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Question 1. Which character in an ICD- 10 - CM code is typically used to indicate laterality? A) First B) Third C) Fifth D) Seventh Answer: C Explanation: The fifth or sixth character in ICD- 10 - CM codes is often used to indicate laterality (right, left, bilateral), adding specificity to the diagnosis. Question 2. When coding a neoplasm, which code should be assigned if the primary site is unknown? A) Code for secondary site only B) Code for benign neoplasm C) Code for primary site as “unknown primary” D) Omit neoplasm coding Answer: C Explanation: When the primary site is unknown, the appropriate code for “unknown primary” should be assigned alongside the secondary site(s). Question 3. Which of the following is a correct use of the ICD- 10 - CM placeholder character? A) "Z" B) "Y" C) "X" D) "0" Answer: C Explanation: The “X” character is used as a placeholder in ICD- 10 - CM to allow for future code expansion or to fill in empty characters when a 7th character is required.
Question 4. Excludes1 notes in ICD- 10 - CM indicate: A) The conditions may be coded together B) The code listed should never be used at the same time as the code above the note C) The condition is only coded if documented D) The code is optional Answer: B Explanation: Excludes1 notes mean the two conditions should not be coded together as they represent mutually exclusive diagnoses. Question 5. In the CPT manual, what does a “bullet” symbol (●) next to a code indicate? A) A new code B) Add-on code C) Revised code D) Deleted code Answer: A Explanation: A bullet symbol (●) in CPT indicates a new code for that particular year. Question 6. Which chapter of ICD- 10 - CM contains codes for diseases of the circulatory system? A) Chapter 9 B) Chapter 10 C) Chapter 11 D) Chapter 12 Answer: A Explanation: Chapter 9 of ICD- 10 - CM addresses diseases of the circulatory system (I00–I99).
Explanation: The seventh character “A” denotes an initial encounter for active treatment of a condition such as a fracture. Question 10. What type of code is required for documenting laterality in CPT? A) Modifier 25 B) Modifier 59 C) Modifier LT or RT D) Modifier 50 Answer: C Explanation: Modifiers LT (left) and RT (right) are used in CPT to indicate laterality. Question 11. Which of the following is NOT a valid use of modifier 59 in CPT coding? A) To indicate a distinct procedural service B) To bypass NCCI edits when appropriate C) To unbundle procedures inappropriately D) To report separate anatomical sites Answer: C Explanation: Modifier 59 should not be used to unbundle procedures that are not distinct; misuse may constitute fraud. Question 12. What is the principal diagnosis? A) Any diagnosis listed on the claim B) The first diagnosis alphabetically C) The main condition treated or investigated during the encounter D) The patient’s chronic condition Answer: C
Explanation: The principal diagnosis is the main reason for the patient encounter, as determined after study. Question 13. How is “sequela” represented in ICD- 10 - CM coding? A) As a primary diagnosis only B) Using the code for the acute phase C) With a specific code indicating late effects D) By omitting the code Answer: C Explanation: Sequela codes represent conditions that are the residual effect after the acute phase has passed, using specific codes for late effects. Question 14. Which code set is used for outpatient facility billing on the UB-04 form? A) ICD- 10 - CM only B) CPT only C) ICD- 10 - PCS and CPT D) HCPCS Level II and CPT Answer: D Explanation: Outpatient facilities use HCPCS Level II and CPT codes on the UB-04 (CMS-1450) form for billing. Question 15. In E/M coding, what is the key criterion for selecting a level of service under 2021/ guidelines? A) Patient age B) Medical Decision Making or total time spent C) Patient gender D) Number of diagnoses
D) Bundled payment Answer: B Explanation: Capitation pays a set amount per patient, regardless of the number or type of services rendered. Question 19. The Medicare program that covers hospital inpatient services is: A) Part A B) Part B C) Part C D) Part D Answer: A Explanation: Medicare Part A covers inpatient hospital care, skilled nursing, and certain home health services. Question 20. Which of the following is an example of a HCPCS Level II code? A) 99213 B) M C) J D) 45378 Answer: C Explanation: HCPCS Level II codes are alphanumeric and include codes like J3490 for unclassified drugs. Question 21. A CPT add-on code is identified by which symbol? A) ▲ B) ● C) +
D) *
Answer: C Explanation: Add-on codes in CPT appear with a plus sign (+) and indicate additional procedures performed in conjunction with a primary service. Question 22. What does the “minimum necessary” standard of HIPAA require? A) Release all PHI without restriction B) Only use, disclose, or request the least amount of PHI needed to accomplish the intended purpose C) Restrict all access to PHI D) Ignore patient requests for information Answer: B Explanation: HIPAA’s minimum necessary standard ensures only the essential amount of PHI is used or disclosed. Question 23. When can modifier 25 be applied to an E/M service? A) When E/M is the only service provided B) When a significant, separately identifiable E/M service is provided by the same physician on the same day as another procedure C) For all new patient visits D) Only for surgical procedures Answer: B Explanation: Modifier 25 is used when an E/M service is separate from another procedure performed on the same day. Question 24. What is the function of the “Z” codes in ICD- 10 - CM? A) Indicate neoplasms B) Indicate external causes
C) Encounter type D) Complication Answer: B Explanation: The first character in ICD- 10 - CM codes is always a letter indicating the chapter/section of disease. Question 28. What is the purpose of the OIG Work Plan? A) Billing for supplies only B) Identifying areas of potential fraud, waste, and abuse for focused review and enforcement C) Setting medical necessity guidelines D) Licensing physicians Answer: B Explanation: The OIG Work Plan outlines focus areas for audit and enforcement to prevent fraud, waste, and abuse. Question 29. Which suffix indicates a surgical removal in medical terminology? A) - itis B) - ectomy C) - algia D) - emia Answer: B Explanation: The suffix “-ectomy” indicates surgical removal of a body part. Question 30. Which section of the CPT manual contains codes for anesthesia services? A) 10021- 69990 B) 70010- 79999
