Question 1: A patient is seen for a new patient office visit. The physician spends 45 minutes total time on date of encounter. Which E/M code applies under the 2021 guidelines?

• 99202
• 99204 (Correct answer)
• 99205
• 99203

Correct answer: 99204

Under 2021 AMA guidelines, 99204 corresponds to 45–59 minutes of total time on the date of service for a new patient.

Question 2: An anesthesiologist provides general anesthesia for a total hip arthroplasty. After the surgical procedure is complete, and at the surgeon's request, the anesthesiologist performs a femoral nerve block for postoperative pain management. How should the anesthesiologist report their services?

• Report the anesthesia code and append modifier 22 for the extra work of the nerve block.
• Report only the anesthesia code for the hip arthroplasty.
• Report the nerve block as the primary service and the anesthesia as secondary.
• Report the anesthesia code and the nerve block code, appending modifier 59 to the nerve block code. (Correct answer)

Correct answer: Report the anesthesia code and the nerve block code, appending modifier 59 to the nerve block code.

When a nerve block is performed for the exclusive purpose of postoperative pain management and not as the primary anesthetic, it is a separate and reportable service. The anesthesia for the surgical procedure is reported, and the nerve block (e.g., CPT 64447) is also reported with modifier 59 to indicate it is a distinct procedural service from the anesthesia provided for the surgery.

Question 3: When a provider bills for services that were never rendered to the patient, this is classified as:

• Phantom billing (Correct answer)
• Duplicate billing
• Unbundling
• Upcoding

Correct answer: Phantom billing

Phantom billing (also called billing for services not rendered) is submitting claims for services that were never actually provided to the patient.

Question 4: When is it appropriate to use an unspecified ICD-10-CM code?

• When the medical record lacks sufficient information to assign a more specific code (Correct answer)
• Never — coders must always query the physician for additional detail
• Only when the condition is still being worked up and no diagnosis is confirmed
• Only as a secondary diagnosis, never as the principal diagnosis

Correct answer: When the medical record lacks sufficient information to assign a more specific code

Unspecified codes are valid when the medical record documentation genuinely does not support assignment of a more specific code.

Question 5: When coding a sequela (late effect) condition in ICD-10-CM, what is the correct sequencing?

• Code only the original injury or illness
• Do not code resolved past conditions
• Code only the original injury with the 7th character for sequela
• Sequence the nature of the sequela first, followed by the sequela cause code (Correct answer)

Correct answer: Sequence the nature of the sequela first, followed by the sequela cause code

For sequela coding, the residual condition (nature of the sequela) is sequenced first, followed by the sequela code identifying the original cause, with limited exceptions.

Question 6: In ICD-10-CM fracture coding, what does the 7th character 'A' indicate?

• Initial encounter for fracture (Correct answer)
• Subsequent encounter with routine healing
• Anatomical fracture site
• Acute open fracture

Correct answer: Initial encounter for fracture

The 7th character 'A' designates the initial encounter, used while the patient is actively receiving treatment for the fracture.

Question 7: Which modifier indicates that a procedure was performed by a resident under the supervision of a teaching physician?

• Modifier -GE
• Modifier -GT
• Modifier -GX
• Modifier -GC (Correct answer)

Correct answer: Modifier -GC

Modifier -GC is appended to indicate that a service was performed in part by a resident under the direction of a teaching physician.

Question 8: What is a combination code in ICD-10-CM?

• A code that links two unrelated diagnoses on the same claim
• A single code that classifies two diagnoses, a diagnosis with a complication, or a diagnosis with an associated manifestation (Correct answer)
• A code used only when two chronic conditions coexist
• A code that combines a diagnosis with a CPT procedure code

Correct answer: A single code that classifies two diagnoses, a diagnosis with a complication, or a diagnosis with an associated manifestation

A combination code is one code that captures multiple clinical concepts simultaneously, such as a condition and its associated complication or manifestation.

Question 9: A physician removes a 1.5 cm benign lesion from the back along with 0.3 cm margins. What is the excised diameter used for code selection?

• 2.1 cm (Correct answer)
• 0.6 cm
• 1.5 cm
• 1.8 cm

Correct answer: 2.1 cm

Excised diameter = lesion size + widest margin on all sides, so 1.5 + 0.3 + 0.3 = 2.1 cm.

Question 10: Which of the following best describes a 'global surgical package'?

• Preoperative care only
• Only the intraoperative services
• Only services provided in the hospital setting
• All services related to the procedure including pre-op, intra-op, and post-op care within a specified period (Correct answer)

Correct answer: All services related to the procedure including pre-op, intra-op, and post-op care within a specified period

The global surgical package includes all pre-operative, intra-operative, and standard post-operative care within the defined global period (0, 10, or 90 days) for no additional charge.

Question 11: Which of the following is a method of preserving a bodily part using cryopreservation?

• Chemicals
• Heat
• Saturation
• Freezing (Correct answer)

Correct answer: Freezing

Cryopreservation is a process used to preserve biological materials, such as cells, tissues, or organs, by cooling them to very low temperatures. This method effectively halts biological activity and prevents degradation, allowing for long-term storage. Therefore, freezing is the fundamental method employed in cryopreservation.

Question 12: Which modifier is appended to indicate a service was performed by a physician other than the primary surgeon during the postoperative period?

• -24
• -54
• -55 (Correct answer)
• -25

Correct answer: -55

Modifier -55 is used when postoperative care is transferred to and performed by a different physician.

Question 13: What is 'excluded provider' status in the context of Medicare and Medicaid compliance?

