Name: 

The annual budgeted amount for office supplies is $7,000.  As of September the department spent $5,400.  Calculate the variance for office supplies

The medical transcription unit is open Monday through Friday during the day.  It is responsible for transcribing an average of 200,000 lines of dictation in each four-week period.  The transcription minimum productivity standard for this unit is 1,000 lines per day.  How many FTE (full-time equivalent) transcriptionists are needed to staff this unit?

Finding easier/better ways to perform work is called work:

The HIM director is concerned about backlogs occurring in the technical area.  Which management tool would the director utilize to determine the amount of time employees currently spend on various activities?

The HIM department occupies a large closed area on the first floor of the hospital.  Both the main section of the department and the filing area are within this closed area of the first floor.  Which would be the most appropriate transportation system for use between the main section and the file area?

The HIM manager performed a one-day work sampling of a file clerk’s activity.  Of 300 tasks observed, the employee speaks on the telephone 76 times.  How much of the employee’s time is spent on the phone if the employee works seven (7) hours per day?

A coding supervisor has received permission to expand her unit by one extra person.  She has a small, but steady, backlog of discharged records to be coded.  Her coders, all excellent employees, handle all of the functions of the unit, including answering the telephone, making copies of face sheets to be forwarded to the billing office, and analyzing the records for deficiencies.  The supervisor also performs some coding when time permits.  The coding supervisor should hire a(n):

Which is the correct sequence for performing a health information department QM study?

The hospital needs to expand the current filing space of 18,225 filing inches to allow for an additional 3,250 filing inches.  They are buying all new shelving for their records.  Each new shelving unit has 8 shelves, each measuring 36 inches.  The total number of shelving units needed is:

A court ordered subpoena duces tecum issued to a hospital is signed by the:

A 17-year-old patient requests her patient record be sent to her insurance company; the R.H.I.T. would:

Using the case mix analysis below, identify the physician who costs the hospital the most money under the DRG system.
            DRG #5 - Reimbursement Amount $2,690.00
Physician           # of Patients                   Average Cost/Case                Total 
       A                         40                                    2,410                           96,400
       B                         27                                    2,990                           80,730
       C                           6                                    2,280                           13,680
       D                         15                                    3,004                           45,060

The release of information from records at an alcohol-drug abuse center:

Which procedures that alert systems managers that unauthorized access to a computer is being attempted?

Written authorization for release of information from a deceased patient’s record could be signed by the:

The R.H.I.T. receives a subpoena duces tecum on a current inpatient.  There are no previous hospitalizations for this patient.  The R.H.I.T. would:

Malpractice is a form of:

In the litigation process, the summons advises the defendant that:

During the trial, a jury decides questions of:

Willful disregard of a subpoena is punishable as:

A person against whom an action is brought in a lawsuit is the:

A patient comes to the physician’s office complaining of a wart on his foot.  The physician recommends removal.  The patient sits on the examining table and raises his foot.  This is an example of:

A court assigns a person to “stand in the place of parents and possess their legal rights toward a child.”  This is called:

Authority delegated to a subordinate should be commensurate with:

A transcription unit supervisor decides that an error rate of 2% or less is acceptable (no more than 2% of the lines transcribed may contain errors).  After proofreading a sample of work, it was determined that 2,586 lines of dictation contained 156 lines with errors.  This unit has:

A job description should undergo revision:

Which is the usual first step in applying discipline for a first offense?

The essential items that should be recorded by all data systems to provide a complete picture of the inpatient’s stay are referred to as the:

As director of the health information management department, you manage the department through four (4) supervisors who collectively supervise all of the department’s functions.  One day you notice a senior coder quickly code a discharged patient’s record from the face sheet and then turn to the next record.  She codes again from the face sheet and turns to a third record.  You should discuss the problem with the:

Which computer system network uses a series of computers which directly communicate with one other without passing through a central host CPU?

