The principal diagnosis is shingles (Herpes zoster). As no specific complications are mentioned in the scenario, the correct code is 053.9, Herpes zoster without mention of complication. The patient's anxiety is an acute emotional response to the stress of the physical illness. This is most accurately captured by code 308.0, Acute reaction to stress, predominant disturbance of emotions. This code is more specific than a general anxiety code because it directly links the condition to a significant, identifiable stressor. The sequencing correctly places the primary reason for the encounter first.

B. 053.9, 308.3, 300.00: This option incorrectly includes multiple and redundant codes for the mental health condition. Coding both an acute stress reaction and an unspecified anxiety state is improper.

C. 053.8, 300.00: This option incorrectly uses 053.8 (Herpes zoster with other unspecified complications), which is not supported by the documentation, and the less specific anxiety code 300.00.

D. 053.8, 308.0: This option incorrectly codes shingles as "with other unspecified complications" (053.8), as the scenario does not describe any complications beyond the typical rash.

1. National Center for Health Statistics (NCHS)

Centers for Disease Control and Prevention (CDC). International Classification of Diseases

Ninth Revision

Clinical Modification (ICD-9-CM). 2013.

Page/Section: Tabular List of Diseases and Injuries. Code 053.9 is defined as "Herpes zoster without mention of complication." Code 308.0 is defined as "Acute reaction to stress

Predominant disturbance of emotions." This supports the selection of the most specific codes based on the provided clinical scenario.

2. Johns

M. L. Health Information Management Technology: An Applied Approach (4th ed.). AHIMA Press. 2013.

Page/Section: Chapter 7

"Clinical Classifications and Coding

" discusses the principle of assigning codes to the highest level of specificity documented. The scenario's description of an "anxiety that occurred as a reaction to the stress" directly aligns with the definition of an acute stress reaction (308.x) rather than a general anxiety state (300.00).

3. University of Illinois Chicago

Department of Biomedical and Health Information Sciences. BHIS 410: Medical Coding I Course Syllabus.

Page/Section: Course materials on "Coding Mental

Behavioral and Neurodevelopmental Disorders" emphasize the importance of identifying the relationship between physical and mental conditions. The guidelines instruct coders to select codes that reflect such relationships

making 308.0 (a reactive condition) more appropriate than 300.00 (a general state).

Under the Medicare hospital Outpatient Prospective Payment System (OPPS), every HCPCS/CPT code is assigned a Payment Status Indicator (PSI). This one- or two-digit alphabetic code is critical as it dictates the specific payment methodology for the service or procedure. For instance, the PSI determines if a service is paid separately under an Ambulatory Payment Classification (APC), if its cost is packaged into another service's payment, if it is not paid under OPPS, or if it is subject to other specific payment rules. This mechanism is fundamental to how the OPPS functions and ensures proper claims processing and reimbursement for outpatient services.

A. geographic practice cost indices: These adjust payments based on regional cost variations for physician work, practice expense, and malpractice insurance, but do not define the payment method for a service.

B. major diagnostic categories: These are broad classifications of diagnoses used in the inpatient prospective payment system (IPPS) for grouping patients, not in the outpatient system for coding.

C. minimum data set: This is a standardized clinical assessment tool used for care planning and reimbursement in long-term care facilities, not hospital outpatient settings.

1. Sayles

N. B.

& Gordon

L. T. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press.

Page/Section: Chapter 17

"Reimbursement Methodologies

" section on "Outpatient Prospective Payment System (OPPS)." The text states

"Each HCPCS code is assigned a payment status indicator (PSI) that establishes how the service is paid under the OPPS."

2. Centers for Medicare & Medicaid Services (CMS). (2023). Medicare Claims Processing Manual

Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS).

Page/Section: Section 10.2

"Payment Status Indicators." This section details that "A payment status indicator is assigned to every HCPCS code" and provides a list of indicators (e.g.

A

C

N

T

V) with explanations of their corresponding payment status under OPPS.

3. Harrington

M. K. (2020). Health Care Finance and the Mechanics of Insurance and Reimbursement. Jones & Bartlett Learning.

Page/Section: Chapter 8

"Reimbursement for Hospital and Other Institutional Providers

" section on "Hospital Outpatient Prospective Payment System." The text explains that status indicators are assigned to HCPCS codes to identify the payment conditions for each service.

ICD-9-CM uses “late effect” (sequela) codes to link a residual condition to its original cause. The Official Guidelines for Coding and Reporting state that when an index entry or table does not supply a specific late-effect code, the coder must report only the code that describes the residual condition itself. No additional code for the original injury or illness is assigned because, without an established late-effect code, the linkage between the cause and the residual cannot be expressed in the classification.

