Certified Coding Associate (CCA) Exam — Questions and Answers

Question 1: What is the purpose of the ICD-10-PCS coding system?

Coding procedures for inpatient care (Correct answer)
Coding physician services
Coding dental procedures
Coding diagnoses for outpatient care

Correct answer: Coding procedures for inpatient care

The ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) is specifically designed for coding procedures performed in the inpatient hospital setting. It provides a comprehensive system for classifying surgical, medical, and diagnostic procedures unique to hospital admissions. This system is distinct from ICD-10-CM, which codes diagnoses, and CPT, which codes outpatient procedures.

Question 2: Which CPT modifier is appended when a procedure or service is reduced or eliminated at the physician's discretion?

-58
-55
-52 (Correct answer)
-56

Correct answer: -52

Modifier -52 indicates that a service or procedure was partially reduced or eliminated at the physician's discretion.

Question 3: What does "DRG" stand for in the context of medical coding and billing?

Diagnosis and Revenue Group
Diagnosis Related Group (Correct answer)
Diagnosis Reporting Guide
Disease Reimbursement Group

Correct answer: Diagnosis Related Group

In the context of medical coding and billing, DRG stands for Diagnosis Related Group. DRGs are a system used by Medicare and some other payers to classify inpatient hospital stays into groups for payment purposes. Each DRG represents a group of patients with similar diagnoses, treatments, and resource consumption, determining the fixed reimbursement amount for the hospital.

Question 4: A woman, age 66, suffers a spiral fractured right tibia while skiing. She undergoes an initial evaluation in the emergency room and is then hospitalized right away for an intramedullary implant procedure with Dr. Riva. She experiences an uncommon implant reaction during the first 24 hours of her recuperation in which the pressure inside her leg has risen dangerously high. She is swiftly readmitted to the operating room so that Dr. Riva can perform surgery to relieve the implant's pressure. What modifier is required for classifying this second surgery, according to your understanding of Medicare's global surgical package provisions?

77
79
78 (Correct answer)
76

Correct answer: 78

Modifier 78 is required for classifying this second surgery. This modifier indicates an unplanned return to the operating room by the same physician for a related procedure during the post-operative period of the original surgery. In this scenario, the pressure relief surgery is directly related to the initial intramedullary implant procedure and occurred within its global period.

Question 5: A compliance program in a healthcare organization is primarily designed to:

Reduce documentation requirements
Maximize reimbursement for all services
Increase patient volume
Prevent, detect, and correct non-compliance with laws and regulations (Correct answer)

Correct answer: Prevent, detect, and correct non-compliance with laws and regulations

A compliance program is designed to prevent, detect, and correct violations of healthcare laws, regulations, and standards.

Question 6: When a patient is seen for aftercare following a fracture repair, which Z code category is typically used?

Z00 (Encounter for general examination)
Z47 (Orthopedic aftercare) (Correct answer)
Z23 (Encounter for immunization)
Z51 (Encounter for other aftercare)

Correct answer: Z47 (Orthopedic aftercare)

Category Z47 codes are used for orthopedic aftercare, such as follow-up care after fracture repair with hardware removal or cast change.

Question 7: What does the qualifier 'Diagnostic' in ICD-10-PCS indicate about a procedure?

A biopsy or sampling procedure done to confirm a diagnosis (Correct answer)
The procedure used imaging guidance
The procedure is performed for treatment
The procedure was not completed

Correct answer: A biopsy or sampling procedure done to confirm a diagnosis

The qualifier 'Diagnostic' (X) in ICD-10-PCS identifies procedures such as biopsies performed to obtain tissue for diagnosis.

Question 8: In a doctor's progress note, a diabetic patient is noted as having "FBS 110 mg%, urine sugar, no acetone." Where would this notation be placed in a POMR progress note?

Observation
Subjective
Assessment
Objective (Correct answer)

Correct answer: Objective

In a Problem-Oriented Medical Record (POMR) using the SOAP (Subjective, Objective, Assessment, Plan) format, 'Objective' refers to measurable and observable data. Blood sugar readings (FBS 110 mg%) and urine test results (urine sugar, no acetone) are clinical findings obtained through examination or testing, making them objective data. This section provides factual information that can be verified.

Question 9: Which ICD-10-CM placeholder character is used when a code has fewer than the required number of characters?

0 (zero)
9
Z
X (Correct answer)

Correct answer: X

The letter 'X' is used as a placeholder in ICD-10-CM codes to allow for future expansion and to maintain the correct number of characters.

Question 10: What is a Coordination of Benefits (COB) situation?

When Medicare is the sole payer
When a patient has no insurance coverage
When a patient has more than one insurance plan covering the same services (Correct answer)
When a provider does not accept insurance

Correct answer: When a patient has more than one insurance plan covering the same services

COB occurs when a patient is covered by more than one insurance plan, and the plans coordinate to avoid overpayment.

Question 11: What is a Remittance Advice (RA)?

A document authorizing a procedure
A document sent by payers explaining payment or denial of claims (Correct answer)
A patient's insurance card
A physician's order for treatment

Correct answer: A document sent by payers explaining payment or denial of claims

A Remittance Advice is sent by payers to explain how claims were processed, including payment amounts or denial reasons.

Question 12: What does a comA compliance plan's goal is to assist your office in adhering to the right coding and billing procedures. A compliance plan is a document, or set of documents, that outlines the HIPAA regulations that your practice must adhere to. The compliance plan describes, among other things, how frequently your office should audit, how staff should be instructed on confidentially, and how to choose a compliance manager to make sure that all compliance plan components are carried out.pliance plan serve?

