PAT Track: Pre – Assessment (V.25)

1. CMS includes these conditions/procedures in their 30-day risk-standardized unplanned readmission measures to grade facilities, and if they have excess readmissions as compared to their peers, a reduction in payment can be applied. Which of the conditions below are used in this calculation (select the condition that is NOT included)?

2. The Medicare Spend Per Beneficiary calculation performed by CMS (choose the ONE best answer)

3. The document that is best suited to streamline care transitions from the hospital stay is the discharge summary. Which of the following are noted as being important in capture of the discharge summary? Select EACH CORRECT answer.

4. You are rounding on a patient with COPD exacerbation. You adjust his nebulizer regimen and add a pulse steroid taper due to persistent wheezing on day two of the hospital stay.  Since there is active management ongoing, you write an order to change him from Observation to Inpatient.  He is not clinically unstable, but he is not progressing as quickly as you wished.  The optimal rounding level for this patient (that you spent 15 minutes in total time caring for) would be

5. You are called to see an 81-year-old current smoker with COPD for admission. You review standard admit labs, films, EKGs and note the oxygen initial saturation of 86% which is now 93% on 3 liters and drops to 90% when speaking.  You look at the EKG yourself and make an interpretation.  You feel the patient should be placed in the hospital in inpatient status due to a tenuous pulmonary state.  The admit status level most appropriate for the medical decision making is

6. Using an NPP in a shared clinical decision-making capacity and billing for such has new rules since 2022. You spend 14 minutes on rounds in review of the PA note and in seeing the patient.  You document a note –“see and agree with above” – even though you have been told that the “medical decision making will drive the charge”.  The billing staff sees the note, realizes the lack of documentation will render only a level one visit at best (99231), but notes that you and the PA both documented your time in the encounter.  In the PA note, she mentions 23 minutes for time to see patient, call family, do a note, and review labs.  The billing staff decides to bill based on total time of 37 minutes.  The 37 minutes allow what level of E&M bulling for this rounding visit?

7. If a patient has aspiration pneumonia, add which of the following to correctly capture the clinical picture and enhance the DRG? Choose the one of the following that is correct.

8. For 2024, new codes were added as comorbidities and complications (cc’s) from a non-cc category. These were derived from the

9. Choose the condition coded to the highest level of severity

10. You have a longstanding Medicare patient (not Medicare Advantage) come in with COPD exacerbation. He is not on oxygen at home, and his sats were 77% on RA and did not stabilize until he was placed on BiPAP.  This presentation is as before, and he usually stays 4-5 days before stabilizing enough to return home (and most of these hospitalizations requiring BiPAP). He refuses mechanical ventilation and has this noted on his chart.  You expect this admission to be as previous and to stay more than two midnights, so you ordered for inpatient care on admission.  The patient responded more quickly than expected and on the evening rounds of day two, asked to go home.  He is on room air, ambulates with stable vitals, and amazingly seems back to baseline.  His family came into town this morning and are here to visit him. They agree to watch over him and to get him into his PCP tomorrow morning or call back tonight if he worsens.  Clinically, you agree with his request, and you feel good about the discharge plan. Because the patient did not pass two midnights, you should

11. A surgical procedure was admitted electively as “inpatient” for a procedure that is on the “Inpatient Only” list. After the procedure, the Attending Surgeon states she disagrees with that determination because the procedure was “not that hard” and the patient will be going home first of next morning, before the second midnight. You have knowledge of inpatient and observation status determination, so you offer to help her work through this process.  You recommend for her to

12. The CMS Medicare Advantage (MA) Final Rule in 2023 was released partly because

13. A 59-year-old female presents with non-exertional mid-sternal chest pain that is non-radiating. Her EKG is NSR, 82, and otherwise is normal. The pain started 3.5 hours ago and did not resolve with rest. She has no cardiac risk factors except for a mother who died of an acute MI at the age of 86. She does not smoke. Her BMI is 30. Additional work up in the emergency department showed normal labs and the cardiac enzyme test – a high-sensitivity cardiac troponin (hs-cTn) – with a limit of quantitation (LoQ) being 4 ng/L.  Clinically, this patient should be

14. Which of the following, if documented correctly, could aid in capturing an inpatient status for the heart failure patient on day ONE? Select all that apply.

15. True statements about heart failure (select the one best answer)

16. Which of the following is FALSE with respect to documentation of respiratory failure?

17. A 77-year-old male with a 60 pack-year smoking history and non-supplemental oxygen requiring COPD presents with SOB x 3d duration. Though not indicative of securing an inpatient status determination on admission, the following information would help in making that inpatient clinical decision:  (choose all that are correct)

18. The following COPD scenarios would merit hospitalization:

19. The National Institutes of Health Stroke Scale (NIHSS) is one tool to use to help determine whether a patient deems to meet medical necessity for inpatient level of care.  Which score below is indicative of such consideration from the 15 elements in the tool? (choose the most correct answer)

20. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He is discharged but did complete an MRI that was already scheduled before leaving (but after discharge) It shows a small ischemic infarct that appears new in the basis pontis.  The most appropriate diagnosis for this hospital stay is

21. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He idid complete an MRI that was already scheduled before leaving that showed a small ischemic infarct that appears new in the basis pontis.  The most appropriate status for this hospital stay is

22. A condition is noted to be an infection-related condition that is causing organ disfunction that is manifesting as hypotension unresolved by fluid resuscitation requiring vasopressors. The lactate level is >2mmol/L after adequate IVF boluses.  This clinical state is best defined as

23. Which of the following is incorrect regarding cellulitis?

24. An 81-year-old female from a local nursing home is being considered for hospitalization due to a UTI. Which of the clinical conditions below lean you towards an observation (instead of an inpatient) status determination?  Choose the single best answer.