856; 64859: These codes are for major peripheral nerves of the "arm or leg" and are less specific than 64836, which precisely identifies the ulnar motor nerve in the hand.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Chicago

IL: AMA.

Page/Section: Nervous System

Surgery; Codes 64836

64837. The code descriptions specify "Suture of one nerve

hand or foot; ulnar motor" for 64836 and the parenthetical note for 64837 indicates it is an add-on code for each additional nerve.

2. Bowie

M. J. (2022). Understanding Current Procedural Terminology and HCPCS Coding Systems

2023 Edition. Cengage Learning.

Chapter 16: Nervous System: This chapter explains the hierarchy of nerve repair codes

emphasizing the use of the most specific code available and the correct application of primary and add-on codes for multiple nerve repairs in the same anatomical area.

3. AHIMA. (2022). Clinical Coding Workout: Practice Exercises for Skill Development. Chicago

IL: AHIMA Press.

Section: Nervous System Coding Scenarios. This resource provides examples and rationales that reinforce the principle of selecting the most precise CPT code and using add-on codes for additional

distinct procedures performed during the same session.

According to the ICD-10-CM Official Guidelines for Coding and Reporting, signs and symptoms are appropriate for coding when a related definitive diagnosis has not been established or confirmed by the provider. In this case, the patient presented with chest pain, and the suspected diagnosis of a myocardial infarction (MI) was definitively "ruled out." Since the scenario does not provide an alternative established diagnosis, the coder must report the sign or symptom that prompted the encounter. Therefore, coding only the chest pain is the correct procedure. Coding a condition that has been ruled out is a violation of standard coding principles.

A. The myocardial infarction was explicitly ruled out; therefore, it cannot be coded as if it were an established condition.

B. It is incorrect to code a condition that has been ruled out. The MI should not be coded at all.

C. "Impending myocardial infarction" is a specific diagnosis (e.g., unstable angina) that was not documented or established in the scenario.

1. National Center for Health Statistics. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024. Centers for Disease Control and Prevention.

Section I.B.4: "Codes that describe symptoms and signs

as opposed to diagnoses

are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider."

Section IV.H: "Do not code diagnoses documented as 'probable'

'suspected'

'questionable'

'rule out'

or 'working diagnosis' or other similar terms indicating uncertainty. Rather

code the condition(s) to the highest degree of certainty for that encounter/visit

such as symptoms

signs

abnormal test results

or other reason for the visit." (This applies to outpatient settings

and the principle of not coding a "ruled out" condition is universal).

2. Leon-Chisen

N. (2023). ICD-10-CM and ICD-10-PCS Coding Handbook with Answers. American Hospital Association (AHA) Press.

Chapter 2

General Coding Guidelines

Section on Signs and Symptoms: This section explains that if the signs and symptoms are not part of a disease process that has been diagnosed

they should be coded. When a suspected condition is ruled out

the reason for the encounter (the symptom) is coded.

3. Johns

M. L. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press.

Chapter 6

Clinical Classification Systems

Section on ICD-10-CM Coding Conventions and Guidelines: This chapter details the fundamental rule that coders should not assign a code for a condition that the physician has specifically documented as "ruled out." The coder should instead code the existing signs or symptoms.

Insulin is a primary anabolic hormone that regulates glucose metabolism. When blood glucose levels rise, the pancreas secretes insulin, which binds to receptors on target cells (primarily muscle, fat, and liver cells). This binding facilitates the transport of glucose from the bloodstream into the cells. Once inside, glucose is used for energy production through glycolysis or stored as glycogen (glycogenesis) in the liver and muscles. By promoting both the uptake and utilization of glucose by cells, insulin effectively increases the rate of glucose metabolism, thereby lowering blood glucose concentrations.

A. Insulin promotes the conversion of glucose into glycogen for storage (glycogenesis), which increases, not decreases, glycogen concentration in the liver.

B. The principal function of insulin is to lower blood glucose levels by promoting its uptake into cells; glucagon is the hormone that increases blood glucose.

C. Insulin is an anabolic hormone that inhibits the breakdown of fats (lipolysis) and promotes the synthesis of fatty acids and triglycerides for storage.

1. Hall

J. E.

& Hall

M. E. (2021). Guyton and Hall Textbook of Medical Physiology (14th ed.). Elsevier. Chapter 79

"Insulin

Glucagon

and Diabetes Mellitus

" section "Effect of Insulin on Carbohydrate Metabolism

" pp. 982-984.

2. Wilcox

G. (2005). Insulin and Insulin Resistance. The Clinical Biochemist Reviews

26(2)

19–39. Section "Physiological Actions of Insulin

" p. 20

paragraph 2.