In order to be useful, data must be:

A computer program which uses clinical information to assign inpatients to DRGs is called a(n):

Mary Smith was assigned patient number 35-36-49 on her previous admission.  The latest number assigned by the admitting office to a patient was 44-48-52.  If the unit numbering system is used, the number assigned to Mary Smith the next time she is admitted to the hospital will be:

Which of the following systems is utilized when a patient is readmitted to the hospital, is assigned a new medical record number, and has old medical records merged with the new medical record?

Whch is the part of the computer that contains instructions for storing, manipulating, and retrieving data?

Which lists all patients admitted to the facility in chronological order?

Which is a comprehensive medical information system for ambulatory care which allows for the capture and storage of narrative medical information?

In which system would downtime be a major disadvantage?

Which device converts digital computer signals to analog signals and transmits them over telephone lines?

Who has final responsibility for the completion/accuracy of the record?

In long term care facilities, restraints may be used:

The nurse should document the reason for administration of:

Concurrent occurrences screening provides for the identification of:

Virginia is the health information technician who performed analysis on charts of patients discharged the previous day.  To be sure she had all of the discharged patient charts, she needs to:

JCAHO standards require that if a complete history and physical has been obtained within ____ prior to admission, a durable, legible copy may be used on the inpatient medical record provided there is no significant change(s) recorded at the time of admission.

Dr. Jones, the consulting physician on the Smith case wrote this note in the medical record: 7/15/92 2:30 p.m.  I have examined the patient, Jim Smith, and read the medical record.  Mr. Smith is complaining of chest pain and states that it has been getting progressively worse during the past few days prior to admission.  There is no evidence of any similar occurrence in the past.  The patient had cholecystectomy in 1980.  The patient is the manager of a local food distributorship; the patient states that his job is very stressful.  The patient told Dr. Jones that his father died of heart disease.  Complete physical examination was conducted and documented in the medical record.  Dr. Jones also documented a number of recommendations in the medical record.  According to JCAHO standards, the report is incomplete due to lack of a documented:

Which would be documented on a physical examination?

Which diagnosis is based upon symptoms and physical signs of two or more contrasting diseases?

All tissue specimens removed during an operation must be examined thoroughly by a qualified pathologist:

Dr. Doe’s patient was discharged from the hospital on 1/1.  On 1/8, the patient was readmitted with a similar condition.  Dr. Doe wrote a lengthy progress note explaining changes in the patient’s condition since the time of discharge.  The analysis clerk marked “H&P lacking.”  Upon evaluation, the clerk was:

Marge Voltz was treated in the hospital for varicose veins and was discharged 5/13.  After returning to work full time, she developed complications and was readmitted on 6/9 for additional treatment of this painful condition.  Her attending physician should document a(n):

Each week Dr. Blue brings a rubber signature stamp to the medical record department.  He gives it to his secretary and tells her to use it to stamp all of his dictated reports.  This means of authentication is:

In the unit filing system, the file drawers or shelves should not be filled to more than ____ capacity.

The doctor wrote a final entry on the progress notes which read, “11/4 Patient admitted yesterday with slight epigastric pain which has been diagnosed as dyspepsia.  Patient will be discharged today to be followed in my office.”  The analysis clerk marked “discharge summary lacking” on the deficiency slip.  The clerk’s analysis was:

A deficiency slip is completed in the health information management department and attached to the patient’s record.  It is considered:

Monitoring the accuracy of quantitative analysis of health records is illustrated by:

A patient expired October 12.  The pathologist submitted the completed protocol of the autopsy two months later on December 10.  The report was filed:

An automated incomplete record control system is most useful in situations where:

The clerk retrieved a medical record for a physician, completed the medical record requisition form according to the departmental procedure for manual chart tracking.  The clerk then placed the medical record in the physician’s box.  Next, the clerk should file a copy of the requisition form in the:

A record with the discharge date of August 9 is lacking a report and two signatures on September 15.  The medical staff follows JCAHO requirements for chart completion.  This record is considered:

Which numbering system makes it easiest to purge inactive medical records for microfilming?

