CPC Practice Exam

1. When a clinical documentation specifies that a procedure was performed, which coding system should the coder select to describe the specific procedure and its technical components?

• A. CPT, which describes specific procedures, services, and technical components
• B. ICD-10-PCS, which reports procedures performed during inpatient hospital admissions
• C. ICD-10-CM, which classifies the diagnoses, symptoms and reasons for the encounter
• D. HCPCS Level II, which reports supplies, drugs and equipment not described in CPT

2. A coder is selecting a code for a supply item not found in the CPT codebook. Where should the coder look for the appropriate code?

• A. ICD-10-CM, whose Chapter 21 Z codes describe the equipment and supplies furnished to the patient
• B. HCPCS Level II, which is designed to identify supplies, equipment, and services not included in CPT
• C. CPT code 99070 (supplies and materials), which reports any supply item that has no specific CPT code
• D. The payer's local coverage policy, which assigns a proprietary item number for each supply dispensed

3. A HCPCS J code is defined as "injection, drug X, 10 mg." The provider documents administration of 30 mg. How many units are reported?

• A. 3 units
• B. 1 unit
• C. 30 units
• D. 10 units

4. Which HCPCS Level II code category reports drugs administered other than by the oral method?

• A. The A codes
• B. The L codes
• C. The J codes
• D. The E codes

5. A coder is assigning a code for a piece of durable medical equipment supplied to a patient at home. Which characteristic identifies a valid HCPCS Level II code for this item?

• A. Three alphabetic characters followed by two numeric digits
• B. A three-to-seven character code with a decimal point
• C. One alphabetic character followed by four numeric digits
• D. Five numeric digits, the same format used by CPT codes

6. Which principle explains why an ICD-10-CM excludes note indicates that two conditions should not be coded together for a single encounter?

• A. Insurance carriers have determined that only one of the two conditions can be treated at a single encounter
• B. The second condition is a manifestation that is always captured by the first code and needs no separate entry
• C. The conditions represent mutually exclusive clinical presentations that should not coexist in the same patient
• D. Coding both conditions would duplicate the same clinical concept and inflate the reported severity of the encounter

7. A coder must apply the 'Code First' instruction found in the ICD-10-CM tabular list for one of the patient's conditions. What does this coding convention require?

• A. The specified underlying condition must be coded before the condition listed under the 'Code First' note
• B. The condition carrying the note must appear first on the claim so the payer adjudicates it as the primary diagnosis
• C. The provider must document and treat the underlying condition before the manifestation can be reported at all
• D. Only the underlying condition is reported, because the manifestation is already captured within its code

8. When the alphabetic index and the tabular list appear to conflict in ICD-10-CM, which governs?

• A. The tabular list, though both must always be consulted
• B. The payer's internal policy, which supersedes both references
• C. The alphabetic index, because every code search begins there
• D. Whichever of the two produces the more specific code

9. In ICD-10-CM, what does the instructional note "Excludes1" indicate about the two codes it links?

• A. The excluded code must be sequenced first whenever both conditions are present
• B. The two conditions are mutually exclusive and may never be reported together
• C. The two conditions may be reported together whenever both are documented by the provider
• D. The excluded code is a synonym that may be substituted when the primary code is unavailable

10. A physician documents "probable pneumonia" for an outpatient office visit. How should this be coded?

• A. Code pneumonia as if it were confirmed, because the outpatient guideline treats 'probable' as established
• B. Code both pneumonia and the presenting symptoms, sequencing the symptoms first as the reason for the visit
• C. Report no diagnosis code for the visit until the chest X-ray confirms or rules out the pneumonia
• D. Code the signs and symptoms, because uncertain diagnoses are not coded in the outpatient setting

11. Which ICD-10-CM convention indicates that an additional code is required and specifies its sequencing?

• A. The order of the chapters in the tabular list, which requires codes from earlier chapters to be listed first
• B. The presence of a placeholder 'X' in the fifth position, which signals that a companion code must follow
• C. The order of the subterms under the main term in the alphabetic index, which fixes the sequence of codes on the claim
• D. "Code first" and "use additional code" notes, which establish mandatory etiology and manifestation sequencing

12. What is the purpose of the placeholder character "X" in an ICD-10-CM code?

• A. It marks the code as unspecified so the payer knows that laterality was not documented
• B. It stands in for any character the coder cannot determine from the available documentation
• C. It fills an empty character position so a required seventh character lands in the correct place
• D. It flags the code as non-billable until the placeholder is replaced with a documented character

13. A patient returns for a scheduled follow-up during the healing phase of a fracture treated at the initial encounter. Which seventh character generally applies?

