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CODE SPECIALIST MODULE CS NATIONAL
CERTIFICATION EXAM 2026 EXAMINATION
TEST
◉ When more than two physicians work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are called.... Answer: co-surgeons ◉ This modifier indicates an increased service and is overused and results in an increase in payment of 20% to 30%. As such, the assignment of this modifier comes under particularly close scrutiny by third-party payers. What is this modifier? Answer: - 22 ◉ When adding multiple CPT modifiers to a code, you would list the modifiers from: When adding multiple HCPCS modifiers, list in: If CPT modifiers and HCPCS modifiers are both used, list: Answer: CPT- highest to lowest HCPS-ascending alphabetical order both- CPT (highest to lowest) then HCPS (ascend. alpha.) ◉ What part of the CPT manual lists a full description for all modifiers? Answer: appendix A
◉ When a CPT codes does not fully explain an unusual procedure,what should be added to the code? Answer: modifier ◉ Third-Party payers require this modifier for a mandated service. Answer: - 32 (like a rape test required by police, or phyiscal exam needed for workers comp; third-party payer will pay 100% for mandated services) ◉ Modifier - 47, anesthesia by the surgeon, is never added to what CPT code? Answer: Anesthesia Code ◉ How many units of service may be billed when reporting the - 50 modifier (bilateral) to Medicare? Answer: one unit (For medicare, just submit 27447-50 for procedure done left and right; whereas other payers want two lines 27447 and 27447-50.) ◉ When reporting - 51 modifier to indicate multiple procedure performed, which procedure should be reported first on the claim? Answer: Primary Procedure
◉ Describing the services provided by the facility. Answer: Technical Component ◉ Bundling together of time effort and services for a specific procedure into one code instead of reporting each component separately Answer: Surgical Package ◉ Code assignments in the E/M section varies according to three factors: Answer: 1. place of service
- type of service
- patient status ◉ Type of service (for E/M) examples Answer: consultation, admission, newborn care, office visit ◉ Six sections of the CPT manual Answer: Evaluation and Management Anesthesia Surgery Radiology Pathology and Laboratory Medicine
◉ Patient status (for E/M) Answer: new, established, outpatient, inpatient ◉ A new patient is one who has not received a face-to-face professional service from that physician or another physician in the same practice of the same specialty for _____ years. Answer: 3 years ◉ Another name for the HCPCS Level II is: Answer: national codes ◉ The face-to-face encounter between a physician and a patient for primary management of the patient's health status is a/an _____. Answer: office visit ◉ The key component of E/M service is _____. Answer: medical decision-making ◉ The four levels of medical decision-making complexity are: Answer: 1.straightforward 2.low 3.moderate 4.high ◉ The complexity of medical decision-making is based on: Answer:
- number of diagnoses
◉ Where are POA guidelines found in ICD- 10 - cm Answer: Appendix 1 ◉ IPPS Answer: inpatient prospective payment system ◉ Under the _____ each case is categorized into a DRG Answer: Inpatient prospective payment system ◉ One _____ group per admission Answer: DRG ◉ MS-DRG variables Answer: - principal diagnosis
- secondary diagnosis
- principal or significant procedure
- age/sex
- discharge disposition ◉ modifier - 51 Answer: Multiple procedures ◉ To code lesion procedures you need ..........., .............., size of ............., and whether the lesion is ...................... Answer: the site, number, size of the excised lesion, and whether the lesion is malignant or benign.
◉ When coding the excision of a lesion, the size of the lesion is based on the following measurement: Answer: lesion and narrowest width of margin ◉ ingrown toenail Answer: onychocryptosis ◉ When reporting subcutaneous hormone pellet replacement, you would code the following: Answer: replacement only (This is hormone replacement therapy after menopause. The pellet is absorbed by system and doesn't have to be removed. Thus you don't code removal just replacement.) ◉ ..................... requires no closure because no incision is made ....................includes simple closure but may require more complex closure .................. may be by any method including freezing, burning, chemicals, etc. Answer: Shaving of lesions Excision Destruction ◉ Don't report BOTH ................ performed at the same time as the biopsy is ....................into the excision service. Answer: a biopsy and an excision bundled
◉ ___________________is the separation and removal of the nail plate, preserving the root so the nail will grow back Answer: avulsion ◉ blood trapped under a finger or toenail, its evacuated by puncturing the nail with an ........................needle. Answer: Subungual hematoma electrocautery ◉ __________________is located in the sacral area and is most often caused by an ingrown hair. Answer: Pylonidal Cysts ◉ These are included in which section: lesion injection, tattooing, tissue expansion, contraceptive capsule insertion/removal, and hormone implantation services Answer: Introduction ◉ _____________is an elastic material formed into a sac that is then filled with fluid or air so it expands like a balloon? These are used to prepare site for .............. Answer: Tissue expanders permanent impant
