Code Specialist Module - CS National Certification Exam, Exams of Computer Science

Code Specialist Module - CS National Certification Exam

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2025/2026

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Code Specialist Module - CS National Certification Exam
1. Which organization maintains and publishes the ICD-10-CM code set in the
United States?
A) American Medical Association (AMA)
B) Centers for Medicare & Medicaid Services (CMS)
C) Centers for Disease Control and Prevention (CDC)
D) National Center for Health Statistics (NCHS)
ANSWER: D
EXPLANATION: The NCHS, part of the CDC, maintains ICD-10-CM for morbidity
coding in the U.S.
2. What is the primary purpose of the Alphabetic Index in ICD-10-CM?
A) To provide complete coding instructions
B) To list all codes in numerical order
C) To locate codes for diseases, injuries, and symptoms
D) To determine medical necessity
ANSWER: C
EXPLANATION: The Alphabetic Index helps locate terms and corresponding codes;
final code selection must be verified in the Tabular List.
3. A coder may assign a diagnosis code as "probable," "suspected," "likely," or
"rule out" when:
A) The physician documents these terms
B) Never - only code confirmed diagnoses
C) For outpatient encounters only
D) When the coder believes it's appropriate
ANSWER: B
EXPLANATION: ICD-10-CM Official Guidelines prohibit coding uncertain diagnoses
in any setting except for inpatient admissions.
4. Which ICD-10-CM chapter contains codes for factors influencing health status
and contact with health services?
A) Chapter 1
B) Chapter 15
C) Chapter 18
D) Chapter 21
ANSWER: D
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Code Specialist Module - CS National Certification Exam

  1. Which organization maintains and publishes the ICD- 10 - CM code set in the United States? A) American Medical Association (AMA) B) Centers for Medicare & Medicaid Services (CMS) C) Centers for Disease Control and Prevention (CDC) D) National Center for Health Statistics (NCHS) ANSWER: D EXPLANATION: The NCHS, part of the CDC, maintains ICD- 10 - CM for morbidity coding in the U.S.
  2. What is the primary purpose of the Alphabetic Index in ICD- 10 - CM? A) To provide complete coding instructions B) To list all codes in numerical order C) To locate codes for diseases, injuries, and symptoms D) To determine medical necessity ANSWER: C EXPLANATION: The Alphabetic Index helps locate terms and corresponding codes; final code selection must be verified in the Tabular List.
  3. A coder may assign a diagnosis code as "probable," "suspected," "likely," or "rule out" when: A) The physician documents these terms B) Never - only code confirmed diagnoses C) For outpatient encounters only D) When the coder believes it's appropriate ANSWER: B EXPLANATION: ICD- 10 - CM Official Guidelines prohibit coding uncertain diagnoses in any setting except for inpatient admissions.
  4. Which ICD- 10 - CM chapter contains codes for factors influencing health status and contact with health services? A) Chapter 1 B) Chapter 15 C) Chapter 18 D) Chapter 21 ANSWER: D

EXPLANATION: Chapter 21 (Z00-Z99) contains codes for circumstances other than diseases or injuries.

  1. What does the 7th character "A" typically indicate in injury codes? A) Initial encounter B) Subsequent encounter C) Sequela D) Routine follow-up ANSWER: A EXPLANATION: "A" indicates initial encounter (active treatment); "D" indicates subsequent encounter; "S" indicates sequela.
  2. A patient is seen for chemotherapy treatment. What ICD- 10 - CM code category should be sequenced first? A) The malignancy being treated B) Z51.11, Encounter for antineoplastic chemotherapy C) Adverse effects of chemotherapy D) The patient's symptoms ANSWER: B EXPLANATION: According to coding guidelines, when a patient receives chemotherapy, Z51.11 should be sequenced first, followed by the malignancy.
  3. Which of the following is NOT a mandatory component of an ICD- 10 - CM code? A) Category B) Subcategory C) Extension D) 7th character ANSWER: D EXPLANATION: Not all codes require 7th characters. Only specific categories (like injuries, pregnancy, external causes) require them.
  4. What does the term "code also" indicate in ICD- 10 - CM? A) Code the condition first B) An additional code should be used if applicable C) Do not code the condition D) Use an external cause code ANSWER: B EXPLANATION: "Code also" instructs the coder to use an additional code to provide more complete information.

D) Unrelated E/M service ANSWER: A EXPLANATION: Modifier - 25 is used when a significant, separately identifiable E/M service is performed on the same day as a procedure.

