Certified Outpatient Coder (COC) — Questions and Answers

Question 1: When a patient presents with signs and symptoms that are integral to a confirmed diagnosis, how are they coded?

They are only coded if listed as complications
They are NOT coded separately — they are included in the disease code (Correct answer)
They may optionally be coded for severity tracking
They are coded first, followed by the confirmed diagnosis

Correct answer: They are NOT coded separately — they are included in the disease code

Signs and symptoms that are routinely associated with a confirmed disease process are not coded separately, as they are integral components of the diagnosis.

Question 2: What distinguishes a consultation from a new patient visit in E/M coding?

Consultations require a request from another provider and a written report back (Correct answer)
Consultations do not count toward global period
New patient visits always use lower-level codes
Consultations are only for specialist physicians

Correct answer: Consultations require a request from another provider and a written report back

A consultation requires a written or verbal request from another provider and mandates that the consultant render a written opinion or report back to the requesting provider.

Question 3: When a drug has both a CPT and a HCPCS Level II code, which should be used for outpatient hospital coding?

Either code is acceptable
HCPCS Level II code, as it is more specific for the drug (Correct answer)
Only report the diagnosis, not the drug administration
CPT code always takes precedence

Correct answer: HCPCS Level II code, as it is more specific for the drug

HCPCS Level II drug codes (J-codes) provide more specific information about the drug dose and route and are preferred for outpatient drug billing.

Question 4: The combining form 'osteo-' relates to:

tendon
muscle
bone (Correct answer)
joint

Correct answer: bone

Osteo- relates to bone, as in osteoporosis or osteomyelitis.

Question 5: An outpatient visit where the physician's total time is 40 minutes for an established patient would be coded as:

99212
99214 (Correct answer)
99215
99213

Correct answer: 99214

Under 2021 guidelines, 40 minutes of total time for an established patient maps to 99214 (30–39 minutes = 99213; 40–54 minutes = 99214).

Question 6: A patient is seen for a follow-up visit for a healed fracture with residual stiffness of the wrist. Which ICD-10-CM character identifies this as a sequela encounter?

7th character S (Correct answer)
7th character A
7th character G
7th character D

Correct answer: 7th character S

The 7th character 'S' designates a sequela encounter, used when residual conditions remain after the acute phase of an injury has resolved.

Question 7: Which letter begins HCPCS Level II codes for durable medical equipment (DME)?

A
L
E (Correct answer)
K

Correct answer: E

HCPCS Level II codes beginning with the letter 'E' represent durable medical equipment such as wheelchairs and hospital beds.

Question 8: Modifier -TC (Technical Component) is a HCPCS modifier used to report:

A teleconsultation service
The global service including both components
Only the technical/equipment portion of a diagnostic test (Correct answer)
The physician's interpretation only

Correct answer: Only the technical/equipment portion of a diagnostic test

Modifier -TC identifies only the technical component (equipment, supplies, technician) of a diagnostic procedure, separate from the professional interpretation.

Question 9: Which ICD-10-CM guideline governs the use of code Z23 (Encounter for immunization)?

Z23 is always the principal or first-listed diagnosis code (Correct answer)
Z23 is used only when the immunization is refused
Z23 is sequenced as an additional code only
Z23 applies only to pediatric immunizations

Correct answer: Z23 is always the principal or first-listed diagnosis code

Z23 is assigned as the first-listed code when the sole reason for the encounter is to receive an immunization.

Question 10: When coding an outpatient encounter for a condition that is documented as 'probable' or 'suspected,' what is the correct ICD-10-CM guideline?

Use a Z code for suspected conditions
Code the signs and symptoms, not the unconfirmed diagnosis (Correct answer)
Code the suspected condition as confirmed
Code 'probable' conditions only if the provider uses the term 'rule out'

Correct answer: Code the signs and symptoms, not the unconfirmed diagnosis

In outpatient settings, uncertain diagnoses such as 'probable' or 'suspected' should not be coded; instead, code the signs and symptoms.

Question 11: A patient presents to an outpatient clinic with a pathological fracture of the right femur due to metastatic bone disease from breast cancer. Which code is sequenced first?

The pathological fracture code
The fracture sequencing depends on the reason for the visit
The primary breast cancer code
The metastatic bone disease code (Correct answer)

Correct answer: The metastatic bone disease code

In outpatient coding, metastatic disease is coded first when it is the reason for the encounter, with the fracture as a secondary code.

Question 12: Which CPT section includes codes for surgical pathology?

