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Question 1 reset

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A patient is admitted with pneumonia and a history of chronic obstructive pulmonary disease (COPD). The physician documents "pneumonia due to COPD exacerbation." How should these conditions be coded?

Pneumonia only

COPD only

Pneumonia and COPD, with pneumonia sequenced first

COPD and Pneumonia, with COPD sequenced first

Question 2 reset

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An outpatient clinic performed a complex laceration repair on a patient's forehead. What CPT® code category would this service fall under?

Evaluation and Management

Anesthesia

Surgery

Radiology

Question 3 reset

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A physician documents a patient's diabetes as "well-controlled." Which ICD-10-CM code is most appropriate?

E11.9, Type 2 diabetes mellitus without complications

E11.8, Type 2 diabetes mellitus with other specified complications

E11.69, Type 2 diabetes mellitus with other specified manifestations

E11.29, Type 2 diabetes mellitus with other circulatory complications

Question 4 reset

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A hospital submits a claim for a patient who underwent a laparoscopic cholecystectomy. The claim includes codes for the procedure and routine postoperative pain management. According to NCCI edits, how should this be handled?

Both codes should be paid separately.

The pain management code should be denied as it's considered incidental to the surgery.

The procedure code should be denied.

Both codes should be modified with a -25 modifier.

Question 5 reset

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A coder is reviewing a patient's chart and finds a discrepancy between the diagnosis documented by the physician and the laboratory results. What is the most ethical course of action?

Assign the code that yields the highest reimbursement.

Query the physician for clarification.

Assign the code based on the laboratory results.

Ignore the discrepancy and assign a code based on the physician's initial documentation.

Question 6 reset

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Which of the following is a key component of the Evaluation and Management (E/M) coding system?

Anesthesia time

Number of medications prescribed

Extent of history, examination, and medical decision making

Patient's insurance coverage

Question 7 reset

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A patient presents to the emergency department with severe abdominal pain and vomiting. The physician performs a detailed history, a comprehensive physical exam, and the medical decision making is of high complexity. What level of emergency department E/M code is likely to be assigned?

99281

99282

99284

99285

Question 8 reset

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A surgeon performs a laparoscopic appendectomy and during the same surgical session, removes a benign ovarian cyst through the same incision. How should the cyst removal be coded?

It should not be coded separately as it was done through the same incision.

It should be coded with the same primary procedure code.

It should be coded with a separate CPT® code and potentially a modifier.

It should be coded as a complication of the appendectomy.

Question 9 reset

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A patient is discharged from the hospital after a 5-day stay for pneumonia. What is the principal diagnosis?

The condition that was present on admission and determined to be the reason for admission

The condition that required the longest length of stay

The condition that was most expensive to treat

The condition listed first by the physician

Question 10 reset

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An outpatient physical therapy clinic bills for services using CPT® codes. What coding system does this fall under?

ICD-10-CM

HCPCS Level II

CPT®

DRG

Question 11 reset

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A hospital utilizes a system where codes are automatically assigned based on the electronic text of the physician's documentation. What type of technology is this?

Electronic Health Record (EHR)

Practice Management System

Computer-Assisted Coding (CAC)

Encoder Software

Question 12 reset

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A coder notices that a physician consistently documents "rule out" a certain condition but never definitively diagnoses it. How should this be coded in the outpatient setting?

Code the condition as if it were confirmed.

Code the signs and symptoms.

Do not code anything.

Query the physician to change the documentation.

Question 13 reset

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What is the primary purpose of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)?

To report procedures performed in inpatient settings

To report physician services in outpatient settings

To classify diagnoses and reasons for healthcare encounters

To determine reimbursement rates for hospitals

Question 14 reset

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A patient is admitted for a stroke and develops pneumonia on the third day of hospitalization. What is the correct coding and sequencing?

Stroke as the principal diagnosis, followed by pneumonia as a secondary diagnosis.

Pneumonia as the principal diagnosis, followed by stroke as a secondary diagnosis.

Only the stroke should be coded.

Only the pneumonia should be coded.

Question 15 reset

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Which of the following is an example of a modifier that might be used to indicate that a procedure was performed on the left side of the body?

-25

-50

-LT

-RT

Question 16 reset

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A hospital receives a denial for a claim where a laparoscopic cholecystectomy and an open appendectomy were performed during the same encounter. The denial indicates "bundling issues." What likely caused this denial?