It makes sure you are properly credentialed
It allows your office to defend itself in case of an audit
It helps your employees claim worker's compensation
It helps your office follow the correct coding and billing protocols (Correct answer)

Correct answer: It helps your office follow the correct coding and billing protocols

A compliance plan is a crucial set of guidelines designed to ensure that a healthcare practice adheres to all relevant laws and regulations, particularly those concerning coding, billing, and HIPAA. Its primary purpose is to prevent fraud, waste, and abuse by establishing internal controls and procedures. By following these protocols, the office minimizes the risk of errors and maintains ethical and legal operations.

Question 13: The GPCI factors the following factors into the RBRVS calculation:

The gegraphic location of a practice of a practice or provider (Correct answer)
The overhead cost of the practice
The malpractice risk of a procedure
The type of provider specialty

Correct answer: The gegraphic location of a practice of a practice or provider

GPCI stands for Geographic Practice Cost Index. It is a component of the Resource-Based Relative Value Scale (RBRVS) physician payment system used by Medicare. The GPCI adjusts the physician work, practice expense, and malpractice expense components of the RBRVS to account for variations in the cost of practicing medicine in different geographic areas.

Question 14: A coder is assigning CPT codes for a surgical procedure. The provider performed a medically necessary service and a service that is bundled per the National Correct Coding Initiative (NCCI). What should the coder do?

Report only the more complex bundled code (Correct answer)
Report both codes
Query the payer before coding
Report both codes with modifier -59 to bypass the bundle

Correct answer: Report only the more complex bundled code

When NCCI bundles a component service into a comprehensive code, only the comprehensive code should be reported unless a specific exception applies.

Question 15: Which of the following is the correct sequence for looking up a diagnosis code in ICD-10-CM?

Locate in Alphabetic Index first, then verify the code in the Tabular List (Correct answer)
Use only the Tabular List for all code selection
Use only the Alphabetic Index for final code assignment
Verify in Tabular List first, then confirm in Alphabetic Index

Correct answer: Locate in Alphabetic Index first, then verify the code in the Tabular List

The correct process is to locate the term in the Alphabetic Index to find a code, then verify and finalize the code in the Tabular List.

Question 16: What is the significance of the 'discharge status' code in inpatient coding?

It records the attending physician's specialty
It captures the patient's primary insurance
It identifies the admitting diagnosis
It indicates where the patient went after being discharged from the hospital (Correct answer)

Correct answer: It indicates where the patient went after being discharged from the hospital

The discharge status code indicates the patient's disposition upon leaving the hospital, such as home, skilled nursing facility, or expired.

Question 17: Which CPT code range covers Evaluation and Management (E/M) services?

00100–01999
70010–79999
10004–69990
99202–99499 (Correct answer)

Correct answer: 99202–99499

E/M service codes in CPT are found in the range 99202–99499, covering office visits, hospital care, consultations, and other E/M categories.

Question 18: How should a patient with Type 2 diabetes mellitus controlled by diet alone be coded in ICD-10-CM?

E11.9 – Type 2 diabetes mellitus without complications (Correct answer)
E10.9 – Type 1 diabetes mellitus without complications
E13.9 – Other specified diabetes mellitus
E11.65 – Type 2 diabetes mellitus with hyperglycemia

Correct answer: E11.9 – Type 2 diabetes mellitus without complications

Diet-controlled Type 2 diabetes mellitus without complications is coded as E11.9.

Question 19: When a patient is admitted to the hospital and the working diagnosis changes by the time of discharge, the coder should:

Code the final confirmed diagnosis established at discharge as principal (Correct answer)
Code both the admitting and discharge diagnoses
Code the admitting diagnosis as principal
Query the physician to verify the admitting diagnosis only

Correct answer: Code the final confirmed diagnosis established at discharge as principal

Inpatient coding guidelines require coding the diagnosis confirmed at the time of discharge, not the working or admitting diagnosis.

Question 20: A patient is seen for essential hypertension and type 2 diabetes with diabetic chronic kidney disease stage 3. How many ICD-10-CM codes are required?

2
3 (Correct answer)
1
4

Correct answer: 3

Three codes are needed: E11.22 (type 2 diabetes with diabetic chronic kidney disease), N18.3 (CKD stage 3), and I10 (essential hypertension).

Question 21: A patient is treated for sepsis due to Staphylococcus aureus. How should this be coded?

A41.01 as principal diagnosis only (Correct answer)
B95.61 followed by A41.01
A41.01 for sepsis, then the organism code
A41.9 followed by B95.61

Correct answer: A41.01 as principal diagnosis only

A41.01 (Sepsis due to Methicillin susceptible Staphylococcus aureus) fully captures both the sepsis and the organism in one combination code.

Question 22: In ICD-10-PCS, how many characters does every procedure code contain?

6
8
5
7 (Correct answer)

Correct answer: 7

Every ICD-10-PCS code is exactly 7 characters long, with each character representing a specific aspect of the procedure.

Question 23: HIPAA stands for what?

Health Insurance Porst-Payment Auditing Association
Health Insurance Portability and Accountability Act (Correct answer)
Health Insurance Accountability and Auditing Act
Health Insurance Protection and Accountability Association

Correct answer: Health Insurance Portability and Accountability Act

HIPAA stands for the Health Insurance Portability and Accountability Act. Enacted in 1996, this federal law established national standards to protect sensitive patient health information from unauthorized disclosure. It also includes provisions aimed at improving the portability and continuity of health insurance coverage.

Question 24: Which of the following is an example of upcoding?