C) 00100- 01999
D) 90000- 99999
Answer: C Explanation: CPT codes 00100-01999 are designated for anesthesia services. Question 31. What does the abbreviation "EOB" stand for in medical billing? A) Explanation of Benefits B) End of Billing C) Entry of Benefits D) Electronic Billing Answer: A Explanation: EOB stands for Explanation of Benefits, a statement sent by insurance companies explaining claim payment. Question 32. Which of the following is considered protected health information (PHI) under HIPAA? A) Patient phone number B) Provider NPI number C) Insurance company address D) Medicare fee schedule Answer: A Explanation: Patient phone number is PHI; provider and company details are not. Question 33. Which body system does the code I50.9 (ICD- 10 - CM) relate to? A) Digestive B) Circulatory
C) Identify healthcare providers in HIPAA transactions D) Identify procedures Answer: C Explanation: The NPI uniquely identifies healthcare providers in transactions required by HIPAA. Question 37. Which code range in CPT is used for radiology procedures? A) 10021- 69990 B) 70010- 79999 C) 80050- 89398 D) 99000- 99499 Answer: B Explanation: CPT codes 70010-79999 cover radiology procedures. Question 38. What is “upcoding” in medical billing? A) Coding at a lower level than the service provided B) Using outdated codes C) Assigning codes for a more severe diagnosis or more expensive service than provided D) Not using modifiers Answer: C Explanation: Upcoding is the fraudulent practice of billing for higher-level services than actually provided. Question 39. Which form is used for professional billing? A) UB- 04 B) CMS- 1500
C) 837I
D) 837D
Answer: B Explanation: The CMS-1500 is used by individual healthcare professionals for claim submission. Question 40. What does “DRG” stand for in inpatient reimbursement? A) Diagnosis Related Group B) Diagnostic Review Grid C) Drug Reference Guide D) Durable Reimbursement Guide Answer: A Explanation: DRG stands for Diagnosis Related Group, a system for hospital inpatient reimbursement. Question 41. In CPT coding, what is the purpose of “parenthetical notes”? A) List deleted codes B) Provide coding instructions or guidelines C) Indicate new codes D) List code modifiers Answer: B Explanation: Parenthetical notes offer important coding instructions or guidelines related to the use of codes. Question 42. What is the function of RVUs in the Medicare Fee Schedule? A) Identify patients B) Measure the relative resources required to provide a service
C) Increase claim denials D) Decrease documentation Answer: B Explanation: Compliance programs help prevent, detect, and correct violations, reducing legal and financial risks. Question 46. What is the correct sequencing for coding multiple injuries in ICD- 10 - CM? A) Alphabetical order B) Most severe injury first C) Most recent injury first D) Least severe first Answer: B Explanation: The most severe injury should be sequenced first when coding multiple injuries. Question 47. Which code set is primarily used for inpatient procedure coding? A) CPT B) HCPCS Level II C) ICD- 10 - PCS D) ICD- 10 - CM Answer: C Explanation: ICD- 10 - PCS is used for inpatient procedure coding in the U.S. Question 48. What does “medical necessity” mean in claim submission? A) The service was requested by the patient B) The service is reasonable and necessary for the patient’s condition or treatment
C) The service is expensive D) The service is elective Answer: B Explanation: Services must be medically necessary—reasonable and essential for the patient’s diagnosis or treatment. Question 49. What is the purpose of an Advance Beneficiary Notice (ABN)? A) To inform patients of covered services B) To notify patients that a service may not be covered and the patient may be liable for payment C) To collect copays D) To document medical necessity Answer: B Explanation: An ABN notifies Medicare beneficiaries that a service may not be covered, and they may be responsible for payment. Question 50. Which chapter of ICD- 10 - CM covers infectious and parasitic diseases? A) Chapter 1 B) Chapter 2 C) Chapter 3 D) Chapter 4 Answer: A Explanation: Chapter 1 (A00-B99) covers infectious and parasitic diseases. Question 51. Which modifier is used to indicate bilateral procedures in CPT coding? A) 25 B) 50
C) LC
D) LD
Answer: B Explanation: LT stands for left side, and RT for right side, in HCPCS modifiers. Question 55. What is the typical format for a CPT code? A) 5 digits, all numeric B) 7 digits, alphanumeric C) 3 digits, numeric D) 4 digits, alphanumeric Answer: A Explanation: CPT codes are 5-digit, all numeric codes. Question 56. How should an external cause code (V, W, X, Y) be sequenced? A) Always first B) After the principal diagnosis code C) Never used D) Before procedure codes Answer: B Explanation: External cause codes are always sequenced after the injury or condition code. Question 57. What is the difference between excision and resection in surgical terminology? A) Excision is partial removal; resection is total removal B) Excision is complete removal; resection is partial C) Both terms mean the same
D) Excision is for organs only Answer: A Explanation: Excision denotes partial removal of tissue; resection refers to complete removal of an organ or structure. Question 58. Which field on the UB-04 identifies the type of bill? A) Field 4 B) Field 14 C) Field 42 D) Field 67 Answer: A Explanation: Field 4 on the UB-04 designates the type of bill. Question 59. What is the purpose of an Explanation of Benefits (EOB)? A) To itemize all patient medications B) To notify providers and patients how a claim was processed C) To list hospital admissions D) To authorize surgery Answer: B Explanation: EOBs explain how claims were processed, including what was paid, denied, or adjusted. Question 60. What is the function of the GPCI in Medicare reimbursement? A) Determines patient eligibility B) Adjusts payment rates based on geographic location C) Sets copay amounts
