Certified Coding Associate (CCA) Exam — Questions and Answers

Question 1: When coding an encounter for chemotherapy administration in ICD-10-CM, which code is sequenced first?

The symptom code related to the cancer
The adverse effect code for the chemotherapy drug
The malignancy code
The Z code for encounter for antineoplastic chemotherapy (Correct answer)

Correct answer: The Z code for encounter for antineoplastic chemotherapy

ICD-10-CM guidelines instruct sequencing the Z51.11 (encounter for antineoplastic chemotherapy) code first, followed by the malignancy code.

Question 2: A coder assigns a code from category Z23 (Encounter for immunization). Where in the medical record should the coder look to confirm which vaccine was administered?

The physician's order and immunization record (Correct answer)
The billing worksheet
The discharge summary
The nursing notes only

Correct answer: The physician's order and immunization record

The physician's order and immunization administration record document the specific vaccine given, which guides accurate code assignment.

Question 3: Which of the following claims about the proper classification of hospital discharge services is TRUE?

Code 99239 is used only for discharge services that also include a final examination as part of the discharge procedure.
Codes 99238 and 99239 can be used for patients being discharged from nursing facility care.
A discharge service of 30 minutes is coded 99239.
When someone is discharged from inpatient services on the same date as admission, the coder consults E/M series 99234–99236. (Correct answer)

Correct answer: When someone is discharged from inpatient services on the same date as admission, the coder consults E/M series 99234–99236.

CPT codes 99234-99236 are specifically designated for 'Observation or Inpatient Hospital Care, Including Admission and Discharge Services.' These codes are used when a patient is admitted to observation status or as an inpatient and then discharged on the *same calendar date*. This combines the admission and discharge services into a single code based on the total time and complexity of the encounter.

Question 4: A coder finds that a diagnosis code in the ICD-10-CM Tabular List has an Excludes1 note. This means:

The excluded code should be reported in addition to the current code
The excluded condition cannot be coded at the same time as the current code (Correct answer)
The excluded condition is included in the current code and need not be listed separately
The excluded code is an alternative code that may be used instead

Correct answer: The excluded condition cannot be coded at the same time as the current code

An Excludes1 note is a 'pure' exclusion indicating that the two conditions cannot occur together and therefore cannot be coded simultaneously.

Question 5: What is a Remittance Advice (RA)?

A physician's order for treatment
A document sent by payers explaining payment or denial of claims (Correct answer)
A document authorizing a procedure
A patient's insurance card

Correct answer: A document sent by payers explaining payment or denial of claims

A Remittance Advice is sent by payers to explain how claims were processed, including payment amounts or denial reasons.

Question 6: What is the main goal of clinical documentation improvement (CDI)?

Replacing physician documentation with coding staff entries
Speeding up the discharge process
Reducing the number of diagnoses documented
Ensuring documentation accurately reflects the patient's clinical status to support coding and quality reporting (Correct answer)

Correct answer: Ensuring documentation accurately reflects the patient's clinical status to support coding and quality reporting

CDI aims to improve the quality and completeness of clinical documentation so that coding accurately reflects the patient's condition and care.

Question 7: Which of the following is NOT a component considered when selecting the level of an E/M service under the 2021 revised guidelines?

Medical decision making
Total time spent on the date of encounter
Physical examination elements (Correct answer)
Number of diagnoses addressed

Correct answer: Physical examination elements

The 2021 E/M guidelines eliminated the use of physical examination elements as a scoring component; level is now based on MDM or total time.

Question 8: Which of these groups is in charge of the CCA examination?

CAC
CCA
AHIMA (Correct answer)
HIM

Correct answer: AHIMA

The Certified Coding Associate (CCA) examination is developed and administered by the American Health Information Management Association (AHIMA). AHIMA is a leading professional organization for health information management, responsible for setting standards, providing education, and offering various certifications, including the CCA, to validate the competence of coding professionals.

Question 9: What is the name of the federal initiative to identify and address erroneous payments made through Medicare's Fee-for-Service (FFS) programs?

Fiscal intermediaries (fis)
National correct coding initiative (ncci)
Parentheses ( )
Recovery audit contractors (RACs) (Correct answer)

Correct answer: Recovery audit contractors (RACs)

Recovery Audit Contractors (RACs) are third-party organizations contracted by the Centers for Medicare & Medicaid Services (CMS) to identify and recover improper Medicare payments. They review claims to detect overpayments and underpayments made to healthcare providers, playing a crucial role in ensuring the integrity of the Medicare Fee-for-Service program.

Question 10: A patient undergoes a procedure and develops a complication requiring a return to the OR. The complication code should be sequenced:

As an additional diagnosis only
It should not be coded
As the principal or first-listed diagnosis (Correct answer)
Before the original procedure code

Correct answer: As the principal or first-listed diagnosis

When a complication requires a return to the OR, it becomes the principal diagnosis for that subsequent encounter.

Question 11: A patient is admitted following a car accident with a fractured femur and a head injury. After study, the femur fracture required surgery. Which is the principal diagnosis?

Either condition per UHDDS
The first condition listed by the physician
Head injury, as it is more severe
Fractured femur, as it required surgical treatment (Correct answer)

Correct answer: Fractured femur, as it required surgical treatment

The condition chiefly responsible for the admission after study is the principal diagnosis; in this case, the femur fracture prompted surgery.

Question 12: Which code set is commonly used by Certified Coding Associates for outpatient coding?