• A provider barred from participation in federal healthcare programs (Correct answer)
• A provider who has opted out of Medicare
• A provider who only accepts private insurance
• A provider who treats only Medicaid patients

Correct answer: A provider barred from participation in federal healthcare programs

An excluded provider has been prohibited by the OIG from participating in Medicare, Medicaid, and other federal healthcare programs.

Question 14: Which anesthesia code range covers procedures on the thorax (chest wall and shoulder girdle)?

• 00100–00222
• 00500–00580
• 00400–00474 (Correct answer)
• 00300–00352

Correct answer: 00400–00474

CPT codes 00400–00474 cover anesthesia for procedures on the integumentary system of the thorax and shoulder girdle.

Question 15: A wound requiring complex repair includes which of the following distinguishing features?

• Layered closure involving only subcutaneous fat
• Use of topical anesthetic only
• Scar revision, debridement, extensive undermining, or retention sutures (Correct answer)
• Single-layer closure only

Correct answer: Scar revision, debridement, extensive undermining, or retention sutures

Complex repair involves more than layered closure, requiring scar revision, debridement, extensive undermining, retention sutures, or other complex techniques.

Question 16: Which section covers clinical pathology consultations in CPT?

• Evaluation and Management (99000–99499)
• Surgery (10000–69999)
• Medicine (90000–99999)
• Pathology and Laboratory (80000–89999) (Correct answer)

Correct answer: Pathology and Laboratory (80000–89999)

Pathology and Laboratory services, including clinical pathology consultations, are reported using CPT codes 80000–89999.

Question 17: What does an 'Excludes2' note in ICD-10-CM mean?

• The excluded condition is not included here, but both conditions may coexist and be coded simultaneously (Correct answer)
• Only one of the two conditions may be coded per encounter
• The excluded condition is completely forbidden from use with this code
• The excluded code must be sequenced after this code

Correct answer: The excluded condition is not included here, but both conditions may coexist and be coded simultaneously

An Excludes2 note means the excluded condition is not included in the current code, but a patient may have both conditions at the same time, in which case both codes may be assigned.

Question 18: In ICD-10-CM, a 7th character 'A' appended to a fracture code indicates:

• Initial encounter for fracture (Correct answer)
• Subsequent encounter for fracture
• Malunion of fracture
• Sequela of a fracture

Correct answer: Initial encounter for fracture

The 7th character 'A' designates the initial encounter while the patient is receiving active treatment for the fracture.

Question 19: Controlled hypotension induced during anesthesia to reduce surgical bleeding is reported with which qualifying circumstance?

• 99116
• 99140
• 99100
• 99135 (Correct answer)

Correct answer: 99135

Code 99135 is used for anesthesia complicated by utilization of controlled hypotension.

Question 20: A coder is reviewing a chart where the physician documented 'UTI' without further specification. Which ICD-10-CM code should be assigned?

• N39.0 (Correct answer)
• N30.90
• N39.3
• N30.00

Correct answer: N39.0

N39.0 (Urinary tract infection, site not specified) is used when the physician documents UTI without identifying a specific site.

Question 21: What modifier is appended to indicate that an E/M service was performed on the same day as a procedure, and the decision to perform that procedure was made at that visit?

• -32
• -25
• -57 (Correct answer)
• -24

Correct answer: -57

Modifier -57 indicates the E/M service resulted in the initial decision to perform a major surgery (90-day global period).

Question 22: A patient sustains a fracture of the right distal radius in a car accident. The accident occurred in a parking lot. Which external cause code category would be used?

• V03 (Pedestrian injured in collision with car)
• W18 (Other slipping, tripping, stumbling falls)
• V49 (Car occupant injured in other transport accidents)
• V47 (Car occupant injured in collision with fixed or stationary object) (Correct answer)

Correct answer: V47 (Car occupant injured in collision with fixed or stationary object)

A collision in a parking lot involving a car hitting a fixed or stationary object falls under category V47 for the car occupant.

Question 23: A patient undergoes a laparoscopic cholecystectomy with intraoperative cholangiography. Which modifier should be appended to the cholangiography code?

• No modifier needed (Correct answer)
• Modifier -26
• Modifier -51
• Modifier -59

Correct answer: No modifier needed

Intraoperative cholangiography performed during the same operative session as cholecystectomy does not require a modifier because it is a separately identifiable procedure bundled with the surgical report.

Question 24: Which CPT code range is used for nuclear medicine diagnostic procedures?

• 78000–78999 (Correct answer)
• 76000–76999
• 77000–77999
• 79000–79999

Correct answer: 78000–78999

Nuclear medicine diagnostic imaging procedures are reported using CPT codes 78000–78999.

Question 25: What does the ending -centesis mean?

• Puncture, tap (Correct answer)
• Surgical fixation
• Binding, fusion
• Disease growth

Correct answer: Puncture, tap

The suffix '-centesis' in medical terminology means surgical puncture to remove fluid or to tap. Examples include 'amniocentesis' (puncture of the amniotic sac) or 'thoracentesis' (puncture of the chest cavity to remove fluid), illustrating its meaning of puncturing or tapping a body cavity.

Question 26: What is the purpose of a placeholder 'X' in ICD-10-CM?

• To represent an external cause secondary code
• To flag a manifestation code
• To allow a code to extend to a required 7th character position (Correct answer)
• To indicate an unspecified or unknown diagnosis

Correct answer: To allow a code to extend to a required 7th character position

The placeholder X fills an empty character position so that a code requiring a 7th character can be properly structured.

Question 27: Under ICD-10-CM, how is an encounter for chemotherapy for a malignant neoplasm coded?