• A. S, for sequela
• B. No seventh character is used for follow-up visits
• C. D, for subsequent encounter
• D. A, for initial encounter

14. A patient has a malignant neoplasm of the colon that has metastasized to the liver. How are the sites generally sequenced when treatment is directed at the metastatic site?

• A. Only the metastatic site is reported, because a primary that has already spread is no longer coded as an active condition
• B. The metastatic site is sequenced first when treatment is directed at it, with the primary site reported additionally
• C. The primary site is always sequenced first regardless of which site is being treated, with the secondary site listed next
• D. Only the primary site is reported, because the metastasis is captured by the histology of the primary neoplasm code

15. A diagnosis code is reported at a less specific level than the documentation supports. What is the consequence?

• A. It is preferred, because unspecified codes are safer in an audit than a more specific code that could be challenged
• B. It has no effect on claim adjudication, since payers reimburse the category and not the individual code
• C. It automatically triggers a fraud investigation, because reporting less specificity is treated as intentional
• D. It fails the requirement to code to the highest level of specificity documented and may cause denials

16. A patient is seen for a condition and the record documents both an acute and a chronic form of the same condition, with separate entries in the index. How are they sequenced?

• A. The acute or subacute code is sequenced first
• B. The chronic code is sequenced first as the underlying condition
• C. Only the chronic code is reported, since it includes the acute form
• D. Only the acute code is reported, since it reflects the current visit

17. Which sequencing rule applies when a patient is admitted or seen for treatment of a complication of surgery?

• A. The original surgical diagnosis is always sequenced first, with the complication reported second
• B. Complications are never coded separately, because they are included in the global surgical package
• C. The complication code is sequenced first when it is the reason for the encounter
• D. The complication is reported only as a secondary code, after the code for the original surgery

18. A radiology report documents an injury to the patient's right wrist, and the ICD-10-CM classification offers laterality-specific codes for this condition (right, left, unspecified). Given the clear documentation, which code should the coder select?

• A. The bilateral wrist injury code
• B. The right-side-specific code
• C. The unspecified-laterality code
• D. The left-side-specific code

19. A patient's record documents type 2 diabetes mellitus with a specified diabetic complication, and ICD-10-CM classifies this relationship using a single code capturing both the underlying disease and the complication. What coding principle does this represent?

• A. An Excludes1 conflict that requires the coder to report the diabetes code and omit the complication
• B. A default code assigned when the documentation does not specify which complication the patient has
• C. A dual coding requirement that mandates two separate codes, one for the disease and one for the complication
• D. A combination code that classifies the underlying disease together with its associated complication

20. In the ICD-10-CM Alphabetic Index, a main term is followed by a code with no additional qualifying subterms matching the documented condition. What does this code represent when no more specific information is documented?

• A. The default code, appropriate when the record does not specify a more detailed variant
• B. A code reserved for inpatient use, because outpatient claims must always carry the full detail
• C. A code that can never be reported without first querying the physician for the missing detail
• D. A placeholder that must be replaced with a more specific code before the claim can be submitted

21. The ICD-10-CM index instructs the coder to interpret the word 'with' in a code title or index entry as meaning the two listed conditions are associated, even without the physician explicitly linking them elsewhere in the record. What does this convention allow the coder to do?

• A. Ignore the second condition entirely, because the combination code already reports it and a separate code would be a duplicate
• B. Query the physician before every use of a combination code, because the classification cannot establish a relationship on its own
• C. Link the two conditions listed together in the classification without requiring the provider to explicitly state a causal relationship
• D. Assume that any condition listed in the patient's past history is related to the primary diagnosis, even without current documentation of either

22. When coding a patient encounter, the ICD-10-CM chapter-specific coding guideline for a particular condition appears to conflict with a general coding guideline that would otherwise apply. Which guideline takes precedence?

• A. The general guideline always overrides chapter-specific guidance, since it applies to every chapter
• B. The coder should default to the alphabetic index alone and disregard both guidelines
• C. The chapter-specific guideline takes precedence over the general guideline
• D. The physician's stated preference determines which of the two guidelines applies

23. A coder must decide the sequencing of codes for an encounter. Which consideration most directly determines which diagnosis is listed first?

