CPC Cheat Sheet 2026

The 30 highest-yield CPC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Which modifier is used to indicate that a service was performed by a nurse practitioner or physician assistant acting as the primary provider? → -SA
2. When coding an obstetric case, the default assumption about the trimester should be: → The trimester documented in the medical record
3. Why do medical coders need to stay updated with regulatory changes? → To follow the latest rules and maintain compliance
4. What is a 'remittance advice' (RA) in medical billing? → A document sent to the provider by the payer showing claim payment or denial details
5. Which type of wound closure is classified as 'complex repair' in CPT? → Closure involving debridement, extensive undermining, or retention sutures
6. What are the key components of the Affordable Care Act (ACA) related to medical coding? → Tracking insurance claims
7. Which chapter in ICD-10-CM contains codes for factors influencing health status (Z codes)? → Chapter 21
8. Which type of code is used to indicate that a patient has a personal history of a condition that no longer exists? → Z code (personal history)
9. In ICD-10-CM, the abbreviation 'NEC' stands for: → Not elsewhere classifiable
10. When a patient is seen for a condition that is both acute and chronic, how should it be coded? → Code the acute condition first, then the chronic
11. Which of the following is an example of upcoding? → Billing a comprehensive office visit when documentation only supports a brief visit
12. Which modifier indicates that only the professional component of a service was provided by the reporting physician? → -26
13. A patient undergoes arthroscopic surgery of the knee; the surgeon also performs an arthroscopic chondroplasty during the same session. How is this coded? → Both arthroscopic procedures; modifier -59 may apply per payer
14. What is the purpose of the National Correct Coding Initiative (NCCI) in claim validation? → To prevent improper payment of procedures that should not be billed together
15. Under Medicare's teaching physician rules, what is required for a resident to bill an E/M service at the level documented by the resident? → Teaching physician must be present during key portions and document their presence
16. CPT code 99024 is used to report: → A postoperative follow-up visit included in the global package (no charge)
17. What is the importance of accurate documentation in medical billing? → To ensure correct billing and prevent issues
18. When a procedure is performed a second time by the same physician due to a complication, which modifier is used? → -76
19. Which section of the CMS-1500 (02-12) claim form is used to report the patient's diagnosis codes? → Box 21
20. Under HIPAA, which transaction standard is used for electronic health care claim submission? → ASC X12 837
21. Physician documentation states 'I reviewed the X-ray personally.' For radiology coding, this supports: → Professional component only
22. What is the role of coding compliance programs? → To ensure legal and ethical standards are followed in coding
23. Which directional term means closer to the point of attachment or trunk of the body? → Proximal
24. HCPCS Level II codes are used primarily to report: → Supplies, equipment, non-physician services, and drugs not covered by CPT
25. Which documentation element is essential when billing prolonged services with modifier -99? → Start and stop times of direct patient contact
26. Which modifier is used when a procedure is performed by a resident under the supervision of a teaching physician? → -GC
27. What is the purpose of a National Coverage Determination (NCD) issued by CMS? → Determine whether Medicare covers a specific service nationally
28. A physician bills for a service that was performed by a medical student without direct supervision. Under Medicare rules, this represents: → Fraudulent billing
29. What does it mean when a provider is placed on the OIG's List of Excluded Individuals and Entities (LEIE)? → Federal healthcare programs cannot pay for their services
30. When an operative report is dictated but not yet transcribed, a coder should: → Wait for the complete, signed operative report before coding