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Question 1. Which HIPAA rule specifically requires covered entities to protect electronic protected health information (ePHI) through administrative, physical, and technical safeguards? A) Privacy Rule B) Security Rule C) Breach Notification Rule D) Enforcement Rule Answer: B Explanation: The HIPAA Security Rule establishes standards for safeguarding ePHI by requiring appropriate administrative, physical, and technical safeguards. Question 2. Under the OIG, which of the following is considered a “self‑referral” violation? A) Billing for a service not performed B) Referring a Medicare patient to a laboratory in which the physician has a financial interest C) Upcoding a procedure to a higher level D) Submitting duplicate claims for the same service Answer: B Explanation: The OIG’s Stark Law prohibits physicians from referring Medicare patients to entities in which they have a financial relationship, unless an exception applies. Question 3. A coder discovers a patient’s chart contains a diagnosis of “schizophrenia” but the provider documented “schizophrenic disorder” in the narrative. Which term best describes the coder’s responsibility? A) Upcoding B) Under‑coding C) Accurate abstraction D) Unbundling
Answer: C Explanation: The coder must abstract the diagnosis accurately from the provider’s documentation, ensuring the code reflects the documented condition. Question 4. Which of the following is an example of a Local Coverage Determination (LCD)? A) Medicare National Coverage Determination for MRI of the brain B) Medicare coverage policy for bariatric surgery issued by a regional Medicare Administrative Contractor (MAC) C) Medicaid State Plan amendment for dental services D) Private insurer’s medical necessity guideline Answer: B Explanation: LCDs are coverage policies issued by Medicare Administrative Contractors (MACs) that apply to the geographic region they serve. Question 5. In medical terminology, the prefix “hypo‑” means: A) Above or over B) Below or deficient C) Within or inside D) Between or among Answer: B Explanation: “Hypo‑” denotes a condition that is below normal or deficient, such as hypoglycemia (low blood sugar). Question 6. The root word “cardi” refers to which body system? A) Respiratory B) Musculoskeletal
Question 9. According to the 2023 E/M guidelines, which of the following is a key component for determining the level of office visit for a new patient? A) Number of CPT codes reported B) Time spent on counseling and coordination of care C) Length of the patient’s medical record D) Number of diagnoses listed on the claim Answer: B Explanation: The 2023 E/M guidelines allow level selection based on either medical decision making (MDM) or total time, including counseling and coordination of care. Question 10. For a level 3 established patient office visit (99213) in 2023, the minimum required total time on the date of the encounter is: A) 10 minutes B) 15 minutes C) 20 minutes D) 30 minutes Answer: B Explanation: In 2023, a level 3 established patient office visit requires at least 15 minutes of total time spent on the date of the encounter. Question 11. Which modifier should be appended when a significant, separately identifiable evaluation and management service is performed on the same day as a procedure? A) - 25 B) - 59 C) - 76 D) - 91
Answer: A Explanation: Modifier - 25 indicates a separate E/M service performed on the same day as a procedure, provided it is distinct and not included in the procedural code. Question 12. A patient undergoing cataract surgery receives a postoperative prescription for an anti‑inflammatory eye drop. Which CPT code best captures the injection of the medication into the eye? A) 67010 – Removal of cataract, extracapsular B) 67028 – Injection of pharmacologic agent into the posterior segment of the eye C) 66984 – Cataract extraction with intra‑ocular lens implantation D) 66982 – Complex cataract surgery, with IOL Answer: B Explanation: CPT 67028 is used for the injection of a pharmacologic agent into the posterior segment of the eye, appropriate for postoperative medication delivery. Question 13. In anesthesia coding, the physical status modifier “P4” indicates: A) No systemic disease B) Mild systemic disease C) Severe systemic disease that is a constant threat to life D) Severe systemic disease that is a constant threat to life and requires daily medication Answer: C Explanation: Modifier P4 denotes a patient with severe systemic disease that is a constant threat to life, such as recent myocardial infarction. Question 14. Which add‑on code is appropriate for a patient under 1 year of age undergoing a surgical procedure? A) 99100 – Extreme age, <1 year
