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Question 1. Which of the following best describes the primary purpose of the HIPAA Privacy Rule? A) To regulate the cost of medical services B) To protect individually identifiable health information C) To standardize medical coding terminology D) To enforce penalties for billing fraud Answer: B Explanation: The HIPAA Privacy Rule establishes national standards to safeguard protected health information (PHI) from unauthorized disclosure. Question 2. Under the HIPAA Security Rule, which safeguard is considered administrative? A) Encryption of data at rest B) Firewalls and intrusion detection systems C) Workforce training on security policies D) Secure password requirements Answer: C Explanation: Administrative safeguards include policies, procedures, and training programs that manage the selection, development, and implementation of security measures. Question 3. A coder discovers a physician is repeatedly upcoding services. This behavior most closely aligns with which definition? A) Medical fraud B) Medical abuse C) Billing error D) Coding discrepancy Answer: A Explanation: Fraud involves intentional deception for financial gain, such as upcoding to receive higher reimbursement.
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Question 4. Which of the following is a characteristic of medical abuse rather than fraud? A) Intentional submission of false claims B) Providing services that are medically unnecessary C) Falsifying patient diagnoses D) Submitting claims for services never rendered Answer: B Explanation: Abuse refers to practices that are inconsistent with sound medical, business, or fiscal practices, such as unnecessary services, without the intent to deceive. Question 5. The Office of Inspector General (OIG) is primarily responsible for which of the following? A) Developing CPT codes B) Auditing Medicare and Medicaid providers for fraud, waste, and abuse C) Setting national coverage determinations D) Accrediting medical schools Answer: B Explanation: OIG conducts investigations and audits to protect the integrity of federal health programs. Question 6. A National Coverage Determination (NCD) is issued by: A) State Medicaid agencies B) The Centers for Medicare & Medicaid Services (CMS) C) Private insurance carriers D] Hospital credentialing committees Answer: B Explanation: NCDs are national policies that determine Medicare coverage for specific services, technologies, or procedures.
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Question 10. Which directional term describes a structure that is farther from the point of attachment? A) Proximal B) Distal C) Anterior D) Superior Answer: B Explanation: “Distal” indicates a location farther from the trunk or point of origin. Question 11. In the anatomical position, the palms of the hands face: A) Posteriorly B) Laterally C) Anteriorly D) Inferiorly Answer: C Explanation: The standard anatomical position has the palms facing forward (anteriorly). Question 12. Which CPT category includes codes 99202–99215? A) Anesthesia B) Evaluation & Management (E/M) C) Surgery D) Radiology Answer: B Explanation: These codes represent office and outpatient E/M services for new and established patients. Question 13. A new patient office visit that required a detailed history, a detailed examination, and moderate complexity medical decision making is coded as:
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A) 99202
B) 99203
C) 99204
D) 99205
Answer: C Explanation: 99204 corresponds to a new patient visit with detailed components and moderate-complexity MDM. Question 14. According to the 2023 E/M guidelines, which of the following can be used to determine the level of service for office visits? A) Number of diagnoses only B) Time spent on counseling and coordination of care C) Number of CPT codes billed D) Patient’s insurance type Answer: B Explanation: The 2023 guidelines allow the total time spent on counseling and coordination of care to determine the E/M level. Question 15. Which modifier indicates a distinct procedural service performed on the same day as another procedure? A) - B) - C) - D) - Answer: C Explanation: Modifier -59 denotes a distinct procedural service, separating it from bundled procedures. Question 16. A surgeon performs a unilateral knee arthroscopy with debridement. Which CPT code series should be consulted?
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A) Simple skin repair B) Debridement of subcutaneous tissue C) Excision of malignant skin lesion D) Complex wound closure Answer: B Explanation: 11042 describes the initial debridement of subcutaneous tissue (including fat) for a wound. Question 20. For a patient who undergoes a colonoscopy with removal of three polyps, which CPT code(s) should be reported? A) 45378 only B) 45378 plus 45380 C) 45378 plus 45381 D) 45378 plus 45385 Answer: C Explanation: 45378 (colonoscopy with removal of one or more polyps) is the base code; 45381 (removal of each additional polyp) is reported for each extra polyp removed. Question 21. Which CPT code series includes endotracheal intubation for general anesthesia? A) 31500– B) 33000– C) 34000– D) 35000– Answer: A Explanation: Airway management procedures, including endotracheal intubation, are listed in the 31500–31599 range. Question 22. A patient receives a flu vaccine administered intramuscularly. Which CPT code correctly reports the administration?