Reporting secondary diagnoses correctly
Using modifiers to indicate bilateral procedures
Submitting a claim with a lower-level E/M code than documented
Billing for a higher-level service than what was actually provided (Correct answer)

Correct answer: Billing for a higher-level service than what was actually provided

Upcoding is the fraudulent practice of billing for a higher-level or more expensive service than what was actually performed.

Question 25: What is the purpose of a National Correct Coding Initiative (NCCI) edit?

To identify fraudulent provider billing
To prevent improper payment of procedure codes that should not be billed together (Correct answer)
To assign DRGs for inpatient stays
To validate ICD-10-CM codes on claims

Correct answer: To prevent improper payment of procedure codes that should not be billed together

NCCI edits are bundling edits that prevent Medicare from paying separately for services that should be billed together.

Question 26: A patient is diagnosed with Type 2 diabetes mellitus with diabetic chronic kidney disease stage 4. Which ICD-10-CM guideline applies?

Code only the CKD since it is the more severe condition
Code the diabetes and CKD separately with no linkage assumed
Assume a causal relationship between the diabetes and CKD without physician confirmation (Correct answer)
Query the physician before assuming any relationship

Correct answer: Assume a causal relationship between the diabetes and CKD without physician confirmation

ICD-10-CM guidelines state that a causal relationship between diabetes and CKD is assumed unless the physician documents otherwise, allowing direct combination coding.

Question 27: What is the purpose of an advance directive?

To assign a healthcare proxy without documentation
To authorize billing for future services
To document a patient's wishes regarding healthcare decisions if they become incapacitated (Correct answer)
To schedule follow-up appointments after discharge

Correct answer: To document a patient's wishes regarding healthcare decisions if they become incapacitated

An advance directive is a legal document in which patients specify their healthcare wishes in the event they are unable to make decisions themselves.

Question 28: What is the purpose of the CCA certification exam?

To measure administrative abilities
To evaluate surgical techniques
To assess coding knowledge and skills (Correct answer)
To test clinical skills

Correct answer: To assess coding knowledge and skills

The primary purpose of the CCA certification exam is to evaluate an individual's fundamental knowledge and practical skills in medical coding. It tests their ability to accurately assign codes for diagnoses and procedures, understand coding guidelines, and apply healthcare regulations. This ensures that certified individuals possess the basic competence required for entry-level coding positions.

Question 29: Which of the following is an example of an external cause code?

Car accident (Correct answer)
Hypertension
Influenza
Fractured arm

Correct answer: Car accident

A car accident is an example of an external cause code. External cause codes (found in chapters V, W, X, and Y of ICD-10-CM) describe the circumstances surrounding an injury or other health condition, rather than the nature of the injury itself. They provide valuable data on how injuries occurred, which is important for prevention and public health statistics.

Question 30: What does the suffix '-itis' indicate?

Surgical incision
Inflammation (Correct answer)
Disease
Tumor

Correct answer: Inflammation

The suffix '-itis' means inflammation, as seen in appendicitis or arthritis.

Question 31: What is the correct ICD-10-CM coding guideline when a patient has both an acute and a chronic condition?

Code only the acute condition
Code only the chronic condition
Code both, sequencing the chronic condition first
Code both, sequencing the acute condition first (Correct answer)

Correct answer: Code both, sequencing the acute condition first

When both an acute and chronic form of a condition exist, ICD-10-CM guidelines instruct coding both with the acute condition sequenced first.

Question 32: What is the purpose of a modifier in CPT coding?

To indicate a diagnosis was not confirmed
To provide additional information about a service without changing its definition (Correct answer)
To change the code to a higher reimbursement level
To report a service was not covered

Correct answer: To provide additional information about a service without changing its definition

Modifiers provide additional information about a service or procedure without altering its basic definition or changing the code itself.

Question 33: Which of the following is considered the primary purpose of the health record?

Billing and reimbursement
Quality assurance reporting
Patient care documentation and continuity of care (Correct answer)
Legal evidence in malpractice cases

Correct answer: Patient care documentation and continuity of care

The primary purpose of the health record is to document patient care and support continuity of care among healthcare providers.

Question 34: When coding an encounter for chemotherapy administration in ICD-10-CM, which code is sequenced first?

The symptom code related to the cancer
The adverse effect code for the chemotherapy drug
The malignancy code
The Z code for encounter for antineoplastic chemotherapy (Correct answer)

Correct answer: The Z code for encounter for antineoplastic chemotherapy

ICD-10-CM guidelines instruct sequencing the Z51.11 (encounter for antineoplastic chemotherapy) code first, followed by the malignancy code.

Question 35: Which of the following statements is true about CCA certification requirements?

Only physicians can apply.
No educational requirement is necessary.
A certain amount of work experience is required. (Correct answer)
A bachelor's degree is mandatory.

Correct answer: A certain amount of work experience is required.

While not the only path, having a certain amount of work experience in coding (typically two years) is one of the eligibility requirements for the Certified Coding Associate (CCA) certification. Other pathways include holding a high school diploma or completing an AHIMA-approved coding program. This flexibility allows individuals with practical experience to also qualify for the exam.

Question 36: The Joint Commission's ORYX program and HEDIS are both made to gather data for .

Uniform hospital discharge data set
Performance improvement programs (Correct answer)
Centers of medicare and medicaid services.
The infusion procedure

Correct answer: Performance improvement programs

Both The Joint Commission's ORYX program and HEDIS (Healthcare Effectiveness Data and Information Set) are designed to collect and report data on the quality of healthcare services. This data is then used to evaluate and drive performance improvement initiatives within healthcare organizations. Their goal is to enhance patient care, safety, and efficiency by identifying areas for improvement.

