FREE NCCT Medical Coding (ICD-10-CM/CPT) Questions and Answers

Question 1

In the ICD-10-CM coding system, what is the primary purpose of the 7th character extender?

Accepted Answer

To provide information about the episode of care

Answer

The 7th character in certain ICD-10-CM codes provides information about the episode of care. For injuries and poisonings, for example, 'A' typically stands for the initial encounter, 'D' for a subsequent encounter, and 'S' for sequela (a late effect).

Question 2

CPT (Current Procedural Terminology) codes are used to report:

Accepted Answer

Medical services and procedures

Answer

CPT codes are used to report medical, surgical, and diagnostic procedures and services performed by healthcare providers. In contrast, ICD-10-CM codes are used to report diagnoses and reasons for encounters. CPT codes are essential for billing and reimbursement.

Question 3

A patient sees a physician for a scheduled wellness exam. During the visit, the patient also complains of a new, persistent cough, which the physician evaluates and treats. Which CPT modifier should be appended to the E/M code for the cough evaluation?

Accepted Answer

Modifier -25

Answer

Modifier -25 is used to indicate a 'Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service'. It is used when a separate E/M service is performed on the same day as a preventive visit or a minor procedure.

Question 4

What is the fundamental difference between the ICD-10-CM and CPT code sets?

Accepted Answer

ICD-10-CM reports diagnoses, while CPT reports procedures.

Answer

The ICD-10-CM code set is used to report diagnoses, telling the payer *why* the service was provided. The CPT code set is used to report procedures and services, telling the payer *what* service was performed. Both are required for a complete medical claim.

Question 5

The fraudulent practice of billing for a more complex or expensive service than was actually performed is known as:

Accepted Answer

Upcoding

Answer

Upcoding is the illegal practice of assigning a higher-level code to a medical service than what the documentation supports, in order to receive higher reimbursement. Downcoding is billing for a less complex service, and bundling is grouping related services under a single code.

NCCT - National Center for Competency Testing Practice Test

NCCT - National Center for Competency Testing Practice Test

FREE NCCT Medical Coding (ICD-10-CM/CPT) Questions and Answers