HCPCS Level II
CPT (Correct answer)
ICD-9-CM
ICD-10-PCS

Correct answer: CPT

The Current Procedural Terminology (CPT) code set is specifically designed for reporting medical, surgical, and diagnostic procedures and services performed by physicians and other healthcare providers. For outpatient coding, where services are often procedure-based, CPT codes are the primary system used to describe the work performed. ICD-10-CM codes are used for diagnoses, while ICD-10-PCS is for inpatient procedures, and HCPCS Level II covers non-physician services and supplies.

Question 13: The creation of standards for electronic medical records was required by the .

Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Correct answer)
One code for the final vessel entered
a 'with manipulation' code
Computer-assisted coding

Correct answer: Health Insurance Portability and Accountability Act (HIPAA) of 1996

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated the establishment of national standards for electronic healthcare transactions and identifiers for providers, health plans, and employers. A key component of HIPAA was the requirement to create standards for the security and privacy of electronic medical records (EMRs) to protect patient health information.

Question 14: What is the significance of continuing education for a Certified Coding Associate?

It allows them to perform surgeries.
It replaces the need for accurate coding.
It's a requirement for renewing the certification. (Correct answer)
It grants them access to patient records.

Correct answer: It's a requirement for renewing the certification.

Continuing education is of significant importance for a Certified Coding Associate because it is a mandatory requirement for renewing their certification. The healthcare industry and coding guidelines are constantly evolving, so CEUs ensure that coders stay updated with the latest changes, regulations, and best practices. This ongoing learning maintains their competency and the validity of their credentials.

Question 15: Which ICD-10-CM placeholder character is used when a code has fewer than the required number of characters?

9
Z
0 (zero)
X (Correct answer)

Correct answer: X

The letter 'X' is used as a placeholder in ICD-10-CM codes to allow for future expansion and to maintain the correct number of characters.

Question 16: What is the primary purpose of the Medicare Physician Fee Schedule (MPFS)?

To determine hospital outpatient payment rates
To establish Medicaid reimbursement rates
To assign DRGs for inpatient claims
To set payment rates for physician services under Medicare Part B (Correct answer)

Correct answer: To set payment rates for physician services under Medicare Part B

The MPFS establishes the payment rates for physician and other professional services billed under Medicare Part B.

Question 17: College soccer player Amanda shows up for her second session with Dr. Yakamoto to discuss her damaged meniscus and possible treatments. Her personal doctor requested a consultation visit for her first appointment just last week, and at the conclusion of that appointment, Dr. Yakamoto consented to assume responsibility for her treatment. Which E/M code applies to Amanda's follow-up visit?

99254
99203
99243
99213 (Correct answer)

Correct answer: 99213

Amanda is an established patient because Dr. Yakamoto assumed responsibility for her treatment after the initial consultation, making this her second visit. Code 99213 is for an 'Office or other outpatient visit for the evaluation and management of an established patient,' requiring at least two of three key components: expanded problem-focused history, expanded problem-focused examination, and medical decision making of moderate complexity. Given the discussion of her meniscus and possible treatments, this level is appropriate for a follow-up.

Question 18: what are the names of the four-digit icd9cm diagnostic codes

subcategory codes (Correct answer)
subclassification codes
e codes
subjective

Correct answer: subcategory codes

In ICD-9-CM, the four-digit diagnostic codes are known as subcategory codes. These codes provide a more specific breakdown of conditions within a three-digit category. They are further refined by five-digit subclassification codes for the highest level of detail.

Question 19: Which organization publishes the ICD-10-CM Official Guidelines for Coding and Reporting?

AHIMA
CMS and NCHS (Correct answer)
WHO
AMA

Correct answer: CMS and NCHS

The ICD-10-CM Official Guidelines are published jointly by CMS (Centers for Medicare and Medicaid Services) and NCHS (National Center for Health Statistics).

Question 20: When the words "separate procedure" appear after the code description in a CPT code, you should:

Code for this procedure, even if it was not performed
Only code for the procedure if tit was the only thing performed (Correct answer)
Do not use this code if it is listed as a separate procedure
Code for all other elements of the procedure except this one

Correct answer: Only code for the procedure if tit was the only thing performed

When 'separate procedure' appears after a CPT code description, it indicates that the procedure is usually considered an integral part of a more extensive procedure. Therefore, it should only be coded and reported if it is performed independently and not as a component of another, more comprehensive service. If performed with another procedure, it is typically bundled and not coded separately, unless specific circumstances warrant it (e.g., different site, unusual circumstances, documented modifier).

Question 21: Which Medicare part covers inpatient hospital services?

Medicare Part A (Correct answer)
Medicare Part C
Medicare Part D
Medicare Part B

Correct answer: Medicare Part A

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health services.

Question 22: What is the purpose of the NCCI (National Correct Coding Initiative) edits?

To prevent improper payment of procedures that should not be reported together (Correct answer)
To validate ICD-10-CM diagnosis codes
To establish fee schedules for Medicare services
To define medical necessity for outpatient services

Correct answer: To prevent improper payment of procedures that should not be reported together

NCCI edits identify pairs of CPT codes that should not be billed together because one code is considered a component of the other.

Question 23: An anesthesiologist who is knowledgeable with coding in his area is verifying the modifiers used by a new coder for an anesthetic service that was rendered yesterday. He also instructs and supervises anesthesiology residents, one of whom assisted him during this identical procedure under his direct supervision. The head modifier QY is used in the coder's documentation for anesthesiology services, and the surgical procedure's total modifier combination is QY-QS-P1. How would the doctor talk to the coder about the work's accuracy?

