Certified Coding Associate Exam Certified Coding Associate Knowledge 5 — Questions and Answers
Question 1: Which of the following is the correct definition of 'upcoding'?
- Assigning a less complex code than documented to reduce patient cost
- Assigning a higher-level code than what is documented to increase reimbursement (Correct answer)
- Using outdated codes from a prior year's code set
- Skipping required code characters
Correct answer: Assigning a higher-level code than what is documented to increase reimbursement
Upcoding is the fraudulent practice of billing for a higher level of service or more complex code than what the documentation supports.
Question 2: In ICD-10-PCS, how many characters does every procedure code contain?
- 5
- 6
- 7 (Correct answer)
- 8
Correct answer: 7
Every ICD-10-PCS code is exactly 7 characters long, with each character representing a specific aspect of the procedure.
Question 3: Which CPT modifier indicates that a service was reduced or eliminated at the physician's discretion?
- -22
- -52 (Correct answer)
- -53
- -59
Correct answer: -52
Modifier -52 (Reduced Services) is used when a service is partially reduced or eliminated at the physician's discretion, with a corresponding reduction in reimbursement.
Question 4: A patient with end-stage renal disease (ESRD) also has hypertension. Per ICD-10-CM guidelines, how should this be coded?
- I12.11 only
- N18.6 and I10 separately
- I12.11 and N18.6 (Correct answer)
- I10 and N18.6
Correct answer: I12.11 and N18.6
ICD-10-CM assumes a causal relationship between hypertension and CKD; I12.11 (hypertensive CKD with ESRD) is assigned with N18.6 for the ESRD stage.
Question 5: Which of the following is NOT a component considered when selecting the level of an E/M service under the 2021 revised guidelines?
- Medical decision making
- Total time spent on the date of encounter
- Number of diagnoses addressed
- Physical examination elements (Correct answer)
Correct answer: Physical examination elements
The 2021 E/M guidelines eliminated the use of physical examination elements as a scoring component; level is now based on MDM or total time.
Question 6: What is the purpose of ICD-10-CM's 'code also' instruction?
- Indicates the code is mandatory
- Alerts the coder that a second code may be needed to fully describe the condition (Correct answer)
- Means the code cannot be used as a principal diagnosis
- Restricts use of the code to outpatient settings only
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 7: Which of the following scenarios requires the use of an external cause code (V00–Y99) in ICD-10-CM?
- A patient with essential hypertension
- A patient with type 2 diabetes
- A patient with a fracture sustained in a motor vehicle accident (Correct answer)
- A patient with pneumonia
Correct answer: A patient with a fracture sustained in a motor vehicle accident
External cause codes (V00–Y99) are used to describe the cause, intent, and location of injuries and other health conditions, such as a fracture from a motor vehicle accident.
Certified Coding Associate Exam Certified Coding Associate Knowledge 5
Which of the following is the correct definition of 'upcoding'?