Ethical and Legal Considerations in Medical Coding: Quizzes and Practice

Question 1

Which of the following is NOT considered protected health information (PHI) under HIPAA regulations?

Accepted Answer

Highest level of education attained

Answer

Patient's full name

Answer

Date of birth

Answer

Social Security number

Question 2

What is the primary purpose of the OIG Compliance Program in healthcare?

Accepted Answer

Prevention of fraud and abuse

Answer

Ensuring the accuracy of medical coding

Answer

Investigating patient complaints

Answer

Providing guidance to healthcare providers

Question 3

Which of the following actions does NOT constitute a violation of HIPAA?

Accepted Answer

Accurately coding patient diagnoses and procedures

Answer

Disclosing patient information without consent

Answer

Using patient information for marketing purposes

Answer

Storing patient records in an unencrypted format

Question 4

What term describes the process of assigning codes to patient diagnoses and procedures?

Accepted Answer

Medical coding

Answer

Billing

Answer

Transcription

Answer

Medical record keeping

Question 5

Which modifier is used to indicate a procedure performed on the left side of the body?

Accepted Answer

LT

Answer

RT

Answer

50

Answer

59

Question 6

What is the appropriate action for a medical coder to take when encountering a questionable diagnosis or procedure in a patient's medical record?

Accepted Answer

Contact the provider for clarification

Answer

Correct the code without consulting the healthcare provider

Answer

Ignore the questionable information

Answer

Assign the code based on their own judgment

Question 7

Which organization is responsible for investigating and preventing fraud in healthcare, including improper coding practices?

Accepted Answer

The Office of the Inspector General (OIG)

Answer

The American Health Information Management Association (AHIMA)

Answer

The Centers for Medicare & Medicaid Services (CMS)

Answer

The Federal Bureau of Investigation (FBI)

Question 8

Upcoding refers to a type of coding violation where:

Accepted Answer

Codes are intentionally altered to reflect a higher level of service than what was actually provided

Answer

Codes are intentionally altered to reflect a lower level of service than what was actually provided

Answer

Incorrect codes are used for a specific procedure or diagnosis

Answer

Multiple codes are billed separately for services that should be bundled together

Question 9

It is considered unethical for a medical coder to alter a medical record to correct a coding error if it would result in a:

Accepted Answer

Financial loss for the healthcare provider

Answer

Benefit to the patient

Answer

Improved accuracy of the medical record

Answer

Simplified billing process

Question 10

Which action does NOT constitute a violation of the confidentiality principle in medical coding?

Accepted Answer

Disposing of medical records in a secure manner

Answer

Sharing patient information with unauthorized individuals

Answer

Accessing patient records without a valid reason

Answer

Using patient data for personal gain

Question 11

How should a medical coder handle an error discovered in a medical record?

Accepted Answer

Notify the physician and seek guidance

Answer

Correct the error without informing the physician

Answer

Overlook the error and continue coding

Answer

Inform the patient directly

Question 12

How do the ICD-10-CM and CPT coding systems contribute to ethical and compliant medical coding?

Accepted Answer

They provide standardized terms and specific coding guidelines.

Answer

They eliminate the need for physician signatures on medical records.

Answer

They protect patient privacy through advanced encryption methods.

Answer

They significantly increase the workload of medical coders.

Question 13

What ethical principle is MOST important for medical coders to follow in their work?

Accepted Answer

Confidentiality

Answer

Cost-effectiveness

Answer

Convenience

Answer

Personal gain

Question 14

What is the primary objective of the Health Insurance Portability and Accountability Act (HIPAA)?

Accepted Answer

To safeguard patient health information privacy and security

Answer

To regulate medical coding as a profession

Answer

To standardize medical billing and coding practices

Question 15

Which of the following is an unlikely consequence of violating HIPAA regulations?

Accepted Answer

Receiving a promotion

Answer

Potential imprisonment

Answer

Revocation of certification

Answer

Imposition of fines

Question 16

What ethical obligation do medical coders have when encountering incorrect or incomplete patient data?

Accepted Answer

Report the discrepancy to the appropriate healthcare professional and document it

Answer

Modify the information to ensure completeness and accuracy

Answer

Disregard the issue and proceed with coding

Question 17

Which action violates the objectivity principle in medical coding?

Accepted Answer

Coding based on the patient's insurance status

Answer

Coding based on the patient's medical record

Answer

Coding based on the patient's symptoms

Answer

Coding based on the physician's orders

Question 18

Why is it crucial to adhere to ethical and legal guidelines in medical coding?

