IP Coding 2014 Assessment
Name: ________________________
Complete the following questions before submitting your completed assessment:
Please record the length of time in hours and minutes it took for you to complete this
competency evaluation:
Time:
Date Taken:
What coding resource did you utilize to complete the evaluation? For example, ICD-9CM code books, CPT code book, 3M encoder, Ingenix encoder, etc.
ICD-9, CPT & 3M
What reference materials did you use to assist you in completing the competency
evaluation?
Coders desk reference, internet searches.
INSTRUCTIONS FOR
COMPLETION
Please read all instructions carefully
1)
Use the most current edition of the coding books when answering the questions.
2)
Record all codes legibly in the spaces provided.
3)
Be sure your name or initials are on every page of the evaluation.
4)
Email or fax your completed competency evaluation to:
Prospective Payment Specialist
easy@ppscompliance.com or marissa.smith@ppscompliance.com
FAX: 310-563-1813
PPS CODING ASSESSMENT
Be sure to read each question thoroughly. Assign all applicable ICD-9-CM
diagnoses and procedures. E codes and V codes should be assigned when
applicable. Use 2014 Coding Guidelines and assign discharge dispositions and
POA assignments
PART I: INPATIENT CODING
1. Mr. Jones is an 89 year old male admitted to the facility with severe shortness of breath. He was
found to be in septic shock, acute on chronic renal failure, and COPD exacerbation. He has a
history of hypertension diabetic neuropathy and post-polio syndrome. He was intubated and
started on mechanical ventilator of 36 hours. After removal from the ventilator Mr. Jones
reported slurred speech as well as hemiplegia of his right side. He was taken for an MRI which
revealed an acute cerebrovascular accident. Five days later he was deemed stable for discharge
to the skilled nursing floor.
Diagnosis:
Procedure:
Discharge disposition:
2. Mr. Wright is a 58 year old farm hand whom was in the upstairs level of the barn retrieving hay
when he fell from the loft door 20 feet to the ground. He was air lifted to our facility. CT scan of
the head revealed Intracerebral Hemorrhage, compression of C2 vertebra, and the patient also
had whole body paralysis. Urinalysis revealed microscopic hematuria upon then abdominal CT
scan was ordered revealing contusion of the kidneys and liver. He has a history of spinal fusion
of the lumbar spine. While in the hospital he developed situational depression and was started
on Zoloft.
Diagnosis:
Procedure:
Discharge Disposition:
3. Allan is a 15 year old male whom wrecked his four wheeler while riding around his family’s
home. He had an open fracture of the tibia and fibula shaft, dislocation of his right shoulder, as
well as closed fracture of his distal radius and ulna of his right arm. The emergency room
performed a closed reduction of the shoulder dislocation. He was taken to the operative room
where debridement of the bone of the open fracture was performed of the tibia then ORIF of
the tibia and fibula. An open reduction internal fixation of the radius and ulna were also
performed. Allan is currently being treated for oppositional defiant disorder and ADHD. He
admitted to marijuana abuse, with daily use, as well as smoking cigarettes daily. He was
discharged home three days later.
Diagnosis:
Procedure:
Discharge Disposition:
4. Chuck is a 35 year old male whom presented to the emergency room with extreme testicular
pain. Upon examination a large mass was found as well as testicular torsion. He was emergently
taken to the operative room where the surgeon removed both testicles. The provider suspected
Chuck had testicular carcinoma which the pathology report confirmed. He had a PICC line
inserted and chemotherapy was started. Chuck was discharged home with home health.
Diagnosis:
Procedure:
Discharge Disposition:
5. Tracy is a 39 year old female that presented to our office with flu like symptoms that seemed to
be getting worse. She was started on Tamiflu. Two days later she had collapsed at home at
which time she was taken to the hospital unresponsive. In the emergency room she had a
seizure which she has no history of and developed respiratory failure. A spinal tap was
performed and she was intubated and ventilated. She was admitted to ICU and remained there
for the next 14 days on the ventilator. A gastrostomy was performed due to severe malnutrition
as Tracy had quit eating or drinking before admission. MRI revealed cerebral abnormalities as
well as the spinal fluid’s initial report was showing gram negative bacteria. It was determined
that Tracy has bacterial encephalitis. She was started on antibiotics which she developed a
diffuse body rash. The antibiotics were then switched and she was given Benadryl. Tracy began
to improve and after a 30 day stay was discharged to a rehab facility.