Incorrect sequencing of codes

Lack of a modifier to indicate distinct procedures

Use of an invalid CPT® code

Missing diagnosis code

Question 17 reset

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What is the function of a chargemaster in a healthcare facility?

To track patient demographics

To manage physician schedules

To list all services and supplies with their associated charges

To record patient vital signs

Question 18 reset

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A coder is abstracting data from a patient's medical record for quality reporting purposes. What domain of the CCA exam does this primarily fall under?

Clinical Classification Systems

Reimbursement Methodologies

Health Records and Data Content

Compliance

Question 19 reset

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What does the acronym DRG stand for in the context of inpatient reimbursement?

Diagnostic Related Group

Disease Related Grouping

Diagnosis Related Grouping

Departmental Revenue Generation

Question 20 reset

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A physician performs a minor surgical procedure in the office. What type of claim form is typically used to bill for this service?

UB-04

CMS-1500

ANSI 837I

ANSI 837P

Question 21 reset

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A coder is reviewing a claim denial that cites a lack of medical necessity for a diagnostic test. What should the coder do first?

Resubmit the claim with the same codes.

Write an appeal letter to the payer.

Review the payer's Local Coverage Determination (LCD) or National Coverage Determination (NCD).

Immediately bill the patient for the service.

Question 22 reset

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What is the purpose of a physician query?

To request payment for services rendered

To clarify ambiguous or missing documentation needed for accurate coding

To schedule patient appointments

To order medications for a patient

Question 23 reset

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Which of the following is a key component of HIPAA regulations concerning patient information?

Requiring all medical records to be electronic

Ensuring patient confidentiality and privacy

Standardizing all coding systems

Mandating specific EHR software

Question 24 reset

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A coder accesses a patient's entire medical record, even though they are only coding a single encounter. This is a potential violation of what HIPAA principle?

Security Rule

Privacy Rule

Minimum Necessary Standard

Breach Notification Rule

Question 25 reset

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What is the primary goal of risk adjustment models, such as Hierarchical Condition Categories (HCCs)?

To simplify the coding process

To ensure accurate reimbursement based on patient complexity

To reduce the number of diagnosis codes used

To track the utilization of specific medical services

Question 26 reset

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A coder is reviewing documentation for a patient with hypertension and chronic kidney disease. How should these conditions typically be coded?

Only the hypertension should be coded as it's more common.

Only the chronic kidney disease should be coded as it's more severe.

Both conditions should be coded, and the relationship between them should be identified if documented.

Neither condition should be coded unless they are the primary reason for the encounter.

Question 27 reset

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What is the purpose of the National Correct Coding Initiative (NCCI) edits?

To promote accurate coding and prevent improper payments

To encourage the use of more specific codes

To simplify the billing process for providers

To track the quality of care provided to patients

Question 28 reset

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A coder needs to look up the definition of a specific medical term. What type of reference material would be most helpful?

ICD-10-CM codebook

CPT® codebook

Medical dictionary

Coding guidelines

Question 29 reset

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What is the role of the Master Patient Index (MPI) in a healthcare facility?

To track the financial status of patients

To manage physician credentials

To uniquely identify each patient who has received services

To store electronic health records

Question 30 reset

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A healthcare organization is preparing for an external audit of their coding practices. What is the primary focus of such an audit?

Patient satisfaction scores

Accuracy and compliance of coding and billing

Employee turnover rates

The efficiency of the EHR system

Question 31 reset

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A coder notices that the electronic health record (EHR) system automatically assigns a code that doesn't seem to match the documentation. What should the coder do?

Accept the code assigned by the system.

Manually change the code without reviewing the documentation further.

Review the documentation carefully and assign the correct code based on the clinical information.

Delete the code and not bill for the service.

Question 32 reset

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What is the significance of the "CC" and "HPI" in E/M coding?

They are components of the Past Medical History.

They are elements of the Review of Systems.

They are key components of the History element (Chief Complaint and History of Present Illness).

They relate to the Medical Decision Making complexity.

Question 33 reset

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A patient presents for removal of sutures following a surgery performed at the same practice two weeks prior. How should this service typically be coded in the outpatient setting?

It should be billed as a separate E/M service.

It is usually included in the global surgical package.

It requires a modifier on the original surgical code.

