Certified Medical Coding Specialist Medical Coding (CMCS) Sample 5 — Questions and Answers
Question 1: Which of the following modifiers is used when a procedure is performed by two surgeons of different specialties?
- -62 (Correct answer)
- -66
- -80
- -81
Correct answer: -62
Modifier -62 indicates that two surgeons of different specialties each perform a distinct portion of a single procedure.
Question 2: What is the purpose of the Correct Coding Initiative (CCI) edits?
- To ensure diagnoses match procedure codes
- To prevent improper payment of unbundled procedure codes (Correct answer)
- To validate patient demographic information
- To ensure correct place-of-service coding
Correct answer: To prevent improper payment of unbundled procedure codes
CCI edits are developed by CMS to prevent improper Medicare payments for incorrectly unbundled or mutually exclusive procedure codes.
Question 3: A patient presents with a chief complaint of shortness of breath. After workup, the physician documents 'possible congestive heart failure.' Under inpatient coding guidelines, how is this coded?
- Code shortness of breath only
- Code congestive heart failure as if confirmed (Correct answer)
- Do not code either — await confirmation
- Code both shortness of breath and congestive heart failure
Correct answer: Code congestive heart failure as if confirmed
Inpatient guidelines allow coding of conditions documented as 'possible,' 'probable,' or 'suspected' as if established.
Question 4: When a physician documents 'acute on chronic' heart failure, how should this be coded in ICD-10-CM?
- Code only the acute type
- Code only the chronic type
- Code the combined 'acute on chronic' combination code (Correct answer)
- Code with two separate codes for acute and chronic
Correct answer: Code the combined 'acute on chronic' combination code
ICD-10-CM provides specific combination codes for acute on chronic conditions such as heart failure (e.g., I50.23 for acute-on-chronic systolic heart failure).
Question 5: Which of the following is classified as a Category III CPT code?
- A permanent code for an established procedure
- A temporary code for emerging technology or services (Correct answer)
- A code for unlisted procedures
- An add-on code for a secondary procedure
Correct answer: A temporary code for emerging technology or services
Category III CPT codes are temporary codes used to track emerging technologies and services to support data collection for potential future Category I status.
Question 6: Under the CMS-1500 claim form, Box 21 is used to enter:
- Procedure codes
- Diagnosis codes (Correct answer)
- Revenue codes
- Place of service codes
Correct answer: Diagnosis codes
Box 21 of the CMS-1500 form is designated for ICD diagnosis codes that support medical necessity of the billed services.
Question 7: A coder assigns an E/M code based on medical decision making (MDM). Which of the following represents 'high complexity' MDM?
- One stable chronic illness managed well
- Two or more self-limited problems
- Threat to life or bodily function requiring urgent decision-making (Correct answer)
- One acute uncomplicated illness
Correct answer: Threat to life or bodily function requiring urgent decision-making
High complexity MDM involves problems that pose a threat to life or bodily function and require extensive data review and high-risk management.
Certified Medical Coding Specialist Medical Coding (CMCS) Sample 5
Which of the following modifiers is used when a procedure is performed by two surgeons of different specialties?