The physician would tell the coder to move the modifier QY to the end of the sequence (i.e., QS-P1-QY).
The physician would have no comments because the head modifier for total services rendered (QY
The physician would tell the coder to replace modifier QY with modifier GC for a sequence of GC-QS-P1. (Correct answer)
The physician would tell the coder to replace modifier QY with modifier GC and to reorder the sequence with P1-GC-QS.

Correct answer: The physician would tell the coder to replace modifier QY with modifier GC for a sequence of GC-QS-P1.

Modifier QY indicates medical direction of one CRNA by an anesthesiologist, which is incorrect for a teaching physician directly supervising a resident. Modifier GC is used when a teaching physician provides direct supervision and participates in the management of a service. The correct sequence for modifiers typically places the pricing/payment modifiers (like GC) before informational modifiers (like QS for monitored anesthesia care) and physical status modifiers (like P1).

Question 24: A patient is seen in the ED and diagnosed with chest pain, rule out MI. The workup is negative. What is the correct coding approach for this outpatient visit?

Code both chest pain and rule-out MI
Code the MI as confirmed
Leave diagnosis blank until confirmed
Code the chest pain as the reason for the visit (Correct answer)

Correct answer: Code the chest pain as the reason for the visit

For outpatient encounters, uncertain diagnoses (rule-out, possible, probable) are not coded; instead, code the sign or symptom, such as chest pain.

Question 25: Which of the following is an example of a CPT Category II code?

99213
G0008
4011F (Correct answer)
0075T

Correct answer: 4011F

CPT Category II codes (beginning with a number and ending in 'F') are optional tracking codes used for performance measurement.

Question 26: Which section of CPT codes covers Evaluation and Management (E/M) services?

10000–19999
90281–99199
99202–99499 (Correct answer)
70000–79999

Correct answer: 99202–99499

E/M codes fall in the 99202–99499 range and represent office visits, hospital care, and other evaluation services.

Question 27: Which of the following is NOT a level of HCPCS codes?

Level IV (Correct answer)
Level I
Level II
Level III

Correct answer: Level IV

The Healthcare Common Procedure Coding System (HCPCS) consists of two main levels. Level I comprises the CPT codes, which describe physician services and procedures. Level II codes cover non-physician services, durable medical equipment, prosthetics, orthotics, and supplies. There is no 'Level III' or 'Level IV' in the current standard HCPCS system.

Question 28: In ICD-10-CM, what does the term 'principal diagnosis' mean for inpatient coding?

The first diagnosis listed by the physician
The patient's most chronic condition
The diagnosis present at the time of admission
The condition established after study to be chiefly responsible for occasioning the admission (Correct answer)

Correct answer: The condition established after study to be chiefly responsible for occasioning the admission

The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the patient's admission to the hospital.

Question 29: A coder cannot find a specific code and assigns a less specific code instead. This is known as coding to the highest level of:

Generality
Specificity available (Correct answer)
Documentation
Specificity

Correct answer: Specificity available

When a specific code is unavailable, coders should assign the most specific code supported by the available documentation — coding to the highest level of specificity available.

Question 30: When coding an outpatient visit, which condition should be reported as the first-listed diagnosis?

The condition chiefly responsible for the visit (Correct answer)
The most chronic condition
The condition with the highest code number
The most expensive condition to treat

Correct answer: The condition chiefly responsible for the visit

For outpatient visits, the condition chiefly responsible for the visit (after study) is sequenced as the first-listed diagnosis per UHDDS guidelines.

Question 31: What is the significance of the 'discharge status' code in inpatient coding?

It identifies the admitting diagnosis
It indicates where the patient went after being discharged from the hospital (Correct answer)
It captures the patient's primary insurance
It records the attending physician's specialty

Correct answer: It indicates where the patient went after being discharged from the hospital

The discharge status code indicates the patient's disposition upon leaving the hospital, such as home, skilled nursing facility, or expired.

Question 32: Which law established the federal healthcare fraud and abuse statutes known as the 'Anti-Kickback Statute'?

The False Claims Act
HIPAA
The Affordable Care Act
The Social Security Act (Correct answer)

Correct answer: The Social Security Act

The Anti-Kickback Statute is part of the Social Security Act and prohibits offering or receiving payment to induce referrals for federal healthcare program services.

Question 33: What does the term 'legal health record' refer to?

Only records stored in paper format
The official business record of a healthcare organization used in legal proceedings (Correct answer)
Records created by the legal department
Records older than 10 years

Correct answer: The official business record of a healthcare organization used in legal proceedings

The legal health record is the official business record of a healthcare organization that can be used as evidence in legal proceedings.

Question 34: What is the role of a Clinical Documentation Improvement (CDI) specialist in the coding process?

Managing hospital billing systems
Assigning codes to medical procedures
Communicating with insurance companies
Ensuring accurate medical documentation (Correct answer)

Correct answer: Ensuring accurate medical documentation

A Clinical Documentation Improvement (CDI) specialist plays a crucial role in ensuring accurate medical documentation. They work collaboratively with physicians and other healthcare providers to improve the quality, completeness, and specificity of clinical records. This enhanced documentation directly supports accurate medical coding, which is essential for proper reimbursement and patient care.

Question 35: The Outpatient Prospective Payment System (OPPS) uses which payment unit?

DRG
APC (Correct answer)
RUG
RBRVS

Correct answer: APC

OPPS uses Ambulatory Payment Classifications (APCs) to reimburse hospitals for outpatient services.