The combining of information from independently derived sources for individuals, groups, or institutions using a common number is called:

A list of all abstracted cases in a cancer registry, using a consecutive numbering system prefixed by the year of the abstract is housed in the:

A large university medical center which treats inpatients, emergency patients, ambulatory care patients, and hospital clinic patients, has to file and retrieve hundreds of charts each day.  There are ten file clerks employed.  The filing method in use provides for a perfect distribution of records and permits each file clerk to be assigned responsibility for a particular section of the files.  To enhance the quality of patient care, the BEST system to use in this facility is the _______ numbering system.

The Medical Center utilizes the unit numbering system and terminal digit filing.  Of the following Medical Center numbers, which was the most recently assigned by the admitting department?

The 1000 bed Metropolitan Medical Center treats inpatients, emergency patients, ambulatory care patients and hospital clinic patients.  Its medical staff also does a lot of studies and is in constant demand of the records.  The best record tracking system to use would be:

The 1000 bed Metropolitan Medical Center treats inpatients, emergency patients, ambulatory care patients and hospital clinic patients.  Hundreds of charts are filed and retried daily.  Ten file clerks are employed.  The filing method in use provides for a perfect distribution of records and allows each file clerk to be assigned responsibility for a particular section of the files.  Which filing method is utilized by this facility? 

The health information management department in a 700 bed university health care setting provides access to records 24 hours/day, seven days/week.  To best secure the filing area and continue to maintain accessibility, the director of the health information management department should:

Which is the most important consideration in the retention of records?

The 200 bed Medical Center has retained their original medical records for 20 years.  The majority of the medical staff are also on the staff of the nearby 1000 bed teaching hospital.  Because of limited filing space and no money for microfilming, a decision regarding record retention needs to be made.  The best decision would be to:

Which form of microfilm has the greatest storage density?

In computing the infection rate, the ratio is that of infections to:

The mode of 17, 23, 94, 46, 94, 52, and 25 is _________.

Fetal death rate is determined by dividing total number of fetal deaths for the period by total number of:

A fetal death at 28 weeks’ gestation is classified as:

Which would best illustrate the number of times changes occur over a period of time?

A hospital rendered a total of 57,325 service days to adult inpatients during the past year.  It maintained a bed capacity of 250, except during January through March when a 125-bed wing was closed for alterations.  Rounding off to a whole number, calculate the inpatient bed occupancy rate.

The census taken at midnight August 21 indicated that there were 186 patients remaining in the hospital.  On August 22, 13 adults and children were admitted and ten patients were discharged.  Calculate the daily inpatient census for August 22.

The Medical Center reported discharging 8,300 patients during 1990.  The hospital has a bed capacity of 290 and an occupancy rate of 78%.  Calculate the bed turn-over rate.

A hospital discharged a total of 14,485 inpatients in 1987.  Of those discharges, 380 were deaths, 280 of which died over 48 hours.  There were 295 autopsies performed on inpatients, four performed on outpatients and there were nine unautopsied coroner’s cases.  Three of the deaths were from anesthesia.  There were 5, 362 patients operated on and 6,004 anesthetics administered.  There were 110 postoperative deaths. Calculate the net death rate (rounded to the nearest hundredth).

A hospital discharged a total of 14,485 inpatients in 1987.  Of those discharges, 380 were deaths, 280 of which died over 48 hours.  There were 295 autopsies performed on inpatients, four performed on outpatients and there were nine unautopsied coroner’s cases.  Three of the deaths were from anesthesia.  There were 5, 362 patients operated on and 6,004 anesthetics administered.  There were 110 postoperative deaths. Calculate the gross autopsy rate (rounded to the nearest hundredth).