3. MIT OpenCourseWare. (2004). 7.012 Introductory Biology

Fall 2004. Massachusetts Institute of Technology. Lecture 26 Notes: Hormones and the Endocrine System. Retrieved from https://ocw.mit.edu/courses/7-012-introductory-biology-fall-2004/resources/lecture-26-hormones-and-the-endocrine-system/ (Specifically discusses insulin's role in promoting glucose uptake and storage).

The Uniform Hospital Discharge Data Set (UHDDS) is the most appropriate resource. It was established by the U.S. Department of Health, Education, and Welfare to create a minimum, common core of data elements for all hospital discharges. It provides standardized definitions for patient-specific data items (e.g., principal diagnosis, principal procedure, other significant procedures) that are routinely collected by acute care hospitals. This standardization is essential for building a reliable and comparable data dictionary, ensuring that data elements are defined and used consistently across the facility and when reporting to external agencies.

A. The Minimum Data Set (MDS) is a standardized assessment tool used for residents in Medicare/Medicaid-certified long-term care facilities, not acute care hospitals.

C. The Conditions of Participation (CoP) are broad federal regulations that facilities must meet to participate in Medicare/Medicaid, but they do not provide a specific list of data elements with standard definitions for a data dictionary.

D. The Federal Register is the official journal for publishing federal agency rules and notices. While it would contain the final rule for the UHDDS, it is the publication vehicle, not the data set standard itself.

1. Oachs

P. K.

& Watters

A. J. (Eds.). (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 5

"Healthcare Data Sets

" the text explicitly states

"The UHDDS is a required data set for acute care hospitals that are Medicare providers... The UHDDS definitions are used by hospitals to report inpatient data elements in a standardized manner." (p. 123).

2. National Center for Health Statistics (NCHS). (1985

July 31). Uniform Hospital Discharge Data Set. Centers for Disease Control and Prevention. The official NCHS page details the purpose of UHDDS as providing "a minimum basic data set... for the collection of uniform information on hospital discharges" and provides the list of data items with their definitions. (Section: "Content").

3. Sayles

N. B.

& Trawick

M. A. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 4

"Data Content and Structure

" describes the UHDDS as the standard for collecting data for Medicare and Medicaid programs in the acute care inpatient setting. (p. 98).

An interrogatory is a formal discovery tool used in litigation that consists of a series of written questions served by one party to another. The receiving party is legally required to provide written answers under oath. This method is used to obtain specific factual information about the case from the opposing party before trial. The term encompasses both the written questions asked and the written answers provided in response.

B. deposition: This is a pretrial discovery tool where a witness provides oral testimony under oath in response to questions from an attorney; it is not written.

C. physical and mental examination: This is a court-ordered evaluation of a party's condition by a medical professional, not a set of written questions and answers provided by the party.

D. court order: This is a directive issued by a judge. While a court order might compel a party to answer interrogatories, it is not the discovery tool itself.

1. Brodnik

M. S.

Rinehart-Thompson

L. A.

& Reynolds

R. B. (2016). Fundamentals of Law for Health Informatics and Information Management (3rd ed.). AHIMA Press. In Chapter 3

"The Legal System

" the section on "Discovery" defines interrogatories as "written questions presented to a party or witness designed to gather information" (p. 61).

2. Oachs

P. K.

& Watters

A. J. (Eds.). (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 23

"Legal Process and E-Discovery

" the text describes interrogatories as "written questions that the parties to a lawsuit send each other to ascertain details of matters at issue in the lawsuit" (p. 718).

3. Johns

M. L. (2015). Health Information Management Technology: An Applied Approach (4th ed.). AHIMA Press. Chapter 4

"The Legal and Regulatory Environment

" explains under "The Litigation Process" that "Interrogatories are written questions that must be answered in writing under oath" (p. 111).

According to the ICD-10-CM Official Guidelines for Coding and Reporting, a poisoning occurs when a substance is used incorrectly. This includes the interaction of a drug taken as prescribed with a nonprescribed substance, such as alcohol. In this scenario, the patient took a prescribed medication (Allegra) with wine (alcohol), and the resulting symptoms are due to this interaction. Therefore, the event is classified as a poisoning, not an adverse effect. An adverse effect would only be applicable if the drug was taken correctly and without any interacting, nonprescribed substances.

B. adverse reaction to a drug: This is incorrect because the reaction resulted from the interaction of a prescribed drug with alcohol, which the official guidelines define as a poisoning.

C. late effect of a poisoning: This is incorrect as the symptoms are acute, occurring immediately following ingestion, not a sequela or late effect from a prior poisoning.

D. late effect of an adverse reaction: This is incorrect because the event is a poisoning, not an adverse reaction, and the effects are acute, not late effects.