Question 36: A patient is seen for essential hypertension and type 2 diabetes with diabetic chronic kidney disease stage 3. How many ICD-10-CM codes are required?

2
1
3 (Correct answer)
4

Correct answer: 3

Three codes are needed: E11.22 (type 2 diabetes with diabetic chronic kidney disease), N18.3 (CKD stage 3), and I10 (essential hypertension).

Question 37: In CPT coding, what does the term 'unbundling' refer to?

Combining multiple services into one code
Using modifiers to reduce reimbursement
Billing separately for services normally included in a comprehensive code (Correct answer)
Grouping related E/M codes together

Correct answer: Billing separately for services normally included in a comprehensive code

Unbundling is the improper practice of billing separately for component services that should be reported with a single comprehensive code.

Question 38: Which of the following is the correct definition of 'upcoding'?

Skipping required code characters
Assigning a higher-level code than what is documented to increase reimbursement (Correct answer)
Assigning a less complex code than documented to reduce patient cost
Using outdated codes from a prior year's code set

Correct answer: Assigning a higher-level code than what is documented to increase reimbursement

Upcoding is the fraudulent practice of billing for a higher level of service or more complex code than what the documentation supports.

Question 39: A code listed in the Tabular List of ICD-10-CM with the notation 'Code first' instructs the coder to:

Sequence an underlying condition or cause before the current code (Correct answer)
Report only that single code with no additional codes
Use the code only in outpatient settings
Always sequence that condition as the principal diagnosis

Correct answer: Sequence an underlying condition or cause before the current code

'Code first' instructs the coder to sequence the underlying disease or etiology before the manifestation or current condition code.

Question 40: Which of the following best describes the concept of 'unbundling' in medical billing?

Combining multiple services into one CPT code
Using the correct E/M level for documentation
Adding modifiers to bundled codes
Reporting individual components of a procedure when a comprehensive code exists (Correct answer)

Correct answer: Reporting individual components of a procedure when a comprehensive code exists

Unbundling means billing individual components of a procedure separately when a single comprehensive CPT code already covers all components.

Question 41: What is the purpose of the CCA certification exam?

To assess coding knowledge and skills (Correct answer)
To test clinical skills
To measure administrative abilities
To evaluate surgical techniques

Correct answer: To assess coding knowledge and skills

The primary purpose of the CCA certification exam is to evaluate an individual's fundamental knowledge and practical skills in medical coding. It tests their ability to accurately assign codes for diagnoses and procedures, understand coding guidelines, and apply healthcare regulations. This ensures that certified individuals possess the basic competence required for entry-level coding positions.

Question 42: Which of the following scenarios requires the use of an external cause code (V00–Y99) in ICD-10-CM?

A patient with a fracture sustained in a motor vehicle accident (Correct answer)
A patient with pneumonia
A patient with essential hypertension
A patient with type 2 diabetes

Correct answer: A patient with a fracture sustained in a motor vehicle accident

External cause codes (V00–Y99) are used to describe the cause, intent, and location of injuries and other health conditions, such as a fracture from a motor vehicle accident.

Question 43: Which of the following is a key component of a health record for inpatient encounters?

Financial audit reports
History and physical examination (H&P) (Correct answer)
Marketing materials and brochures
Staff scheduling records

Correct answer: History and physical examination (H&P)

A history and physical examination (H&P) is a required component of the inpatient health record and must be completed within a defined timeframe.

Question 44: What does the abbreviation 'PCS' stand for in the context of ICD-10?

Patient Classification System
Procedure Coding System (Correct answer)
Primary Care Standard
Physician Coding Schedule

Correct answer: Procedure Coding System

PCS stands for Procedure Coding System, the inpatient procedural coding system used alongside ICD-10-CM diagnosis codes.

Question 45: How long must hospitals generally retain adult patient health records under most state laws?

3 years from last treatment
Permanently for all patients
5–10 years from last treatment or discharge (Correct answer)
1 year from last treatment

Correct answer: 5–10 years from last treatment or discharge

Most states require adult health records to be retained for a minimum of 5–10 years from the date of last treatment or discharge.

Question 46: When a patient is seen for aftercare following a fracture repair, which Z code category is typically used?

Z00 (Encounter for general examination)
Z47 (Orthopedic aftercare) (Correct answer)
Z51 (Encounter for other aftercare)
Z23 (Encounter for immunization)

Correct answer: Z47 (Orthopedic aftercare)

Category Z47 codes are used for orthopedic aftercare, such as follow-up care after fracture repair with hardware removal or cast change.

Question 47: What is the main function of the CCA in relation to reimbursement and claims processing?

Verifying patient identity
Providing accurate coding for billing purposes (Correct answer)
Determining patient eligibility for insurance
Ensuring medical necessity of procedures

Correct answer: Providing accurate coding for billing purposes

The main function of a Certified Coding Associate (CCA) in relation to reimbursement and claims processing is to provide accurate coding for billing purposes. CCAs translate complex medical documentation into standardized alphanumeric codes. These codes are crucial for healthcare organizations to submit correct claims to insurance companies and receive appropriate reimbursement for services provided.

Question 48: What does it signify when a CPT code is preceded by the symbol #?

The the code description has changed
That the code used to be listed with a different number
That the code is listed out of numerical order (Correct answer)
That the code is listed in numerical order

Correct answer: That the code is listed out of numerical order

In the Current Procedural Terminology (CPT) codebook, the # (pound sign) symbol indicates that a code has been resequenced. This means the code appears out of numerical order to group related procedures together for easier reference. This helps coders locate services that are clinically related, even if their numerical sequence is broken.