The Medical Center discharged 1,300 adult and child patients and 40 newborns during September.  Total discharge days for these discharged patients was 11,500 for the adults and children, and 270 for the newborns.  The formula for the average duration of inpatient hospitalization for adult and child patients discharged in September is:

The hospital had three deaths on the OB delivered service and one death on the OB aborted service during 1987 when 575 obstetrical patients were discharged or died; the formula for the maternal death rate is:

A patient was admitted to the hospital on April 24 and discharged on May 2.  The total length of stay for this patient is:

Service classifications can be assigned by using all but which of the following methods?

All accredited cancer registries must have an annual follow-up rate of at least:

Predetermined elements against which aspects of quality of care may be measured are called:

In determining problems that should be assessed for QM purposes, identify which should receive priority consideration.

The QM coordinator’s role in medical care evaluation is to:

When a QM study is performed to reassess the effectiveness of corrective action and to determine whether the problem has been eliminated, we are:

Relevant findings from QM activities must be considering during:

Quality managment findings, conclusions, recommendations, actions taken, and results of action must be:

The nuclear medicine department is going to begin review of the appropriate use of various diagnostic modalities.  What is the first step they must take in initiating this topic-specific study?

Identify the basic tool or control mechanism in risk management.

Under PPS, cases with very high costs are called:

When CPT coding, if the index entry reads “Hallus valgus 28290-28299,” this indicates that the coder:

The path taken in a DRG decision tree is influenced by ________.

In ICD-9-CM, which encloses modifiers that may be present or absent in the diagnostic or procedural statement for code assignment?

Baby Boy Baker was delivered at term by cesarean section because of a breech presentation.  On the day after birth he had an umbilical hemorrhage.  The principal diagnosis on the baby’s record would be:

In ICD-9-CM, a poisoning would include a(n):

The patient is seen in the office with abdominal pain. Upon evaluation, the physician determines that the following diagnoses need to be ruled out: appendicitis, cholecystitis, and pancreatitis.  The doctor arranges for inpatient admission.  The primary diagnosis submitted on the office insurance claim is:

Which is a mechanical complication of an internal prosthetic device?

In ICD-9-CM, which of the codes below can be assigned from category V27 (Outcome of Delivery) with category 650 (Delivery in a completely normal case)?

In ICD-9-CM, which is a mandatory cross-referencing direction to look somewhere else for further information?

A patient was admitted after a motor vehicle accident for observation and evaluation for possible intracranial injury, which was ruled out.  Additional injuries included minor bruises and skin abrasions.  The principal diagnosis would be:

In ICD-9-CM, the term “and” in a code title is interpreted as:

A patient was admitted for chemotherapy treatment for adenocarcinoma of the breast.  Following administration of the therapy, the patient became acutely ill with severe nausea and vomiting which led to dehydration.  Medications were given for nausea and vomiting and IV fluids were administered for dehydration.  The patient remained in the hospital five days.  The principal diagnosis is:

A patient was admitted with acute myocardial infarction, and the physician noted in the history and physical exam that the patient was status post cholecystectomy and had been hospitalized one year previously for pneumonia as well as asthma.  No mention of care for these conditions was documented in the inpatient record for this stay.  At discharge, the physician documented the final diagnoses as: acute myocardial infarction, status post cholecystectomy, pneumonia, and asthma.  Which diagnoses should be coded for this case?

The patient was admitted with lower GI bleeding.  The impression was Crohn’s disease.  A lower GI series was followed by a colonoscopy and right hemicolectomy.  The day after surgery, the patient suffered an acute myocardial infarction.  A percutaneous angioplasty followed.  The final diagnoses were listed on the face sheet as myocardial infarction, emphysema, and ulcerative colitis.  Procedures listed on the face sheet were percutaneous coronary angioplasty, hemicolectomy, colonoscopy, and lower GI series.  Identify the principal diagnosis and principal procedure.

