CEHRS Medical Coding in EHR 3 — Questions and Answers
Question 1: Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally?
- -50 (Correct answer)
- -51
- -59
- -76
Correct answer: -50
Modifier -50 indicates that the same procedure was performed on both sides of the body during the same operative session.
Question 2: What is the primary function of the National Correct Coding Initiative (NCCI) edits?
- To assign DRG weights for inpatient stays
- To prevent improper payment of procedures that should not be billed together (Correct answer)
- To establish fee schedules for Medicare
- To standardize EHR documentation templates
Correct answer: To prevent improper payment of procedures that should not be billed together
NCCI edits are CMS-developed guidelines that identify pairs of codes that cannot be billed together because one is considered bundled into the other.
Question 3: A patient is admitted for pneumonia and also has COPD. Which condition is the principal diagnosis?
- COPD, because it is the chronic underlying condition
- Pneumonia, because it is the reason for admission after study (Correct answer)
- Both should be listed as co-equal principal diagnoses
- The attending physician's first-listed diagnosis always governs
Correct answer: Pneumonia, because it is the reason for admission after study
The principal diagnosis is defined as the condition established after study to be chiefly responsible for causing the admission.
Question 4: Which CPT code range covers Evaluation and Management (E/M) services for office or outpatient visits?
- 99201–99215 (Correct answer)
- 99221–99236
- 99241–99255
- 99281–99288
Correct answer: 99201–99215
CPT codes 99202–99215 (new and established patients) represent E/M services provided in office or outpatient settings.
Question 5: What does 'medical necessity' mean in the context of insurance reimbursement?
- Any service a physician chooses to provide
- Services that are appropriate, reasonable, and necessary for the diagnosis or treatment of an illness or injury (Correct answer)
- All preventive services regardless of diagnosis
- Services mandated by state law
Correct answer: Services that are appropriate, reasonable, and necessary for the diagnosis or treatment of an illness or injury
Medical necessity requires that the service is appropriate for the patient's condition and consistent with accepted standards of medical practice for coverage and reimbursement.
Question 6: In ICD-10-CM, what is the meaning of the placeholder character 'X' in certain code categories?
- It indicates an unknown etiology
- It holds a position to allow future expansion or to enable a 7th character extension (Correct answer)
- It marks codes that require additional digits
- It indicates pediatric-only codes
Correct answer: It holds a position to allow future expansion or to enable a 7th character extension
The placeholder X is used when a code requires a 7th character but has fewer than six characters; X fills the empty positions to reach the correct length.
Question 7: Which of the following best describes 'concurrent coding' in a hospital setting?
- Two coders working on the same chart simultaneously
- Coding performed while the patient is still admitted, allowing for query and documentation improvement (Correct answer)
- Coding inpatient and outpatient visits at the same time
- Using two different code sets for the same encounter
Correct answer: Coding performed while the patient is still admitted, allowing for query and documentation improvement
Concurrent coding allows coders and CDI specialists to review records during an active stay, improving documentation accuracy before discharge.
CEHRS Medical Coding in EHR 3
Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally?