Certified Coding Associate Exam Certified Coding Associate Knowledge 5

Question 1

Which of the following is the correct definition of 'upcoding'?

Accepted Answer

Assigning a higher-level code than what is documented to increase reimbursement

Answer

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?

Accepted Answer

7

Answer

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?

Accepted Answer

-52

Answer

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?

Accepted Answer

I12.11 and N18.6

Answer

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?

Accepted Answer

Physical examination elements

Answer

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.

Certified Coding Associate Exam Practice Test

Certified Coding Associate Exam Practice Test

Certified Coding Associate Exam Certified Coding Associate Knowledge 5