A. Requires a late-effect (cause) code that does not exist; sequencing residual first then cause is permitted only when a valid late-effect code is present.

B. Same issue as A; cannot report an etiology code without an accompanying late-effect code.

D. Coding only the cause misrepresents the clinical reason for the encounter, which is the residual condition.

1. Centers for Disease Control and Prevention & National Center for Health Statistics. ICD-9-CM Official Guidelines for Coding and Reporting

2014

Section I.B.15 “Late Effects

” paragraph 4: “If a late effect code is not available

use only the residual condition code.”

2. American Health Information Management Association. “ICD-9-CM Late Effects Guidelines.” Journal of AHIMA 74(3):64–65

2003.

3. Faye Brown’s ICD-9-CM Coding Handbook

2013 ed.

ch. 3 “Late Effects

” p. 3-8: “When no late-effect code exists

report only the residual condition.”

The supervisor is collecting data on the specific tasks performed by each employee (file clerks and discharge clerk) and, implicitly, the time spent on them over a two-week period. This information is used to create a work distribution chart. This management tool is a matrix that illustrates the tasks performed in a work unit and the amount of time each employee spends on each specific task. Its purpose is to provide a clear picture of the division of labor, identify potential bottlenecks, analyze workload distribution, and highlight areas for process improvement, which directly addresses the supervisor's goal of understanding the situation.

A. A flow process chart tracks the sequential steps, movements, and delays of a single process or form, not the allocation of various tasks among different employees.

B. A movement diagram is a graphical representation of the physical path taken by a worker or object to complete a task, focusing on layout efficiency.

D. A procedure flowchart illustrates the logical steps and decisions within a specific process, but it does not detail which employee performs each task or the time spent.

1. Oachs

P. K.

& Watters

A. (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 29

"Work Design and Performance Improvement

" the text describes a work distribution chart as a tool that "gathers data on work being performed... [it] is useful for capturing data on work being performed

combining tasks performed by each employee

and listing the time spent on each task" (p. 868).

2. Sayles

N. B.

& Gordon

L. L. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 2

"Healthcare Data Management

" explains that a work distribution chart is used to "illustrate the tasks being performed and by whom... to determine if a department’s workload is distributed evenly" (p. 54).

3. University of Illinois Chicago

College of Applied Health Sciences. (n.d.). HIM 451: Management and Business Practices

Lecture 5: Work Design and Productivity. Courseware. The lecture notes define the work distribution chart as a tool to "determine whether a department's workload is distributed evenly" by listing the department's main activities and the tasks performed by each employee.

Strong lateral (horizontal) relationships are characterized by effective communication and coordination between departments or units at the same organizational level. This is most likely to occur when individual departments collaborate to achieve overarching organizational goals rather than focusing solely on their internal objectives. This cooperative spirit breaks down departmental silos, fosters mutual support, and ensures that all parts of the organization are working in concert towards a common mission. Such collaboration is the foundation of an integrated and efficient healthcare facility.

A. vertical relationships are less than adequate.

Weak vertical communication might force lateral workarounds but does not inherently create strong or positive relationships; it often indicates organizational dysfunction.

C. individual departments are only interested in their internal goals.

This describes a "silo mentality," which is the antithesis of strong lateral relationships and leads to fragmentation and internal competition.

D. individual departments avoid one another.

Avoidance signifies a complete breakdown of communication and collaboration, representing the weakest possible state of interdepartmental relationships.

1. Liebler

J. G.

McConnell

C. R.

& Powers

D. A. S. (2021). Management Principles for Health Professionals (8th ed.). Jones & Bartlett Learning. In Chapter 6

"The Organization

" the text explains that coordination is the process of "linking together the activities in the organization to achieve a desired result" and emphasizes that effective horizontal coordination is essential for departments to work together toward common objectives (pp. 128-129).

2. Sayles

N. B.

& Tye

L. L. (Eds.). (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. Chapter 25

"Management and Leadership

" discusses organizational structure and the need for integration across departments. It highlights that effective management ensures "all members of the organization work together to achieve the organization's goals

" which is the essence of strong lateral relationships (p. 836).

Performance improvement (PI) is a continuous, cyclical process. The model shown identifies an opportunity for improvement but omits the critical subsequent steps of implementing a change and then reassessing its effectiveness. A complete PI cycle, such as the widely used Plan-Do-Check-Act (PDCA) model, requires that after an improvement is implemented (the "Do" phase), its results must be monitored and evaluated ("Check" phase) to determine if the desired outcome was achieved. This reassessment is essential to validate the change before the cycle repeats. The provided model lacks this explicit reassessment step.