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A) 90471
B) 90472
C) 90473
D) 90474
Answer: B Explanation: 90472 is used for the administration of a single vaccine or toxoid (intramuscular, subcutaneous, or intradermal) to a patient. Question 23. The CPT code 99291 is used for: A) Initial hospital observation care, per hour B) Critical care, evaluation and management of the first 30-74 minutes C) Hospital discharge day management D) Emergency department visit, high severity Answer: B Explanation: 99291 reports the first 30-74 minutes of critical care services provided to a patient. Question 24. Which of the following modifiers indicates a service was performed by a different provider than the one who performed the primary service? A) - B) - C) - D) - Answer: C Explanation: Modifier -79 indicates an unplanned return to the same provider for a related procedure or service. Question 25. In the CPT manual, the “plus sign (+)” next to a code indicates: A) The code is optional
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B) 77750–
C) 77700–
D) 77400–
Answer: A Explanation: The 77401–77499 series covers radiation treatment planning and delivery, including external beam therapy. Question 29. Which HCPCS Level II code represents a wheelchair (standard, manual, non-power)? A) K B) K C) K D) K Answer: A Explanation: K0001 is the HCPCS code for a standard manual wheelchair. Question 30. A physician orders a basic metabolic panel (BMP). Which CPT code accurately reflects this panel? A) 80048 B) 80053 C) 80061 D) 80076 Answer: A Explanation: 80048 is the code for a basic metabolic panel, which includes electrolytes, glucose, BUN, and creatinine. Question 31. Which ICD- 10 - CM code would be most appropriate for a diagnosis of “acute appendicitis”? A) K35. B) K35.
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C) K36.
D) K37.
Answer: B Explanation: K35.00 specifies acute appendicitis without peritonitis or rupture. Question 32. A coder must link a CPT code for “colonoscopy with biopsy” to an ICD- 10 - CM diagnosis. Which of the following diagnoses best justifies medical necessity? A) Z12.11 (Encounter for screening for malignant neoplasm of colon) B) K63.5 (Polyp of colon) C) K57.30 (Diverticulosis of large intestine without perforation) D) R19.7 (Diarrhea, unspecified) Answer: B Explanation: K63.5 (colon polyp) provides a therapeutic indication for biopsy, establishing medical necessity. Question 33. The symbol “‡” (double dagger) beside a CPT code indicates: A) The code is for a surgical procedure only B) The code is a global period service C) The code is a Medicare-specific code D) The code is a “global” service that includes pre- and post-operative care Answer: D Explanation: The double dagger denotes that the procedure includes a global period covering pre- and post-operative services. Question 34. Which CPT modifier is used when a preventive service is performed on the same day as a diagnostic service? A) - B) - C) -
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D) To indicate a professional component only Answer: B Explanation: Modifier -91 is used for repeat clinical diagnostic laboratory tests performed on the same day. Question 38. A provider performs a “complex wound repair” involving layered closure, flap, and graft. Which CPT code is the most appropriate? A) 12031 B) 13131 C) 14001 D) 15002 Answer: B Explanation: 13131 reports repair of a complex wound (including closure of deep layers, flap, and/or graft) of the scalp, neck, or trunk. Question 39. Which CPT code describes “lateral lumbar spine fusion, posterior technique, single level”? A) 22612 B) 22630 C) 22633 D) 22634 Answer: A Explanation: 22612 is for a single-level posterior lumbar interbody fusion (or lateral approach) of the lumbar spine. Question 40. A radiology claim includes a “MRI of the brain without contrast.” Which CPT code should be reported? A) 70551 B) 70552 C) 70553
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D) 70554