• Malignant neoplasm code first, then Z51.11
• Z51.11 only, neoplasm code is not needed
• Z51.11 (encounter for antineoplastic chemotherapy) first, then the malignancy code (Correct answer)
• Only the neoplasm code is required

Correct answer: Z51.11 (encounter for antineoplastic chemotherapy) first, then the malignancy code

ICD-10-CM guidelines instruct that when the encounter is for chemotherapy, Z51.11 is sequenced first, followed by the code for the malignancy.

Question 28: Where is the decimal point placed in an ICD-10-CM code?

• After the 3rd character (Correct answer)
• After the 4th character
• After the 2nd character
• After the 5th character

Correct answer: After the 3rd character

The decimal point in an ICD-10-CM code is always placed after the 3rd character (the category), separating the category from the etiology/anatomic site/severity characters.

Question 29: A patient has a confirmed HIV infection and also presents with Pneumocystis pneumonia. Which is the correct coding approach?

• Code B20 first, followed by a code for the Pneumocystis pneumonia (Correct answer)
• Code only B20 (HIV disease)
• Code only the Pneumocystis pneumonia
• Code the Pneumocystis pneumonia first, then B20

Correct answer: Code B20 first, followed by a code for the Pneumocystis pneumonia

ICD-10-CM guidelines instruct sequencing B20 (HIV disease) first, followed by additional codes for all associated conditions.

Question 30: What does a 'Code First' instruction in ICD-10-CM direct the coder to do?

• Assign this code as the first secondary diagnosis
• Use this code before any Z-code on the claim
• Sequence the underlying etiology before the manifestation code (Correct answer)
• Always list this code as the principal diagnosis regardless of circumstances

Correct answer: Sequence the underlying etiology before the manifestation code

A 'Code First' note instructs the coder to sequence the underlying condition (etiology) before the manifestation code, following the etiology/manifestation convention.

Question 31: A physician performs a home visit for an established patient with an expanded problem focused history, expanded problem focused exam, and low complexity MDM. Which code applies?

• 99341
• 99348
• 99342
• 99347 (Correct answer)

Correct answer: 99347

99347 is the established patient home visit code requiring at least two of three key components at problem focused/expanded problem focused/straightforward-to-low complexity.

Question 32: When coding nail avulsion (CPT 11730), what additional code is reported if a chemical matrixectomy is also performed?

• 11740
• 11765
• 11750 (Correct answer)
• 11732

Correct answer: 11750

CPT 11750 describes excision of the nail and nail matrix (matrixectomy), which includes chemical destruction; it is reported separately from simple avulsion (11730) when matrixectomy is performed.

Question 33: What does the abbreviation 'NOS' mean in ICD-10-CM?

• Not Otherwise Specified (Correct answer)
• No Other Source Available
• Not On Schedule
• No Operative Symptoms

Correct answer: Not Otherwise Specified

NOS means 'Not Otherwise Specified,' equivalent to 'unspecified,' used when documentation does not provide enough detail for a more precise code.

Question 34: The adenoids are contained in this, which is in the pharynx:

• Oropharynx
• Nasopharynx (Correct answer)
• Sphenoidal
• Laryngopharynx

Correct answer: Nasopharynx

The nasopharynx is the uppermost section of the pharynx, situated behind the nasal cavity and extending down to the soft palate. This region contains the adenoids, which are masses of lymphoid tissue that play a role in the immune system by trapping pathogens. It serves as a passageway for air from the nasal cavity to the oropharynx.

Question 35: A patient undergoes an office visit for an established patient with a detailed history, detailed examination, and medical decision making of moderate complexity. Which E/M level is most appropriate?

• 99212
• 99213
• 99214 (Correct answer)
• 99215

Correct answer: 99214

99214 requires detailed history, detailed exam, and moderate complexity MDM for an established patient office visit.

Question 36: Which modifier indicates a service was mandated by a government, legislative, or regulatory authority?

• -GA
• -32 (Correct answer)
• -99
• -33

Correct answer: -32

Modifier -32 is used when a service is mandated by a payer, government, or regulatory requirement such as a court-ordered examination.

Question 37: A patient undergoes surgical debridement of a 35 sq cm wound on the lower back. The debridement is carried down to, but not including, the fascia. The documentation states that necrotic subcutaneous tissue was removed. How should this service be coded?

• CPT® 11042 for the entire 35 sq cm area.
• CPT® 11042 for the first 20 sq cm and 11045 for the additional 15 sq cm. (Correct answer)
• CPT® 97597 for the first 20 sq cm and 97598 for the additional 15 sq cm.
• CPT® 11043 for the first 20 sq cm and 11046 for the additional 15 sq cm.

Correct answer: CPT® 11042 for the first 20 sq cm and 11045 for the additional 15 sq cm.

CPT® code 11042 is used for the debridement of subcutaneous tissue for the first 20 sq cm or less. Since the debridement was of 35 sq cm, the add-on code +11045 is used to report each additional 20 sq cm, or part thereof. Code 11043 would be incorrect as it represents debridement down to muscle/fascia. Codes 97597 and 97598 represent selective debridement, which is different from the surgical excision described.

Question 38: When reporting anesthesia, which formula is used to calculate the total anesthesia units billed?

• Time units × Base units
• Base units + Time units + Qualifying circumstance units (Correct answer)
• Time units only
• Base units only

Correct answer: Base units + Time units + Qualifying circumstance units

Anesthesia reimbursement is calculated by adding base units, time units (per 15-minute increments), and any qualifying circumstance units.

Question 39: A coder assigns separate CPT codes for each component of a procedure that should be reported with a single comprehensive code. This practice is known as:

• Unbundling (Correct answer)
• Upcoding
• Overcoding
• Fragmentation

Correct answer: Unbundling

Unbundling is the practice of billing separately for services that should be reported together under one comprehensive CPT code.

