FREE CPMS Medical Coding and Revenue Questions and Answers

Question 1

A physician informs the scribe that the patient has a sprained ankle. For the most accurate ICD-10-CM coding, which additional detail is most critical for the scribe to document if provided by the physician?

Accepted Answer

The specific ligaments involved and laterality (right/left)

Answer

ICD-10-CM codes require a high level of specificity to accurately represent the patient's condition. For injuries like sprains, this includes the exact anatomical location, the specific ligaments affected if known, and the laterality (right or left side). This level of detail is crucial for proper billing, establishing medical necessity, and tracking health data. The other options are not relevant for diagnostic coding.

Question 2

In the context of the healthcare revenue cycle, what is the primary purpose of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set?

Accepted Answer

To represent patient diagnoses and establish medical necessity for services rendered.

Answer

ICD-10-CM codes are used to document patient diagnoses. In the revenue cycle, they are used on insurance claims to communicate *why* services were provided. This establishes the medical necessity for the procedures and services that are billed using a different code set (CPT).

Question 3

Which of the following best describes how a scribe's detailed documentation of the History of Present Illness (HPI) and Review of Systems (ROS) directly impacts Evaluation and Management (E/M) coding under the 2021 guidelines?

Accepted Answer

It supports the level of Medical Decision Making (MDM) by capturing the complexity of problems addressed.

Answer

Under the 2021 E/M guidelines, the code level for office visits is primarily determined by the complexity of Medical Decision Making (MDM) or total time. A scribe's thorough documentation of the HPI and ROS provides the detailed clinical information (e.g., number and complexity of problems, data reviewed) that substantiates the provider's MDM, thereby supporting the chosen E/M code level.

Question 4

A physician diagnoses a patient with diabetes and performs a foot exam to check for neuropathy. To ensure proper billing and demonstrate medical necessity, the scribe's documentation should clearly:

Accepted Answer

Link the foot exam procedure to the diabetes diagnosis.

Answer

This concept is known as 'linkage.' For an insurance claim to be paid, the services performed (represented by CPT codes) must be medically justified by a relevant diagnosis (represented by ICD-10-CM codes). The scribe's note must create a clear narrative connection showing the physician performed the foot exam *because of* the patient's diabetes to prove medical necessity to the payer.

Question 5

The term 'upcoding' refers to the fraudulent practice of:

Accepted Answer

Using a billing code for a more complex or expensive service than what was actually provided.

Answer

Upcoding is the illegal practice of assigning a billing code for a service that is more complex, and therefore reimburses at a higher rate, than the service that was truly performed. Meticulous and accurate documentation by the scribe helps create a clear record that justifies the codes selected by the provider or coder, preventing accusations of upcoding.

CPMS - Certified Professional Medical Scribe Practice Test

CPMS - Certified Professional Medical Scribe Practice Test

FREE CPMS Medical Coding and Revenue Questions and Answers