Question 49: Which coding system is used to report inpatient hospital procedures in the United States?

HCPCS Level II
ICD-10-CM
ICD-10-PCS (Correct answer)
CPT-4

Correct answer: ICD-10-PCS

ICD-10-PCS (Procedure Coding System) is the classification system used for coding inpatient hospital procedures in the U.S.

Question 50: What does the suffix '-itis' indicate?

Tumor
Disease
Surgical incision
Inflammation (Correct answer)

Correct answer: Inflammation

The suffix '-itis' means inflammation, as seen in appendicitis or arthritis.

Question 51: what standard language is used to code medical procedures and services?

hcpcs
cpt (Correct answer)
rvus
ama

Correct answer: cpt

CPT (Current Procedural Terminology) is a standardized medical coding system maintained by the American Medical Association (AMA). It is used to describe medical, surgical, and diagnostic services performed by physicians and other healthcare providers. CPT codes are essential for billing and reimbursement of these procedures and services.

Question 52: Which federal law primarily governs healthcare privacy and the security of patient health information?

HITECH Act
HIPAA (Correct answer)
COBRA
ACA

Correct answer: HIPAA

HIPAA (Health Insurance Portability and Accountability Act) governs the privacy and security of protected health information.

Question 53: The following are the names of the most recent Medicare claims processing payment contract entities:

Fiscal intermediaries (fis)
Assignment of benefits
Medicare administrative contractors (MACs) (Correct answer)
Comprehensive error rate testing (cert)

Correct answer: Medicare administrative contractors (MACs)

Medicare Administrative Contractors (MACs) are private healthcare insurers that have been awarded a contract by the Centers for Medicare & Medicaid Services (CMS) to process Medicare Part A and Part B (and Durable Medical Equipment) claims. They serve as the primary contact for providers and handle claims processing, payment, and other administrative functions for specific geographic regions. They replaced the previous system of fiscal intermediaries and carriers.

Question 54: What does the acronym 'EOB' stand for in medical billing?

Explanation of Benefits (Correct answer)
Evidence of Billing
End of Benefits
Estimate of Balance

Correct answer: Explanation of Benefits

EOB stands for Explanation of Benefits, a document sent to patients explaining what the insurance paid and what the patient owes.

Question 55: A patient with type 2 diabetes mellitus is seen for diabetic chronic kidney disease, stage 3. How should this be coded?

Code only the CKD stage 3
Code CKD stage 3 first, then the diabetes
Code the combination code for diabetes with CKD, then CKD stage 3 (Correct answer)
Code only the diabetes

Correct answer: Code the combination code for diabetes with CKD, then CKD stage 3

ICD-10-CM has a combination code for type 2 diabetes with diabetic CKD (E11.22), and an additional code for CKD stage (N18.3) is assigned.

Question 56: What does the ICD-10-CM instruction 'Code first' indicate?

Always list this code as a secondary diagnosis
Use this code only for outpatient encounters
This code may be sequenced in any order
A mandatory sequencing instruction requiring an underlying condition be coded first (Correct answer)

Correct answer: A mandatory sequencing instruction requiring an underlying condition be coded first

The 'Code first' instruction is a mandatory sequencing note that requires the underlying condition or etiology to be sequenced before the manifestation code.

Question 57: What does 'clean claim' mean in medical billing?

A claim that has been paid in full
A claim submitted on paper instead of electronically
A claim submitted without any errors that can be processed for payment (Correct answer)
A claim for preventive services only

Correct answer: A claim submitted without any errors that can be processed for payment

A clean claim is one that is free of errors and contains all required information so it can be processed for payment without delay.

Question 58: In ICD-10-CM, what is a 'combination code'?

A code that applies to multiple age groups
A single code that classifies both an etiology and a manifestation, or a disease with an associated complication (Correct answer)
Two separate codes used together
A code that combines outpatient and inpatient data

Correct answer: A single code that classifies both an etiology and a manifestation, or a disease with an associated complication

A combination code is a single ICD-10-CM code that captures both an etiology and its associated manifestation, or a disease with a common complication.

Question 59: The prefix 'tachy-' means which of the following?

Abnormal
Painful
Slow
Fast (Correct answer)

Correct answer: Fast

The prefix 'tachy-' means fast or rapid, as in tachycardia (rapid heart rate).

Question 60: Which section of ICD-10-PCS is used to code a blood transfusion?

Extracorporeal Therapies
Administration (Correct answer)
Medical and Surgical
Measurement and Monitoring

Correct answer: Administration

Transfusions are coded in the Administration section of ICD-10-PCS because they involve introducing a therapeutic substance into the body.

Question 61: What is the purpose of a modifier in CPT coding?

To change the code to a higher reimbursement level
To report a service was not covered
To indicate a diagnosis was not confirmed
To provide additional information about a service without changing its definition (Correct answer)

Correct answer: To provide additional information about a service without changing its definition

Modifiers provide additional information about a service or procedure without altering its basic definition or changing the code itself.

Question 62: A compliance program in a healthcare organization is primarily designed to:

Maximize reimbursement for all services
Prevent, detect, and correct non-compliance with laws and regulations (Correct answer)
Increase patient volume
Reduce documentation requirements

Correct answer: Prevent, detect, and correct non-compliance with laws and regulations

A compliance program is designed to prevent, detect, and correct violations of healthcare laws, regulations, and standards.

