Download PrepIQ Certified Coding Associate Ultimate Exam and more Exams Technology in PDF only on Docsity!
Ultimate Exam
Question 1. Which component of the health record contains the patient's chief complaint and history of present illness? A) Consent forms B) Progress notes C) Admission questionnaire D) Discharge summary Answer: B Explanation: Progress notes document the chief complaint, HPI, and ongoing clinical observations, whereas consents, questionnaires, and discharge summaries serve different purposes. Question 2. In an EHR, which data element is considered administrative rather than clinical? A) Vital signs B) Operative report C) Insurance authorization number D) Laboratory result Answer: C Explanation: Administrative data includes billing and insurance information such as authorization numbers; vital signs, operative reports, and labs are clinical. Question 3. Which of the following best describes the principle of data completeness? A) Data are free from typographical errors. B) All required fields are populated. C) Data are stored in a secure server. D) Data are updated in real time. Answer: B Explanation: Completeness means that every mandatory element of a record is filled, ensuring no missing information.
Ultimate Exam
Question 4. Under HIPAA, which rule governs the protection of electronic protected health information (ePHI) during transmission? A) Privacy Rule B) Security Rule C) Enforcement Rule D) Transaction Rule Answer: B Explanation: The HIPAA Security Rule sets standards for safeguarding ePHI during storage and transmission. Question 5. The Uniform Hospital Discharge Data Set (UHDDS) is primarily used for which type of encounter? A) Outpatient clinic visit B) Inpatient stay C) Emergency department visit D) Home health service Answer: B Explanation: UHDDS defines data elements for inpatient discharges, facilitating standardized reporting. Question 6. Which coding tool uses a logic engine to suggest codes based on the documentation entered? A) Book-based encoder B) Computer-Assisted Coding (CAC) system C) ICD-10-CM Index D) CPT manual Answer: B Explanation: CAC systems apply natural language processing and algorithms to propose appropriate codes.
Ultimate Exam
B) Chronic kidney disease C) Nephrolithiasis D) Pyelonephritis Answer: B Explanation: Chronic kidney disease is a progressive, long-term decline in renal function. Question 11. When locating a code in the ICD-10-CM Alphabetic Index, which of the following is the correct sequence? A) Look under the main term, then the subterm, then the code. B) Look under the subterm first, then the main term. C) Search the Tabular List before the Index. D) Use the tabular list only for external causes. Answer: A Explanation: The Index is consulted first, locating the main term, then subterm, and finally the code(s) listed. Question 12. Which ICD-10-CM chapter includes codes for “Z00.00 – Encounter for general adult medical examination without abnormal findings”? A) Chapter 1 – Certain infectious and parasitic diseases B) Chapter 9 – Diseases of the circulatory system C) Chapter 21 – Factors influencing health status and contact with health services D) Chapter 18 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Answer: C Explanation: Z-codes (Chapter 21) address factors influencing health status, including routine examinations. Question 13. For a patient who falls from a ladder and sustains a fracture, which external cause code would be appropriate? A) W19.XXXA
Ultimate Exam
B) V15.03A
C) Y92.
D) R10.
Answer: A Explanation: W19.XXXA denotes “Unspecified fall, initial encounter,” appropriate for a ladder fall. Question 14. In ICD- 10 - PCS, what does the second character represent? A) Section B) Body system C) Root operation D) Device Answer: B Explanation: The second character identifies the body system involved in the procedure. Question 15. Which root operation best describes the removal of a tumor from the liver without cutting into surrounding tissue? A) Excision B) Resection C) Extraction D) Resection of part of a body part Answer: A Explanation: Excision removes a whole body part (or tumor) by cutting it away without cutting through other tissue; resection removes a portion of a body part. Question 16. A laparoscopic cholecystectomy would be coded with which approach character? A) Open (0) B) Percutaneous (1) C) Endoscopic (3)
Ultimate Exam
Answer: A Explanation: A4550 is the HCPCS Level II code for “Blood glucose test strips, each”. Question 20. Under the Prospective Payment System for inpatient stays, a patient’s case is assigned to a DRG based primarily on: A) Physician’s specialty B) Length of stay only C) Primary diagnosis, secondary diagnoses, and procedures performed D) Patient’s insurance type Answer: C Explanation: DRG assignment uses the principal diagnosis, comorbidities, complications, and procedures. Question 21. The Resource-Based Relative Value Scale (RBRVS) determines physician payment using which three components? A) Work RVU, Practice expense RVU, Malpractice RVU B) Facility fee, Global fee, Bundled fee C) DRG weight, LOS, Discharge status D) CPT code, Modifier, Place of service Answer: A Explanation: RBRVS comprises work RVU, practice expense RVU, and malpractice RVU, each adjusted by geographic practice cost indices. Question 22. Value-Based Purchasing (VBP) programs link reimbursement to: A) Number of procedures performed B) Quality metrics and patient outcomes C) Length of hospital stay D) Provider’s years of experience Answer: B
Ultimate Exam
Explanation: VBP rewards or penalizes providers based on quality performance measures. Question 23. Which form is used for billing professional services rendered by physicians? A) UB- 04 B) CMS- 1500 C) HCFA- 1500 D) Both B and C (they are the same) Answer: D Explanation: The CMS-1500 and HCFA-1500 refer to the same claim form for professional services. Question 24. The National Correct Coding Initiative (NCCI) primarily addresses: A) Duplicate claim submissions B) Unbundling of services that should be reported together C) Upcoding of diagnoses D) Timely filing of claims Answer: B Explanation: NCCI edits prevent unbundling of procedures that are considered components of a more comprehensive service. Question 25. A “medically unlikely edit” (MUE) is a check that: A) Flags codes that exceed the maximum number of units allowed per claim. B) Verifies patient eligibility. C) Adjusts payment based on diagnosis severity. D) Confirms provider’s NPI number. Answer: A Explanation: MUEs set limits on the number of units of a service that can be reported on a single claim.