Pathology and Laboratory (80000s–89999) (Correct answer)
Radiology (70010–79999)
Medicine (90000s–99199)
Surgery (10004–69990)

Correct answer: Pathology and Laboratory (80000s–89999)

Surgical pathology codes fall within the Pathology and Laboratory section, ranging from 80000s to 89999.

Question 13: Under the 2021 E/M guidelines, which level of MDM corresponds to a straightforward problem with minimal data and minimal risk?

Moderate
Low
Straightforward (Correct answer)
High

Correct answer: Straightforward

Straightforward MDM applies when there is a minimal number of problems, minimal or no data reviewed, and minimal risk of complications.

Question 14: In CPT coding, an 'unlisted procedure' code is used when:

The payer does not cover the service
No specific CPT code adequately describes the service performed (Correct answer)
The procedure is experimental
The procedure was performed in a hospital outpatient setting

Correct answer: No specific CPT code adequately describes the service performed

Unlisted procedure codes are reported when no existing CPT code accurately describes the service; a special report is typically required.

Question 15: Which term describes a procedure in which real-time moving images of an organ are displayed on a screen so that a physician can examine its function and/or structure?

Fluoroscopy (Correct answer)
Magnetic resonance imaging
Computed tomography
Tomography

Correct answer: Fluoroscopy

Explanation: Magnetic resonance imaging (MRI) uses magnets, radio waves, and a computer to display detailed pictures of the inside of the body. Tomography uses waves of energy to create three-dimensional, computer-generated images of any internal structure. Computed tomography is cross-sectional images of the body obtained by a narrow beam of X-rays that quickly rotates around the body.

Question 16: What is the timely filing limit for Medicare Part B claims?

6 months from the date of service
2 years from the date of service
One calendar year from the date of service (Correct answer)
90 days from the date of service

Correct answer: One calendar year from the date of service

Medicare Part B requires claims to be filed within one calendar year (12 months) from the date of service to be eligible for reimbursement.

Question 17: Which modifier is used to report an assistant surgeon's services?

-82
-66
-80 (Correct answer)
-62

Correct answer: -80

Modifier -80 (Assistant Surgeon) is used when a physician acts as an assistant during surgery performed by another physician.

Question 18: Which lung lobe is the most common site for aspiration pneumonia in a supine patient?

Right middle lobe
Left lower lobe
Left upper lobe
Right lower lobe (posterior segment) (Correct answer)

Correct answer: Right lower lobe (posterior segment)

The posterior segment of the right lower lobe is the most dependent region in a supine patient and therefore the most common aspiration site due to gravity.

Question 19: When using total time to select an E/M level, what does 'total time' include?

Only face-to-face time with the patient
All time on the date of encounter, including pre/post-visit activities (Correct answer)
Time spent in the examination room only
Documentation time only

Correct answer: All time on the date of encounter, including pre/post-visit activities

Under 2021 guidelines, total time for office E/M includes all physician/QHP time on the date of encounter: preparing, face-to-face, and post-visit documentation.

Question 20: Chronic obstructive pulmonary disease (COPD) is primarily characterized by:

Restrictive lung pattern with reduced lung volumes
Acute, fully reversible bronchoconstriction
Increased diffusion capacity
Persistent airflow limitation that is not fully reversible (Correct answer)

Correct answer: Persistent airflow limitation that is not fully reversible

COPD is defined by persistent, not fully reversible airflow limitation, distinguishing it from asthma, which is typically reversible.

Question 21: A patient presents to an outpatient surgery center for laparoscopic cholecystectomy due to cholelithiasis with acute cholecystitis. Which code is first-listed?

The cholecystectomy procedure code
Z87.39 – Personal history of digestive disease
K81.0 – Acute cholecystitis alone
K80.00 – Calculus of gallbladder with acute cholecystitis without obstruction (Correct answer)

Correct answer: K80.00 – Calculus of gallbladder with acute cholecystitis without obstruction

The condition that is the reason for the outpatient surgical procedure—cholelithiasis with acute cholecystitis—is coded as first-listed.

Question 22: A 45-year-old female presents to the CT lab for a coronary calcium score exam. The lab report is reviewed by the cardiologist who diagnosed CAD in the patient. What diagnosis codes are reported?