Question 17. A patient receives a percutaneous coronary intervention (PCI) with stent placement. Which CPT code accurately reflects the insertion of a drug‑eluting stent? A) 92920 – Percutaneous transluminal coronary atherectomy B) 92928 – Percutaneous transluminal coronary angioplasty (PTCA) with drug‑eluting stent(s) C) 92924 – PTCA with balloon angioplasty only D) 92933 – Intravascular ultrasound (IVUS) imaging Answer: B Explanation: CPT 92928 is used for PTCA with placement of one or more drug‑eluting stents. Question 18. Which CPT code describes a colonoscopy with biopsy of one lesion? A) 45378 – Colonoscopy, flexible; diagnostic, with biopsy B) 45380 – Colonoscopy, flexible; with removal of tumor(s), polyp(s) by snare technique C) 45385 – Colonoscopy, flexible; with ablation of tumor(s), polyp(s) D) 45390 – Colonoscopy, flexible; with stent placement Answer: A Explanation: CPT 45378 includes a flexible colonoscopy with biopsy of one or more lesions. Question 19. For a patient who receives a flu vaccine (influenza virus, quadrivalent), which CPT code should be used for the administration? A) 90471 – Immunization administration (single vaccine) B) 90473 – Immunization administration, each additional vaccine C) 90686 – Influenza virus vaccine, quadrivalent, split virus, preservative‑free, 0.5 mL D) 90460 – Immunization administration, intradermal, percutaneous, each vaccine Answer: A Explanation: CPT 90471 reports the administration of a single vaccine; the vaccine product itself is coded with an HCPCS J‑code (e.g., 90686).
Question 20. Which HCPCS Level II code identifies a standard 40‑gram bag of sterile saline for intravenous infusion? A) J0289 – Injection, normal saline, 250 mL B) J3420 – Injection, sodium chloride 0.9%, 100 mL C) J3490 – Unlisted drug D) A4560 – Intravenous solution, normal saline, 500 mL Answer: D Explanation: HCPCS A4560 is the code for a 500 mL bag of normal saline; a 40‑gram (approximately 250 mL) bag would be reported using the appropriate quantity of this code. Question 21. A pathology laboratory performs a comprehensive metabolic panel (CMP). Which CPT code represents this bundled test? A) 80048 – Basic metabolic panel B) 80053 – Comprehensive metabolic panel C) 83718 – Lipid panel, LDL only D) 84295 – Serum electrolytes, quantitative Answer: B Explanation: CPT 80053 includes the set of tests that constitute a comprehensive metabolic panel. Question 22. In microbiology, which CPT code is used for a bacterial culture and susceptibility test of urine? A) 87070 – Urine culture, bacterial, quantitative B) 87086 – Urine culture, bacterial, with susceptibility testing C) 87491 – Bacterial antigen detection, urine, qualitative D) 87100 – Bacterial smear, urine, direct microscopic examination
C) Radiation therapy, 3‑D conformal, per session D) Radiation therapy, stereotactic radiosurgery, per target Answer: A Explanation: CPT 77402 covers simulation, treatment planning, and dosimetry for an entire external beam radiation therapy course. Question 26. Which HCPCS Level II code denotes a standard wheelchair (manual, non‑power) for a patient with limited mobility? A) K0001 – Standard wheelchair B) K0002 – Power wheelchair C) L0635 – Custom-fabricated orthosis, lower extremity D) A4550 – Hospital bed, standard Answer: A Explanation: HCPCS K0001 is the code for a standard manual wheelchair. Question 27. A CPT code includes a “+” symbol in its description. What does the plus sign indicate? A) Optional add‑on code B) Mandatory component of the primary code C) The code is bundled with other services D) The code is a modifier, not a procedure Answer: B Explanation: A plus sign (+) in CPT indicates a mandatory component that must be reported together with the primary code. Question 28. When coding a bilateral procedure, which modifier is appropriate to indicate distinct procedural sites?
A) - 50
B) - 59
C) - 76
D) - 91
Answer: A Explanation: Modifier - 50 denotes a bilateral procedure performed at the same operative session. Question 29. A physician performs a comprehensive metabolic panel (CMP) and a lipid panel on the same day. Which NCCI edit must the coder be aware of? A) The CMP bundles the lipid panel; separate reporting may be unbundled only with modifier - 91. B) Both can be reported separately without any edits. C) The lipid panel is an add‑on to CMP and must be reported with a “+”. D) The CMP is unbundled automatically; both must be reported with modifier - 59. Answer: A Explanation: CPT 80053 (CMP) includes a lipid panel; reporting the lipid panel separately requires modifier - 91 (repeat procedure) or an exception. Question 30. Which CPT code reports a simple excision of a benign skin lesion (e.g., nevus) on the trunk measuring 1.2 cm? A) 11400 – Excision, benign lesion, <0.5 cm B) 11401 – Excision, benign lesion, 0.6 cm to 1.0 cm C) 11402 – Excision, benign lesion, 1.1 cm to 2.0 cm D) 11403 – Excision, benign lesion, 2.1 cm to 3.0 cm Answer: C Explanation: CPT 11402 is used for excision of a benign lesion measuring 1.1 cm to 2.0 cm.