  1. What does the term "separate procedure" mean in CPT? A) Always bill separately B) Procedure that is integral to another service C) Stand-alone procedure that can be billed separately D) Bundled procedure ANSWER: B EXPLANATION: "Separate procedure" indicates the service is integral to another procedure when performed at the same session.
  2. A 45-year-old patient undergoes a screening colonoscopy. The physician removes two polyps. What modifier should be appended? A) - 33 B) - 52 C) - 59 D) No modifier needed ANSWER: A EXPLANATION: Modifier - 33 indicates preventive services. Screening colonoscopy with polyp removal becomes diagnostic/therapeutic.
  3. Which CPT section contains codes for Evaluation and Management services? A) 10000- 19999 B) 20000- 29999 C) 30000- 39999 D) 99201- 99499 ANSWER: D EXPLANATION: E/M codes are in the range 99202-99499 (new 2021/2023 guidelines have reorganized these codes).
  4. The three key components of E/M services are: A) History, exam, medical decision making B) Time, complexity, diagnosis C) Documentation, medical necessity, coding D) History, time, treatment plan ANSWER: A

EXPLANATION: History, examination, and medical decision making are the three key components for E/M level selection.

  1. What is the correct CPT code for an intermediate repair of a 2.5 cm laceration of the arm? A) 12001 B) 12002 C) 12031 D) 12032 ANSWER: D EXPLANATION: 12032 is for intermediate repair of wounds 2.6 cm to 7.5 cm. 2.5 cm would be 12031.
  2. Modifier - 59 is used to indicate: A) Distinct procedural service B) Multiple procedures C) Bilateral procedure D) Repeat procedure ANSWER: A EXPLANATION: Modifier - 59 identifies procedures/services that are distinct or independent from other services.
  3. Which CPT code range is used for Pathology and Laboratory services? A) 80000- 89999 B) 90000- 99999 C) 70000- 79999 D) 60000- 69999 ANSWER: A EXPLANATION: Pathology and Laboratory codes are in the 80000-89999 range.
  4. What does HCPCS stand for? A) Healthcare Common Procedure Coding System B) Hospital Care Procedure Coding System C) Health Classification Procedure System D) Healthcare Procedural Code Set ANSWER: A EXPLANATION: HCPCS = Healthcare Common Procedure Coding System, used for supplies, durable medical equipment, and drugs.

D) - 77

ANSWER: A

EXPLANATION: Modifier - 59 or more specific X{EPSU} modifiers can override NCCI edits when services are distinct.

  1. What does the acronym APC stand for in hospital outpatient coding? A) Ambulatory Payment Classification B) Ambulatory Procedure Code C) Associated Payment Category D) Ambulatory Patient Classification ANSWER: A EXPLANATION: APCs are the payment system for hospital outpatient services under Medicare.
  2. The OCE (Outpatient Code Editor) performs which function? A) Validates coding for outpatient claims B) Creates new HCPCS codes C) Sets physician fees D) Trains outpatient coders ANSWER: A EXPLANATION: OCE edits and validates coding on outpatient claims before payment.
  3. Which compliance program element is required by the OIG? A) Written policies and procedures B) Annual coder certification C) Physician education only D) Internal audits only ANSWER: A EXPLANATION: The OIG's 7 elements include written policies, training, communication lines, audits, enforcement, response, and investigations.
  4. The False Claims Act prohibits: A) Knowingly submitting false claims to the government B) Coding errors due to lack of knowledge C) All coding mistakes D) Only intentional fraud ANSWER: A EXPLANATION: The FCA imposes liability for knowingly submitting false claims, not for innocent errors.
  1. What does the Stark Law primarily regulate? A) Physician self-referral B) False claims C) Privacy violations D) Emergency treatment ANSWER: A EXPLANATION: Stark Law prohibits physician referrals for designated health services to entities with which they have financial relationships.
  2. The Anti-Kickback Statute prohibits: A) Offering or receiving remuneration for referrals B) All physician discounts C) Contracting with hospitals D) Employing physicians ANSWER: A EXPLANATION: AKS prohibits offering/paying/requesting/receiving anything of value to induce referrals.
  3. Under HIPAA, what is the minimum necessary rule? A) Use/disclose only minimum PHI needed B) Never disclose PHI C) Always get patient authorization D) Encrypt all PHI ANSWER: A EXPLANATION: Minimum necessary: use/disclose only the minimum PHI needed to accomplish the purpose.
  4. What is a Business Associate Agreement (BAA)? A) Contract with entities handling PHI on behalf of covered entity B) Physician employment contract C) Hospital merger agreement D) Insurance contract ANSWER: A EXPLANATION: BAA is required under HIPAA when a covered entity shares PHI with a business associate.
  5. Which diagnosis is coded first according to ICD- 10 - CM guidelines? A) Condition established after study to be chiefly responsible for admission B) The most expensive condition C) The chronic condition
  1. Which symbol indicates a code is not for primary malignancy in the Neoplasm table? A) ◄ B) ✓ C) * D) † ANSWER: A EXPLANATION: The ◄ symbol indicates the code should not be used for primary malignancy.
  2. What does the "diagnosis present on admission" requirement apply to? A) All inpatient claims B) Outpatient claims only C) Physician office claims D) Emergency department claims ANSWER: A EXPLANATION: POA indicator is required for all diagnoses on inpatient claims under Medicare.
  3. A "U" code in ICD- 10 - CM is used for: A) Special purposes like COVID- 19 B) Unspecified conditions C) Urgent care visits D) Unrelated conditions ANSWER: A EXPLANATION: U codes are for special purposes like emerging diseases (U07.1 for COVID-19).
  4. What is the correct code for "acute respiratory failure with hypoxia"? A) J96. B) J96. C) J96. D) J96. ANSWER: A EXPLANATION: J96.01 is acute respiratory failure with hypoxia. J96.02 is with hypercapnia.
  5. Which ICD- 10 - CCM chapter contains codes for pregnancy, childbirth, and puerperium? A) Chapter 15