Z13.0, I25.83
Z13.6, I25.10 (Correct answer)
I25.83
Z13.9, I25.84

Correct answer: Z13.6, I25.10

Explanation: CAD stands for Coronary Artery Disease. In the ICD-10-CM index, look up Screening/ cardiovascular disorder/ which points to Z13.6. Also look up Disease/ coronary (artery) / which says to see Disease, heart, ischemic, atherosclerotic. This entry points to I25.10.

Question 23: A patient with type 2 diabetes mellitus is seen for diabetic chronic kidney disease, stage 3. Which code set is correct?

E11.9, N18.3
E11.649, N18.3
E11.22, N18.3 (Correct answer)
E11.65, N18.3

Correct answer: E11.22, N18.3

E11.22 is the combination code for type 2 diabetes with diabetic chronic kidney disease, and N18.3 specifies stage 3 CKD.

Question 24: A 6-year-old boy is diagnosed with childhood asthma with exacerbation by the emergency room physician. His caretakers are chain smokers and the physician documents exposure to environmental tobacco smoke. What diagnosis code(s) are reported?

J45.41, Z77.22, Z72.0
J45.909, Z77.22
J45.901, Z77.22, Z72.0
J45.901, Z77.22 (Correct answer)

Correct answer: J45.901, Z77.22

Explanation: In the ICD-10-CM index, look up Asthma/ childhood/ with exacerbation (acute) which points to J45.901. Verify this code in the tabular. There is an instructional note under category J45 which states to use an additional code to identify exposure to environmental tobacco smoke (Z77.22). Verify this code in the tabular. It would be inappropriate to code tobacco use (Z72.0) on this encounter for the child because it is not the child who is a chain smoker. Also, there is an Excludes1 note under Z77.22 for tobacco use (Z72.0) indicating that these codes cannot be coded together.

Question 25: Which CPT code category uses time as the key controlling factor for code selection in E/M coding as of 2021 guidelines?

Inpatient consult codes (99241–99245)
Hospital observation codes (99217–99220)
Emergency department codes (99281–99285)
Office/outpatient E/M codes (99202–99215) (Correct answer)

Correct answer: Office/outpatient E/M codes (99202–99215)

The 2021 E/M guideline changes allow office/outpatient codes 99202–99215 to be selected based solely on total time on the date of the encounter.

Question 26: Which term means 'pertaining to both sides'?

ipsilateral
bilateral (Correct answer)
unilateral
contralateral

Correct answer: bilateral

Bilateral means pertaining to both sides, from bi- (two) + lateral (side).

Question 27: A patient reports to the ASC for excision of a lipoma of the neck. The lab report later indicated a diagnosis of malignant neoplasm of the neck. What diagnosis code(s) are reported?

D17.0, C76.0
C76.0 (Correct answer)
C79.89, D17.0
D17.0, D09.8

Correct answer: C76.0

Explanation: ICD-10-CM guideline IV.N Ambulatory surgery states if the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding since it is the most definitive. In the Table of Neoplasms, look up neck NEC/ malignant primary/ which directs to C76.0. Verify this code in the tabular.

Question 28: What is the diagnosis code for post-traumatic osteoarthritis of the left elbow?

M19.022
M19.229
M19.232
M19.122 (Correct answer)

Correct answer: M19.122

Explanation: In the ICD-10-CM index, look up Osteoarthritis/ post-traumatic/ elbow/ which directs to M19.12-. Checking the tabular, the correct code is M19.122 which indicates the left elbow.

Question 29: What does the STARK Law (Physician Self-Referral Law) prohibit?

Discharge planning before 24 hours of admission
Physicians billing for services not rendered
Hospitals charging fees above the Medicare fee schedule
Physicians referring patients to entities where they have a financial interest for designated health services (Correct answer)

Correct answer: Physicians referring patients to entities where they have a financial interest for designated health services

The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities in which the physician or an immediate family member has a financial relationship, for designated health services.

Question 30: An instructional note 'Excludes1' in ICD-10-CM means:

The excluded condition can be coded together if both conditions are documented
The excluded condition has been incorporated into the current code
The excluded code should be assigned as an additional code
The two conditions cannot occur together and cannot be coded simultaneously (Correct answer)

Correct answer: The two conditions cannot occur together and cannot be coded simultaneously

Excludes1 indicates a pure exclusion—the conditions are mutually exclusive and cannot be assigned together.

Certified Outpatient Coder (COC)

The COC certification from AAPC validates expertise in outpatient facility and hospital coding using ICD-10-CM, CPT, and HCPCS Level II codes, including APC payment methodology and CMS outpatient prospective payment system rules.

Questions

35 min

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70%

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