Pulmonology

PULMONOLOGY CDI.

You have 45 minutes to complete 45 questions. The test will automatically stop, and the result will be submitted.

Please choose 1 correct option out of 4 for each question.

You will be asked to enter your full name, email address, and WhatsApp number so we can attribute the results to each person.

TVH Pulmonology

1 / 45

To accurately code for Bronchiectasis, the record must specify:

Recurrent episodes of bronchitis requiring multiple antibiotic courses

The presence of an acute exacerbation or associated infection and the suspected etiology

The findings of tram track lines on a high resolution CT scan

The patient's daily volume of productive cough and sputum

2 / 45

When documenting Chronic Obstructive Pulmonary Disease for risk adjustment, the clinician must specify:

The presence of a chronic cough and history of tobacco use

The specific type such as emphysema or chronic obstructive bronchitis and acuity

The patient's most recent FEV1 FVC ratio from spirometry

The number of pack years smoked over the patient's lifetime

3 / 45

To differentiate between Sleep Apnea types for therapy, the clinician must specify:

The number of apneas and hypopneas per hour of sleep

Obstructive or central sleep apnea and the current treatment status

The patient's score on the Epworth Sleepiness Scale

The presence of a high Mallampati score and a large neck circumference

4 / 45

When documenting a Lung Transplant, the record must specify:

A history of bilateral lung transplantation for end stage cystic fibrosis

The transplant status or presence of rejection or infection and the type of transplant

The name of the transplant center and the date of the procedure

The patient's current immunosuppressive medication levels

5 / 45

To support the coding of Chronic Respiratory Failure, the documentation must mention:

The continuous use of supplemental oxygen at home for several years

The baseline hypoxemia or hypercapnia and the stability of the patient's condition

The results of the patient's most recent pulmonary function tests

The presence of a barrel chest and secondary polycythemia

6 / 45

For a diagnosis of Hemothorax, the clinical note must link:

The presence of blood in the pleural space to a traumatic injury

The acute hemorrhage or chronic collection to the specific traumatic or non traumatic cause

The volume of blood drained during the initial tube thoracostomy

The patient's hemoglobin level and the need for a blood transfusion

7 / 45

In documenting Pulmonary Hypertension, the record must link the condition to:

An elevated mean pulmonary artery pressure measured during a right heart cath

The specific WHO group such as Group 1 PAH or Group 2 due to left heart disease

The patient's six minute walk distance and WHO functional class

The presence of right ventricular hypertrophy on an echocardiogram

8 / 45

When documenting Acute Bronchitis, senior documentation should clarify:

A productive cough following a viral upper respiratory infection

The specific causative organism such as due to RSV or Mycoplasma and the exclusion of COPD

The duration of symptoms and the presence of low grade fever

The absence of a focal infiltrate on a chest X ray

9 / 45

To accurately code for Occupational Lung Disease, the clinician should specify:

A history of working in coal mines or with industrial chemicals

The specific dust or agent such as asbestosis or silicosis or berylliosis and chronicity

The findings of small rounded opacities in the upper lobes on X ray

The results of the patient's occupational health screening exams

10 / 45

In documenting a Lung Abscess, the report must specify:

A thick walled cavity with an air fluid level on a chest CT

The etiology such as due to aspiration or specific organism and pneumonia

The response to a prolonged course of intravenous antibiotics

The presence of foul smelling sputum and high grade fevers

11 / 45

For a patient with Sarcoidosis, auditable records must specify:

The presence of hilar lymphadenopathy on a chest X ray

The organ involvement such as pulmonary or skin or cardiac and the current stage

The result of the serum Angiotensin Converting Enzyme level

The findings of non caseating granulomas on a transbronchial biopsy

12 / 45

In documenting a Tracheostomy, senior level documentation should include:

The presence of a surgical airway to facilitate mechanical ventilation

The status such as chronic dependence and the reason for the initial creation

The size and type of the tracheostomy tube currently in place

The patient's progress with a speaking valve or capping trials

13 / 45

When documenting a Pleural Effusion, senior documentation should clarify:

The presence of dullness to percussion on a physical exam

The underlying cause such as malignant or infectious or heart failure and laterality

The results of the LDH and protein levels from a thoracentesis

The estimated volume of fluid based on the blunting of the costophrenic angle

14 / 45

For a patient with Pneumonia, auditable records must specify the laterality, the lobe, and:

The total duration of the patient's fever prior to admission

The causative agent such as viral or bacterial or fungal and the specific type

The appearance of the sputum

The presence of a silhouette sign on the lateral chest X ray

15 / 45

In documenting an Endobronchial Lesion, the operative report must include:

A mass obstructing the right mainstem bronchus seen on bronchoscopy

The location or lobe, the histologic appearance, and the degree of obstruction

The technique used for biopsy such as brushings or washings or forceps

The presence of any associated distal post obstructive pneumonia

16 / 45

To accurately code for Tracheomalacia, the note must specify:

