Prepare for medical coding certification exams with this free practice test. This guide covers CPT codes, ICD-10 diagnosis codes, and HCPCS Level II codes.
Q: National Coverage Determination (NCD)
Answer: Which of the following Medicare policies determines if a particular item or service is covered by Medicare?
Q: Adjudication
Answer: Which of the following is considered the final determination of the issues involving settlement of an insurance claim?
Q: Encounter Form
Answer: A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information
Q: Admitting clerk
Answer: A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance information and documenting the chief complaint.
Q: Using data encryption software on office workstations
Answer: Which of the following privacy measures ensures protected health information (PHI)
Q: Sagittal
Answer: Divides the body from left and right
Q: Coordination of Benefits
Answer: Which of the following provisions ensures that an insured’s benefits from all insurance companies do not exceed 100% of allowable medical expenses?
Q: Verify the age of the account
Answer: Which of the following actions should be taken first when reviewing a delinquent claim?
Q: Claims are expedited
Answer: Advantage of electronic claim submission
Q: Claim control number
Answer: Which of the following components of an explanation of benefits expedites the process of a phone appeal?
Q: Billing for services not provided
Answer: Which of the following actions by a billing and coding specialist is considered fraud?
Q: Blocks 14 through 33
Answer: The patient’s condition and the provider’s information are shown in what blocks in CMS 1500 form?
Q: Coding Compliance Plan
Answer: Which of the following includes procedures and best practices for correct coding?
Q: Use Arial size 10 font
Answer: When completing a CMS 1500 form which of the following is an acceptable action for the billing and coding specialist to take
Q: The claim requires an attachment
Answer: Which of the following indicates a claim should be submitted on paper instead of electronically?
Q: NPI (National Provider Identifier)
Answer: According to HIPAA Standards which of the following identifies the rendering provider on the CMS 1500 claim form in Block 24J?
Q: Block 32
Answer: Service facility location information in CMS 1500
Q: Block 31
Answer: Signature of the Physician in CMS 1500
Q: Block 27
Answer: Accept Assignment in CMS 1500
Q: Block 26
Answer: Patient’s Account Number in CMS 1500
Q: Block 25
Answer: Federal Tax I.D. Number / SSN / EIN in CMS 1500
Q: Block 24J
Answer: Rendering Provider ID # in CMS 1500
Q: Block 24G
Answer: Days or Units in CMS 1500
Q: Block 24F
Answer: Charges in CMS 1500
Q: Block 24E
Answer: Diagnosis Pointer in CMS 1500
Q: Block 24 D
Answer: Procedures, Services or Supplies in CMS 1500
Q: Block 24 B
Answer: Place of Service in CMS 1500
Q: Block 24 A
Answer: Dates of Services in CMS 1500
Q: Block 23
Answer: Prior Authorization Number in CMS 1500
Q: Block 21
Answer: Diagnosis or nature of illness or injury in CMS 1500
Q: Block 20
Answer: Outside Lab in CMS 1500
Q: Block 22
Answer: Resubmission code in CMS 1500
Q: Block 18
Answer: Hospitalization Dates related to current services in CMS 1500
Q: Block 17
Answer: Name of referring provider or other source in CMS 1500
Q: Block 17A
Answer: Referring provider NPI in CMS 1500
Q: Block 14
Answer: Date of Current Illness, Injury or Pregnancy (LMP)
Q: Block 16
Answer: Dates patient unable to work in current occupation
Q: Block 13
Answer: Insured’s or authorized person’s signature for payment of medical benefits to physician or supplier for services rendered.
Q: Block 9
Answer: Secondary insurance
Q: Coinsurance
Answer: Term describes when a plan pays 70% of the allowed amount and the patient pays 30%
Q: Adjustment column of the credits
Answer: A provider charged $500 to a claim that had an allowable amount of $400. In whichof the following columns should the billing and coding specialist apply the non-allowedcharge?
Q: The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets and identifiers
Answer: Which of the following HIPAA compliance guidelines affecting electronic health record
Q: They streamline patient billing by summarizing the services rendered for a given date of service.
Answer: Why does correct claim processing rely on accurately completed encounter forms?
Q: Add-on codes
Answer: In the anesthesia section of the CPT manual, which of the following are consideredqualifying circumstances?
