Certified Medical Coding Specialist Professional Standards & Competencies 2 — Questions and Answers
Question 1: Which organization administers the Certified Medical Coding Specialist (CMCS) credential?
- American Health Information Management Association (AHIMA)
- Medical Association of Billers (MAB) (Correct answer)
- American Academy of Professional Coders (AAPC)
- National Healthcareer Association (NHA)
Correct answer: Medical Association of Billers (MAB)
The CMCS credential is administered by the Medical Association of Billers (MAB).
Question 2: 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?
- Correct the code without notifying anyone
- Query the physician for clarification before coding (Correct answer)
- Report the physician directly to the OIG
- Submit the claim with the documented diagnosis regardless
Correct answer: Query the physician for clarification before coding
Querying the physician is the appropriate first step to clarify documentation before assigning a code.
Question 3: Under HIPAA, which of the following is NOT considered a covered entity?
- Health insurance plans
- Healthcare clearinghouses
- Healthcare providers who transmit health information electronically
- Employers who self-administer wellness programs with no PHI transmission (Correct answer)
Correct 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.
Question 4: A coder is asked by a supervisor to upcode a procedure to increase reimbursement. The coder should:
- Comply if the physician agrees verbally
- Refuse and document the incident per compliance policy (Correct answer)
- Comply only if the amount is under $500
- Query the insurance company before deciding
Correct answer: Refuse and document the incident per compliance policy
Upcoding is fraudulent; the coder must refuse and report the request through established compliance channels.
Question 5: Which coding guideline requires that all confirmed conditions present at discharge be coded for inpatient records?
- UHDDS principal diagnosis definition (Correct answer)
- UACDS outpatient guideline
- HIPAA minimum necessary standard
- OIG Work Plan instruction
Correct 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.
Question 6: Which of the following best describes 'code to the highest level of specificity'?
- Always use the first code listed in the Alphabetic Index
- Assign the most detailed code supported by the documentation (Correct answer)
- Use an unspecified code when any doubt exists
- Select the code with the highest reimbursement rate
Correct 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.
Question 7: A medical coder's primary obligation when documentation is ambiguous is to:
- Select the code that maximizes reimbursement
- Assume the most severe diagnosis to be safe
- Query the provider for clarification (Correct answer)
- Leave the field blank on the claim form
Correct answer: Query the provider for clarification
When documentation is ambiguous, the coder must query the provider rather than assume or select based on reimbursement.
Certified Medical Coding Specialist Professional Standards & Competencies 2
Which organization administers the Certified Medical Coding Specialist (CMCS) credential?