Certified Coding Associate Exam Certified Coding Associate Professional 5 — Questions and Answers
Question 1: Which root operation in ICD-10-PCS is defined as 'cutting out or off, without replacement, all of a body part'?
- Excision
- Resection (Correct answer)
- Destruction
- Extirpation
Correct answer: Resection
Resection in ICD-10-PCS means cutting out or off, without replacement, all of a body part, distinguishing it from Excision which is only part of the body part.
Question 2: In CPT, a 'separate procedure' designation means:
- It can always be billed in addition to other procedures
- It is commonly part of a larger procedure and should not be billed separately when performed with a related procedure (Correct answer)
- It requires a separate operative report
- It is only reported for outpatient services
Correct answer: It is commonly part of a larger procedure and should not be billed separately when performed with a related procedure
A 'separate procedure' designation in CPT indicates the procedure is integral to a larger service and should not be reported separately when performed as part of that service.
Question 3: 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 4: Which of the following best describes the function of a code editor in medical billing?
- Converts handwritten notes to electronic format
- Reviews claims for coding accuracy before submission (Correct answer)
- Schedules patient appointments
- Assigns revenue codes to hospital claims
Correct answer: Reviews claims for coding accuracy before submission
A code editor or claims scrubber reviews submitted codes for compliance, accuracy, and payer-specific requirements prior to claim submission.
Question 5: A surgeon performs an arthroscopic repair of a torn medial meniscus. Which CPT code range would apply?
- 20000-20999 (General musculoskeletal)
- 27000-27899 (Leg/knee)
- 29800-29999 (Arthroscopy) (Correct answer)
- 26000-26989 (Hand/Fingers)
Correct answer: 29800-29999 (Arthroscopy)
Arthroscopic knee procedures, including meniscal repairs, are found in the Arthroscopy subsection of the Musculoskeletal CPT codes (29800-29999).
Question 6: What is the significance of the 'CC/MCC' classification in inpatient DRG reimbursement?
- It determines the outpatient ambulatory payment classification
- Complications and comorbidities that affect the DRG assignment and increase reimbursement (Correct answer)
- The total count of diagnoses listed on the UB-04
- The code for a Medicare Advantage plan
Correct answer: Complications and comorbidities that affect the DRG assignment and increase reimbursement
CCs (complications/comorbidities) and MCCs (major complications/comorbidities) are secondary diagnoses that, when present, increase the DRG weight and reimbursement.
Question 7: Under HIPAA, which of the following is NOT considered protected health information (PHI)?
- Patient's date of birth linked to a diagnosis
- De-identified data with all 18 identifiers removed (Correct answer)
- A patient's medical record number
- An insurance claim with the patient's name
Correct answer: De-identified data with all 18 identifiers removed
De-identified health information, from which all 18 HIPAA identifiers have been removed, is not considered PHI and is not protected under the Privacy Rule.
Certified Coding Associate Exam Certified Coding Associate Professional 5
Which root operation in ICD-10-PCS is defined as 'cutting out or off, without replacement, all of a body part'?