CPC Certified Professional Coder MCQ 4 — Questions and Answers
Question 1: Under HIPAA, which code set is mandated for reporting diagnoses on professional claims?
- CPT-4
- ICD-10-CM (Correct answer)
- ICD-10-PCS
- HCPCS Level II
Correct answer: ICD-10-CM
HIPAA mandates ICD-10-CM for diagnosis reporting on all covered electronic transactions for outpatient and professional claims.
Question 2: A patient has a malignant neoplasm of the sigmoid colon with metastasis to the liver. What is the correct sequencing?
- Primary malignancy of colon first, then secondary malignancy of liver (Correct answer)
- Secondary malignancy of liver first, then primary malignancy of colon
- Code only the metastatic site
- Code only the primary site
Correct answer: Primary malignancy of colon first, then secondary malignancy of liver
When both primary and secondary malignant neoplasms are present and both are being treated, the primary site is sequenced first per ICD-10-CM guidelines.
Question 3: Which modifier indicates that a procedure was performed by a resident under the supervision of a teaching physician?
- Modifier -GC (Correct answer)
- Modifier -GE
- Modifier -GX
- Modifier -GT
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 4: When coding a wound repair, which of the following factors determines the appropriate CPT code?
- Patient age and wound location only
- Length of repair, complexity, and anatomical site (Correct answer)
- Number of sutures used
- Type of anesthesia administered
Correct answer: Length of repair, complexity, and anatomical site
Wound repair codes are selected based on the length of the wound (in centimeters), the complexity of repair (simple, intermediate, complex), and the anatomical location.
Question 5: What does the term 'unbundling' mean in medical coding?
- Combining multiple codes into one comprehensive code
- Reporting multiple procedure codes separately when one comprehensive code should be used (Correct answer)
- Separating the professional from technical component
- Using add-on codes without the primary code
Correct answer: Reporting multiple procedure codes separately when one comprehensive code should be used
Unbundling is the practice of billing multiple procedure codes separately when a single, more comprehensive code should be reported, and is considered fraudulent billing.
Question 6: A patient is admitted for pneumonia and also has COPD. The physician treats both conditions. How should these be coded?
- Code only pneumonia as the principal diagnosis
- Code only COPD since it is a chronic condition
- Code pneumonia as principal diagnosis with COPD as an additional diagnosis (Correct answer)
- Code COPD first because it is the chronic underlying condition
Correct answer: Code pneumonia as principal diagnosis with COPD as an additional diagnosis
Pneumonia is the condition that prompted admission and is the principal diagnosis; COPD is an additional diagnosis that was managed and affects care.
Question 7: Which of the following best describes a 'global surgical package'?
- Preoperative care only
- All services related to the procedure including pre-op, intra-op, and post-op care within a specified period (Correct answer)
- Only the intraoperative services
- Only services provided in the hospital setting
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.
CPC Certified Professional Coder MCQ 4
Under HIPAA, which code set is mandated for reporting diagnoses on professional claims?