Question 63: A coder encounters the instruction 'Code first underlying disease' in ICD-10-CM. This is an example of which type of instructional note?

Use additional code note
Etiology/manifestation convention (Correct answer)
Includes note
Excludes1 note

Correct answer: Etiology/manifestation convention

The 'Code first underlying disease' note is part of the etiology/manifestation coding convention in ICD-10-CM.

Question 64: Which suffix means 'viewing' or 'visual examination'?

-otomy
-scopy (Correct answer)
-plasty
-ectomy

Correct answer: -scopy

The suffix '-scopy' means visual examination, as in colonoscopy (examination of the colon).

Question 65: Which of the following is an example of protected health information (PHI) under HIPAA?

Aggregate hospital discharge data
De-identified patient statistics published in a research study
A patient's name combined with their diagnosis (Correct answer)
Employee health and safety records

Correct answer: A patient's name combined with their diagnosis

PHI includes individually identifiable health information, such as a patient's name combined with their medical condition or diagnosis.

Question 66: Which ICD-10-CM code category is used to report encounters for aftercare following surgery?

Z87 – Personal history codes
Z00 – Encounters for general examination
Z51 – Encounter for other aftercare and medical care
Z47 – Orthopedic aftercare (Correct answer)

Correct answer: Z47 – Orthopedic aftercare

Z47 is used to report orthopedic aftercare encounters following surgery, such as removal of fracture fixation devices.

Question 67: After seeing Natasha in the office, the doctor determined that she had acute bronchitis and COPD. What ICD-9 diagnosis code would be appropriate for her condition?

466.0
491.21
466.0, 491.22
491.22 (Correct answer)

Correct answer: 491.22

In ICD-9-CM, code 491.22 specifically represents 'Obstructive chronic bronchitis with acute exacerbation.' This code is appropriate when a patient with Chronic Obstructive Pulmonary Disease (COPD), which often includes chronic bronchitis, experiences an acute worsening of their condition, such as acute bronchitis. It accurately captures both aspects of Natasha's diagnosis.

Question 68: In ICD-10-PCS, what character position identifies the root operation?

First character
Second character
Fourth character
Third character (Correct answer)

Correct answer: Third character

The third character in an ICD-10-PCS code identifies the root operation (e.g., Excision, Repair, Replacement).

Question 69: A patient is treated for sepsis due to Staphylococcus aureus. How should this be coded?

A41.01 for sepsis, then the organism code
B95.61 followed by A41.01
A41.01 as principal diagnosis only (Correct answer)
A41.9 followed by B95.61

Correct answer: A41.01 as principal diagnosis only

A41.01 (Sepsis due to Methicillin susceptible Staphylococcus aureus) fully captures both the sepsis and the organism in one combination code.

Question 70: What does the abbreviation 'NEC' mean in the ICD-10-CM Index?

Not elsewhere classifiable (Correct answer)
No external cause
Not elsewhere coded
Not entirely coded

Correct answer: Not elsewhere classifiable

NEC stands for 'Not Elsewhere Classifiable,' indicating there is no more specific code available for the condition.

Question 71: What does "E/M" stand for in medical coding?

evaluation and Management
Emergency and Maintenance
Examination and Manipulation (Correct answer)
Equipment and Medication

Correct answer: Examination and Manipulation

In medical coding, E/M stands for Evaluation and Management. E/M codes are a category within the CPT code set used to report physician services for assessing and managing a patient's health condition. These codes are crucial for billing office visits, hospital visits, consultations, and other encounters where a physician evaluates a patient's problem and determines a course of action.

Question 72: Under HIPAA, which entity is classified as a 'covered entity'?

Health plan (Correct answer)
Medical transcription service
Medical equipment manufacturer
Pharmaceutical company

Correct answer: Health plan

Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically are classified as covered entities under HIPAA.

Question 73: The "newborn period" according to ICD-9-CM is the time period from birth to the ___ day after birth.

26th
34th
28th (Correct answer)
30th

Correct answer: 28th

According to ICD-9-CM guidelines, the 'newborn period' or 'perinatal period' is defined as the time from birth up to and including the 28th day following birth. This specific timeframe is important for accurate coding of conditions affecting newborns, as certain codes are only applicable during this period.

Question 74: In ICD-10-CM, what does the placeholder character 'X' indicate?

A dummy placeholder used to allow for future expansion or to fill a required position (Correct answer)
The code applies to male patients only
The condition is unknown
The code is invalid and should not be used

Correct answer: A dummy placeholder used to allow for future expansion or to fill a required position

The placeholder character 'X' is used in ICD-10-CM to allow for future expansion and to fill positions when additional characters are required.

Question 75: A coder sees the note 'ESRD on dialysis.' Which code(s) should be assigned?

N18.6 and Z99.2 (Correct answer)
Z99.2 only
N18.6 only
N18.5 and Z99.2

Correct answer: N18.6 and Z99.2

Both N18.6 (end-stage renal disease) and Z99.2 (dependence on renal dialysis) are assigned when a patient has ESRD on dialysis.

Question 76: In CPT coding, what is a 'global surgical package'?

All services normally included in a single surgical procedure, including pre- and post-operative care (Correct answer)
A bundle of codes for multiple unrelated surgeries
A group of codes for same-day surgery only
A code set for outpatient procedures exclusively

Correct answer: All services normally included in a single surgical procedure, including pre- and post-operative care

The global surgical package bundles the pre-operative, intraoperative, and standard post-operative care into one surgical code reimbursement.