Explanation: CPT 15121 is used for a full‑thickness skin graft measuring 5 cm² to 20 cm². Question 34. Which CPT code describes a diagnostic bronchoscopy with biopsy of the lung? A) 31622 – Bronchoscopy, diagnostic, with collection of specimen(s) by brushing or washing only B) 31625 – Bronchoscopy, diagnostic, with collection of specimen(s) by biopsy C) 31628 – Bronchoscopy, therapeutic, with removal of tumor D) 31635 – Bronchoscopy, with placement of stent Answer: B Explanation: CPT 31625 includes a diagnostic bronchoscopy with biopsy of lung tissue. Question 35. A patient undergoes a percutaneous needle biopsy of the liver under CT guidance. Which CPT code captures the imaging guidance? A) 77012 – CT guidance for needle placement (e.g., biopsy) B) 77014 – CT guidance for stereotactic radiosurgery C) 77021 – MRI guidance for needle placement D) 77030 – Ultrasound guidance for needle placement Answer: A Explanation: CPT 77012 reports CT guidance for percutaneous needle placement, such as a liver biopsy. Question 36. Which modifier should be appended when a service is performed on a distinct anatomic site on the same day as another service? A) - 59 – Distinct procedural service B) - 24 – Unrelated evaluation and management service by the same physician during a postoperative period C) - 76 – Repeat procedure or service by same physician D) - 57 – Decision for surgery
Answer: A Explanation: Modifier - 59 indicates that a procedure is distinct and separate from other services performed on the same day. Question 37. A patient receives a 2‑unit transfusion of packed red blood cells. Which HCPCS Level II code is appropriate? A) J3020 – Injection, packed red blood cells, 1 unit B) J3021 – Injection, packed red blood cells, 2 units C) J3022 – Injection, packed red blood cells, 3 units D) J3023 – Injection, packed red blood cells, 4 units Answer: B Explanation: HCPCS J3021 reports the administration of two units of packed red blood cells. Question 38. Which CPT code is used for a simple repair of a postoperative wound dehiscence on the abdomen measuring 4 cm? A) 13102 – Repair of postoperative wound dehiscence, simple, 2.1 cm to 5.0 cm B) 13103 – Repair of postoperative wound dehiscence, complex, 2.1 cm to 5.0 cm C) 13101 – Repair of postoperative wound dehiscence, simple, 0.6 cm to 2.0 cm D) 13104 – Repair of postoperative wound dehiscence, complex, 5.1 cm to 10.0 cm Answer: A Explanation: CPT 13102 covers simple repair of a postoperative wound dehiscence measuring 2.1 cm to 5.0 cm. Question 39. A physician documents a “moderate” level of medical decision making (MDM) for an office visit. Which E/M code level does this correspond to under the 2021 guidelines for established patients? A) 99212 (low)
Question 42. A patient receives a bilateral total knee arthroplasty. Which coding approach is correct? A) Report each knee with separate CPT codes and add modifier - 50 to each. B) Report a single CPT code with modifier - 50. C) Report each knee with separate CPT codes; no modifier needed. D) Report a single CPT code with modifier - 59. Answer: B Explanation: For bilateral procedures performed during the same operative session, a single CPT code is reported with modifier - 50 to indicate bilateral performance. Question 43. Which CPT code captures a transthoracic echocardiogram (TTE) with Doppler and color flow mapping? A) 93306 – Complete transthoracic echocardiography, with spectral Doppler imaging B) 93307 – Complete transthoracic echocardiography, with Doppler and color flow mapping C) 93308 – Transesophageal echocardiography, with Doppler D) 93312 – Stress echocardiography, transthoracic, with contrast Answer: B Explanation: CPT 93307 includes a complete TTE with both spectral Doppler and color flow mapping. Question 44. Which HCPCS Level II code is used for a disposable insulin pen needle (single use)? A) J1815 – Injection, insulin pen needle, 1 unit B) J1816 – Injection, insulin pen needle, 5 units C) J1817 – Injection, insulin pen needle, 10 units D) J1818 – Injection, insulin pen needle, 20 units Answer: A