Question 40: To alter refractive error, a procedure is carried out in which corneal tissue from a donor is frozen, reshaped, and implanted into the recipient's anterior corneal stroma. <br> This describes what CPT code?

• 65765 (Correct answer)
• 65760
• 65770
• 65710

Correct answer: 65765

The description 'corneal tissue from a donor is frozen, reshaped, and implanted into the recipient's anterior corneal stroma to alter refractive error' precisely matches the definition of CPT code 65765. This code is for 'Keratomileusis; allogenic, frozen tissue.' This procedure involves reshaping donor corneal tissue and implanting it to correct refractive errors.

Question 41: In a depression in the skull, this gland is found at the base of the brain:

• Pineal
• Pituitary (Correct answer)
• Thymus
• Hypothalamus

Correct answer: Pituitary

The pituitary gland is a small, pea-sized endocrine gland located at the base of the brain, specifically nestled within a bony depression in the sphenoid bone called the sella turcica. It is often referred to as the 'master gland' because it produces hormones that control many other endocrine glands and regulate vital body functions. Its strategic location protects it while allowing it to interact with the hypothalamus.

Question 42: Which chapter of ICD-10-CM contains codes for neoplasms?

• Chapter 3 (D50–D89)
• Chapter 1 (A00–B99)
• Chapter 2 (C00–D49) (Correct answer)
• Chapter 4 (E00–E89)

Correct answer: Chapter 2 (C00–D49)

Chapter 2 of ICD-10-CM (codes C00–D49) covers all neoplasms, including malignant, benign, in situ, and neoplasms of uncertain behavior.

Question 43: A medical practice bills Medicare for a service using a CPT code that represents a higher level of service than what was actually performed. This is an example of:

• Downcoding
• Unbundling
• Duplicate billing
• Upcoding (Correct answer)

Correct answer: Upcoding

Upcoding occurs when a provider bills for a higher-level or more expensive service than was actually rendered.

Question 44: What does the etiology/manifestation convention require in ICD-10-CM?

• The manifestation code is always sequenced before the etiology code
• Manifestation codes may stand alone when the etiology is unknown
• Two codes are required: the underlying disease first, followed by the manifestation code (Correct answer)
• Only one code is needed when a condition has both an etiology and manifestation

Correct answer: Two codes are required: the underlying disease first, followed by the manifestation code

The etiology/manifestation convention requires two codes, with the underlying disease (etiology) sequenced first and the manifestation code listed second; manifestation codes cannot be principal diagnoses.

Question 45: Which HCPCS Level II modifier indicates that a purchased item is new and different from a replaced item?

• NR
• UE
• NU (Correct answer)
• RB

Correct answer: NU

Modifier NU indicates a new DME item purchased (as opposed to used or rental), while UE indicates used durable medical equipment.

Question 46: For outpatient coding, how should a diagnosis documented as 'possible' or 'probable' be coded?

• Code the signs, symptoms, or other definitive reason for the visit instead (Correct answer)
• Leave the encounter without a diagnosis code
• Code the condition as if confirmed
• Append a special uncertainty modifier to the diagnosis code

Correct answer: Code the signs, symptoms, or other definitive reason for the visit instead

For outpatient encounters, uncertain diagnoses ('possible,' 'probable,' 'suspected') must NOT be coded as confirmed; instead, code the documented signs, symptoms, or other definitive findings.

Question 47: According to the Office of Inspector General (OIG), which of the following is considered one of the seven fundamental elements of an effective compliance program for a physician practice?

• Conducting appropriate training and education for employees. (Correct answer)
• Guaranteeing a 10% annual increase in practice revenue.
• Outsourcing all billing and coding functions to a third-party vendor.
• Purchasing the most expensive Electronic Health Record (EHR) system available.

Correct answer: Conducting appropriate training and education for employees.

The OIG has outlined seven core elements for an effective compliance program. These include: (1) Implementing written policies, procedures, and standards of conduct; (2) Designating a compliance officer or contact; (3) Conducting effective training and education; (4) Developing effective lines of communication; (5) Conducting internal monitoring and auditing; (6) Enforcing standards through well-publicized disciplinary guidelines; and (7) Responding promptly to detected offenses and undertaking corrective action.

Question 48: Which CPT code range is used for anesthesia services?

• 00100–01999 (Correct answer)
• 10004–19499
• 20100–29999
• 30000–39999

Correct answer: 00100–01999

CPT anesthesia codes are found in the 00100–01999 range and are reported by anesthesiologists and CRNAs.

Question 49: The OIG Work Plan is published annually to indicate which areas are under scrutiny for potential fraud and abuse. Who publishes the OIG Work Plan?

• Centers for Medicare & Medicaid Services (CMS)
• Office of Inspector General (OIG) of HHS (Correct answer)
• American Medical Association (AMA)
• Department of Justice (DOJ)

Correct answer: Office of Inspector General (OIG) of HHS

The OIG Work Plan is published by the HHS Office of Inspector General and outlines planned audits and investigations for the coming year.

Question 50: Which factor does NOT contribute to the 'amount and/or complexity of data' element of medical decision making?

• Reviewing external records
• Patient's vital signs (Correct answer)
• Ordering tests
• Independent interpretation of a test

Correct answer: Patient's vital signs

Vital signs are part of the physical examination, not the data complexity element of MDM.

Question 51: Destruction of 10 flat warts using cryotherapy on the face is reported with which code?

• 17110
• 17111 (Correct answer)
• 17000
• 17003

Correct answer: 17111

CPT 17111 covers destruction of benign lesions (other than skin tags or cutaneous vascular proliferative lesions) when 15 or more lesions are treated — wait, actually 17110 is up to 14 and 17111 is 15+. For 10 warts, CPT 17110 is correct.