• A. The alphabetical order of the diagnosis descriptions as they appear in the index
• B. The condition chiefly responsible for the encounter as supported by documentation
• C. The diagnosis with the longest code, because more characters indicate greater specificity
• D. The diagnosis that carries the highest reimbursement under the payer's fee schedule

24. When abstracting a diagnosis from a physician's documentation, a coder encounters a condition described only as 'possible' or 'probable' in the outpatient record. In outpatient coding, how should such an uncertain diagnosis generally be handled?

• A. Code the condition as if it were confirmed, to capture the highest level of specificity available
• B. Code the documented signs, symptoms, or findings rather than the unconfirmed condition
• C. Omit the encounter from coding entirely until the physician confirms or rules out the condition
• D. Query the payer for permission to report the possible diagnosis as an established condition

25. A coder reviewing documentation for a patient with diabetes must determine whether the record supports type 1 or type 2 classification before assigning a code, since long-term management differs significantly between the two forms. Which documentation element most directly resolves this distinction for coding purposes?

• A. The patient's stated preference for a particular insulin brand
• B. The physician's specific documentation of the diabetes type
• C. The patient's age alone, since age always determines the type
• D. The billing department's default assignment

26. A coder is applying a modifier to a CPT code. Which of the following best describes the primary purpose of using modifiers in procedural coding?

• A. To reduce the number of separate codes needed on a claim by combining related services under one code
• B. To indicate to the payer that the procedure was performed incorrectly or outside the standard of care
• C. To increase the reimbursement for the procedure by signaling that additional physician work was performed
• D. To provide additional information that clarifies or changes the meaning of the base procedure code

27. A coder selects a CPT code for a procedure with multiple components (e.g., evaluation, preparation, and execution). The CPT descriptor for the code states 'includes.' What does this convention tell the coder?

• A. The components listed are optional and may be reported separately with modifier 51 when each is performed
• B. The components listed are add-on services that increase the total reimbursement when they are documented
• C. The provider may choose to report the components separately or bundled, depending on the payer's policy
• D. The components listed are included in the code value and should not be separately reported

28. A CPT code description is preceded by a bullet symbol in the codebook. What does this indicate?

• A. The code is exempt from modifier 51 reporting
• B. The code includes moderate (conscious) sedation
• C. The code's descriptor has been revised this edition
• D. The code is new for the current edition

29. A CPT code is designated as an add-on code with a plus symbol. How must it be reported?

• A. Always in addition to a primary procedure code, and never alone
• B. Alone, as a standalone service
• C. With modifier 51 appended to reduce payment
• D. Only when the primary procedure is performed on a different date

30. A surgeon performs a procedure on both the left and right knees during the same session. Which modifier reports the bilateral nature of the service?

• A. Modifier 22
• B. Modifier 50
• C. Modifier 51
• D. Modifier 59

31. CPT codes ending in the letter T, such as those in the 0001T series, belong to which category?

• A. Category I, the main body of procedure codes, in the alphanumeric appendix
• B. Category II, supplemental performance measurement tracking codes ending in T
• C. HCPCS Level II temporary codes, which CMS assigns while a permanent code is pending
• D. Category III, temporary codes for emerging technology, services and procedures

32. Which modifier indicates that a procedure was discontinued after anesthesia was administered to the patient?

• A. Modifier 73 in the facility setting, or modifier 52 for physician reporting
• B. Modifier 52 in both the facility and the physician setting, with a reduced fee
• C. Modifier 78 in the facility setting, or modifier 22 for physician reporting
• D. Modifier 74 in the facility setting, or modifier 53 for physician reporting

33. A patient undergoes a planned staged procedure during the global period of a prior surgery by the same physician. Which modifier applies?

• A. Modifier 76
• B. Modifier 58
• C. Modifier 78
• D. Modifier 79

34. Modifier 59 is used to identify a distinct procedural service. What is the primary compliance concern with this modifier?