Question 37: A patient is seen for essential hypertension with chronic kidney disease stage 3. How many ICD-10-CM codes are required?

Two codes: one for hypertension and one for CKD
No code — hypertension is assumed with CKD
One combination code (Correct answer)
Three separate codes

Correct answer: One combination code

ICD-10-CM provides a combination code (I12.9) that captures both hypertensive chronic kidney disease, eliminating the need for two separate codes.

Question 38: A patient is admitted with acute respiratory failure due to pneumonia. Which condition should be sequenced as the principal diagnosis?

Either may be sequenced first per UHDDS (Correct answer)
Acute respiratory failure
Pneumonia
The condition present on admission

Correct answer: Either may be sequenced first per UHDDS

When two conditions equally meet the UHDDS definition of principal diagnosis, either may be sequenced first.

Question 39: What does the acronym 'EOB' stand for in medical billing?

Estimate of Balance
End of Benefits
Evidence of Billing
Explanation of Benefits (Correct answer)

Correct answer: Explanation of Benefits

EOB stands for Explanation of Benefits, a document sent to patients explaining what the insurance paid and what the patient owes.

Question 40: A 43-year-old man who was involved in an automobile accident is taken by emergency personnel to the hospital with life-threatening injuries. He is promptly given the go-ahead for critical care services upon arrival. The doctor providing care spends 105 minutes that day stabilizing and treating the patient. Choose the suitable E/M code or codes for this service.

99291, 99292×2 (Correct answer)
99285
99283
99291, 99292

Correct answer: 99291, 99292×2

Critical care services are coded based on the total time spent. Code 99291 is used for the first 30-74 minutes of critical care. For each additional 30 minutes beyond the initial 74 minutes, code 99292 is reported. If the total time spent was 135 minutes (rather than the stated 105 minutes, which would be 99291, 99292), this would account for the initial 74 minutes (99291) plus two additional 30-minute increments (135 - 74 = 61 minutes, which covers two units of 99292).

Question 41: Under ICD-10-CM guidelines, signs and symptoms that are integral to a confirmed disease are:

Coded separately to provide additional specificity
Coded with a 'manifestation' code
Reported using a 'Z' code for the symptom
Not coded separately, as they are included in the confirmed diagnosis code (Correct answer)

Correct answer: Not coded separately, as they are included in the confirmed diagnosis code

Signs and symptoms that are routinely associated with a disease process are not coded separately when a definitive diagnosis has been established.

Question 42: Which HCPCS Level II code letter series (A codes) primarily represents?

Chiropractic services
Vision services
Enteral and parenteral therapy
Transportation, medical and surgical supplies, and administrative codes (Correct answer)

Correct answer: Transportation, medical and surgical supplies, and administrative codes

HCPCS A codes cover transportation services, medical and surgical supplies, miscellaneous supplies, and administrative codes.

Question 43: What is the main focus of outpatient coding?

Coding for inpatient procedures
Coding for physician services (Correct answer)
Coding for long-term care facilities
Coding for pharmacy services

Correct answer: Coding for physician services

The main focus of outpatient coding is coding for physician services. This includes services provided in clinics, physician offices, emergency departments (for the physician's portion), and ambulatory surgery centers. It primarily involves CPT codes for procedures and services, along with ICD-10-CM codes for diagnoses, to ensure accurate billing and reimbursement for the professional component of care.

Question 44: What does the CPT coding system primarily focus on?

Diagnoses and conditions
Inpatient procedures
Hospital administration codes
Outpatient procedures and services (Correct answer)

Correct answer: Outpatient procedures and services

The CPT (Current Procedural Terminology) coding system is primarily used to describe medical, surgical, and diagnostic services performed by physicians and other healthcare providers. Its main focus is on outpatient procedures and services, detailing the specific interventions provided to patients. These codes are essential for accurate billing and reimbursement for services rendered outside of an inpatient hospital stay.

Question 45: The suffix '-ectomy' refers to which of the following?

Visual examination
Surgical repair
Surgical removal (Correct answer)
Inflammation

Correct answer: Surgical removal

The suffix '-ectomy' means surgical removal or excision of a body part.

Question 46: Which document in the health record provides a physician's assessment of a patient's condition at the end of a hospitalization?

Nursing assessment
Consultation report
Discharge summary (Correct answer)
Admission note

Correct answer: Discharge summary

The discharge summary provides a comprehensive overview of the patient's hospital stay, including diagnoses, treatment, and follow-up instructions.

Question 47: Which of the following best describes the concept of 'unbundling' in medical billing?

Adding modifiers to bundled codes
Reporting individual components of a procedure when a comprehensive code exists (Correct answer)
Using the correct E/M level for documentation
Combining multiple services into one CPT code

Correct answer: Reporting individual components of a procedure when a comprehensive code exists

Unbundling means billing individual components of a procedure separately when a single comprehensive CPT code already covers all components.

Question 48: What does 'clean claim' mean in medical billing?

A claim submitted without any errors that can be processed for payment (Correct answer)
A claim for preventive services only
A claim that has been paid in full
A claim submitted on paper instead of electronically

Correct answer: A claim submitted without any errors that can be processed for payment

A clean claim is one that is free of errors and contains all required information so it can be processed for payment without delay.

Question 49: In CPT, what does the modifier '-26' indicate when appended to a radiology code?

Professional component only (Correct answer)
Bilateral procedure
Global service
Technical component only

Correct answer: Professional component only

Modifier -26 indicates the physician's professional component (interpretation and report) when billed separately from the technical component.