Ultimate Exam
Question 29. Which of the following best defines “interoperability” in health information technology? A) The ability of a single system to store large volumes of data. B) The capacity for different health IT systems to exchange and interpret shared data. C) The use of paper charts alongside electronic records. D) The encryption of patient data for security. Answer: B Explanation: Interoperability refers to seamless data exchange and interpretation across disparate systems. Question 30. A coder uses an electronic encoder that suggests multiple codes for a single diagnosis. The appropriate action is to: A) Choose the first code listed. B) Review the documentation and select the most specific code. C) Apply all suggested codes. D) Skip coding and request a query. Answer: B Explanation: The coder must verify documentation and assign the most specific, accurate code. Question 31. Which ICD- 10 - CM chapter contains codes for “E11.9 – Type 2 diabetes mellitus without complications”? A) Chapter 4 – Endocrine, nutritional and metabolic diseases B) Chapter 5 – Mental, behavioral and neurodevelopmental disorders C) Chapter 7 – Diseases of the eye and adnexa D) Chapter 12 – Diseases of the skin and subcutaneous tissue Answer: A Explanation: Diabetes mellitus is classified under Chapter 4.
Ultimate Exam
Question 32. The ICD- 10 - PCS root operation “Insertion” is used for which of the following procedures? A) Placement of a central venous catheter B) Removal of a gallbladder C) Repair of a laceration D) Inspection of a joint Answer: A Explanation: Insertion denotes placing a device that remains after the procedure (e.g., central line). Question 33. A CPT code for a bilateral knee arthroscopy performed in one session would require which modifier? A) - 26 B) - 59 C) - 50 D) - 76 Answer: C Explanation: Modifier - 50 indicates a bilateral procedure performed at the same operative session. Question 34. Which of the following HCPCS Level II codes is used for a powered wheelchair? A) E B) K C) L D) A Answer: A Explanation: E1234 is the HCPCS Level II code for “Power wheelchair”. Question 35. Under the Prospective Payment System, the “outlier” payment is applied when:
Ultimate Exam
B) Signature of the individual or personal representative. C) Statement of the purpose of the use. D) Provider’s NPI number. Answer: D Explanation: The provider’s NPI is not required in a HIPAA authorization; the other elements are mandatory. Question 39. In ICD- 10 - CM, the “use additional code” note for a diagnosis indicates: A) The code must be reported alone. B) A supplemental code provides more detail and should be reported in addition. C) The code is obsolete. D) The code is only for inpatient use. Answer: B Explanation: “Use additional code” directs coders to add a supplemental code for further specificity. Question 40. Which section of the ICD- 10 - PCS Table of Sections contains codes for “Medical and Surgical” procedures? A) Section 0 B) Section 1 C) Section 2 D) Section 3 Answer: A Explanation: Section 0 of ICD- 10 - PCS is designated for Medical and Surgical procedures. Question 41. A patient receives a flu vaccine during a wellness visit. Which CPT code set should be used to report the vaccine administration? A) CPT Category I B) CPT Category II
Ultimate Exam
C) HCPCS Level II D) ICD- 10 - CM Answer: C Explanation: Vaccines and their administration are reported with HCPCS Level II codes (e.g., 90658 for influenza vaccine). Question 42. Which modifier indicates that a service was performed on a distinct, separate anatomical site on the same day? A) - 51 B) - 59 C) - 76 D) - 91 Answer: B Explanation: Modifier - 59 denotes a distinct procedural service, indicating a separate site or procedure. Question 43. Under the RBRVS system, which factor most directly influences the work RVU component? A) Geographic location of the practice. B) Time spent performing the service. C) Cost of medical supplies. D) Number of patients seen per day. Answer: B Explanation: Work RVU reflects the relative effort, skill, and time required to perform a service. Question 44. In the context of coding compliance, “upcoding” refers to: A) Assigning a code of higher complexity than documented. B) Using the most specific code available. C) Grouping multiple services under a single code.