Q: UB-04 claim form
Answer: Ambulatory surgery centers, home health care, and hospice organizations use this form
Q: Aging report
Answer: Shows outstanding balance and it is a report used to arrange the accounts receivable from the date of service
Q: Guidelines to each section
Answer: The lists of unlisted codes in the CPT manual are listed in?
Q: Verifying that the medical records and the billing records match
Answer: Purpose of an internal auditing program in a physician’s office
Q: Private third-party payers
Answer: Medigap coverage is offered to Medicare beneficiaries by which of the following?
Q: To ensure the patients understands his portion of the bill
Answer: A patient’s portion of the bill should be discussed with a patient before a procedure is performed for which of the following reasons
Q: Follow up insurance claims by date
Answer: An insurance claim register (aged insurance report) facilitates which of the following?
Q: Patient’s responsibility
Answer: When posting payment accurately, which of the following items should the billing and coding specialist include?
Q: CMS-1500 claim form
Answer: 1. Standard insurance form used by all government and most commercial insurance payers.2. Which of the following should the Billing and Coding Specialist complete to be reimbursed for the patients services.
Q: Urethratresia
Answer: Which of the following describes an obstruction of the urethra?
Q: Operative report
Answer: Proper supportive documentation for reporting CPT and ICD codes for surgical procedures
Q: Delinquent claim
Answer: A claim that is overdue for payment and is 120 days old
Q: $40
Answer: A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off patient’s account?
Q: A claim that is delinquent for 60 days
Answer: Which of the following claims would appear on an aging report?
Q: The age of the account
Answer: The primary information used to determine the priority of collection letters to patients
Q: Phone number
Answer: Which of the following pieces of guarantor information is required when establishing a patient’s financial record?
Q: Patient eligibility is determined monthly
Answer: Which of the following is true regarding Medicaid eligibility?
Q: Arthroscopy
Answer: A provider performs an examination of a patient’s knee joint via small incision and an optical device. Which of the following terms describes this procedure?
Q: The billing and coding specialist unbundles a code to receive higher reimbursement
Answer: Which of the following is considered Fraud?
Q: Send the medical information pertaining to the dates of service requested in the subpoena
Answer: A provider’s office receives a subpoena requesting medical documentation from a patient’s medical record. After confirming the correct authorization, which of the following actions should the billing and coding specialist take?
Q: Contractual allowance
Answer: Which of the following is an example of a remark code from an explanation of benefits document?
Q: Appendix A and in the front of the book
Answer: The list of Modifiers are found where in the CPT book?
Q: 99201-99499
Answer: E&M codes
Q: 00100-01999, 99100-99140
Answer: Anesthesia is found
Q: Chief complaint
Answer: The reason the patient came to see the physician
Q: HIPAA
Answer: Health Insurance Portability and Accountability Act
Q: Brackets
Answer: Used to enclose synonyms, alternative wording, or explanatory phrase
Q: Bullets
Answer: Represents a new procedure or service code added since the previous edition of the manual
Q: Triangle
Answer: Revised code
Q: Circle/Dots
Answer: New code
Q: Plus sign
Answer: Add-on code
Q: Circle with a line through it
Answer: Represents Exemption from the use of modifier -51
Q: Lightning bolt
Answer: Product Pending FDA Approval
Q: Star symbol
Answer: Telemedicine
Q: Modifier 22
Answer: Increased procedural services
Q: Modifier 50
Answer: Bilateral procedure
Q: Modifier 51
Answer: Multiple procedures
Q: Modifier 52
Answer: Reduced services
Q: Modifier 53
Answer: Discontinued procedure
Q: Place of Service code #12
Answer: Home
Q: Place of Service code #1
Answer: Pharmacy
Q: Place of Service code #13
Answer: Assisted Living Facility
Q: Place of Service code #20
Answer: Urgent care facility
Q: Place of service code #21
Answer: In patient hospital
Q: Place of service code #23
Answer: Emergency Room – Hospital
Q: Place of service code #34
Answer: Hospice
Q: Place of service code #31
Answer: Skilled Nursing facility
Q: Place of service code #32
Answer: Nursing facility
Q: Place of service code #99
Answer: Other place of service
Q: algia
Answer: pain
Q: iasis
Answer: condition of
Q: oma
Answer: tumor, mass
Q: opathy
Answer: disease of
Q: orrhagia
Answer: hemorrhage
Q: lysis
Answer: destruction, breakdown, separation
Q: lytic
Answer: destroy