Question 50: A patient undergoes a procedure and develops a complication requiring a return to the OR. The complication code should be sequenced:

As the principal or first-listed diagnosis (Correct answer)
Before the original procedure code
It should not be coded
As an additional diagnosis only

Correct answer: As the principal or first-listed diagnosis

When a complication requires a return to the OR, it becomes the principal diagnosis for that subsequent encounter.

Question 51: What does the term 'deficiency analysis' mean in health information management?

Identifying incomplete or missing elements in health records (Correct answer)
Reviewing patient satisfaction surveys
Analyzing coding errors in claims
Reviewing financial performance of a department

Correct answer: Identifying incomplete or missing elements in health records

Deficiency analysis involves reviewing health records to identify incomplete or missing documentation that must be completed by the responsible provider.

Question 52: What does the abbreviation 'PCS' stand for in the context of ICD-10?

Patient Classification System
Primary Care Standard
Physician Coding Schedule
Procedure Coding System (Correct answer)

Correct answer: Procedure Coding System

PCS stands for Procedure Coding System, the inpatient procedural coding system used alongside ICD-10-CM diagnosis codes.

Question 53: Which modifier is appended to a CPT code when a surgical procedure is performed by two surgeons acting as co-surgeons?

-66
-82
-80
-62 (Correct answer)

Correct answer: -62

Modifier -62 (Two Surgeons) is used when two surgeons of different specialties each perform distinct portions of a single reportable procedure.

Question 54: Which CPT modifier indicates a bilateral procedure was performed?

-50 (Correct answer)
-52
-53
-51

Correct answer: -50

Modifier -50 is appended when the same procedure is performed on both sides of the body during the same operative session.

Question 55: The creation of standards for electronic medical records was required by the .

a 'with manipulation' code
Computer-assisted coding
Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Correct answer)
One code for the final vessel entered

Correct answer: Health Insurance Portability and Accountability Act (HIPAA) of 1996

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated the establishment of national standards for electronic healthcare transactions and identifiers for providers, health plans, and employers. A key component of HIPAA was the requirement to create standards for the security and privacy of electronic medical records (EMRs) to protect patient health information.

Question 56: Under CPT guidelines, which modifier indicates that a procedure was performed bilaterally?

-51
-RT and -LT
-59
-50 (Correct answer)

Correct answer: -50

CPT modifier -50 is used to report bilateral procedures performed during the same operative session.

Question 57: Typically, Tricare Prime patients are required to see a doctor:

Whenever their commander asks them to
Whenever they feel like it
At their typical private practice doctor’s office
At their military treatment facility (Correct answer)

Correct answer: At their military treatment facility

Tricare Prime is a managed care health plan for military beneficiaries that typically requires patients to enroll with a primary care manager (PCM) at a military treatment facility (MTF). Under this plan, patients generally receive most of their routine care at the MTF and need referrals to see specialists or receive care outside the MTF.

Question 58: A patient with type 2 diabetes mellitus is seen for diabetic chronic kidney disease, stage 3. How should this be coded?

Code only the diabetes
Code the combination code for diabetes with CKD, then CKD stage 3 (Correct answer)
Code only the CKD stage 3
Code CKD stage 3 first, then the diabetes

Correct answer: Code the combination code for diabetes with CKD, then CKD stage 3

ICD-10-CM has a combination code for type 2 diabetes with diabetic CKD (E11.22), and an additional code for CKD stage (N18.3) is assigned.

Question 59: For immediate treatment of a flare-up of end-stage renal illness, Mr. Jackson was admitted as an inpatient. His personal doctor visits the hospital the day after his admission for a checkup and a chart review. For his visit to the doctor, choose the appropriate E/M code series.

Initial hospital care (99221–99223)
Subsequent hospital care (99231–99233) (Correct answer)
Office or other outpatient services (99201–99215)
Initial observation care (99218–99220)

Correct answer: Subsequent hospital care (99231–99233)

This is a unique situation where the hospital where the patient received care takes precedence over the individual who provided that therapy when choosing an E/M code (his personal physician). With that knowledge, office or outpatient services are immediately eliminated since in-hospital therapy is seen as inpatient care and because the doctor in question is not visiting the patient at his own office (as an outpatient). This disqualifies initial observation care because the patient was not formally designated as being under observation status. The initial hospital care E/M service standards specifically say that these codes "are intended to report the first hospital inpatient visit with the patient by the admitting physician [AI]," therefore the correct response is subsequent hospital care (CPT 16). The E/M series after hospital care should be reviewed for the proper E/M code because it is obvious that this is not applicable to the second day of Mr. Jackson's treatment.

Question 60: What does the 7th character 'A' represent in ICD-10-CM injury codes?

Subsequent encounter
Initial encounter (Correct answer)
Acute phase
Sequela

Correct answer: Initial encounter

The 7th character 'A' in ICD-10-CM injury codes denotes the initial encounter, meaning the patient is receiving active treatment for the injury.

Question 61: Determine the punctuation mark that is used to augment any additional words or explanatory information that may or may not be included in the ICD-9-CM coding statement of diagnosis or procedure. The case's code number is unaffected by the punctuation. The punctuation is used in all three volumes of ICD-9-CM and is regarded as a nonessential modifer.

Subjective
Brackets [ ]
Parentheses ( ) (Correct answer)
Subtraction -

Correct answer: Parentheses ( )

In ICD-9-CM, parentheses ( ) are used to enclose nonessential modifiers. These are supplementary words or explanatory information that may or may not be present in the diagnostic statement but do not affect the code assignment. They provide additional detail without changing the fundamental meaning of the code.

Question 62: When a patient is admitted due to a complication of a medical device, which ICD-10-CM code category is typically assigned?