Inspiratory stridor and a barky cough that worsens with agitation

Whether congenital or acquired and the severity of the dynamic airway collapse

The findings of a saber sheath trachea on a chest CT

The percentage of airway narrowing seen during a dynamic bronchoscopy

17 / 45

For a patient with Alpha 1 Antitrypsin Deficiency, the record should specify:

Early onset emphysema in a non smoker with a family history

The genetic phenotype or ZZ MZ status and the presence of associated liver disease

The serum Alpha 1 antitrypsin level and the results of protein electrophoresis

The patient's eligibility for augmentation therapy with prolastin

18 / 45

In documenting Chronic Respiratory Insufficiency, senior documentation should include:

A baseline need for 2 liters of oxygen with activity only

he presence of chronic hypoxemia or hypercapnia that does not meet respiratory failure criteria

The patient's baseline oxygen saturation at rest and on room air

The impact of the condition on the patient's daily functional status

19 / 45

For a diagnosis of Pulmonary Alveolar Proteinosis, the clinical note must include:

A crazy paving pattern seen on a high resolution chest CT

The suspected etiology such as autoimmune or secondary and the need for lung lavage

The presence of opaque PAS positive material in the alveoli

The patient's serum anti GM CSF antibody level

20 / 45

To accurately code for Hypersensitivity Pneumonitis, the note should mention:

Recurrent flu like symptoms after exposure to organic dust or birds

The specific offending agent such as farmer's lung and the acuity

The presence of ground glass opacities and centrilobular nodules on CT

The patient's response to environmental avoidance and steroids

21 / 45

When documenting Chronic Bronchitis, the clinician should specify:

A cough productive of sputum for at least three months in two years

The specific type such as simple or obstructive and the tobacco use status

The presence of cyanosis and peripheral edema

The results of the patient's DLCO testing from their PFTs

22 / 45

For a diagnosis of Pleural Plaque, senior documentation should specify:

Calcified areas on the diaphragm and chest wall seen on CT

The presence of asbestosis or history of asbestos exposure and the location

The clinical absence of pulmonary functional impairment

The difference between parietal and visceral pleural involvement

23 / 45

In documenting a Pulmonary Infiltrate, the record must include:

A new area of increased density seen on a postoperative chest X ray

The specific lobe or laterality and the suspected clinical cause such as pneumonia

The presence of air bronchograms within the affected area

The response of the opacity to a trial of antibiotics or diuretics

24 / 45

When documenting Allergic Rhinitis in a pulmonary patient, the clinician should specify:

Chronic nasal congestion and sneezing during the spring months

The etiology such as perennial or seasonal and the presence of associated asthma

The results of skin prick testing for common environmental allergens

The effectiveness of intranasal corticosteroids in reducing symptoms

25 / 45

In documenting Asthma, senior level documentation must distinguish between:

Childhood onset versus adult onset respiratory symptoms

The severity and frequency such as moderate persistent or intermittent and current status

Allergic triggers versus exercise induced bronchospasm

The patient's adherence to a daily inhaled corticosteroid regimen

26 / 45

For a diagnosis of Lung Cancer, the record must specify the primary site, the laterality, and:

The patient's history of environmental or occupational asbestos exposure

The histologic type such as small cell or non small cell adenocarcinoma and the TNM stage

The result of the PD L1 expression level from the biopsy

The presence of paraneoplastic symptoms such as SIADH or hypercalcemia

27 / 45

A Pulmonology service wants to ensure proper capture of tobacco risk. Which change is most effective?

Asking coders to assume tobacco use for every patient with COPD

Using a template that requires documentation of nicotine dependence or history of use

Recording pack years in the social history but not the diagnosis list

Leaving tobacco documentation to the primary care provider only

28 / 45

In documenting Respiratory Failure in an infant, the clinician must distinguish between:

Grunting and nasal flaring during the neonatal period

Respiratory distress syndrome of the newborn or transient tachypnea of the newborn

The gestational age at birth and the birth weight in grams

The response to surfactant administration in the delivery room

29 / 45

To support the diagnosis of Acute Respiratory Failure in a hospitalized patient, documentation should include:

Mild tachypnea and a subjective feeling of shortness of breath

Hypoxemia or hypercapnia with a clinical need for supplemental oxygen or mechanical support

A chest X ray showing bilateral patchy opacities

The patient's response to a single dose of an inhaled bronchodilator

30 / 45

To accurately code for a Pneumothorax, the clinician should specify:

Sudden onset of shortness of breath and decreased breath sounds

The type such as spontaneous or traumatic or iatrogenic and whether it is a tension pneumothorax

The percentage of lung collapse estimated from the chest X ray

The presence of a deep sulcus sign on a supine film

31 / 45

For a diagnosis of Bronchospasm, the clinical note must emphasize:

Wheezing and chest tightness following exposure to cold air

The acute occurrence or exacerbation and the underlying cause such as asthma

The improvement of peak flow readings after a nebulizer treatment

The presence of air trapping seen on a chest X ray

32 / 45

To differentiate between Acute and Chronic Respiratory Failure, the note should state:

The severity of the patient's dyspnea upon arrival at the ED

The chronicity such as acute on chronic and the underlying mechanism

The baseline blood gas values compared to the current admission

The duration of the patient's home oxygen use

33 / 45

To accurately code for a Diaphragmatic Hernia, the clinician should specify:

Abdominal contents seen in the thoracic cavity on an X ray

Whether congenital or acquired traumatic and the specific laterality

The presence of lung hypoplasia in a neonatal patient

The anatomical type such as Bochdalek or Morgagni

34 / 45

For a patient with a Pulmonary Embolism, the documentation must specify:

Sudden onset of pleuritic chest pain and tachycardia

The presence of acute cor pulmonale or absence thereof and the specific location

The result of the D dimer test and the Wells criteria score

The use of therapeutic anticoagulation versus an IVC filter

35 / 45

For a diagnosis of Interstitial Lung Disease, documentation should emphasize:

Chronic dry cough and fine crackles on auscultation

The specific subtype such as idiopathic pulmonary fibrosis or sarcoidosis and any associated disease

The presence of digital clubbing and exertional desaturation

The findings of a honeycombing pattern on a chest CT scan

36 / 45

For a patient with a Lung Mass, the radiology or clinical report should specify:

A large solid lesion discovered on a screening chest CT

The precise location or laterality and the suspicion for malignancy versus infection

The presence of spiculated margins and internal calcifications

The proximity of the lesion to the pleura or the mediastinum

37 / 45

To support the diagnosis of Adult Respiratory Distress Syndrome, the note should specify:

Severe hypoxemia that does not fully improve with 100 percent oxygen

The severity based on the PF ratio such as mild or moderate or severe and the precipitating cause

The presence of bilateral infiltrates on a chest X ray without heart failure

The requirement for high level PEEP and prone positioning in the ICU

38 / 45

For a patient with a Chylothorax, senior documentation must include:

Milky appearing pleural fluid drained from the chest

The etiology such as traumatic or malignant and the triglyceride level

The patient's response to a medium chain triglyceride diet

The presence of lymphopenia and high fat content in the pleural fluid

39 / 45

When documenting Cystic Fibrosis, the clinician should state:

A positive sweat chloride test and a history of recurrent pneumonias

The manifestation such as with pulmonary or gastrointestinal involvement and mutation

The patient's current FEV1 percentage of predicted and their colonization status

The frequency of daily airway clearance therapies and enzyme use

40 / 45

When documenting Atelectasis, senior documentation should specify:

Small areas of lung collapse seen in the postoperative period

The extent such as lobar or segmental and the underlying clinical cause

The improvement of breath sounds with the use of an incentive spirometer

The findings of crowding of the pulmonary vessels on a chest X ray

41 / 45

For a diagnosis of Carbon Monoxide Poisoning, senior documentation must specify:

Headache, nausea, and dizziness after exposure to a faulty furnace

The carboxyhemoglobin level or presence of neurologic symptoms and source

The duration of high flow oxygen therapy received in the ED

The patient's mental status and the findings on a brain MRI

42 / 45

To support the coding of Sleep Related Hypoventilation, the note should describe:

Elevated carbon dioxide levels during a sleep study in an obese patient

The underlying condition such as obesity hypoventilation syndrome or neuromuscular disease

The patient's average oxygen saturation nadir during REM sleep

The presence of morning headaches and daytime somnolence

43 / 45

When documenting a Mediastinal Mass, the clinician should emphasize:

A widened mediastinum seen on a routine frontal chest X ray

The anatomical compartment such as anterior or middle or posterior and the size

The suspicion for lymphoma, thymoma, or a germ cell tumor

The presence of symptoms such as dysphagia or superior vena cava syndrome

44 / 45

To support the diagnosis of Empyema, the documentation should specify:

A loculated pleural collection seen on a chest ultrasound or CT

The presence of purulent fluid or positive cultures and the anatomical site

The pH, glucose, and LDH levels from the pleural fluid analysis

The need for a large bore chest tube or VATS decortication

45 / 45

When documenting Pulmonary Edema, the clinician should distinguish between:

Crackles heard at the lung bases and a history of orthopnea

Acute cardiogenic edema due to heart failure versus non cardiogenic such as ARDS

The presence of Kerley B lines and a pleural effusion on X ray

The patient's response to high dose intravenous diuretics

Your score is

The average score is 98%