CPC Certified Professional Coder 4 — Questions and Answers
Question 1: Which official guideline governs ICD-10-CM coding and must be followed by all coders?
- CPT Editorial Panel Guidelines
- ICD-10-CM Official Guidelines for Coding and Reporting (Correct answer)
- CMS Transmittals only
- AMA Coding Companion
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 2: A patient is admitted for a fracture repair. The coder finds a sign/symptom code and a definitive diagnosis code for the same condition. Which should be reported?
- The sign/symptom code only
- Both the sign/symptom and definitive diagnosis codes
- The definitive diagnosis code only (Correct answer)
- The external cause code only
Correct answer: The definitive diagnosis code only
When a definitive diagnosis is established, ICD-10-CM guidelines instruct coders to report the definitive diagnosis rather than the signs or symptoms that led to the diagnosis.
Question 3: Modifier -51 is used to indicate:
- A procedure was repeated on the same day
- Multiple procedures were performed during the same operative session (Correct answer)
- A procedure was performed by two surgeons
- A procedure required additional physician work
Correct answer: Multiple procedures were performed during the same operative session
Modifier -51 is appended to secondary procedures to indicate that multiple procedures were performed at the same operative session.
Question 4: When coding an outpatient encounter, which diagnosis should be reported as the first-listed diagnosis?
- The chronic condition managed most recently
- The condition established after study to be chiefly responsible for the visit (Correct answer)
- The symptom that brought the patient in
- The most expensive condition to treat
Correct answer: The condition established after study to be chiefly responsible for the visit
For outpatient services, the first-listed diagnosis is the condition, after study, found to be chiefly responsible for the services provided during the encounter.
Question 5: A coder is unsure how to assign a CPT code and checks the CPT Index. Which action should follow finding a term in the index?
- Report the index page number as the code
- Go directly to the listed code range in the tabular section to verify (Correct answer)
- Use the first code listed without further review
- Consult only the lay description
Correct answer: Go directly to the listed code range in the tabular section to verify
The CPT Index directs coders to a possible code or range; coders must always verify the correct code by reading the full description in the tabular section.
Question 6: 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)
- Interprofessional telephone/internet consultation (99446–99452) (Correct answer)
- Telehealth visit (99441–99443)
- Care plan oversight (99339–99340)
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 7: What is the purpose of the NCCI (National Correct Coding Initiative) edits?
- To approve new CPT codes annually
- To prevent improper payment of procedure code pairs that should not be billed together (Correct answer)
- To set reimbursement rates for Medicare
- To define medical necessity for outpatient visits
Correct answer: To prevent improper payment of procedure code pairs that should not be billed together
NCCI edits are CMS-developed code pair edits that prevent unbundling by identifying procedure combinations that should not be reported together.
CPC Certified Professional Coder 4
Which official guideline governs ICD-10-CM coding and must be followed by all coders?