Professional Standards & Competencies Flashcards
7 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Professional Standards & Competencies flashcards as text
Which organization administers the Certified Medical Coding Specialist (CMCS) credential?
Answer: Medical Association of Billers (MAB)
The CMCS credential is administered by the Medical Association of Billers (MAB).
A medical coder discovers that a physician consistently documents a diagnosis that is not supported by the clinical findings in the record. What is the most appropriate first step?
Answer: Query the physician for clarification before coding
Querying the physician is the appropriate first step to clarify documentation before assigning a code.
Under HIPAA, which of the following is NOT considered a covered entity?
Answer: Employers who self-administer wellness programs with no PHI transmission
Employers who do not transmit PHI electronically in the course of healthcare transactions are not HIPAA covered entities.
A coder is asked by a supervisor to upcode a procedure to increase reimbursement. The coder should:
Answer: Refuse and document the incident per compliance policy
Upcoding is fraudulent; the coder must refuse and report the request through established compliance channels.
Which coding guideline requires that all confirmed conditions present at discharge be coded for inpatient records?
Answer: UHDDS principal diagnosis definition
The Uniform Hospital Discharge Data Set (UHDDS) guidelines direct that all conditions present at discharge be coded on inpatient records.
Which of the following best describes 'code to the highest level of specificity'?
Answer: Assign the most detailed code supported by the documentation
Coding to the highest level of specificity means selecting the most detailed, precise code the documentation supports.
A medical coder's primary obligation when documentation is ambiguous is to:
Answer: Query the provider for clarification
When documentation is ambiguous, the coder must query the provider rather than assume or select based on reimbursement.