S codes for traumatic injury
Z codes for factors influencing health
T codes for complications of surgical and medical care (Correct answer)
Y codes for external cause

Correct answer: T codes for complications of surgical and medical care

Complications of medical devices and implants are classified in the T codes (T82–T85 range) in ICD-10-CM.

Question 63: In CPT, what is the purpose of an 'add-on' code (indicated by a '+' symbol)?

It can be reported alone without a primary procedure code
It indicates a service performed by a second surgeon
It must be reported in addition to a primary procedure and cannot be used alone (Correct answer)
It replaces the primary code when a more complex service is performed

Correct answer: It must be reported in addition to a primary procedure and cannot be used alone

CPT add-on codes, marked with a '+', are always reported in conjunction with a primary procedure code and are never used independently.

Question 64: What does the acronym 'MS-DRG' stand for?

Multi-System Disease Reference Guide
Medicare Severity Diagnosis Related Group (Correct answer)
Medical-Surgical Diagnostic Resource Group
Medical Standard Documentation Review Group

Correct answer: Medicare Severity Diagnosis Related Group

MS-DRG stands for Medicare Severity Diagnosis Related Group, used by Medicare for inpatient hospital reimbursement.

Question 65: The Outpatient Prospective Payment System (OPPS) uses which payment unit?

RUG
APC (Correct answer)
RBRVS
DRG

Correct answer: APC

OPPS uses Ambulatory Payment Classifications (APCs) to reimburse hospitals for outpatient services.

Question 66: Which organization publishes the ICD-10-CM Official Guidelines for Coding and Reporting?

AMA
CMS and NCHS (Correct answer)
AHIMA
WHO

Correct answer: CMS and NCHS

The ICD-10-CM Official Guidelines are published jointly by CMS (Centers for Medicare and Medicaid Services) and NCHS (National Center for Health Statistics).

Question 67: What is the purpose of the NCCI (National Correct Coding Initiative) edits?

To validate ICD-10-CM diagnosis codes
To define medical necessity for outpatient services
To establish fee schedules for Medicare services
To prevent improper payment of procedures that should not be reported together (Correct answer)

Correct answer: To prevent improper payment of procedures that should not be reported together

NCCI edits identify pairs of CPT codes that should not be billed together because one code is considered a component of the other.

Question 68: Which of the following is the correct approach to code a wound closure performed with adhesive strips (Steri-Strips)?

Report a complex closure code
Report a repair code with simple closure
Report only an E/M code — no separate repair code (Correct answer)
Report an intermediate repair code

Correct answer: Report only an E/M code — no separate repair code

Closure with adhesive strips alone does not warrant a separate CPT repair code; only the E/M service is reported.

Question 69: Which of the following is an example of a CPT Category II code?

99213
4011F (Correct answer)
G0008
0075T

Correct answer: 4011F

CPT Category II codes (beginning with a number and ending in 'F') are optional tracking codes used for performance measurement.

Question 70: Why is it important to include ICD-9 codes on a claim?

They report the procedures performed on the patient
They indicate the code linkage on the claim
They indicate the medical necessity of the service (Correct answer)
They are the services that are charged for on the claim

Correct answer: They indicate the medical necessity of the service

ICD-9 (and now ICD-10) codes are diagnosis codes that describe the patient's condition or the reason for their visit. They are essential on a claim because they provide the medical justification for the services (CPT codes) performed, thereby establishing medical necessity. Without appropriate diagnosis codes, insurance companies may deny claims as they cannot ascertain why the services were rendered.

Question 71: Which law established the federal healthcare fraud and abuse statutes known as the 'Anti-Kickback Statute'?

The False Claims Act
The Affordable Care Act
The Social Security Act (Correct answer)
HIPAA

Correct answer: The Social Security Act

The Anti-Kickback Statute is part of the Social Security Act and prohibits offering or receiving payment to induce referrals for federal healthcare program services.

Question 72: How long must hospitals generally retain adult patient health records under most state laws?

1 year from last treatment
3 years from last treatment
Permanently for all patients
5–10 years from last treatment or discharge (Correct answer)

Correct answer: 5–10 years from last treatment or discharge

Most states require adult health records to be retained for a minimum of 5–10 years from the date of last treatment or discharge.

Question 73: The following are the names of the most recent Medicare claims processing payment contract entities:

Comprehensive error rate testing (cert)
Assignment of benefits
Medicare administrative contractors (MACs) (Correct answer)
Fiscal intermediaries (fis)

Correct answer: Medicare administrative contractors (MACs)

Medicare Administrative Contractors (MACs) are private healthcare insurers that have been awarded a contract by the Centers for Medicare & Medicaid Services (CMS) to process Medicare Part A and Part B (and Durable Medical Equipment) claims. They serve as the primary contact for providers and handle claims processing, payment, and other administrative functions for specific geographic regions. They replaced the previous system of fiscal intermediaries and carriers.

Question 74: The following entities have established messaging standards for electronic data interchange in healthcare:

HL7 (Correct answer)
Cpt
Hl6
Adt

Correct answer: HL7

HL7 (Health Level Seven International) is a not-for-profit organization that develops international standards for the transfer of clinical and administrative data between healthcare software applications. Its standards are widely used for electronic data interchange in healthcare, facilitating interoperability and communication between different systems.

Question 75: Under HIPAA, which entity is classified as a 'covered entity'?

Health plan (Correct answer)
Pharmaceutical company
Medical transcription service
Medical equipment manufacturer

Correct answer: Health plan

Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically are classified as covered entities under HIPAA.

Question 76: Which ICD-10-CM code category is used to report body mass index (BMI)?

