Master medical coding concepts with these flashcards for the CPC exam. This guide covers CPT code categories, modifiers, ICD-10-CM guidelines, E/M services, and coding compliance.
Q: When a patient has a blood test for HIV that is inconclusive, what ICD-10-CM code is assigneda. Z21b. R75c. B20d. Z11.4
Answer: b. R75
Q: What does MRSA stand fora. Methicillin Resistant Staphylococcus Aureusb. Methicillin Resistant Streptococcus Aureusc. Moderate Resistance Susceptible Aureusd. Mild Resistance Steptococcus Aureus
Answer: a. Methicillin Resistant Staphylococcus Aureus
Q: What does the forth character in diabetes mellitus diabetes codes indicate?a. The condition as controlled or uncontrolledb. Any complication associated with diabetesc. Type of diabetes (type 1, or Type 2, secondary)d. If the diabetes is primary or secondary diabetes
Answer: b. Any complication associated with diabetes
Q: When do you code acute respiratory failure as a secondary diagnosisa. the patient has any other condition at the same timeb. When it is determined to be the cause of the shortness of breathc. Acute respiratory failure is always listed firstd. When it occurs after admission
Answer: d. When it occurs after admission
Q: When the type of diabetes mellitus is not documented in the medical note, what is used as the default typea. Type 2b. Type 1c. Can be type 1 or 2d. Scondary diabetes
Answer: a. Type 2
Q: When is it appropriate to use history of malignancy, from category Z85a. once the malignancy is removed form that site but the patient is still receiving chemotherapyb. When the patient cancels treatment for that sitec. It has been excised, no evidence of any existing primary malignancy, and there is not further treatment directed to the sited. when 5 years has passed after surgery
Answer: c. It has been excised, no evidence of any existing primary malignancy, and there is not further treatment directed to the site
Q: If a patient uses insulin, what type of diabetic does it mean the patient isa. secondary diabetesb. type 2c. type 1d. the use of insulin does not specify the patient is a certain type of diabetic
Answer: d. the use of insulin does not specify the patient is a certain type of diabetic
Q: Pneumonia due to adenovirus. What ICD-1-CM code is reporteda. B34.0b. J12.0c. B97.0d. B30.1
Answer: b. J12.0
Q: a 50 year old patient has been diagnosed with elevated blood pressure. The patient does not have a history of hypertension. The correct ICD-10-CM code to report isa. R03.0b. I10c. I13.0d. I15.0
Answer: b. I10
Q: What type of fracture is considered traumatica. pathologic fractureb. spontaneous fracturec. stress fractured. compound fracture
Answer: d. compound frature
Q: Can Z codes be listed as a primary code?a. No; Z codes are never listed as primary codesb. No; Z codes are always reported as secondary codesc. No; Z codes are reported for external injuries and where it happened which is always listed as secondaryd. Yes; Z codes can be sequenced as primary and secondary codes
Answer: d. Yes; Z codes can be sequenced as primary and secondary codes
Q: Where can you find the Table of Drugs and Chemicalsa. Tabular List of the ICD-10-CM codebookb. Alphabetic Index of the ICD-10-CM codebookc. Index to Procedures of the b. Alphabetic Index of the ICD-10-CM codebookd. CPT codebook
Answer: b. Alphabetic Index of the ICD-10-CM codebook
Q: In which circumstances would an external cause code be reporteda. Delivery of a newbornb. Causes of injury or health conditionc. Chemotherapy treatment of neoplasmsd. Only for the cause of motor vehicle accidents
Answer: b. Causes of injury or health condition
Q: What would be considered an adverse effecta. Wound infection after surgeryb. hemorrhaging after a vaginal deliveryc. shortness of breath when runningd. rash developing when taking penicillin
Answer: d. rash developing when taking penicillin
Q: What does the root work colp/o stand fora. cervixb. vaginac. uterusd. Fallopian tubes
Answer: b. vagina
Q: What does the abbreviation CKD stand fora. Chronic Kidney Dysfunctionb. Congenital Kidney Disorderc. Chronic Kidney Disease
Answer: c. Chronic Kidney Disease
Q: Which statement is TRUE for reporting burn codesa. burn codes are coded by the anatomical site and sequenced form top to bottom of the anatomical bodyb. first degree burns involve the epidermis and dermis and should always be sequenced first for multiple degrees of burns.c. Sunburns are classified with traumatic burns and should be the only burn code reportedd. the highest degree of burn is reported as the primary code
Answer: d. the highest degree of burn is reported as the primary code
Q: What chapter contains codes for diseases and disorders of the nailsa. Chapter 13: Diseases of Musculoskeletal and Connective Tissueb. Chapter 16: Certain Conditions Originating in the Perinatalc. Chapter 14: Diseases of the Genitourinary Systemd. Chapter 12: Diseases of the Skin and Subcutaneous Tissue
Answer: d. Chapter 12: Diseases of the Skin and Subcutaneous Tissue
Q: What does the 7th character A indicate in Chapter 19a. Initial encounterb. Subsequent encounterc. Sequelad. Adverse effect
Answer: a. Initial encounter
Q: The provider documents CKD stage 5 and ESRD. What ICD-10-CM code(s) is/are reporteda. N18.4b. N18.6, N18.4c. N18.4, N18.6d. N18.6
Answer: d. N18.6
Q: What is the definition of a postpartum complication?a. any complication occurring within the six-week period prior to deliveryb. b. Any complication occurring within the six-week period after delivery
Answer: b. Any complication occurring within the six-week period after delivery
Q: What is NOT an example of active treatment for pathological fracturesa. Surgical treatmentb. Emergency department encounterc. Evaluation and treatment by a new physiciand. Cast change
Answer: d. Cast change
Q: According to ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) codes have sequencing priority over what codesa. Codes from all other chaptersb. All codes including Z33.1
Answer: a. Codes from all other chapters
Q: Many coding professionals go on to find work asa. Accountantsb. Consultants
Answer: b. Consultants
Q: A medical record contains information on all but what areasa. Observationsb. Medical or surgical interventionsc. Treatment outcomesd. Financial records
Answer: d. Financial records
Q: Technicians who specialize in coding are calleda. coding specialistsb. LPN’s
Answer: a. coding specialists
Q: What type of provider goes through approximately 26 1/2 months of education and is licensed to practice medicine with the oversight of a physician
Answer: Physician Assistant (PA)
Q: The Medicare program is made up of several parts. Which part is most significant to coders working in physician offices and covers physician fees without the use of a private insurer?