Ultimate Exam
D) Z85.3 – Personal history of malignant neoplasm of breast Answer: A Explanation: Z63.5 records family disruption, a social determinant impacting health. Question 48. In ICD- 10 - CM, the seventh character “A” after an injury code indicates: A) Initial encounter B) Subsequent encounter C) Sequela D) Unspecified encounter Answer: A Explanation: “A” denotes the initial encounter for an injury or condition. Question 49. When coding a laparoscopic cholecystectomy in ICD- 10 - PCS, which root operation is used? A) Excision B) Resection C) Removal D) Resection of part of a body part Answer: C Explanation: Removal is the root operation for taking out an organ (gallbladder) completely. Question 50. Which HCPCS Level II code is used for a “home glucose monitoring device”? A) E B) A C) K D) G Answer: A
Ultimate Exam
Explanation: E0601 denotes “Blood glucose monitor, each”. Question 51. The “clinical documentation improvement” (CDI) program primarily aims to: A) Increase the number of codes submitted. B) Enhance the accuracy and completeness of provider documentation. C) Reduce the time needed for claim submission. D) Train coders on new software. Answer: B Explanation: CDI focuses on improving documentation quality to support accurate coding and reimbursement. Question 52. Which of the following is a required element in a valid HIPAA “Release of Information” (ROI) form? A) Provider’s tax identification number. B) Specific description of the information to be disclosed. C) Billing address of the patient. D) Date of the provider’s license expiration. Answer: B Explanation: An ROI must clearly specify what PHI may be released. Question 53. In the ICD- 10 - CM Index, the term “fracture” is listed as a main term. Which of the following is the correct way to locate a code for a “closed fracture of the left femur”? A) Look under “fracture,” then “left femur,” then “closed.” B) Look under “femur,” then “fracture,” then “closed.” C) Look under “closed fracture,” then “left femur.” D) Look under “left femur,” then “fracture,” then “closed.” Answer: A Explanation: The Index hierarchy is main term → subterm → additional term; “fracture” is the main term.
Ultimate Exam
Question 57. In the context of coding, “MCC” stands for: A) Major Complications or Comorbidities B) Medical Coding Certification C) Multiple Claim Category D) Managed Care Contract Answer: A Explanation: MCC denotes major complications or comorbidities that affect DRG assignment. Question 58. Which CPT modifier indicates that a service was performed by a teaching physician under the supervision of a resident? A) - 26 B) - 52 C) - 57 D) - 99 Answer: A Explanation: Modifier - 26 designates the professional component performed by the teaching physician. Question 59. A coder is assigning a code for “acute appendicitis with peritonitis.” Which ICD- 10 - CM code should be selected? A) K35. B) K35. C) K36. D) K37. Answer: B Explanation: K35.2 corresponds to “Acute appendicitis with peritonitis.” Question 60. Which of the following is a characteristic of a “hybrid” health record system?
Ultimate Exam
A) All data are stored on paper only. B) Data are stored exclusively in a cloud environment. C) Both electronic and paper records are used concurrently. D) Records are stored on removable media only. Answer: C Explanation: Hybrid systems combine electronic and paper documentation. Question 61. In ICD- 10 - CM, the code “M54.5” refers to: A) Low back pain B) Cervical disc disorder C) Thoracic spine fracture D) Lumbosacral sprain Answer: A Explanation: M54.5 is the code for “Low back pain.” Question 62. Which of the following is NOT a function of a Computer-Assisted Coding (CAC) system? A) Generating code suggestions from clinical text. B) Automatically submitting claims to payers. C) Highlighting potential coding errors. D) Learning from coder corrections over time. Answer: B Explanation: CAC assists with coding but does not directly submit claims; claim submission is a separate function. Question 63. A patient undergoes a “percutaneous transluminal coronary angioplasty (PTCA).” In ICD- 10 - PCS, which approach character is appropriate? A) Open (0) B) Percutaneous (1) C) Endoscopic (3)