• A. It may only be appended to evaluation and management codes, so reporting it on a surgical procedure triggers an automatic denial of the entire claim
• B. It always reduces the reimbursement for the second procedure, so it should be replaced with modifier 51 whenever two procedures are performed during the same operative session
• C. It is required on every claim that lists more than one procedure, so omitting it causes the secondary procedures to be denied as duplicates
• D. It can be misused to bypass edits that correctly bundle services, so it must be supported by documentation of a genuinely separate encounter, site or session

35. What does the global surgical package generally include?

• A. Only the procedure itself, with every preoperative and postoperative visit billed separately as an E/M service
• B. Treatment of complications that require a return to the operating room during the postoperative period
• C. The procedure, typical preoperative and postoperative care, and related follow-up within the global period
• D. All care provided to the patient for one calendar year after the surgery, including treatment of unrelated conditions

36. A coder is assigning a code for a surgical procedure performed through an endoscope. Which principle applies?

• A. The endoscopic code is reported in addition to the open code, with modifier 51 on the lesser of the two
• B. Approach is irrelevant to CPT selection, because relative values are assigned to the procedure, not the technique
• C. The approach documented determines code selection, so an endoscopic approach requires the endoscopic code
• D. Open and endoscopic approaches use interchangeable codes, because the anatomic result of the procedure is the same

37. Which statement about reporting an unlisted CPT code is correct?

• A. It never requires additional documentation, because the payer prices the service from the physician's fee schedule
• B. It may be used whenever the exact code is difficult to locate, provided a note explains why the search was abandoned
• C. It is used only when no Category I or Category III code describes the service, and requires a supporting report
• D. It should be used instead of a Category III code for new technology, because Category III codes are not payable

38. A code from the CPT Category II code set is being considered for a patient encounter where a screening was performed. What is the correct application of these codes?

• A. They are used only for anesthesia services and carry a base unit value instead of an RVU
• B. They report performance measurement data and carry no relative value for reimbursement
• C. They replace the Category I codes for identical procedures whenever a screening is performed
• D. They describe new and emerging technologies and services that are still awaiting FDA approval

39. A surgeon performs three separate procedures through the same operative approach during a single surgical session. Which modifier is appended to the secondary and subsequent procedure codes to indicate multiple procedures were performed at the same session?

• A. Modifier 59
• B. Modifier 51
• C. Modifier 76
• D. Modifier 25

40. A patient returns to the same physician later on the same day for a repeat electrocardiogram to monitor a changing condition. Which modifier indicates that the identical procedure was repeated by the same physician on the same date?

• A. Modifier 91
• B. Modifier 59
• C. Modifier 76
• D. Modifier 77

41. A coder abstracting a procedure notes that the documentation describes services beyond what a single base code captures. Which action best supports accurate reporting when the documented work exceeds the base procedure description?

• A. Split the encounter across two separate dates of service to justify reporting the additional codes
• B. Report only the base code and ignore the additional documented work, since it is included in the global package
• C. Report the additional documented service using the appropriate add-on or supplemental code when supported
• D. Round up to a more expensive code in an unrelated family that better reflects the total work performed

42. A medical coder is reviewing an operative report and must select the code that most precisely reflects the documented procedure. When two codes could apply but one describes the service to a greater level of specificity, which principle should guide the selection?

• A. Assign both codes and append modifier 59 to the second so the payer can decide which one to reimburse
• B. Assign whichever code carries the higher reimbursement, since both are supported by the operative report
• C. Assign the more general code to avoid over-reporting, because a specific code invites closer payer scrutiny in audits
• D. Assign the code that describes the service to the highest level of specificity supported by the documentation

43. What is the primary function of the National Correct Coding Initiative (NCCI) edits in procedural coding?

• A. To prevent unbundling by identifying codes that should not be reported together on the same claim
• B. To set the maximum allowable reimbursement for each procedure listed in the Medicare physician fee schedule
• C. To determine whether the diagnosis on the claim establishes medical necessity for each surgical procedure
• D. To map CPT procedure codes to their HCPCS Level II equivalents for supplies billed on the same claim

44. A coder must establish the medical necessity linkage between a reported procedure and the patient's documented condition. What coding principle does this reflect?

• A. Any procedure listed in CPT is presumed medically necessary once it is reported with a valid diagnosis code
• B. The provider's documentation must contain the phrase 'medically necessary' next to each procedure ordered
• C. The diagnosis (ICD-10-CM code) must support the medical reasonableness of the reported procedure (CPT code)
• D. The diagnosis and procedure codes must be drawn from the same chapter so the payer can match them automatically

45. A coder reviews a claim where the physician documented 'right knee pain' in the chief complaint but ordered an MRI of the right ankle. The coder coded for both knee and ankle pain. Which documentation principle has the coder violated?