Answer: Part B
Q: The Medicare program is made up of several parts. Which part is affected by the Centers for Medicare and Medicaid -Hierarchical Condition Categories (CMS-HCC)
Answer: Part C
Q: What does CMS-HCC stand fora. Centers for Medicare and Medicaid Services – Hierarchial Condition Categoryb. Centers for Medicare and Medicaid Services – Hospital Correct Coding Initiative
Answer: a. Centers for Medicare and Medicaid Services – Hierarchial Condition Category
Q: When coding an operative report, what action would NOT be recommendeda. Starting with the procedure listedb. Reading the body of the reportc. Coding form the header without reading the body of the report.d. Highlighting unfamiliar words
Answer: c. Coding form the header without reading the body of the report.
Q: Outpatient coders focus on learning which coding manuals
Answer: CPT, HCPCS Level II, ICD-10-CM
Q: If an NCD doesn’t exist for a particular service/procedure performed ona Medicare patient, who determines coverage
Answer: MAC (Medicare Administrative Contractor)
Q: The ___ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare.a. NCDb. Medicare Physician Fee Schedulec. MS-DRGd. Internet Only Manual
Answer: NCD (National Coverage Determinations Manual)
Q: NCD serve what purposea. to provide payment options to physiciansb. To spell out CMS policies on when Medicare will pay for items or services.
Answer: b. To spell out CMS policies on when Medicare will pay for items or services.
Q: MAC stands for
Answer: Medicare Administrative Contractor
Q: Local Coverage Determinations (LCD) are administered by
Answer: Each regional MAC
Q: LCD only have jurisdiction in their ____ area
Answer: regional
Q: ABN stands for
Answer: Advance Beneficiary Notice
Q: When are providers responsible for obtaining an ABN for a service not considered medically necessarya. Prior to providing a service or item to a beneficiaryb. After providing a service or item to a beneficiary
Answer: a. Prior to providing a service or item to a beneficiary
Q: A covered entity does NOT includea. Healthcare providerb. Patientc. Clearinghoused. Health plan
Answer: b. Patient
Q: What is the definition of codinga. deciphering explanation EOB provided by an insurance carrierb. translating documentation into numerical/alphanumerical codes used to obtain reimbursement
Answer: b. translating documentation into numerical/alphanumerical codes used to obtain reimbursement
Q: Who is responsible for enforcing the HIPAA security rule
Answer: OCR (Office of Civil Rights)
Q: Healthcare providers are responsible for developing ___ and policies and procedures regarding privacy in their practicesa. Feesb. Notice of Privacy Practices
Answer: Notice of Privacy Practices
Q: A covered entity may obtain consent of the individual to use or disclose PHI to carry out all but what of the followinga. healthcare operationsb. for public use
Answer: for public use
Q: The minimum necessary rule is based on sound on sound current practice that protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean.a. Practices should send records without releasesb. Providers should develop safeguards to prevent unauthorized access
Answer: b. Providers should develop safeguards to prevent unauthorized access
Q: The minimum necessary rule applies toa. Uses or disclosures that are required by other lawb. Covered entities taking reasonable steps
Answer: b. Covered entities taking reasonable steps
Q: HITECH provides a ___ day window which any violation not due to willful neglect may be corrected without penalty
Answer: 30
Q: HITECH was enacted as part of the American Recovery and Reinvestment Act in what year
Answer: 2009
Q: Which of the following choices is NOT a benefit of an active compliance plana. faster, more accurate payment of claimsb. eliminates risk of an auditc. Fewer billing mistakesd. Increased accuracy of physician documentation
Answer: b. eliminates risk of an audit
Q: What will the scope of a compliance program depend ona.The insurance carrier the physician is contracted withb. Size and resources of the physician’s practice
Answer: b. Size and resources of the physician’s practice
Q: Evaluation and Management services are often provided in a standard format such as SOAP. What does the acronym SOAP stand for
Answer: SubjectiveObjectiveAssessmentPlan
Q: According to the OIG, internal monitoring and auditing should be performed by what meansa. Periodic auditsb. a baseline audit
Answer: a. Periodic audits