Z68 (Correct answer)
E66
Z17
R73

Correct answer: Z68

BMI codes are found in category Z68 and are used as secondary codes when a provider documents obesity.

Question 77: A patient undergoes a surgical procedure that is discontinued after anesthesia is administered but before the intended procedure begins. Which modifier applies?

-53 (Correct answer)
-73
-74
-52

Correct answer: -53

Modifier -53 is used when a physician discontinues a surgical procedure after anesthesia administration due to extenuating circumstances.

Question 78: Which healthcare setting uses the UB-04 claim form for billing?

Ambulatory surgery centers only
Physician office
Inpatient hospital and outpatient facilities (Correct answer)
Skilled nursing facilities only

Correct answer: Inpatient hospital and outpatient facilities

The UB-04 (CMS-1450) is used by inpatient hospitals, outpatient hospitals, and other facility-based providers.

Question 79: What is the purpose of an audit in medical coding?

Eliminating the need for documentation
Identifying over-utilization of services (Correct answer)
Establishing new coding guidelines
Approving insurance claims

Correct answer: Identifying over-utilization of services

The purpose of an audit in medical coding is to identify potential issues such as over-utilization or under-utilization of services, coding errors, and non-compliance with regulations. Audits review coded claims and supporting medical documentation to ensure accuracy and adherence to coding guidelines. This process helps prevent fraud, waste, and abuse, ensuring appropriate reimbursement and compliance.

Question 80: What is the primary purpose of the Medicare Physician Fee Schedule (MPFS)?

To determine hospital outpatient payment rates
To assign DRGs for inpatient claims
To set payment rates for physician services under Medicare Part B (Correct answer)
To establish Medicaid reimbursement rates

Correct answer: To set payment rates for physician services under Medicare Part B

The MPFS establishes the payment rates for physician and other professional services billed under Medicare Part B.

Question 81: Which of the following is a part of the ICD-10-PCS code structure?

Seven alphanumeric characters (Correct answer)
Two letters followed by four digits
Three characters followed by a hyphen
Four numeric digits

Correct answer: Seven alphanumeric characters

The ICD-10-PCS code structure consists of seven alphanumeric characters. Each character represents a specific aspect of the procedure, such as the section, body system, root operation, body part, approach, device, and qualifier. This standardized structure allows for a highly detailed and precise classification of inpatient procedures.

Question 82: Which modifier is appended to a CPT code to indicate a procedure was performed bilaterally?

-51
-59
-50 (Correct answer)
-RT

Correct answer: -50

CPT modifier -50 is used when a procedure is performed bilaterally during the same operative session.

Question 83: A healthy patient who is a matching donor arrives at the hospital for surgery on behalf of his brother, who requires a kidney transplant. The admitting physician performs a thorough history, thorough examination, and extremely complicated medical decision-making. What kind of code would be appropriate for this encounter?

99222
99236
99233
99223 (Correct answer)

Correct answer: 99223

The patient is a healthy donor admitted for surgery, and the physician performs a thorough history, thorough examination, and extremely complicated medical decision-making. This description aligns with a high-level initial hospital inpatient or observation care service. Code 99223 represents an initial hospital inpatient or observation care, typically requiring three key components: comprehensive history, comprehensive examination, and medical decision making of high complexity.

Question 84: Which section of the CPT manual contains codes for Evaluation and Management services?

99500–99607
99202–99499 (Correct answer)
99000–99082
99100–99140

Correct answer: 99202–99499

E/M codes are found in the range 99202–99499 in the CPT manual, covering office visits, hospital care, and other encounter types.

Question 85: Written or oral authorization to move forward with caution is categorized as:

Informed consent (Correct answer)
Refusal of consent
Expressed consen
Implied consent

Correct answer: Informed consent

Informed consent is a legal and ethical principle that requires a healthcare provider to obtain permission from a patient before performing a medical procedure or treatment. This authorization must be given after the patient has received and understood all relevant information, including the nature of the procedure, its risks, benefits, and alternatives. It signifies a patient's autonomous decision-making regarding their care.

Question 86: What does the abbreviation PHI mean?

Private health information
Protected health information (Correct answer)
Patient health information
Personal health information

Correct answer: Protected health information

PHI stands for Protected Health Information. This term refers to any information about health status, provision of healthcare, or payment for healthcare that can be linked to a specific individual. It is safeguarded under the Health Insurance Portability and Accountability Act (HIPAA) to ensure patient privacy and data security.

Question 87: What is the purpose of ICD-10-CM's 'code also' instruction?

Restricts use of the code to outpatient settings only
Alerts the coder that a second code may be needed to fully describe the condition (Correct answer)
Indicates the code is mandatory
Means the code cannot be used as a principal diagnosis

Correct answer: Alerts the coder that a second code may be needed to fully describe the condition

The 'code also' instruction alerts the coder that two codes may be required to fully describe a condition, though sequencing depends on the circumstances.

Question 88: Which accreditation organization sets standards for hospitals including health information management practices?

The Joint Commission (TJC) (Correct answer)
AAPC
CMS
AHIMA

Correct answer: The Joint Commission (TJC)

The Joint Commission (TJC) is a major accrediting body that sets standards for hospital operations including medical record management.

Question 89: What is the correct ICD-10-CM code category for adverse effects of drugs taken correctly as prescribed?

Y40–Y59
S00–S09
T36–T50 with 5th character 5 (Correct answer)
T36–T50 with 5th character 1

Correct answer: T36–T50 with 5th character 5

Adverse effects of drugs properly administered are coded with T36–T50 using the 5th character '5' (adverse effect).