• A. The coder should code only what is clearly documented and supported by test orders or findings, not infer additional diagnoses
• B. The coder should code both joints whenever imaging of more than one anatomic site is documented in the same encounter
• C. The coder should code the site of the imaging study, because the test order overrides the chief complaint whenever the two conflict
• D. The coder should query the physician only when the documentation is incomplete, and otherwise code every site that is mentioned

46. Under the query process, a coder identifies a discrepancy between a documented diagnosis and the clinical findings. Which action best exemplifies appropriate query protocol?

• A. Contact the physician by phone, obtain verbal confirmation, code on the basis of that conversation, and keep a note of the call in the coder's own log
• B. Code the diagnosis that best matches the clinical findings, note the discrepancy in the medical record, and release the claim without a query
• C. Code the diagnosis as documented, submit the claim, and simultaneously ask the physician to clarify the clinical basis in an addendum
• D. Refrain from coding the questionable diagnosis, document the discrepancy, and submit a formal query requesting clarification before claim submission

47. Which term describes reporting several individual component codes separately when a single comprehensive code exists?

• A. Unbundling
• B. Bundling
• C. Downcoding
• D. Upcoding

48. What is the purpose of the National Correct Coding Initiative?

• A. To license and credential the coding professionals who submit claims to Medicare Administrative Contractors
• B. To set the physician fee schedule payment amounts by assigning relative value units to each procedure code
• C. To prevent improper payment through edits that identify code pairs that should not be reported together
• D. To assign ICD-10-CM diagnosis codes to the procedures on a claim so that medical necessity is established

49. A coder notices that a provider consistently documents a level of service that is not supported by the record. What is the appropriate action?

• A. Ignore the pattern, because the coder's role is limited to code assignment, not documentation
• B. Query the provider and escalate through the practice's compliance program
• C. Code the level of service the provider selected, since the provider bears responsibility
• D. Silently downcode all of the provider's claims to the level the documentation supports

50. Which characteristic makes a physician query non-compliant?

• A. Offering multiple reasonable clinical options including "other" and "unable to determine"
• B. Being posed in writing and retained in the record
• C. Suggesting a specific diagnosis or indicating the financial impact of the answer
• D. Citing the specific documentation that prompted the question

51. Under the federal False Claims Act, what conduct creates liability?

• A. Only conduct that a court finds intentional beyond a reasonable doubt in a criminal proceeding
• B. Failing to obtain prior authorization before providing a service covered by a federal program
• C. Knowingly submitting or causing the submission of a false or fraudulent claim for payment
• D. Any billing error that results in an overpayment, regardless of the provider's intent or knowledge

52. What does the federal Anti-Kickback Statute prohibit?

• A. Charging different fees to different payers for the same service without disclosing the fee schedule to each
• B. Reporting more than one procedure on a single claim without appending the multiple-procedure modifier 51
• C. Knowingly offering or receiving remuneration to induce referrals of federal health care program business
• D. Employing more than one coder in a practice without a written compliance plan on file for each employee

53. How long must documentation supporting a submitted claim generally be retained and available?

• A. For the period required by payer contract, federal rule and state law, whichever is longest
• B. For thirty days after submission, the window in which a payer may request additional records
• C. Until the claim is paid and the remittance advice has been posted to the patient's account
• D. There is no retention requirement once the claim has passed the payer's timely filing limit

54. A practice discovers it has been overpaid by a federal health care program due to a coding error. What is the general obligation?

• A. Offset the amount against future claims for the same patient without notifying the payer
• B. Take no action if the error was unintentional, because liability requires intent to deceive
• C. Report and return the overpayment within the statutory deadline after identification
• D. Retain the funds unless the payer identifies the error and formally requests a refund

55. Which element is essential in every medical record entry supporting a billed service?

• A. The coder's initials in place of the provider's signature when the provider is unavailable
• B. Legible, dated documentation authenticated by the rendering provider
• C. The patient's insurance identification number and group number on each page
• D. The expected reimbursement amount for each service listed in the entry

56. A physician assistant provides a service that is billed under the supervising physician's number under incident-to rules. What is a core requirement?