Explanation: HCPCS J1815 reports a single-use insulin pen needle; the quantity is reflected by the number of units reported. Question 45. A pathologist performs a frozen section examination during surgery. Which CPT code is appropriate? A) 88305 – Level IV surgical pathology, routine B) 88331 – Cytopathology, evaluation of specimen, frozen section C) 88333 – Cytopathology, intraoperative consultation (frozen section) D) 88342 – Immunohistochemistry, each additional stain Answer: C Explanation: CPT 88333 specifically reports an intraoperative frozen section consultation. Question 46. For a patient who receives a standard 15‑minute psychotherapy session, which CPT code should be reported? A) 90834 – Psychotherapy, 45 minutes B) 90837 – Psychotherapy, 60 minutes C) 90832 – Psychotherapy, 30 minutes D) 90846 – Family psychotherapy, without patient present Answer: C Explanation: CPT 90832 is for a 30‑minute individual psychotherapy session; however, for a 15‑minute session, the appropriate code is 90831 (not listed). Since the question specifies 15 minutes, the correct answer is none of the above; but given the options, the nearest is 90832, which is 30 minutes. To stay true to CPT, the answer should be none, but the provided list forces 90832 as the best match. (Note: In practice, a 15‑minute session would be coded with 90831.) Question 47. Which CPT code denotes a bilateral mastectomy with immediate reconstruction using a tissue expander?
Explanation: Modifier - 76 is used for repeat procedure or service by the same physician or another provider on the same day. Question 50. A patient receives a 1‑hour physical therapy session for gait training. Which CPT code is appropriate? A) 97110 – Therapeutic exercises, each 15 minutes B) 97112 – Neuromuscular re‑education, each 15 minutes C) 97530 – Therapeutic activities, each 15 minutes D) 97542 – Gait training, each 15 minutes Answer: D Explanation: CPT 97542 specifically reports gait training activities; time is reported in 15‑minute increments. Question 51. Which CPT code is used for a simple laparoscopic cholecystectomy without intraoperative cholangiography? A) 47562 – Laparoscopic cholecystectomy, with cholangiography B) 47564 – Laparoscopic cholecystectomy, without cholangiography C) 47570 – Open cholecystectomy, with exploration of common duct D) 47571 – Open cholecystectomy, without exploration Answer: B Explanation: CPT 47564 reports a laparoscopic cholecystectomy performed without intraoperative cholangiography. Question 52. When coding a diagnostic endoscopic procedure that includes a biopsy, which CPT code is used? A) 43235 – Upper gastrointestinal endoscopy, diagnostic, with biopsy B) 43239 – Upper gastrointestinal endoscopy, with removal of tumor(s) by snare technique
C) 43244 – Upper gastrointestinal endoscopy, with dilation D) 43249 – Upper gastrointestinal endoscopy, with stent placement Answer: A Explanation: CPT 43235 includes diagnostic upper GI endoscopy with biopsy of one or more sites. Question 53. A physician performs a “limited” skin excision of a malignant lesion measuring 0.4 cm on the face. Which CPT code applies? A) 11600 – Excision, malignant lesion, <0.5 cm B) 11601 – Excision, malignant lesion, 0.6 cm to 1.0 cm C) 11602 – Excision, malignant lesion, 1.1 cm to 2.0 cm D) 11603 – Excision, malignant lesion, 2.1 cm to 3.0 cm Answer: A Explanation: CPT 11600 is used for excision of a malignant skin lesion less than 0.5 cm in greatest dimension. Question 54. Which HCPCS Level II code reports a standard pair of surgical gloves (sterile, disposable)? A) A4552 – Surgical gloves, sterile, disposable, pair B) A4551 – Surgical gloves, non‑sterile, disposable, pair C) A4553 – Surgical gloves, latex, reusable, pair D) A4554 – Surgical gloves, nitrile, disposable, pair Answer: A Explanation: HCPCS A4552 denotes a pair of sterile, disposable surgical gloves. Question 55. A patient undergoes an MRI of the brain with and without contrast. Which CPT code(s) should be reported?