Question 90: Which of the following represents the correct use of an 'Excludes1' note in ICD-10-CM?

The two codes cannot be used together because they represent the same condition (Correct answer)
The excluded code is required as an additional code
The excluded condition should be sequenced first
The excluded code may be used together with this code if the patient has both conditions

Correct answer: The two codes cannot be used together because they represent the same condition

An 'Excludes1' note means the two codes represent the same condition and cannot be reported together; they are mutually exclusive.

Question 91: Which organization offers the Certified Coding Associate (CCA) certification?

American Academy of Professional Coders (AAPC)
Healthcare Information and Management Systems Society (HIMSS)
American Health Information Management Association (AHIMA) (Correct answer)
Which organization offers the Certified Coding Associate (CCA) certification?

Correct answer: American Health Information Management Association (AHIMA)

The American Health Information Management Association (AHIMA) is the professional organization that offers and maintains the Certified Coding Associate (CCA) certification. AHIMA is a leading authority in health information management and provides various credentials for health information professionals, ensuring high standards in the field.

Question 92: What does "E/M" stand for in medical coding?

Emergency and Maintenance
Equipment and Medication
Examination and Manipulation (Correct answer)
evaluation and Management

Correct answer: Examination and Manipulation

In medical coding, E/M stands for Evaluation and Management. E/M codes are a category within the CPT code set used to report physician services for assessing and managing a patient's health condition. These codes are crucial for billing office visits, hospital visits, consultations, and other encounters where a physician evaluates a patient's problem and determines a course of action.

Question 93: What is the correct sequencing rule when a patient is admitted for chemotherapy?

Sequence the malignancy as the principal diagnosis
Sequence the primary symptom as the first-listed diagnosis
Sequence the encounter for chemotherapy (Z51.11) as the principal diagnosis (Correct answer)
Sequence the metastatic site first

Correct answer: Sequence the encounter for chemotherapy (Z51.11) as the principal diagnosis

When a patient is admitted for chemotherapy administration, Z51.11 is sequenced as the principal diagnosis, followed by the malignancy code.

Question 94: When the words "separate procedure" appear after the code description in a CPT code, you should:

Do not use this code if it is listed as a separate procedure
Code for all other elements of the procedure except this one
Only code for the procedure if tit was the only thing performed (Correct answer)
Code for this procedure, even if it was not performed

Correct answer: Only code for the procedure if tit was the only thing performed

When 'separate procedure' appears after a CPT code description, it indicates that the procedure is usually considered an integral part of a more extensive procedure. Therefore, it should only be coded and reported if it is performed independently and not as a component of another, more comprehensive service. If performed with another procedure, it is typically bundled and not coded separately, unless specific circumstances warrant it (e.g., different site, unusual circumstances, documented modifier).

Question 95: What does "HIPAA" stands for?

Health Information Privacy and Accountability Act
Health Insurance and Privacy Act
Health Information Processing and Administration Act
Health Insurance Portability and Accountability Act (Correct answer)

Correct answer: Health Insurance Portability and Accountability Act

HIPAA stands for the Health Insurance Portability and Accountability Act. Enacted in 1996, this federal law primarily aims to protect patient health information, improve the efficiency and effectiveness of the healthcare system, and ensure health insurance portability for workers. It sets national standards for electronic healthcare transactions and data privacy.

Question 96: The HCPCS Level II 'J codes' are primarily used for which of the following?

Durable medical equipment
Temporary codes for emerging services
Vision and hearing services
Drugs administered other than oral method (Correct answer)

Correct answer: Drugs administered other than oral method

J codes (J0000–J9999) represent drugs administered by injection, infusion, or other non-oral routes, such as chemotherapy agents.

Question 97: The Tabular List in ICD-10-CM is organized into how many chapters?

21 (Correct answer)
22
17
19

Correct answer: 21

ICD-10-CM's Tabular List is organized into 21 chapters, each representing a body system or type of condition.

Question 98: Which coding classification system is used exclusively for inpatient hospital procedure coding in the United States?

ICD-10-CM
HCPCS Level II
CPT
ICD-10-PCS (Correct answer)

Correct answer: ICD-10-PCS

ICD-10-PCS (Procedure Coding System) is the classification system mandated for coding inpatient hospital procedures in the US.

Question 99: What type of code is used when a patient has a condition that is not yet confirmed but is being evaluated?

Uncertain diagnosis code
Signs and symptoms codes (Correct answer)
Screening code
Confirmed diagnosis code

Correct answer: Signs and symptoms codes

In outpatient settings, coders report signs and symptoms rather than unconfirmed diagnoses; uncertain diagnoses may only be coded as confirmed in inpatient settings.

Question 100: In the outpatient setting, which of the following should be coded as the first-listed diagnosis?

The condition that caused the greatest resource use
The chronic condition that is always managed at each visit
The condition requiring the most complex treatment
The condition chiefly responsible for the outpatient service as documented by the provider (Correct answer)

Correct answer: The condition chiefly responsible for the outpatient service as documented by the provider

For outpatient services, the first-listed diagnosis is the condition, after study, chiefly responsible for the service provided on that encounter.

Question 101: What does the prefix 'brady-' mean in medical terminology?

Small
Fast
Large
Slow (Correct answer)

Correct answer: Slow

The prefix 'brady-' means slow, as in bradycardia (slow heart rate).

Certified Coding Associate (CCA) Exam

The Certified Coding Associate (CCA) credential demonstrates foundational competency in medical coding across all healthcare settings, including physician offices and hospitals. It validates knowledge of coding guidelines and regulations.

100

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120 min

Time Limit

70%

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