Mrs. Lam was sent from her doctor's office to the outpatient laboratory for a urinalysis. Her insurance company denied the claim, stating that the procedure was not necessary. The healthcare professional reviewed the claim and saw that a urinalysis was ordered, and the diagnosis listed on the encounter form was upper respiratory infection. Why was this claim denied?
What will be an ideal response?
This claim was denied because a diagnosis of upper respiratory infection would not show medical necessity for a lab test to be run on a urine sample. This demonstrates improper code linkage and a lack of medical necessity.
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A day care teacher was bitten on the hand by a toddler and has bruising, swelling, and minor bleeding from the wound. Which one of the following should cause the most concern?
A) The possibility of the child still being dangerous B) Infection of the wound C) Delayed bleeding from the wound D) Uncontrolled swelling of the soft tissues
The EMT is administering oxygen at 95% through a nonrebreathing face mask. He would document this as a FiO2 of:
A) 0.21. B) 0.50. C) 0.95. D) 1.00.
Which of the following is a confirmatory document for coders?
A. HPI B. Physical examination C. Discharge summary D. Physical therapy report
Which would you consider a possible sign of client abuse?
A. A change in personality B. Not having access to cable TV C. Not wanting to wear her or his hearing aid D. Only having two pairs of shoes