A. are missing a step requiring regular employee input into the process.

While employee input is a best practice for successful PI, it is not considered a discrete, mandatory step in foundational PI models themselves.

B. are missing a step requiring reporting to the board of directors.

Reporting is a communication or governance function that is an output of the PI process, not a core operational step within the improvement cycle.

D. aren't missing any steps; the model is a good one.

The model is fundamentally incomplete because it fails to include the implementation of a solution and the subsequent evaluation of that solution's effectiveness.

1. Sayles

N. B.

& Trawick

M. H. (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 25

"Quality and Performance Improvement

" the text describes the PDCA (Plan-Do-Check-Act) cycle

emphasizing that after implementing a change ("Do")

the organization must "Check" the results and "Act" on the findings. The model in the question omits these crucial "Do

" "Check

" and "Act" components

which are encompassed by the concept of ongoing monitoring and reassessment of an implemented change.

2. Agency for Healthcare Research and Quality (AHRQ). (2020

January). Plan-Do-Study-Act (PDSA) Cycle. U.S. Department of Health & Human Services. Retrieved from https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html. This official resource outlines the standard four-stage cycle for improvement. It explicitly states that the "Study" (or Check) phase involves analyzing data to determine if the change was effective

a step of reassessment missing from the question's diagram.

3. McLaughlin

C. P.

& Kaluzny

A. D. (2006). Continuous Quality Improvement in Health Care: Theory

Implementations

and Applications (3rd ed.). Jones and Bartlett Publishers. Chapter 4

"Tools and Techniques for Continuous Improvement

" details the Shewhart Cycle (PDCA)

noting that the cycle is not complete without studying the results of a test (Check/Study) and taking action based on those results (Act). This confirms the need for a reassessment phase.

Accepting assignment for Medicare Part B services is a binding agreement where the provider consents to accept the Medicare-approved amount as payment in full. This amount is determined by the Medicare Physician Fee Schedule (MPFS). Consequently, the provider is legally prohibited from "balance billing" the patient, which is the practice of charging the patient for the difference between the provider's usual charge and the Medicare-approved amount. The provider may only collect the annual deductible and the 20% coinsurance from the patient. This protects beneficiaries from excess charges for covered services.

A. Providers are not reimbursed at a premium for accepting assignment; this option incorrectly describes Medicare payment rules.

B. There is no standard 10% bonus added to the MPFS for providers who accept assignment.

D. Both participating (PAR) and non-participating (non-PAR) providers can accept assignment, so this is not a defining characteristic.

1. Centers for Medicare & Medicaid Services. (2023). Medicare Claims Processing Manual

Chapter 1 - General Billing Requirements. (Rev. 12385

11-22-23). Section 30.2.4

"Definition of Assignment

" states

"By accepting assignment

the physician or other supplier agrees to accept the Medicare-approved amount as payment in full for the covered services."

2. LaTour

K. M.

Eichenwald-Maki

S.

& Oachs

P. K. (2021). Health Information Management: Technology and Lifecycles (6th ed.). AHIMA Press. In Chapter 13

"Reimbursement Methodologies

" the text explains that when a provider accepts assignment

they are "banned from balance billing the patient" (p. 435).

3. Johns

M. L. (2020). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 20

"Reimbursement

" clarifies that under the Medicare Physician Fee Schedule (MPFS)

providers who accept assignment agree to accept the Medicare-approved amount and cannot bill the patient for any remaining balance.

The principle of management described is the span of control. This principle refers to the number of subordinates or functional areas that a manager can effectively supervise. The job description explicitly defines the Assistant Director's scope of responsibility by listing the three specific areas (record processing, transcription, and release of information) they will oversee, which constitutes their span of control.

A. specialization: This refers to the division of labor where individuals focus on specific tasks, not the scope of a manager's supervisory responsibilities.

B. centralized authority: This describes an organizational structure where decision-making is concentrated at the top, not the number of areas a single manager supervises.

D. delegation: This is the process of assigning tasks and authority to others, not the definition of the manager's overall supervisory scope.

1. American Health Information Management Association (AHIMA). (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 26

"Management and Leadership

" span of control is defined as "the number of direct reports to a manager" and is a key element of organizational structure.

2. Liebler

J. G.

& McConnell

C. R. (2021). Management Principles for Health Professionals (8th ed.). Jones & Bartlett Learning. Chapter 6

"The Organizing Function

" defines span of management (or span of control) as "the number of immediate subordinates who report to any one manager" and discusses how it shapes the organizational chart.

3. McWay

D. C. (2021). Today's Health Information Management: An Integrated Approach (3rd ed.). Cengage. Chapter 3

"The Role of the Health Information Management Professional

" discusses organizational structure

where span of control is presented as a fundamental principle determining how many employees a manager supervises.

