Certified Medical Coding Specialist Professional Standards & Competencies 4

Question 1

A coder is uncertain whether a condition documented as 'possible pneumonia' should be coded for an outpatient encounter. The correct approach is to:

Accepted Answer

Code the sign or symptom prompting the evaluation, not the uncertain condition

Answer

Outpatient coding guidelines prohibit coding uncertain diagnoses; the coder reports the sign or symptom instead.

Question 2

Which of the following practices could constitute Medicare fraud?

Accepted Answer

Billing for a 99213 when a 99212 was documented

Answer

Billing a higher-level E/M service than the documentation supports is upcoding, which constitutes Medicare fraud.

Question 3

Continuing education units (CEUs) are required for CMCS credential maintenance primarily to ensure:

Accepted Answer

Knowledge stays current with evolving coding systems and regulations

Answer

CEUs keep credentialed professionals current with changing codes, guidelines, and regulations that affect coding accuracy.

Question 4

Which of the following is the best example of a 'query' in the coding context?

Accepted Answer

A coder sends a written request asking the physician to clarify if a condition is related to a procedure

Answer

A compliant query is a written communication asking the provider to clarify documentation without leading to a specific answer.

Question 5

The concept of 'code linkage' in medical billing refers to:

Accepted Answer

Connecting the diagnosis code to the procedure code to demonstrate medical necessity

Answer

Code linkage connects the diagnosis to the procedure on the claim to demonstrate that the service was medically necessary.

Certified Medical Coding Specialist Practice Test