1. Centers for Disease Control and Prevention (CDC). (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024. U.S. Department of Health and Human Services. Section I.C.19.e.5.b.i states

"A poisoning is a reaction to the improper use of a medication... Poisonings are also the result of an interaction of a drug(s) and alcohol." (Page 81).

2. American Hospital Association (AHA). (2022). ICD-10-CM and ICD-10-PCS Coding Handbook with Answers. Chapter 21: Injury

Poisoning

and Certain Other Consequences of External Causes. The handbook clarifies that when a patient takes a correctly prescribed and administered drug that results in a reaction due to interaction with alcohol

the condition is coded as a poisoning.

3. Johns

M. L. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 10

"Clinical Classification Systems

" in the section discussing ICD-10-CM coding for poisonings

reiterates the official guideline that a drug-alcohol interaction is classified as a poisoning.

The procedure described is a "revision" of a male sling procedure performed six months prior. In CPT coding, a revision of this nature involves removing the existing device and placing a new one. CPT code 53442, "Removal and replacement of suburethral sling for male urinary incontinence, including placement of new sling," accurately and specifically describes this service. The code for the initial placement (53440) is inappropriate because this is a subsequent, replacement procedure. The other codes describe different types of procedures or devices for treating incontinence or urethral issues.

A. 53449: This code is for the repair of an inflatable urethral sphincter, a different type of incontinence device than the sling mentioned.

C. 53440: This code is for the initial placement of a male sling, not for a revision or replacement of a previously placed one.

D. 53431: This code describes a urethroplasty, which is a surgical reconstruction of the urethra, not a sling procedure for incontinence.

1. American Medical Association. CPT® 2024 Professional Edition. Chicago

IL: AMA Press; 2023. (Code descriptors for 53440

53442

53449

53431 in the Urinary System/Urethra subsection).

2. AHIMA. Clinical Coding Workout: Practice Exercises for Skill Development

2022 Edition. Chicago

IL: AHIMA Press; 2022: 285-290. (Provides practice scenarios and rationale for selecting codes for urological procedures

emphasizing the distinction between initial placement

revision

and removal).

3. Schraudenbach

P.

& Saigal

C. S. (2008). Coding for Male Incontinence and Urethral Stricture Disease. AUA News

13(4)

18-19. (This peer-reviewed publication from the American Urological Association clarifies the appropriate use of CPT codes for male incontinence procedures

distinguishing between initial sling placement and subsequent revisions/replacements).

The current condition, blindness, is a residual effect of a past event. The term "late effect," or sequela, is used to code a condition that remains after the acute phase of an illness or injury has resolved. The initial event was an "allergic reaction" to a correctly administered drug (ampicillin), which is classified as an adverse reaction. Poisoning refers to reactions from improper use of a medication (e.g., overdose, wrong substance). Therefore, the blindness is correctly identified as a late effect of an adverse reaction, as it occurred six years after the initial event.

A. poisoning: This is incorrect because an allergic reaction to a properly administered drug is an adverse effect, not a poisoning.

B. adverse reaction to a drug: This is incorrect because the acute adverse reaction occurred in the past; the current diagnosis is the residual condition (late effect).

C. late effect of a poisoning: This is incorrect because the causal event was an adverse reaction, not a poisoning.

1. ICD-10-CM Official Guidelines for Coding and Reporting FY 2024. Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).

Section I.B.10. Sequelae (Late Effects): "A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated...Coding of sequela generally requires two codes sequenced in the following order: The condition or nature of the sequela is sequenced first. The sequela code is sequenced second." This guideline establishes the principle of coding for a late effect.

Section I.C.19.e.5). Adverse Effect: "When the drug was correctly prescribed and properly administered

code the reaction plus the appropriate code from table T36-T50. The adverse effect is sequenced first." This defines the initial event as an adverse effect

distinguishing it from poisoning.

2. Sayles

N. B.

& Trawick

M. A. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press.

Chapter 6

Clinical Classifications and Coding Systems: This chapter details the fundamental principles of ICD-10-CM coding

including the distinction between an adverse effect (a reaction to a drug correctly administered) and a poisoning (a reaction to a drug taken incorrectly). It also defines a sequela (late effect) as a condition that follows an acute illness

aligning with the correct answer.

3. Indiana University. (n.d.). HIM-M 330 Medical Terminology. School of Informatics and Computing.

Course materials on ICD-10-CM coding principles emphasize that a sequela is a chronic condition resulting from a previous acute condition. The coding requires identifying both the residual effect and the original cause

specifying if the cause was an injury

adverse effect

or other illness. This supports identifying the blindness as a sequela of the past adverse reaction.