Question 77: What does the combining form 'oste/o' refer to?

Bone (Correct answer)
Nerve
Muscle
Joint

Correct answer: Bone

The combining form 'oste/o' refers to bone, as in osteoporosis (decrease in bone density).

Question 78: The health record states 'patient presents with chest pain, rule out MI.' This is an outpatient encounter. What should be coded?

Angina pectoris
Both chest pain and MI
Chest pain (Correct answer)
Myocardial infarction

Correct answer: Chest pain

For outpatient visits, coders report the sign/symptom (chest pain) — 'rule out' diagnoses are not coded.

Question 79: What is a Coordination of Benefits (COB) situation?

When Medicare is the sole payer
When a patient has no insurance coverage
When a provider does not accept insurance
When a patient has more than one insurance plan covering the same services (Correct answer)

Correct answer: When a patient has more than one insurance plan covering the same services

COB occurs when a patient is covered by more than one insurance plan, and the plans coordinate to avoid overpayment.

Question 80: What does the suffix '-plasty' indicate?

Abnormal growth
Inflammation
Surgical removal
Surgical repair or reconstruction (Correct answer)

Correct answer: Surgical repair or reconstruction

The suffix '-plasty' means surgical repair or reconstruction, as in rhinoplasty (nose reshaping).

Question 81: Which approach character in ICD-10-PCS represents a procedure performed entirely through orifices?

Percutaneous (3)
Via Natural or Artificial Opening (7) (Correct answer)
Open (0)
External (X)

Correct answer: Via Natural or Artificial Opening (7)

The approach character '7' in ICD-10-PCS represents procedures performed via natural or artificial openings without incision into the body.

Question 82: In ICD-10-CM, the Alphabetic Index entry 'see also' instructs the coder to:

Code both the current and referenced conditions
Look at an alternative main term for additional information (Correct answer)
Use only the referenced code and discard the current one
Ignore the current main term and go to a different one

Correct answer: Look at an alternative main term for additional information

'See also' in the Alphabetic Index directs the coder to another main term that may provide additional or alternative code options.

Question 83: An operative report states the surgeon performed a laparoscopic cholecystectomy that was converted to an open procedure. How should this be coded?

Code only the open approach (Correct answer)
Code the open cholecystectomy with a note about conversion
Code only the laparoscopic approach
Code both approaches with modifier -52

Correct answer: Code only the open approach

Per CPT guidelines, when a laparoscopic procedure is converted to open, only the open procedure code is reported.

Question 84: Which code set is primarily used for reporting durable medical equipment (DME) on Medicare claims?

HCPCS Level II codes (Correct answer)
CPT Category III codes
ICD-10-PCS codes
Revenue codes

Correct answer: HCPCS Level II codes

HCPCS Level II codes are alphanumeric codes (A–V prefixes) used to report DME, supplies, and other services not covered by CPT.

Question 85: What is the purpose of a National Correct Coding Initiative (NCCI) edit?

To assign DRGs for inpatient stays
To validate ICD-10-CM codes on claims
To prevent improper payment of procedure codes that should not be billed together (Correct answer)
To identify fraudulent provider billing

Correct answer: To prevent improper payment of procedure codes that should not be billed together

NCCI edits are bundling edits that prevent Medicare from paying separately for services that should be billed together.

Question 86: In ICD-10-CM, what does a 7th character 'A' indicate when appended to a fracture code?

Initial encounter for closed fracture (Correct answer)
Subsequent encounter for fracture with delayed healing
Sequela of fracture
Subsequent encounter for fracture with routine healing

Correct answer: Initial encounter for closed fracture

The 7th character 'A' in ICD-10-CM fracture codes designates the initial encounter, meaning the patient is receiving active treatment for the fracture.

Question 87: What ICD-10 code should be used to diagnose a malignant tumor in the upper inner quadrant of the right male breast?

C50.411
C50.421
C50.221 (Correct answer)
C50.211

Correct answer: C50.221

The correct ICD-10 code is C50.221. 'C50' indicates a malignant neoplasm of the breast. The fourth character '.2' specifies the upper-inner quadrant of the breast. The fifth character '2' denotes a male patient, and the sixth character '1' indicates the right breast, making C50.221 the precise code for a malignant tumor in the upper inner quadrant of the right male breast.

Question 88: Which section of the CMS-1500 claim form is used to report the diagnosis codes?

Box 21 (Correct answer)
Box 17
Box 24D
Box 33

Correct answer: Box 21

Box 21 on the CMS-1500 form is designated for listing the ICD-10-CM diagnosis codes.

Question 89: Which of the following organizations primarily focuses on medical billing and coding professionals?

AHIMA (Correct answer)
AMA
CDC
WHO

Correct answer: AHIMA

The American Health Information Management Association (AHIMA) is a professional organization that primarily focuses on health information management (HIM) professionals, which includes medical coders and billers. AHIMA provides education, certifications (like CCA, CCS, RHIA, RHIT), and advocacy for the HIM profession, distinguishing it from organizations like AMA (physicians), WHO (global health), or CDC (public health).

Question 90: What does the acronym 'MS-DRG' stand for?

Medical-Surgical Diagnostic Resource Group
Multi-System Disease Reference Guide
Medicare Severity Diagnosis Related Group (Correct answer)
Medical Standard Documentation Review Group

Correct answer: Medicare Severity Diagnosis Related Group

MS-DRG stands for Medicare Severity Diagnosis Related Group, used by Medicare for inpatient hospital reimbursement.