Answer: A Explanation: 70551 is the code for MRI of the brain without contrast. Question 41. Which CPT code is used for “electrocardiogram, routine ECG with interpretation and report”? A) 93000 B) 93010 C) 93015 D) 93025 Answer: A Explanation: 93000 describes a standard 12-lead ECG with interpretation and report. Question 42. The “NCCI” edits are designed to: A) Enhance the specificity of ICD- 10 - CM codes B) Prevent unbundling and inappropriate multiple procedure billing C) Determine the appropriate anesthesia physical status D) Assign global periods to surgical services Answer: B Explanation: The National Correct Coding Initiative (NCCI) edits identify mutually exclusive services and prevent improper multiple billing. Question 43. Which CPT modifier indicates that a service was performed on a “different site” than the original procedure? A) - B) - C) - D) -
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Answer: A Explanation: 12001 reports simple repair of superficial wounds of the face, ears, eyelids, nose, or lips, 2.5 cm or less. Question 47. The “+” sign next to a CPT code indicates: A) The code is only for inpatient use B) The code is an add-on code that must be reported with a primary procedure C) The code is a global service D) The code is optional Answer: B Explanation: The plus sign designates an add-on code that cannot be reported alone. Question 48. A coder must apply modifier -52 to a procedure. Which situation justifies its use? A) The service was performed but not medically necessary B) The service was partially reduced or eliminated at the physician’s discretion C) The service was performed on a different day than scheduled D) The service was performed by a resident under supervision Answer: B Explanation: Modifier -52 indicates a reduced service, where part of the procedure was not performed. Question 49. Which CPT code series includes “bronchoscopy with biopsy”? A) 31200– B) 31500– C) 31600– D) 31700– Answer: C
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Explanation: The 31600–31699 series covers bronchoscopic procedures, including biopsy. Question 50. A patient undergoes “removal of a solitary kidney stone via ureteroscopy”. Which CPT code best captures the procedure? A) 52352 B) 52353 C) 52356 D) 52357 Answer: B Explanation: 52353 reports ureteroscopy, with or without removal of a calculus, with laser lithotripsy. Question 51. Which modifier should be appended when a service is “bilateral” but performed in a single session? A) - B) - C) - D) - Answer: A Explanation: Modifier -50 indicates a bilateral procedure performed during the same operative session. Question 52. In the CPT manual, the “‡‡” symbol denotes: A) A non-reimbursable service B) A service that is covered only under Medicare Part B C) A service that is considered a “global” service with a 90-day postoperative period D) A service that is “global” with a 10-day postoperative period Answer: D
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Explanation: 62322 describes injection of a therapeutic agent into the epidural or subarachnoid space. Question 56. The “- 25 ” modifier is appropriate when: A) A preventive service is provided on the same day as a problem-focused visit B) A significant, separately identifiable E/M service is performed on the same day as a procedure C) The same procedure is repeated within 30 days D) The service is performed by a different provider Answer: B Explanation: Modifier -25 signals a distinct E/M service separate from the procedural service on the same date. Question 57. Which CPT code series covers “skin grafts”? A) 14000– B) 15000– C) 16000– D) 17000– Answer: B Explanation: The 15000–15999 series includes codes for skin grafts and related procedures. Question 58. A patient receives “fluoroscopy-guided lumbar puncture”. Which CPT code should be reported? A) 62270 B) 62272 C) 62274 D) 62275 Answer: B Explanation: 62272 reports lumbar puncture with fluoroscopic guidance.
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Question 59. Which ICD- 10 - CM code best describes “type 2 diabetes mellitus with diabetic peripheral neuropathy”? A) E11. B) E11. C) E11. D) E11. Answer: D Explanation: E11.65 specifies type 2 diabetes mellitus with peripheral angiopathy (including neuropathy). Question 60. For a “full-field digital mammography (both breasts)”, which CPT code is appropriate? A) 77055 B) 77056 C) 77057 D) 77058 Answer: B Explanation: 77056 reports screening digital mammography, bilateral. Question 61. Which CPT modifier indicates a “surgical procedure performed on the same anatomical site as a previous procedure within the global period”? A) - B) - C) - D) - Answer: C Explanation: Modifier -78 denotes an unplanned return to the operating room for a related procedure during the global period.