Question 52: The HCPCS Level II modifier 'GX' indicates:

• General exclusion from coverage
• Notice of exclusion from Medicare benefits issued voluntarily under a statutory exclusion (Correct answer)
• Group X classification for high-cost items
• Geographic exclusion for rural services

Correct answer: Notice of exclusion from Medicare benefits issued voluntarily under a statutory exclusion

Modifier GX indicates a voluntary ABN was issued for a service that is statutorily excluded from Medicare benefits.

Question 53: What does a panel code in laboratory coding represent?

• A test requiring a panel of expert reviewers
• An insurance-required battery of tests
• A group of tests commonly performed together, reported as one code (Correct answer)
• A series of tests performed on separate days

Correct answer: A group of tests commonly performed together, reported as one code

A panel code represents a predefined grouping of lab tests that are commonly ordered together, and the panel code must include all listed tests to bill it correctly.

Question 54: ICD-10-CM code Z23 is reported to indicate:

• Adverse effect of vaccine
• Encounter for screening examination
• Encounter for immunization (Correct answer)
• History of vaccination

Correct answer: Encounter for immunization

Z23 is used to report an encounter for immunization/vaccination as the reason for the visit.

Question 55: Which of the following best describes 'unbundling' in medical coding?

• Reporting multiple component codes when a comprehensive code should be used (Correct answer)
• Reporting an inaccurate diagnosis to justify a procedure
• Reporting a code without supporting documentation
• Reporting a more complex code than what was performed

Correct answer: Reporting multiple component codes when a comprehensive code should be used

Unbundling is the improper practice of billing multiple separate codes when a single comprehensive code should be used.

Question 56: To divert or create an artificial passage is what this term means:

• Occipital
• Shunt (Correct answer)
• Burr
• Catheter

Correct answer: Shunt

In medical terminology, a 'shunt' refers to a bypass or diversion. It is an artificial passage or a natural channel that diverts a bodily fluid from one part of the body to another. For example, a ventriculoperitoneal shunt diverts cerebrospinal fluid from the brain to the abdomen.

Question 57: ICD-10-CM Z codes are primarily used to represent:

• Symptoms without a definitive diagnosis
• Factors influencing health status and reasons for encounters not due to illness or injury (Correct answer)
• External causes of morbidity and injury
• Neoplasm diagnoses and tumor staging

Correct answer: Factors influencing health status and reasons for encounters not due to illness or injury

Z codes capture reasons for encounters such as preventive screenings, immunizations, history of conditions, and other factors affecting health status that are not diseases or injuries.

Question 58: In ICD-10-CM, what type of character always occupies the first position of every code?

• A numeric digit representing severity
• A special character representing code type
• A numeric digit representing the body system
• An alpha character representing the chapter category (Correct answer)

Correct answer: An alpha character representing the chapter category

The first character of every ICD-10-CM code is always an alpha (letter) character, which identifies the chapter grouping.

Question 59: The National Correct Coding Initiative (NCCI) edits are used by CMS to prevent improper billing of which type?

• Upcoding of E/M services
• Unbundling of CPT codes (Correct answer)
• Incorrect modifier usage
• Duplicate claims submission

Correct answer: Unbundling of CPT codes

NCCI edits are CMS policy guidelines that prevent unbundling by identifying code pairs that should not be billed together.

Question 60: How many continuing education units (CEUs) must a CPC holder earn to renew their credential every two years?

• 24
• 18
• 48
• 36 (Correct answer)

Correct answer: 36

CPC credential holders must earn 36 CEUs every two years to maintain their AAPC certification in good standing.

Question 61: What does an 'Excludes1' note in ICD-10-CM indicate?

• The excluded code should always be listed second
• The condition is included within the current code
• The excluded condition may be coded elsewhere in the classification
• The two conditions cannot coexist, so both codes should never be reported together (Correct answer)

Correct answer: The two conditions cannot coexist, so both codes should never be reported together

An Excludes1 note is a 'pure' exclusion meaning the two conditions are mutually exclusive and can never be coded together for the same patient at the same time.

Question 62: A patient undergoes an excision of a benign lesion measuring 1.5 cm from the back. Which measurement determines the correct CPT code?

• The diameter of the lesion plus the narrowest margin required (Correct answer)
• The depth of the lesion
• The area of the lesion in square centimeters
• The diameter of the lesion only

Correct answer: The diameter of the lesion plus the narrowest margin required

For excision coding, the correct CPT code is determined by the lesion's diameter plus the narrowest margin excised in centimeters.

Question 63: When diabetes mellitus type is not documented in the medical record, what is the ICD-10-CM default?

• Type 2 diabetes mellitus (Correct answer)
• Gestational diabetes mellitus
• Type 1 diabetes mellitus
• Secondary diabetes mellitus

Correct answer: Type 2 diabetes mellitus

Per ICD-10-CM guidelines, when the type of diabetes mellitus is not documented, the default assignment is Type 2 diabetes mellitus.

Question 64: A patient with lumbar spinal stenosis undergoes an arthrodesis operation. Three lumbar interspaces were treated during the surgery. <br> <br> Which ICD-10 and CPT codes should the doctor report?