• A. The physician must have established the plan of care and remain involved, with direct supervision available as required
• B. The physician need never have seen the patient, provided the physician assistant holds an individual NPI that is on file with the payer
• C. Incident-to billing applies to new patient problems, as long as the physician is physically present in the office suite
• D. Incident-to billing applies in the inpatient hospital setting, where the physician is available on the nursing unit

57. What distinguishes a Local Coverage Determination from a National Coverage Determination?

• A. An LCD is issued by a Medicare Administrative Contractor for its jurisdiction; an NCD applies nationwide
• B. Neither affects claim payment; they are educational documents describing accepted standards of clinical practice
• C. An LCD applies nationwide to all Medicare claims, while an NCD is limited to the contractor's regional jurisdiction
• D. Both are issued by individual practices as part of their compliance plans and filed with the Medicare contractor

58. When is an Advance Beneficiary Notice appropriately issued to a Medicare beneficiary?

• A. Before providing a service the provider believes Medicare will likely not cover, so the patient can decide whether to accept financial responsibility
• B. Only for services that are statutorily excluded from Medicare coverage, such as routine dental care or cosmetic surgery
• C. For every service provided to every Medicare beneficiary, as a routine intake form that protects the practice against any future denial
• D. After the claim has been denied by Medicare, so that the patient understands why the unpaid balance is being transferred to personal financial responsibility

59. Which term describes the process of a payer reviewing a submitted claim and determining payment?

• A. Utilization review
• B. Capitation
• C. Credentialing
• D. Adjudication

60. A denial is received stating the service is bundled into another procedure performed the same day. What is the appropriate first step?

• A. Review the NCCI edits and the documentation to determine whether a distinct service modifier is genuinely supported
• B. Append modifier 59 and resubmit immediately, because a bundling denial simply signals that the modifier was omitted
• C. Write off the charge without review, because bundled services can never be paid once the payer has applied the edit
• D. Bill the patient for the denied amount, since a denial for bundling shifts the financial responsibility to the patient

61. A provider documents a level 3 established patient office visit, but the coder submits the claim using a level 5 evaluation and management code to increase reimbursement, even though the documentation does not support that level of service. What is this practice called?

• A. Upcoding
• B. Bundling
• C. Unbundling
• D. Downcoding

62. A billing department routinely reports a lower level of evaluation and management service than what the physician's documentation actually supports, out of concern about being audited. What compliance issue does this practice create?

• A. It automatically qualifies as a self-disclosed overpayment, so the practice must file a refund report for each downcoded claim it identifies
• B. It still constitutes inaccurate coding and may violate the requirement to code to the level actually supported by documentation
• C. It eliminates all compliance risk, because underpayment can never be characterized as a false claim under federal law
• D. It is required practice under the False Claims Act, which directs providers to resolve any doubt in favor of the lower level

63. A coder reviewing a series of progress notes from the same provider notices that the history and exam sections are identical word-for-word across multiple distinct patient encounters on different dates. What compliance concern does this raise?

• A. None, because templated notes are always acceptable as long as the provider signs each encounter
• B. A required practice under electronic health record standards for consistency across encounters
• C. Cloned documentation, which may not accurately reflect the unique findings of each encounter
• D. Evidence of upcoding only, since identical exams do not affect the integrity of the documentation

64. A medical record entry supporting a billed service lacks any provider signature, credential, or other means of authentication. What is the compliance impact on the claim?

• A. The entry can still support the claim without any authentication
• B. Authentication is only required for surgical procedures
• C. A nurse's signature alone always satisfies authentication requirements regardless of who performed the service
• D. The unauthenticated entry may not be considered valid documentation to support the billed service

65. A physician realizes several days after an encounter that important clinical detail was omitted from the original documentation. What is the compliant method for adding this information to the medical record?

• A. Add a dated and signed addendum that references the original entry without altering it
• B. Delete the original entry and rewrite it in full so the record contains only one complete note
• C. Verbally inform the coder of the missing detail so the claim reflects it without changing the record
• D. Leave the record unchanged, because clinical detail cannot be added after the date of the encounter

66. A healthcare organization's compliance department reviews an annually published federal document identifying areas of high fraud, waste, and abuse risk that auditors intend to scrutinize, and uses it to prioritize internal coding audits. What is this document commonly known as?

• A. The Local Coverage Determination
• B. The OIG Work Plan
• C. The CPT Editorial Summary
• D. The National Coverage Determination

67. A physician refers a patient for designated health services to an imaging facility in which the physician holds a financial ownership interest, without qualifying for an applicable exception. Which law primarily addresses this type of self-referral arrangement?