It should be billed with a specific suture removal code.

Question 34 reset

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What is the purpose of a quantitative analysis of a medical record?

To evaluate the quality of the physician's documentation

To ensure all essential components of the record are present and complete

To identify specific diagnoses and procedures

To assess the appropriateness of the treatment plan

Question 35 reset

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A coder needs to understand the guidelines for coding a specific type of fracture. Where would they most likely find this information?

The patient's insurance policy

The hospital's billing department policies

Official coding guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting)

A medical supply catalog

Question 36 reset

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What does the term "unbundling" refer to in coding?

Reporting multiple codes for services that should be covered by a single comprehensive code.

Assigning a lower-level code than what is supported by the documentation.

Grouping related services together under a single code.

Using modifiers inappropriately.

Question 37 reset

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A coder is working with Hierarchical Condition Categories (HCCs). What type of data is used to assign these codes?

Inpatient procedure codes

Outpatient E/M codes

Diagnosis codes

Revenue codes

Question 38 reset

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What is the primary purpose of utilizing encoder software in coding?

To communicate with insurance payers

To automatically generate physician queries

To assist coders in looking up codes and ensuring accuracy

To manage patient appointments

Question 39 reset

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A patient requests a copy of their medical record. According to HIPAA, what is a key consideration for releasing this information?

The patient's ability to pay for the copies

Whether the record contains sensitive information

Verifying the patient's identity and obtaining proper authorization

The format in which the record is stored

Question 40 reset

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What is "information blocking" as it relates to healthcare?

Preventing patients from accessing their medical records

Sharing patient information without consent for research purposes

Practices that unreasonably limit the availability and exchange of electronic health information

Using outdated technology to store medical records

Question 41 reset

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A physician documents "acute bronchitis due to influenza." How should this be coded?

Bronchitis only

Influenza only

Bronchitis and Influenza, with bronchitis sequenced first

Influenza and Bronchitis, with influenza sequenced first

Question 42 reset

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What is the primary benefit of using Computer-Assisted Coding (CAC) software?

It eliminates the need for human coders.

It guarantees 100% coding accuracy.

It can improve coding efficiency and potentially accuracy.

It automatically submits claims to payers.

Question 43 reset

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A coder is reviewing a physician's documentation and finds the term "status post appendectomy." What does "status post" indicate?

The patient is currently undergoing an appendectomy.

The patient has a history of having an appendectomy.

The patient is scheduled for an appendectomy.

The appendectomy was unsuccessful.

Question 44 reset

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What is the role of Local Coverage Determinations (LCDs)?

To provide national coding guidelines

To specify when a particular service is covered and medically necessary by a specific Medicare Administrative Contractor (MAC)

To outline the process for appealing claim denials

To list all ICD-10-CM codes and their definitions

Question 45 reset

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A coder needs to assign a CPT® code for a surgical procedure. What part of the CPT® codebook would they consult?

The index

The appendices

The main body organized by section (e.g., Surgery, Medicine)

The introduction

Question 46 reset

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What is a common reason for a claim denial related to diagnosis coding?

The use of CPT® codes for diagnosis reporting

The diagnosis code is not specific enough to support the service billed

The patient's insurance does not cover the diagnosed condition

The diagnosis code was not listed on the superbill

Question 47 reset

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A hospital is implementing a new electronic health record (EHR) system. What is an important consideration regarding data confidentiality and privacy during this transition?

Backing up the old system data

Training staff on the new system's functionalities

Ensuring secure data migration and access controls in the new system

Updating the hospital's website with the new system information

Question 48 reset

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A coder is reviewing a patient's encounter where multiple procedures were performed. To determine if any modifiers are needed, what should the coder consult?

The patient's insurance card

The hospital's policy on modifier usage

CPT® and HCPCS Level II coding guidelines

A medical dictionary

Question 49 reset

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A physician performs a sigmoidoscopy and removes a polyp. The documentation states "cold snare polypectomy." How should the polyp removal be coded?

With the code for sigmoidoscopy only.

With a separate code for polyp removal using a cold snare technique.

With a code for biopsy of the colon.

It should not be coded separately.

Question 50 reset

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What is the primary goal of a healthcare compliance program?

To maximize reimbursement

To ensure adherence to laws, regulations, and ethical standards

To streamline the coding process

To improve patient satisfaction scores

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