◉ Do not report an expander code from the Introduction category, after a ...........in which a temporary expander has been inserted. Answer: mastectomy ◉ ------------requires closure of one or more layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin closure. Also, if it's single layered but needs to be "extensively cleaned" the wound closure, is considered as the .............. repair Answer: Intermediate repair intermediate repair ◉ a procedure in which healthy tissue is manipulated or rearranged from a site close to or next to an area that is open due to disease or injury.. Answer: ATT adjacent tissue transfer ◉ The square cm measurement (for skin replacement and skin substitute) is applied to adults and ...............years. The % is for children ................years. Answer: adults & children over 10 years children younger 10 years ◉ Paring or cutting codes are divided based on the: Answer: number of lesions removed
◉ Relative weight is published in the ____ _____ and the updated _____ ____ ____ ______ regulations Oct every year Answer: federal register , Inpatient prospective payment system ◉ Complication Answer: is a diagnosis that describes a condition arising after the beginning of hospital observation and treatment and then modifying the course of pts illness or the medical care required ◉ comorbidty Answer: defined as a pre existing condition that because of its presence with a specific principal diagnosis will likely cause an increase to the pts length of stay in hospital ◉ Current MS-DRG is a _____ tiered system Answer: three
- major diagnostic categories MDCs
- surgical or medical
- MS-DRGs ◉ AHIMA Answer: American Health Information Management Association ◉ NCHS Answer: National Center for Health Statistics
◉ ICD- 10 - CM and PCS are published by ____ _____ _____ Answer: American Hospital Association ◉ ICD- 10 - CM is maintained by Answer: National Centers Health statistics ◉ ICD-10 PCS is maintained by Answer: CMS ◉ Code set level 11 is a standardized coding system that is used primarily to identify products, supplies and services that are ______ included in the CPT codes Answer: not ◉ Code set level 11 codes not included in the CPT codes are Answer: Ambulance services, durable medical equipment, prosthetic/orthos, supplies ◉ Medicare Administrative Contractors are contracted to Answer: Perform prepayment medical reviews ◉ MAC (medicare administrative contractors) calculates the Answer: payment amount ◉ RAC Answer: Recovery Audit Contractor
◉ The condition established after study to be chiefly responsible for occasioning the admission of the pt to the hospital is Answer: Principal diagnosis ◉ If two procedures appear to be principal the one most related to the ________ __________ should be selected as the principal procedure Answer: principal diagnosis ◉ Discharge Disposition is a ____ ______ code Answer: two digit 01 discharged home 20 expired 09 admitted as an inpatient to hospital ◉ Section 5001 (c) of the Deficit reduction act of 2005 requires reporting _______ by hospitals Answer: POA ◉ Which of the following organizations is responsible for updating the procedure classification of ICD- 10 - PCS? Answer: Centers for Medicare and Medicaid Services (CMS) is responsible for updating ICD- 10 - PCS ◉ Which character in an ICD- 10 - CM diagnosis code provides information regarding encounter of care? Answer: Seventh character
provides information about encounter of care, such as intial encounter, subsequent encounter, or sequelae ◉ The _______ note indicates that the conditions listed after it should never be used at the same time as the code above this note. Answer: Excludes ◉ A condition that is produced by another illness or an injury and remains after the acute phase of the illness or injury is referred to as a/an _______. Answer: Sequela ◉ A hospital's payment rate is based on which of the following factors? Answer: Type of hospital Designation of the hospital as large urban, other urban, or rural Wage index for the geographic area where the hospital is located ◉ What does the fourth character of an ICD- 10 - CM diagnosis code capture?a. An atomic site b. Severity c. Etiology d. Supplemental information Answer: C. The fourth character captures etiology. The fifth captures an atomic site. The sixth captures severity.
d. Not specified Answer: CComplex closure includes the repair of wounds requiring more than layered closure, namely, scar revision, debridement, extensive undermining, stents, or retention sutures. ◉ thrombectomy Answer: removing a thrombus; use root operation EXTIRPATION which is taking or cutting out solid material from a body part ◉ judkins technique Answer: The Judkins technique provides x-ray imaging of the coronary arteries by introducing one catheter into the femoral artery with maneuvering up into the left coronary artery orifice, followed by a second catheter guided up into the right coronary artery, and subsequent injection of a contrast material. ◉ For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and stage of the pressure ulcer __________. Answer: Coding Guideline I.C.12.a.5 notes that pressure ulcers present on admission but healed at the time of discharge are assigned the code for site and stage at time of admission. ◉ If a patient is admitted with a pressure ulcer of one stage, and it progresses to a higher stage during the same encounter, what should the coder do? Answer: Report two codes for that site—one for the stage on admission and one for the highest stage during the hospitalization.
◉ CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of services greater than the norm would indicate. These MUEs were implemented on January 1, 2007, and are applied to which code set? Answer: HCPCS/ CPT codes ◉ Which classification system is in place to reimburse home health agencies? Answer: HHRGs, Home health resource groups ◉ Different prospective payment systems: hospital inpatient hospital reahbilitation long-term care home health Answer: MS-DRGs CMGs (case mix groups) LTC-MS-DRGs (long term care medicare severity....) HHRGs (Home health resource groups) ◉ On October 1, 2012, the Affordable Care Act established which of the following, requiring CMS to reduce payments to IPPS hospitals with excess admissions?a. hospital acquired conditions (HACs)b. MS-DRGsc. hospital readmissions reduction programd. RUG- 111 Answer: c. hospital readmissions reduction program