B) Chapter 14 C) Chapter 16 D) Chapter 17 ANSWER: A EXPLANATION: Chapter 15 (O00-O9A) contains pregnancy codes.

  1. What is the 7th character requirement for fracture codes? A) Always required B) Never required C) Required for certain categories D) Optional ANSWER: C EXPLANATION: 7th character is required for specific categories like fractures, burns, injuries.
  2. Modifier - 50 indicates: A) Bilateral procedure B) Multiple procedures C) Assistant surgeon D) Repeat procedure ANSWER: A EXPLANATION: Modifier - 50 indicates a bilateral procedure performed.
  3. What is the purpose of a CCI edit? A) Prevent unbundling of related procedures B) Set payment rates C) Create new codes D) Train physicians ANSWER: A EXPLANATION: CCI (Correct Coding Initiative) edits prevent improper payment when codes are billed together.
  4. Which modifier indicates a professional component? A) - 26 B) - TC C) - 22 D) - 32 ANSWER: A EXPLANATION: Modifier - 26 indicates the professional component (physician's interpretation).

D) Revenue Audit Contractor ANSWER: A EXPLANATION: RACs audit Medicare claims for overpayments and underpayments.

  1. The term "upcoding" refers to: A) Assigning higher-level codes than supported B) Using outdated codes C) Not coding all diagnoses D) Using unspecified codes ANSWER: A EXPLANATION: Upcoding = billing for higher-level services than actually provided/documented.
  2. Which law established the National Provider Identifier (NPI)? A) HIPAA B) Stark Law C) False Claims Act D) ACA ANSWER: A EXPLANATION: HIPAA mandated the NPI as a unique identifier for healthcare providers.
  3. What is the purpose of the ICD- 10 - CM Official Guidelines? A) Provide coding instruction and conventions B) Set payment rates C) Create new codes D) Train physicians ANSWER: A EXPLANATION: The guidelines provide official instruction for proper ICD- 10 - CM coding.
  4. Which coding system is used for inpatient procedures? A) ICD- 10 - PCS B) CPT C) HCPCS Level II D) DRG ANSWER: A EXPLANATION: ICD- 10 - PCS is used for inpatient procedures in hospital settings.
  1. What is the structure of an ICD- 10 - PCS code? A) 7 alphanumeric characters B) 5 numeric characters C) 3 characters plus modifier D) Variable length ANSWER: A EXPLANATION: ICD- 10 - PCS codes have exactly 7 alphanumeric characters, each with specific meaning.
  2. The first character in ICD- 10 - PCS represents: A) Section B) Body system C) Root operation D) Approach ANSWER: A EXPLANATION: Character 1 = Section (Medical/Surgical, Obstetrics, Imaging, etc.).
  3. What does the root operation "Excision" mean in ICD- 10 - PCS? A) Cutting out or off, without replacement B) Cutting into a body part C) Taking out some or all of a body part D) Altering the body part ANSWER: A EXPLANATION: Excision = cutting out or off a portion of a body part, without replacement.
  4. Which ICD- 10 - PCS approach means "through the skin"? A) Percutaneous B) Open C) Endoscopic D) Via natural opening ANSWER: A EXPLANATION: Percutaneous = through the skin or mucous membrane.
  5. What does MS-DRG stand for? A) Medicare Severity Diagnosis Related Group B) Medical Surgical Diagnosis Related Group C) Medicare Service Diagnosis Related Group D) Medical Severity Diagnosis Related Group ANSWER: A
  1. Which modifier indicates a staged or related procedure? A) - 58 B) - 59 C) - 76 D) - 77 ANSWER: A EXPLANATION: Modifier - 58 indicates a staged or related procedure during postoperative period.
  2. What does NCD stand for? A) National Coverage Determination B) National Coding Directive C) Non-Covered Diagnosis D) National Compliance Directive ANSWER: A EXPLANATION: NCDs are Medicare coverage policies established by CMS.
  3. LCD stands for: A) Local Coverage Determination B) Laboratory Code Determination C) Limited Coverage Diagnosis D) Local Coding Directive ANSWER: A EXPLANATION: LCDs are coverage policies established by Medicare Administrative Contractors.
  4. The term "medical necessity" means: A) Services reasonable and necessary for diagnosis/treatment B) Services the patient wants C) All possible services D) Experimental services ANSWER: A EXPLANATION: Medical necessity = services reasonable and necessary for diagnosis/treatment of illness/injury.
  5. Which form is used for physician certification of medical necessity for DME? A) CMS- 484 B) CMS- 1500 C) UB- 04 D) CMS- 1450