Diagnosis:
Procedure:
Discharge Disposition:
6. Susie is an 8 year old female admitted to our same day surgery unit for a tonsillectomy for her
chronic tonsillitis. Postoperatively she began to have severe bleeding from the surgical site and
was admitted to inpatient. She was then taken to the operative room where cauterization was
performed. The bleeding stopped. She was monitored an additional 24 hours which no
additional bleeding occurred. She was discharged home with her mother with instructions to
return immediately if bleeding occurs again.
Diagnosis:
Procedure:
Discharge Disposition:
7. Betty is an 89 year old female who resides at the nursing home. She has had severe diarrhea and
abdominal pain for the past few days. She was sent for testing and admission. Betty tested
positive for C. diff colitis and was also dehydrated. Flagyl was started and she had intravenous
hydration. Betty has a long medical history of hypertension, BKA, legal blindness, and breast
cancer. Seven days later Betty was returned back to the nursing home in stable condition.
Diagnosis:
Procedure:
Discharge Disposition:
8. Sally is scheduled for a total knee replacement. She has a known diagnosis of DJD of the knee.
Postoperative labs revealed acute blood loss anemia which was treated with a red blood cell
transfusion. Sally was discharged to the skilled nursing center.
Diagnosis:
Procedure:
Discharge Disposition:
9. Alicia is a 38 year old bipolar female that overdosed on Alcohol, Xanax, and Seroquel in a suicide
attempt. Alicia is a known alcoholic drinking Rum daily. Three days into the stay Alicia developed
delirium tremens. She requested discharge to the psychiatric center to further undergo her
depressive state. The provider documented her as having severe bipolar disorder depressed
recurrent with psychosis.
Diagnosis:
Procedure:
Discharge Disposition:
10. Misty is a 28 year old female admitted in active labor. She is 39 weeks pregnant and her water
broke at home. She had some decelerations on the monitor that the provider was monitoring
when she stated she felt the urge to push. When the infant presented there was a tight nuchal
cord around the infant’s neck which was quickly reduced. One more push and the infant was
delivered, inspection revealed Misty to have a 2nd degree laceration that was sutured. She was
discharged to home with her daughter the next day.
Diagnosis:
Procedure:
Discharge Disposition:
11. Brooklyn is a newborn born at 39 weeks gestational age by natural delivery. She was
administered her Hepatitis B vaccination and discharged home with her mother.
Diagnosis:
Procedure:
Discharge Disposition:
12. Rick is a 45 year old male admitted with abdominal pain. Rick was diagnosed with Acute on
Chronic Pancreatitis. Rick is HIV positive. He also is a known smoker. He was treated and
released to home.
Diagnosis:
Procedure:
Discharge Disposition:
13. Ellen is a 93 year old female admitted with altered mental status. Blood cultures revealed E. Coli.
Urine cultures also revealed E. Coli. Ellen was started on intravenous antibiotics for E. Coli Sepsis
and UTI. Ellen currently takes steroids on a daily basis for treatment of her Rheumatoid Arthritis.
She also takes Plavix for her history of pulmonary embolism and DVT’s. Three days into the stay
Ellen developed difficulty breathing at which time the provider stated she has aspiration
pneumonia. Ellen was eventually discharged home with home health.
Diagnosis:
Procedure:
Discharge Disposition:
14. Sam presented to the ER with shortness of breath. A BNP showed 8,000 and chest xray showing
CHF. Dr. Cardiology stated that Sam once again has acute on chronic systolic chf due to noncompliance with his Lasix. Sam has COPD which he uses daily bronchodilators. He also has
hypertensive heart disease with stage 4 renal failure. Sam signed out AMA three days into his
stay.
Diagnosis:
Procedure:
Discharge Disposition:
15. Jane is a 54 year old female with severe crushing chest pain and back pain. EKG revealed Non ST
myocardial infarction. She was taken to the cardiac catheterization suite where a left heart
catheterization, bilateral angiography, and left ventriculogram showed 80% CAD of her LAD and
95% CAD of her RCA. At which time overlapping drug eluting stents were placed within the RCA
and a drug eluting stent was placed in her LAD. She has a family history of premature CAD,
tobacco abuse, hypercholesterolemia being treated with Lipitor. Three days later she was
discharged home.
Diagnosis:
Procedure:
Discharge Disposition: