2020 Medical Necessity – Heart Failure Post Test

Quiz Summary

0 of 5 Questions completed

Questions:

You have already completed the quiz before. Hence you can not start it again.

Quiz is loading…

You must sign in or sign up to start the quiz.

You must first complete the following:

Results

Quiz complete. Results are being recorded.

Results

0 of 5 Questions answered correctly

Your time:

You have reached 0 of 0 point(s), (0)

Congratulations, you passed.

Current
Review
Answered
Correct
Incorrect

Question 1 of 5

1. Question
Regarding HF diagnoses on hospitalized patients, which is FALSE?
- Noting a “previous echo two months ago w/ EF 23%” in the record will allow appropriate documentation of “Acute exacerbation of CHF, likely systolic”.
- Acute HF means “new onset” and so any exacerbation of a known HF condition should be documented “acute on chronic”.
- “Fluid overload” is a term that does not translate in the coding world, so it should not be used when noting heart failure exacerbation.
- “History of” heart failure means that it was a condition in the past that no longer exists. So avoid use of “history of” if the patient is still being managed for that condition (with ACEI, etc.).
- All of the above statements are true.
Correct

Incorrect
Question 2 of 5

2. Question
A 82 year old with HFrEF (31%) presents with a 2 day history of weight gain, DOE, LE edema of +3, and a RA saturation of 92% (baseline is 95%). His labs are stable with K+ 4.2, Hgb 9.9, and a Cr of 1.4 (baseline 0.9). CXR shows increased lung markings and a slight effusion. You order inpatient, but the Physician Advisor has requested a reconsideration for placement in Observation. What are some clinical indicators on day TWO that would confirm a need for continued care beyond two midnights and merit an inpatient admission? Choose ALL that are correct:
- The saturation drops to 88% and the 2 liters of oxygen is titrated to 3 liters with a sat of 93%.
- The renal numbers increase on day two and you document a concern that further diuresis is needed and as such, the renal status may worsen.
- When removing the oxygen (2 liters), the saturation drops to 85% on ambulation to the bathroom, requiring a re-institution of oxygen therapy to maintain baseline saturations.
- The Hgb drops to 9.2. All other conditions are improving.
Correct

Incorrect
Question 3 of 5

3. Question
Hemodynamic instability (orthostatic VS, altered mentation) is found in a patient with heart failure on ED presentation. This patient is appropriate for inpatient admission IF the patient on day two continues to exhibit instability after treatment and appears to be in need of care that exceeds two midnights. That care is noted in the progress notes to show “active management”.
- True
- False
Correct

Incorrect
Question 4 of 5

4. Question
A 68 year old DM patient with ASCVD and HFrEF (40% EF), presents with Acute HF exacerbation. The patient, on day two has a Cr of 1.15, down from 1.16 (baseline 1.13). There are still crackles in the bases but weight is down 11 pounds and O₂ sats are better overall at 96% off of supplemental oxygen. On ambulation, sats remain > 93% on RA. He was admitted as inpatient by your colleague yesterday. You feel…
- Inpatient care is appropriate because of the O2 sat and crackles.
- The patient can be discharged to home, but the inpatient order cannot be changed.
- Observation is appropriate, so a new order needs to be written and case management notified before discharge.
- Inpatient care is appropriate because of the Cr is still above baseline.
Correct

Incorrect
Question 5 of 5

5. Question
A 68 year old DM with ASCVD and HFpEF (53% EF 4mo prior) presents via EMS to the ED with SOB and chest pain. CXR shows bilateral pleural effusions with blunted diaphragms. ED saturation is 98% on 2 liters NC. RR 18 with accessory muscle use, and some difficulty speaking in complete sentences. BNP is 815 (prior 4 months ago was 14). Lactic acid is 1.9 and WBC is 11,000. There is no fever. EKG is normal except for tachycardia (sinus, 119). So, you decide the most appropriate next step is to order …
- Inpatient and a full cardiac work-up and add a Sepsis and pneumonia diagnosis
- Observation because the O2 sat is normal
- Inpatient because the BNP is elevated with the present lactate level and CXR findings
- Observation at present but attention is directed to investigation of the EMS findings re: baseline O2 saturation and follow-up labs. Low threshold for changing to inpatient if clinical improvement is not seen.
Correct

Incorrect

2020 Medical Necessity – Heart Failure Post Test

You must achieve a score of 80% or above to pass the post test.

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

Need Help Accessing the Site?

We're Here To Assist You