• 22600, 22614, 22614 and M48.06
• 22630, 22632, 22632, and M48.06 (Correct answer)
• 22630, 22630, and M48.06
• 22600 and M48.062

Correct answer: 22630, 22632, 22632, and M48.06

CPT code 22630 describes 'Arthrodesis, posterior interbody technique, lumbar region (e.g., PLIF); single interspace.' For additional interspaces, add-on code 22632 is used: 'Arthrodesis, posterior interbody technique, lumbar region (e.g., PLIF); each additional interspace.' Since three lumbar interspaces were treated, 22630 is reported for the first, and 22632 is reported twice for the two additional interspaces. M48.06 is the correct ICD-10-CM code for lumbar spinal stenosis.

Question 65: In CPT, what does a bullet (•) symbol next to a code indicate?

• The code requires a modifier
• The code has been deleted
• The code has been revised
• The code is new for the current year (Correct answer)

Correct answer: The code is new for the current year

A bullet (•) symbol in the CPT codebook indicates that the code is new for the current edition.

Question 66: According to ICD-10-CM guidelines, when should signs and symptoms be coded in addition to a confirmed diagnosis?

• Only when the physician documents both the sign and the diagnosis separately
• When the sign or symptom is not routinely associated with the confirmed diagnosis (Correct answer)
• Always, for every outpatient encounter
• Only for inpatient admissions

Correct answer: When the sign or symptom is not routinely associated with the confirmed diagnosis

Signs and symptoms that are NOT integral to (routinely associated with) a confirmed diagnosis should be coded as additional codes.

Question 67: Which official guideline governs ICD-10-CM coding and must be followed by all coders?

• AMA Coding Companion
• ICD-10-CM Official Guidelines for Coding and Reporting (Correct answer)
• CMS Transmittals only
• CPT Editorial Panel Guidelines

Correct answer: ICD-10-CM Official Guidelines for Coding and Reporting

The ICD-10-CM Official Guidelines for Coding and Reporting, published annually, are the authoritative source for correct diagnosis coding.

Question 68: Which of the following best describes the 'correct coding initiative' (CCI) edits?

• Automated prepayment edits preventing improper code combinations from being billed together (Correct answer)
• A list of codes requiring prior authorization
• A set of modifiers used to bypass bundling
• Guidelines for sequencing diagnosis codes

Correct answer: Automated prepayment edits preventing improper code combinations from being billed together

CCI (Correct Coding Initiative) edits are CMS automated prepayment edits that prevent improper billing of code combinations that are considered mutually exclusive or bundled.

Question 69: What does the abbreviation ICD-10-CM stand for?

• International Classification of Diseases, 10th Revision, Clinical Modification (Correct answer)
• International Classification of Diagnoses, 10th Revision, Clinical Method
• International Coding of Diagnoses, 10th Revision, Clinical Manual
• Internal Classification of Diseases, 10th Revision, Coding Manual

Correct answer: International Classification of Diseases, 10th Revision, Clinical Modification

ICD-10-CM stands for International Classification of Diseases, 10th Revision, Clinical Modification — the U.S. diagnostic coding system.

Question 70: Which of the following is the correct sequencing rule for inpatient coding of a complication that arose during the stay?

• Sequence the condition that prompted admission as principal diagnosis; the complication is secondary (Correct answer)
• Always list the complication as the principal diagnosis
• Complications are never coded separately during inpatient stays
• List the complication first only if it required surgical intervention

Correct answer: Sequence the condition that prompted admission as principal diagnosis; the complication is secondary

The condition that prompted admission after study is the principal diagnosis; complications that develop during the stay are coded as additional diagnoses.

Question 71: Which of the following is the correct way to report a bilateral procedure when the CPT code descriptor does not specify bilateral?

• Report the code once with modifier -50
• Either A or B depending on payer requirements (Correct answer)
• Report the code twice on separate lines with modifier -RT and -LT
• Report with modifier -51

Correct answer: Either A or B depending on payer requirements

Bilateral procedures can be reported with modifier -50 or with separate line items using -RT and -LT modifiers; the approach depends on specific payer requirements.

Question 72: The radius is defined as

• Outer bone located in the lower leg
• Inner bone located in the forearm
• Outer bone located in the forearm (Correct answer)
• Inner bone located in the lower leg

Correct answer: Outer bone located in the forearm

The radius is one of the two long bones located in the forearm, extending from the elbow to the wrist. When the arm is in the anatomical position (palms facing forward), the radius is situated on the lateral side of the forearm, which is the side closer to the thumb. This makes it the 'outer' bone of the forearm.

Question 73: Under the OIG Compliance Program Guidance, which element is considered the foundation of an effective compliance program?

• Regular auditing and monitoring
• Designation of a compliance officer (Correct answer)
• Effective lines of communication
• Written policies and procedures

Correct answer: Designation of a compliance officer

The OIG identifies the designation of a compliance officer as the foundational element because this person oversees all other compliance activities.

Question 74: Which of the following is an observation Z code category for a medical observation encounter for suspected diseases and conditions that have been ruled out?

• Z02
• Z03 (Correct answer)
• Z05
• Z04

Correct answer: Z03

Z03 is the ICD-10-CM Z code category for 'Medical observation and evaluation for suspected diseases and conditions ruled out.' This category is used when a patient is admitted for observation due to a suspected condition that, after evaluation, is determined not to be present. The other Z codes (Z05, Z02, Z04) refer to other types of observation or examinations.

Question 75: Which code set is primarily used for outpatient and physician office coding in the CPC exam?

• DRG codes
• CPT (Correct answer)
• HCPCS Level III
• ICD-10-PCS

Correct answer: CPT

CPT (Current Procedural Terminology) codes are the primary procedure code set tested on the CPC exam for outpatient/physician services.

Question 76: A 55-year-old male patient receives a 50 mg injection of a non-chemotherapeutic drug in the physician's office. The HCPCS Level II drug table lists the code for this drug as 'per 25 mg'. How should this be coded?