Question 91: Which of these patient evaluation elements DOES NOT belong with the other two, according to your understanding of the three foundations of E/M services (history, exam, and medical decision-making)?

Chief complaint
History of present illness
Level of risk (Correct answer)
Review of systems

Correct answer: Level of risk

The three foundational components of Evaluation and Management (E/M) services are history, examination, and medical decision-making (MDM). The history component includes the chief complaint, history of present illness, and review of systems. The 'Level of risk' is a key element *within* the medical decision-making component, not a separate foundational component itself.

Question 92: When a patient is admitted due to a complication of a medical device, which ICD-10-CM code category is typically assigned?

T codes for complications of surgical and medical care (Correct answer)
Z codes for factors influencing health
S codes for traumatic injury
Y codes for external cause

Correct answer: T codes for complications of surgical and medical care

Complications of medical devices and implants are classified in the T codes (T82–T85 range) in ICD-10-CM.

Question 93: What does the acronym "HIPAA" stand for in the context of medical coding?

What does the acronym "HIPAA" stand for in the context of medical coding?
Healthcare Information Privacy and Accountability Act
Health Insurance Portability and Accountability Act (Correct answer)
Hospital Information Protection and Assurance Act

Correct answer: Health Insurance Portability and Accountability Act

The acronym 'HIPAA' stands for the Health Insurance Portability and Accountability Act. Enacted in 1996, HIPAA is a federal law that established national standards to protect sensitive patient health information. It ensures patient privacy, data security, and the ability to transfer and continue health insurance coverage.

Question 94: Which of the following best describes the concept of "coding specificity"?

Using a wide range of code sets
Choosing the most accurate code based on dicumentation (Correct answer)
Coding quickly without careful consideration
Coding at a general level

Correct answer: Choosing the most accurate code based on dicumentation

Coding specificity refers to choosing the most accurate and detailed code based on the available documentation. It means selecting a code that precisely describes the patient's condition, the anatomical site, the severity, and any other relevant factors. This level of detail is crucial for accurate data collection, reimbursement, and quality reporting.

Question 95: Which document authorizes a provider to treat a patient and indicates the patient understands the nature of the treatment?

Advance directive
Authorization for release of information
Informed consent (Correct answer)
Assignment of benefits

Correct answer: Informed consent

Informed consent is the process by which a patient is informed about a procedure and voluntarily agrees to undergo it.

Question 96: Which ICD-10-CM convention indicates that a code requires an additional character to be valid?

Code first
A placeholder X (Correct answer)
NEC
NOS

Correct answer: A placeholder X

A placeholder 'X' is used in ICD-10-CM to allow for future expansion and must be used to fill out required character positions.

Question 97: In ICD-10-CM, what does the instruction 'Use additional code' mean?

The code is invalid unless paired with a manifestation code
A second code should be added to provide further detail about the condition (Correct answer)
The code is sequenced after the combination code
The code applies only to inpatient settings

Correct answer: A second code should be added to provide further detail about the condition

'Use additional code' instructs the coder to add a supplementary code to provide more complete information about the condition.

Question 98: What kind of company carries out Medicare and Medicaid certification surveys for hospitals under contract with the CMS?

State licensure agencies (Correct answer)
Conditions of participation agencies
E codes
Health level seven (hl7) international

Correct answer: State licensure agencies

State licensure agencies, often departments of health, are typically contracted by the Centers for Medicare & Medicaid Services (CMS) to conduct certification surveys for hospitals. These surveys ensure that hospitals meet the federal 'Conditions of Participation' necessary to receive Medicare and Medicaid payments, thereby maintaining quality and safety standards.

Question 99: Which of the following is NOT typically coded using ICD-10-PCS codes?

Open-heart surgery
Diagnosis of a respiratory infection (Correct answer)
Insertion of a pacemaker
Hip replacement surgery

Correct answer: Diagnosis of a respiratory infection

ICD-10-PCS (Procedure Coding System) codes are specifically used for *inpatient hospital procedures*. Diagnoses, such as a respiratory infection, are coded using ICD-10-CM (Clinical Modification) codes. Surgical procedures like open-heart surgery, pacemaker insertion, and hip replacement, when performed in an inpatient setting, would be coded with ICD-10-PCS.

Question 100: What does CCS mean?

Certified Coding Software
Certified Coding Specialist (Correct answer)
Certified Coding System
Certified Coding Stem

Correct answer: Certified Coding Specialist

CCS stands for Certified Coding Specialist. This is another professional certification offered by AHIMA, indicating a higher level of coding proficiency, particularly in complex inpatient and outpatient coding scenarios. It is distinct from the CCA (Certified Coding Associate), which is an entry-level certification.

Question 101: What is the primary goal of the CCA certification program?

To promote hospital management skills
To ensure proficiency in surgery
To provide patient care training
To ensure professional coders (Correct answer)

Correct answer: To ensure professional coders

The primary goal of the CCA certification program is to ensure professional coders. It validates the competency of entry-level coders in various healthcare settings, demonstrating their foundational knowledge and skills in medical coding. This certification helps maintain high standards in the coding profession and supports accurate healthcare data.

Certified Coding Associate (CCA) Exam

The Certified Coding Associate (CCA) credential demonstrates foundational competency in medical coding across all healthcare settings, including physician offices and hospitals. It validates knowledge of coding guidelines and regulations.

100

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120 min

Time Limit

70%

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