ANSWER: A

EXPLANATION: CMS-484 is the Certificate of Medical Necessity for DME.

  1. What is the timely filing limit for Medicare claims? A) 1 calendar year from date of service B) 6 months from date of service C) 2 years from date of service D) 90 days from date of service ANSWER: A EXPLANATION: Medicare claims must be filed within 1 calendar year after date of service.
  2. Which act established the RBRVS payment system? A) OBRA 1989 B) HIPAA 1996 C) ACA 2010 D) TEFRA 1982 ANSWER: A EXPLANATION: OBRA 1989 established the Resource-Based Relative Value Scale.
  3. What does E/M documentation guidelines require? A) Legible, complete documentation supporting level of service B) Only diagnosis codes C) Only procedure notes D) Only physician signature ANSWER: A EXPLANATION: Documentation must support medical necessity and level of service billed.
  4. Which coding certification is offered by AHIMA? A) CCS B) CPC C) COC D) CPB ANSWER: A EXPLANATION: AHIMA offers CCS (Certified Coding Specialist).
  5. What does the acronym AAPC stand for? A) American Academy of Professional Coders B) American Association of Procedure Coders
  1. Which code set is used for dental procedures? A) CDT B) CPT C) HCPCS D) ICD- 10 - CM ANSWER: A EXPLANATION: CDT = Code on Dental Procedures and Nomenclature.
  2. What does NPI stand for? A) National Provider Identifier B) National Payer Identifier C) National Patient Identifier D) National Procedure Identifier ANSWER: A EXPLANATION: NPI = 10-digit unique identifier for healthcare providers.
  3. Which form is used for professional claims? A) CMS- 1500 B) UB- 04 C) CMS- 1450 D) HCFA- 1500 ANSWER: A EXPLANATION: CMS-1500 (formerly HCFA-1500) is for professional claims.
  4. What does ERA stand for? A) Electronic Remittance Advice B) Electronic Reimbursement Advice C) Electronic Remittance Authorization D) Electronic Reimbursement Authorization ANSWER: A EXPLANATION: ERA = Electronic Remittance Advice (electronic explanation of benefits).
  5. Which act established mandatory claims attachment standards? A) HIPAA B) ACA C) TEFRA D) OBRA ANSWER: A EXPLANATION: HIPAA established standards for electronic claims attachments.
  1. What does the term "clean claim" mean? A) Claim without errors that can be processed B) Claim for preventive services C) New patient claim D) Claim for minor services ANSWER: A EXPLANATION: Clean claim = complete, accurate claim without errors.
  2. Which modifier indicates a service was repeated? A) - 76 B) - 77 C) - 91 D) - 59 ANSWER: A EXPLANATION: Modifier - 76 indicates a repeat procedure by same physician.
  3. What does ABN stand for? A) Advance Beneficiary Notice B) Advanced Billing Notification C) Advance Billing Notice D) Advanced Beneficiary Notification ANSWER: A EXPLANATION: ABN = Advance Beneficiary Notice of Noncoverage.
  4. When is an ABN required? A) When Medicare may not pay for a service B) For all Medicare services C) Only for elective surgery D) Only for hospital admissions ANSWER: A EXPLANATION: ABN is required when provider believes Medicare may deny payment.
  5. What does CCI stand for? A) Correct Coding Initiative B) Correct Classification Initiative C) Current Coding Information D) Certified Coding Instructor ANSWER: A EXPLANATION: CCI = Correct Coding Initiative (NCCI edits).