• Report the J-code with 1 unit
• Do not report a J-code, as it's included in the administration
• Report the J-code with 2 units (Correct answer)
• Report the J-code with 50 units

Correct answer: Report the J-code with 2 units

When the dosage administered is greater than the amount listed in the HCPCS code descriptor, the coder must report the appropriate number of units. In this scenario, since the code is for 25 mg and the patient received 50 mg, the J-code should be reported with 2 units (50 mg / 25 mg = 2).

Question 77: Which modifier indicates that a procedure was performed by a resident under the supervision of a teaching physician?

• Modifier -GX
• Modifier -GE
• Modifier -GT
• Modifier -GC (Correct answer)

Correct answer: Modifier -GC

Modifier -GC is used to indicate a service was performed in part by a resident under the direction of a teaching physician.

Question 78: When reporting anesthesia for a surgeon who performs their own anesthesia, which modifier is used?

• 23
• QZ
• 47 (Correct answer)
• AA

Correct answer: 47

Modifier 47 is appended to the surgical procedure code when the surgeon administers regional or general anesthesia personally.

Question 79: A patient is seen for hypertension and type 2 diabetes. There is a combination code available. The coder should:

• Query the physician before coding
• Code each condition separately
• Use the combination code (Correct answer)
• Code only hypertension as the primary condition

Correct answer: Use the combination code

ICD-10-CM provides combination code E11.65 for type 2 diabetes with hyperglycemia and E11- codes; when a combination code fully describes the conditions, use it rather than multiple codes.

Question 80: A beneficiary requires a power wheelchair. Which HCPCS Level II code range would apply?

• E1130-E1298
• L7000-L7499
• K0800-K0899 (Correct answer)
• A9000-A9999

Correct answer: K0800-K0899

K0800-K0899 represents power wheelchairs including Group 1, 2, 3, and 4 complex rehab power chairs.

Question 81: Which ICD-10-CM chapter covers mental, behavioral, and neurodevelopmental disorders?

• Chapter 4
• Chapter 6
• Chapter 5 (Correct answer)
• Chapter 7

Correct answer: Chapter 5

ICD-10-CM Chapter 5 (codes F01–F99) covers mental, behavioral, and neurodevelopmental disorders.

Question 82: Which federal law primarily governs the privacy of patient health information relevant to medical coders?

• Stark Law
• HITECH
• EMTALA
• HIPAA (Correct answer)

Correct answer: HIPAA

HIPAA (Health Insurance Portability and Accountability Act) establishes the national standards for protecting patient health information that medical coders must follow.

Question 83: Which of the following is NOT included in the global anesthesia package?

• Intraoperative monitoring
• Routine recovery room management
• Preoperative assessment by the anesthesiologist
• Postoperative pain management via epidural catheter (Correct answer)

Correct answer: Postoperative pain management via epidural catheter

Postoperative pain management through an epidural catheter is separately billable and not included in the routine anesthesia global package.

Question 84: This photograph was taken of a 34-year-old man patient who had previously experienced arm damage. Which nerve is most likely to have been damaged?

• Radial (Correct answer)
• Median
• Axial
• Brachial

Correct answer: Radial

Without the accompanying photograph, it's assumed the image depicts a characteristic sign of radial nerve damage, most commonly 'wrist drop.' The radial nerve innervates the extensor muscles of the forearm and hand. Damage to this nerve prevents the patient from extending their wrist and fingers, causing the hand to hang limply, which is a hallmark symptom of radial nerve injury.

Question 85: His doctor gave a 66-year-old man a viral test for Covid-19. The viral test resulted in a positive result. His physician also sent him for a chest x-ray, where he tested positive for pneumonia at the Rapid Urinalysis Laboratory (RUL). <br> <br> Which code from ICD-10 should be used?

• U07.1, J12.82 (Correct answer)
• J18.9, U07.1
• Z86.16
• U07.1, J96.01

Correct answer: U07.1, J12.82

For a confirmed COVID-19 infection, the primary ICD-10 code is U07.1. When COVID-19 presents with pneumonia, the pneumonia is considered a manifestation of the viral infection. J12.82 is the specific ICD-10 code for 'Pneumonia due to other coronavirus,' which is appropriate for COVID-19 related pneumonia. Therefore, U07.1 is sequenced first, followed by J12.82 to describe the manifestation.

Question 86: A patient has been identified as having an unidentified malignant neoplasm of the oropharynx, and the doctor advises that the patient received radiation therapy for 5 sessions.<br> Which CPT and ICD-10 codes should be used?

• 77427 and C10.9 (Correct answer)
• 77401 and C10.8
• 77427 and C10.8
• 77402 and C10.9

Correct answer: 77427 and C10.9

CPT code 77427 is for 'Radiation treatment management, 5 fractions.' This code is used for weekly radiation therapy management, and 5 sessions would typically fall under one unit of this code. For the diagnosis, C10.9 represents 'Malignant neoplasm of oropharynx, unspecified,' which accurately describes an unidentified malignant neoplasm of the oropharynx. Therefore, 77427 and C10.9 are the appropriate codes.

Question 87: Which type of E/M service is reported when a physician provides advice to another physician via telephone regarding a patient who is not present?

• Office visit (99202–99215)
• Telehealth visit (99441–99443)
• Care plan oversight (99339–99340)
• Interprofessional telephone/internet consultation (99446–99452) (Correct answer)

Correct answer: Interprofessional telephone/internet consultation (99446–99452)

CPT codes 99446–99452 are used for interprofessional telephone or internet consultations between physicians regarding a patient's condition.

Question 88: Which section of the CPT codebook contains codes for non-face-to-face physician services, such as online medical evaluations?