The inpatient discharge diagnosis “rule out diabetes mellitus” should:

In ICD-9-CM, the primary arrangement of the Alphabetic Index of Procedures is according to:

In the diagnostic statement, “carcinoma of the lung with metastasis to the brain,” brain is considered:

When coding neoplasms, if the primary site was previously excised or eradicated on a previous admission with no evidence of recurrence of the original primary site and the patient is admitted with a secondary lesion, code the:

Check the coding on the following work sample to determine accuracy and select the appropriate descriptive statement.  You do not need access to coding books.  The physician documented the following on the inpatient face sheet: gastric carcinoma, no evidence of recurrence; closure of gastrostomy performed.  The coder assigned the following codes: V10.04 and 44.62. Which statement below is true.

Gastrointestinal hemorrhage from esophageal varices; cirrhosis of liver.

Patient admitted for follow-up course of IV chemotherapy for ovarian cancer, resected six months ago.

A liveborn infant was delivered spontaneously with mild erythroblastosis fetalis due to Rh incompatibility.  Exchange transfusion was completed via umbilical vein catheterization.

Patient discharged after total knee joint replacement surgery.  During surgery, received 2 units of blood.  Readmitted with complaints of fever, nausea, vomiting, foamy urine; appeared acutely ill.  SGOT was markedly elevated.  HBSAG identified in serum.  She developed hepatic coma; recovery was slow.  Discharge diagnosis: post-transfusion Hepatitis B with hepatic coma.  Hospital course complicated by exacerbation of chronic obstructive bronchitis; responded well to Theophylline and respiratory therapy.

Allergic reaction to penicillin.

Carcinoma of axillary lymph nodes and lungs, metastatic from breast.

Acute lymphadenitis due to AIDS:

Acute schizophrenic episode in schizophrenic patient with previous long-term remission.

Alzheimer’s disease with dementia.

Alcoholism with hypoglycemic reaction.

Gangrene due to diabetes mellitus (IDDM); postoperative dehiscence of stump; previous amputation of four toes on the same limb (1986).  Below-knee amputation of leg.  Resuture of BK stump.

Tuberculosis of lymph node of neck.  Biopsy of cervical lymph node.  Excision of lymph node.

Congestive heart failure due to hypertension.  Chronic renal failure.

Nonunion of tibial shaft fracture.  Patient fell off ladder while painting his house four months ago.

Patient delivered at 40 weeks gestation, male infant LOA.  Routine amniotomy, low forceps, and episiotomy.

Pulmonary insufficiency due to blow to chest.  Patient hit with baseball playing in a game.

99 year old male pulled foley out at nursing home; staff there unable to reinsert.  Blood at urethral meatus following this (probably due to staff reinsertion of foley attempt causing urethral tear).  Negative otherwise.  Patient transported to hospital ED where foley reinserted by RN.  Small amount of blood seen at urethral meatus.  UA reveals RBCs too numerous to count and WBC 15-19 per/hpf.  Patient on Lasix and Cardizem at nursing home for chronic CHF.  No edema or signs of failure noted.  Diagnosis is UTI.

Pt treated for comminuted intra-articular fracture, left distal radius.

Patient diagnosed with benign lipomatous fibroadipose tissue in breasts.

Removal of bilateral breast tumor with frozen section.

1 cm. wide excision of malignant melanoma, left chest wall with split thickness skin graft (200 sq. cm.).  Incision carried down to deep fascia.

Removal of foreign body, right food (deep) and irrigation of foot wound.

Patient underwent right wrist arthroscopy.

Patient underwent right great toe complete amputation because of non-healing right great toe transphalangeal amputation.

Direct laryngoscopy with laser excision of recurrent papillomatosis.

Patient underwent thrombectomy of left forearm AV graft.

Patient underwent removal of pacemaker generator.

Patient underwent rigid esophagoscopy with foreign body removal.

Patient underwent closed treatment by interdental fixation for fracture.