This statement represents an impermissible disclosure of Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The speaker is sharing specific, identifiable health information (Susan's hysterectomy) with another individual (Mary) in a non-professional setting ("at work"). This disclosure is not for the purposes of treatment, payment, or healthcare operations (TPO), nor is there any indication of patient authorization. It is a clear breach of patient confidentiality and a violation of HIPAA.

A. Disclosing a patient's name and room number to a caller who asks for the patient by name is generally permissible under the HIPAA facility directory provision, unless the patient has opted out.

B. This communication is for scheduling a medical procedure, which falls under the category of "healthcare operations" and "treatment," and is a permitted use and disclosure of PHI.

D. This is a communication between two healthcare providers directly involved in the patient's care for the purpose of treatment, which is a fundamental and permitted disclosure under HIPAA.

1. U.S. Department of Health & Human Services (HHS). Summary of the HIPAA Privacy Rule. "A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s protected health information may be used or disclosed by covered entities... A covered entity may not use or disclose protected health information

except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing." The disclosure in option C is not permitted or authorized. (See Section: "Permitted Uses and Disclosures").

2. Code of Federal Regulations. 45 C.F.R. § 164.502 - Uses and disclosures of protected health information: general rules. This section establishes the fundamental principle that a covered entity may not use or disclose PHI except as permitted or required by the subpart. The disclosure in option C is not for TPO and is therefore impermissible.

3. Sayles

N. B.

& Trawick

M. A. (2021). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. In Chapter 5

"Legal and Compliance

" the text discusses impermissible disclosures

noting that sharing patient information in casual conversations outside of a professional need-to-know context is a violation of the Privacy Rule.

4. Code of Federal Regulations. 45 C.F.R. § 164.510 - Uses and disclosures requiring an opportunity for the individual to agree or to object. This regulation specifically covers facility directories (relevant to option A)

permitting disclosure of the individual's name

location in the facility

and condition in general terms

provided the individual has not objected.

According to the ICD-9-CM Official Guidelines for Coding and Reporting, the principal diagnosis is the condition established after study to be chiefly responsible for the patient's admission. Code V30.00, "Single live born, born in hospital," is assigned as the principal diagnosis for a liveborn infant for the birth admission. The other codes listed are invalid as a principal diagnosis. V codes for outcome of delivery (V27.2) and E codes for external causes of injury (E867) are supplementary classifications and are explicitly prohibited from being used as a principal diagnosis. Morphology codes (M9010/0) are from the International Classification of Diseases for Oncology (ICD-O) and describe tumor histology; they are not valid ICD-9-CM diagnosis codes.

A. V27 codes are for the mother's record only to indicate the outcome of delivery and are never permitted as a principal diagnosis.

C. E codes classify the external causes of injuries and poisonings; they are supplementary and can never be assigned as a principal diagnosis.

D. This is an ICD-O morphology (M) code used by cancer registries to describe cell type; it is not a valid ICD-9-CM diagnosis code.

1. Centers for Disease Control and Prevention (CDC)

National Center for Health Statistics (NCHS). ICD-9-CM Official Guidelines for Coding and Reporting. Effective October 1

2011.

Section I.C.15.a.1 (Newborns): "The appropriate code from category V30

Liveborn infants according to type of birth

is assigned as the principal diagnosis for a normal newborn on the birth record." (Supports correct answer B).

Section I.C.11.a.10 (Outcome of Delivery): "A code from category V27

Outcome of delivery

should be included on every maternal record when a delivery has occurred. These codes are not to be used on the newborn’s record. A code from category V27 is not to be used as a principal diagnosis." (Supports why A is incorrect).

Section I.C.19.a (General E Code Guidelines): "These codes are never to be recorded as a principal diagnosis (first-listed in noninpatient settings)." (Supports why C is incorrect).

2. Sayles

N. B.

& Gordon

L. A. (2016). Health Information Management Technology: An Applied Approach (5th ed.). AHIMA Press.

Chapter 6

Basic Coding Principles: This chapter details the Uniform Hospital Discharge Data Set (UHDDS) definition of a principal diagnosis and the specific rules for supplementary classifications. It explains that E codes and certain V codes cannot be used as the principal diagnosis

while V30 codes are used as the principal diagnosis for newborns.

3. Indiana University

School of Informatics and Computing. HIM-M 330 Medical Terminology Course Materials.

Module on ICD-9-CM Coding: Courseware for this program consistently teaches that E codes are supplemental and cannot be a principal diagnosis

and that V30 is the correct principal diagnosis for a newborn admission

aligning with official NCHS guidelines. (Supports the overall rationale).