• Radiology
• Evaluation and Management (Correct answer)
• Medicine
• Surgery

Correct answer: Evaluation and Management

Non-face-to-face E/M services including online digital evaluation and management services are found within the Evaluation and Management section of CPT.

Question 89: A patient undergoing anesthesia for a procedure involving intracranial neurosurgery would be coded from which CPT range?

• 00300–00352
• 00100–00222
• 00700–00797
• 00600–00670 (Correct answer)

Correct answer: 00600–00670

CPT codes 00600–00670 cover anesthesia for procedures on the spine and spinal cord, while 00210–00222 cover intracranial procedures.

Question 90: What does the abbreviation 'NEC' mean in ICD-10-CM?

• Not Entered in Category
• Not Elsewhere Classified (Correct answer)
• No Established Criteria
• Not Entirely Coded

Correct answer: Not Elsewhere Classified

NEC stands for 'Not Elsewhere Classified,' used when the provider's documentation is specific but no dedicated code exists for that specificity.

Question 91: A physician interprets an X-ray taken at the hospital but does not perform the technical component. Which modifier should be appended?

• Modifier -TC
• Modifier -26 (Correct answer)
• Modifier -52
• Modifier -GC

Correct answer: Modifier -26

Modifier -26 (Professional Component) is appended when a physician provides only the interpretation and report for a diagnostic test.

Question 92: An anesthesiologist begins preparing a patient for surgery in the operating room at 08:00. The surgical procedure starts at 08:30 and finishes at 10:00. The anesthesiologist transfers care of the patient to the PACU nurse at 10:15. What is the total reportable anesthesia time?

• 135 minutes (Correct answer)
• 90 minutes
• 120 minutes
• 105 minutes

Correct answer: 135 minutes

According to CPT guidelines, anesthesia time begins when the anesthesiologist starts preparing the patient for anesthesia in the operating room or an equivalent area. Time ends when the anesthesiologist is no longer in personal attendance, which is when the patient is safely placed under postoperative care. In this scenario, the time starts at 08:00 and ends at 10:15, for a total of 135 minutes.

Question 93: When a patient has a confirmed diagnosis, the coder should code:

• The confirmed diagnosis (Correct answer)
• Signs and symptoms related to the diagnosis
• Both the diagnosis and all associated signs and symptoms
• Only the chief complaint

Correct answer: The confirmed diagnosis

When a definitive diagnosis has been confirmed, code the confirmed diagnosis rather than the signs and symptoms.

Question 94: What does HCPCS Level II primarily cover that CPT does not?

• Surgical procedures
• Evaluation and management services
• Radiology procedures
• Durable medical equipment, supplies, and non-physician services (Correct answer)

Correct answer: Durable medical equipment, supplies, and non-physician services

HCPCS Level II codes cover items like DME, orthotics, prosthetics, drugs, and ambulance services not found in CPT.

Question 95: A female patient, age 23, is now being evaluated by her doctor for anemia. She's had her appendix out for a week now. Her pre-op hemoglobin level was 13.4 g/dL. The doctor performed an appendectomy yesterday, and today's test results showed that she lost a significant amount of blood. Before the operation, she had no previous symptoms of anemia. <br> <br> The patient has anemia; what is the accurate diagnosis?

• D64.89
• D64.9
• D50.00

The patient developed anemia acutely after an appendectomy, with a significant drop in hemoglobin and no prior history of anemia. This clinical picture indicates acute blood loss anemia. The most accurate ICD-10 code for this condition is D62, 'Acute posthemorrhagic anemia,' which specifically describes anemia resulting from sudden, significant blood loss. (Note: D62 is not among the provided options, but it is the correct diagnosis based on the scenario.)

Question 96: How are Pap smear CPT codes primarily categorized?

• By the screening method used (conventional vs. liquid-based) (Correct answer)
• By the patient's age
• By the laboratory's accreditation level
• By the number of slides prepared

Correct answer: By the screening method used (conventional vs. liquid-based)

Pap smear codes distinguish between conventional (glass slide) and liquid-based cytology (e.g., ThinPrep) preparation methods.

Question 97: Which type of CPT code requires additional documentation and narrative to identify the service performed?

• Add-on codes
• Category III codes
• Unlisted procedure codes (Correct answer)
• Category II codes

Correct answer: Unlisted procedure codes

Unlisted procedure codes (e.g., 29999) require a special report explaining the nature, extent, and need for the procedure.

Question 98: Under the Medicare anesthesia payment formula, what does the conversion factor represent?

• The number of minutes per time unit
• The dollar amount paid per anesthesia unit (Correct answer)
• The percentage of the surgical fee paid for anesthesia
• The ratio of base units to time units

Correct answer: The dollar amount paid per anesthesia unit

The conversion factor is a dollar amount per anesthesia unit used to calculate the total anesthesia payment.

Question 99: When a patient has both an acute and a chronic form of the same condition, how should ICD-10-CM codes be sequenced?

• Code only the chronic condition; acute is assumed to be a flare
• Code both, sequencing the chronic condition first
• Code both, sequencing the acute condition first (Correct answer)
• Code only the acute condition; chronic is assumed to be included

Correct answer: Code both, sequencing the acute condition first

Per ICD-10-CM guidelines, when both acute and chronic forms exist, both are coded with the acute (subacute) condition sequenced first.

Question 100: A physician spends 35 minutes of total time on an established office patient encounter in 2021. Which E/M code is most appropriate?

• 99212
• 99215
• 99213
• 99214 (Correct answer)

Correct answer: 99214

Under 2021 guidelines, 99214 covers 30–39 minutes of total time for an established office/outpatient visit.