Accepted Answer

To maintain accurate and compliant medical records, safeguard patient confidentiality, and uphold professional integrity

Answer

To accelerate the coding process

Question 19

What is a primary advantage of using standardized coding systems?

Accepted Answer

Promoting consistency and accuracy in medical records

Answer

Enhancing patient outcomes

Answer

Mitigating fraud risk

Question 20

What is the American Health Information Management Association's (AHIMA's) role in medical coding ethics?

Accepted Answer

Developing and enforcing ethical standards for medical coders

Answer

Certifying medical coders

Answer

Providing training and education on medical coding

Question 21

What is the appropriate action for a medical coder to take if they suspect a physician is intentionally falsifying medical records?

Accepted Answer

Report the issue to the appropriate authorities

Answer

Confront the physician directly

Answer

Discuss the issue with a colleague

Answer

Ignore the issue and continue coding

Question 22

A medical coder is reviewing a patient's chart and notices a procedure documented that seems inconsistent with the diagnosis codes. What is the most ethical action for the coder to take?

Accepted Answer

Query the physician to clarify the discrepancy.

Answer

Consult with a fellow coder and code the record according to their opinion.

Answer

Code the procedure based on the physician's documentation, but note the discrepancy in the chart.

Answer

Use a less specific code that seems to fit the documentation.

Question 23

Which of the following actions would be considered a violation of patient privacy under HIPAA?

Accepted Answer

Discussing a patient's diagnosis with a colleague in the hallway.

Answer

Sharing a patient's medical information with their authorized family member.

Answer

Requesting a patient's consent to disclose their information for billing purposes.

Answer

Using a secure electronic health record system to access patient information for authorized purposes.

Question 24

What is the primary purpose of the False Claims Act?

Accepted Answer

To prevent fraudulent billing practices and recover overpayments to healthcare providers.

Answer

To protect patients' rights to access their medical records.

Answer

To establish national standards for electronic health records.

Answer

To regulate the use of medical devices in healthcare settings.

Question 25

A medical coder is aware that a physician consistently upcodes procedures to increase reimbursement rates. What is the most ethical course of action for the coder?

Accepted Answer

Report the unethical behavior to the appropriate authorities.

Answer

Ignore the issue as it is the physician's responsibility.

Answer

Confront the physician directly about their coding practices.

Answer

Document the instances of upcoding and bring them to the attention of the coding supervisor.

Question 26

Which of the following is NOT a key principle outlined in the AAPC Code of Ethics?

Accepted Answer

Prioritizing financial gain over ethical considerations.

Answer

Acting with integrity and honesty in all coding practices.

Answer

Upholding high standards of professional competence.

Answer

Maintaining the confidentiality of patient information.

Question 27

A medical coder receives a gift basket from a physician's office as a thank you for their efficient coding services. What ethical considerations should the coder be mindful of?

Accepted Answer

Accepting gifts from providers may create a conflict of interest and should generally be declined.

Answer

The coder should disclose the gift to their supervisor and let them decide if it's appropriate.

Answer

Gifts are a common courtesy in the healthcare industry and should always be accepted.

Answer

The coder can accept the gift if it is of minimal value and does not influence their coding decisions.

Question 28

Which of the following best describes the concept of "unbundling" in medical coding?

Accepted Answer

Billing separately for procedures that are typically performed together and billed as a single code.

Answer

Using multiple codes to accurately capture the complexity of a medical procedure.

Answer

Coding a procedure based on its intended purpose, regardless of the actual services performed.

Answer

Assigning codes based on the physician's documentation, even if the documentation is unclear.

Question 29

A medical coder is unsure about the correct code to assign for a specific procedure. What resource should they consult first?

Accepted Answer

The official coding guidelines (e.g., ICD-10-CM, CPT) and associated manuals.

Answer

Review the physician's notes and determine the code based on the documentation.

Answer

Ask a colleague for their opinion on the appropriate code.

Answer

Search online forums for similar coding scenarios and advice.

Question 30

What is the primary responsibility of the Office of the Inspector General (OIG) in healthcare?

Accepted Answer

Investigating and combating fraud, waste, and abuse in federal healthcare programs.

Answer

Developing and maintaining the International Classification of Diseases (ICD).

Answer

Setting standards for medical education and training.

Answer

Providing healthcare coverage to low-income individuals and families.

Question 31

Which of the following is a potential consequence of unethical or fraudulent coding practices?

Accepted Answer

All of the above.

Answer

Legal penalties and fines for the coder and healthcare provider.

Answer

Exclusion from participation in government healthcare programs (e.g., Medicare, Medicaid).

Answer

Damage to the reputation of the healthcare provider and the coding professional.