Q: Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or ___, but also by showing that the physician practice is making additional good faith efforts to submit claims appropriatelya. Mistaken principalsb. Fraudulent claims
Answer: b. Fraudulent claims
Q: How many components should be included in an effective compliance plan
Answer: 7
Q: According to AAPC’s Code of Ethics, a member shall use only ___ and ___ means in all professional dealings
Answer: LegalEthical
Q: Medicare Part D is what type of Insurance
Answer: Prescription drug coverage available to all Medicare Beneficiaries
Q: What type of health insurance provides coverage for low-income families
Answer: Medicaid
Q: What is PHI
Answer: Protected Health Insurance
Q: What form is used to send a provider’s charge to the insurance carrier
Answer: CMS-1500
Q: Which option below is NOT a covered entity under HIPAAa. Medicareb. Medicaidc. BCBSd. Workers Compensation
Answer: d. Workers Compensation
Q: WHich of the following is a BENEFIT of electronic transactionsa. Payment of claimsb. Timely submission of claims
Answer: b. Timely submission of claims
Q: What is the value of a remittance advicea. It catalogs the patient’s coverage benefitsb. It tells you what you will be paid and why any changes to charges were made
Answer: b. It tells you what you will be paid and why any changes to charges were made
Q: The OIG recommends that the physician’s practice enforcement and disciplinary mechanisms bea. Frequentb. Consistent
Answer: b. Consistent
Q: Each October the OIG releases a ___ outlining its priorities for the fiscal year ahead
Answer: work plan
Q: Which provider is NOT a mid-level providera. Physician Assistantb. Nurse Practitionerc. Anesthesiologistd. All choices are mid-level providers
Answer: c. Anesthesiologist
Q: The AAPC was founded in what year
Answer: 1988
Q: According to the 2014 AAPC ____, it shows coders salaries rose 2% to an average of 50,030 for credential professional codersa. Specialty surveyb. Credentialing surveyc. Salary surveyd. CPC review guide
Answer: Salary survey
Q: AAPC credentialed coders have NOT proven mastery ofa. code setsb. evaluation and management principlesc. Administrative regulationsd. documentation guidelines
Answer: Administrative regulations
Q: The AAPC offers over 400 local chapters across the country for the purpose of
Answer: Networking
Q: Which of the following is NOT a function of skina. acts as a gland by synthesizing vitamin Ab. Excretes water, salt, and small amounts of wastec. houses sensory receptors for touch, pressure, pain, and temperatured. Plays an important role in regulation of body temperature
Answer: Acts as a gland by synthesizing vitamin A
Q: Which layer is NOT considered part of the skina. Stratum corneumb. Stratum germinativumc. epidermisd. hypodermis
Answer: Hypodermis
Q: Which of the following is true of the stratum germinativuma. it is composed of about 30 layers of dead, flattened, keratinized cellsb. it is composed of dense fibrous connective tissuec. it lies on top of the dermis and has access to a rich supply of blood
Answer: c. it lies on top of the dermis and has access to a rich supply of blood
Q: WHich of the following best describes psoriasisa. an inflammatory condition characterized by redness pustular and vesicular lesions, crusts, and scalesb. a contagious infection of skin generally caused by staphylococcus bacteriumc. A chronic condition characterized by red, dry, elevated lesions, covered by silvery scales
Answer: c. A chronic condition characterized by red, dry, elevated lesions, covered by silvery scales
Q: Muscle is attached to bone by what methoda. tendons, and cartilageb. tendons, aponeurosis and directly to bone
Answer: Tendons, aponeurosis and directly to bone
Q: What is affected by myasthenia gravisa. Neuromuscular junctionb. muscle/bone connection
Answer: Neuromuscular junction
Q: Which bone(s) have trochanters
Answer: Femur
Q: What is the great toe called
Answer: Hallux
Q: What is a function of the alveoli in the lungs
Answer: Oxygen exchange
Q: Through which vessel is oxygenated blood returned to the heart form the lungs
Answer: Pulmonary vein
Q: Which respiratory structure is comprised of cartilage and ligaments
Answer: Trachea
Q: How many lobes make up the right lung
Answer: 3
Q: A myocardial infarction isa. overgrowth of muscle tissue, affecting the heart’s ability to pumpb. Lack of oxygen to the heart tissue, resulting in tissue death
Answer: Lack of oxygen to the heart tissue, resulting in tissue death
Q: Which of the following does NOT circulate fluids throughout the bodya. endocrine systemb. venous systemc. arterial systemd. lymphatic system
Answer: . endocrine system