CPC Knowledge Skill 2 — Questions and Answers
Question 1: Which code set is used to report diagnoses and reasons for encounters in outpatient settings in the United States?
- ICD-10-PCS
- ICD-10-CM (Correct answer)
- CPT
- HCPCS Level II
Correct answer: ICD-10-CM
ICD-10-CM is the diagnosis coding system used for outpatient and inpatient encounters in the US.
Question 2: A coder notices that a surgeon's operative note describes a procedure that is more extensive than the CPT code billed. What is the most appropriate action?
- Bill the lesser code to avoid audit risk
- Query the physician for clarification before coding (Correct answer)
- Code the more extensive procedure without query
- Report both codes with a modifier
Correct answer: Query the physician for clarification before coding
The coder should query the physician to clarify the documentation before assigning the appropriate code.
Question 3: Which modifier is appended to indicate a service was performed by a physician other than the primary surgeon during the postoperative period?
- -24
- -25
- -54
- -55 (Correct answer)
Correct answer: -55
Modifier -55 is used when postoperative care is transferred to and performed by a different physician.
Question 4: What does the term 'unbundling' refer to in medical coding?
- Combining multiple codes into a single comprehensive code
- Reporting separate codes for services included in a comprehensive code (Correct answer)
- Assigning diagnosis codes before procedure codes
- Using modifiers to bypass payment edits
Correct answer: Reporting separate codes for services included in a comprehensive code
Unbundling is the practice of reporting component services separately when a single comprehensive code should be used.
Question 5: In ICD-10-CM, a 7th character 'A' appended to a fracture code indicates:
- Sequela of a fracture
- Subsequent encounter for fracture
- Initial encounter for fracture (Correct answer)
- Malunion of fracture
Correct answer: Initial encounter for fracture
The 7th character 'A' designates the initial encounter while the patient is receiving active treatment for the fracture.
Question 6: Which section of CPT contains Evaluation and Management codes?
- Section 99100–99140
- Section 99202–99499 (Correct answer)
- Section 70000–79999
- Section 90000–99001
Correct answer: Section 99202–99499
E/M codes are found in the 99202–99499 range of the CPT code set.
Question 7: What is the primary purpose of the National Correct Coding Initiative (NCCI) edits?
- To establish diagnosis coding guidelines
- To prevent improper payment of procedures that should not be billed together (Correct answer)
- To define medical necessity for procedures
- To set fee schedules for Medicare services
Correct answer: To prevent improper payment of procedures that should not be billed together
NCCI edits identify pairs of CPT codes that should not be billed together because one is bundled into the other.
CPC Knowledge Skill 2
Which code set is used to report diagnoses and reasons for encounters in outpatient settings in the United States?