• A. The False Claims Act (31 U.S.C. 3729-3733)
• B. The Anti-Kickback Statute (42 U.S.C. 1320a-7b)
• C. The Physician Self-Referral Law (Stark Law)
• D. The HIPAA Privacy Rule (45 CFR Part 164)

68. An employee of a medical practice becomes aware of a pattern of fraudulent billing and files a lawsuit on behalf of the government, potentially sharing in any resulting recovery. Under which type of legal action does this employee's suit fall?

• A. A Stark Law self-referral claim
• B. An Anti-Kickback Statute safe harbor filing
• C. A HIPAA breach notification
• D. A qui tam action under the False Claims Act

69. A provider who participates in the Medicare program bills a beneficiary directly for the difference between the provider's full charge and the Medicare-allowed amount, beyond any applicable coinsurance or deductible. What compliance issue does this represent?

• A. Prohibited balance billing by a participating provider
• B. A required practice for all providers regardless of participation status
• C. An acceptable practice as long as the patient consents
• D. A coding error unrelated to billing compliance

70. A coder identifies that a patient's chart lacks documentation of a known drug allergy that is referenced elsewhere in the patient's history, creating a risk that incomplete information could affect future clinical decisions. What is the coder's most appropriate compliance-oriented action?

• A. Add the allergy information to the chart directly, because a documented patient safety concern permits a coder to update clinical content
• B. Ignore the discrepancy, since allergy status does not affect code selection and lies outside the coder's scope
• C. Flag the discrepancy through the organization's established query or documentation improvement process for provider resolution
• D. Change the existing entry to match the referenced allergy without notifying the provider, and note the change in the coder's log

71. A laboratory test is repeated on the same day to obtain subsequent results. Which modifier reports this?

• A. Modifier 59
• B. Modifier 77
• C. Modifier 91
• D. Modifier 76

72. Which term refers to the layer of skin containing blood vessels, nerves and hair follicles, lying beneath the epidermis?

• A. The subcutaneous layer
• B. The stratum corneum
• C. The fascia
• D. The dermis

73. Which body system includes the pancreas in its endocrine function?

• A. The lymphatic system only, because the pancreas drains into the thoracic duct
• B. The endocrine system, through the islet cells producing insulin and glucagon
• C. The integumentary system, through the sweat glands that respond to insulin
• D. The urinary system, because pancreatic enzymes are cleared through the kidneys

74. Modifier 25 is appended to an evaluation and management code. What does it signify?

• A. An E/M service reduced in scope because part of the visit time was devoted to performing the procedure
• B. A preventive rather than problem-oriented E/M service provided on the same day as a minor procedure
• C. A significant, separately identifiable E/M service by the same physician on the same day as another procedure
• D. An E/M service performed by a physician of a different specialty in the same group on the same day as the procedure

75. Under current evaluation and management guidelines for office visits, what determines the level of service?

• A. The patient's insurance plan type and the place of service reported
• B. Medical decision making or total time on the date of the encounter
• C. The number of history and examination bullet elements documented
• D. The number of diagnoses listed on the claim, weighted by their severity

76. Which three elements comprise medical decision making for evaluation and management leveling?

• A. Total time, place of service and the number of prescriptions written on the date of the encounter
• B. Chief complaint, review of systems and past history, weighted by the number of systems addressed
• C. Number and complexity of problems, amount and complexity of data, and risk of complications
• D. History, examination and counseling, each scored against the 1995 or 1997 documentation guidelines

77. For evaluation and management purposes, how is a new patient defined?

• A. One who has never been seen at the current practice location, even if the same physician treated the patient at a previous office location within the past three years
• B. One whose insurance coverage has changed since the last visit, because the new payer has no claims history for the patient with the physician
• C. One who has not been seen by any physician in the group within the past twelve months, regardless of that physician's specialty or subspecialty
• D. One who has not received a professional service from the physician or another physician of the same specialty in the same group within the past three years

78. A physician spends 45 minutes on the date of an established patient office encounter, including reviewing outside records and documenting in the chart. How does this time count for E/M selection?

• A. All qualifying time personally spent by the physician on that date counts, including non-face-to-face work
• B. Only the face-to-face portion of the visit counts, so record review and documentation time are excluded from the total
• C. Time spent by clinical staff counts toward the physician's total when the staff work under direct supervision
• D. Time may not be used to select the level for established patient visits; only medical decision making applies

79. A patient is seen for a preventive medicine visit, and during the same encounter the physician also evaluates and treats a new significant problem. How is this reported?

• A. Report the preventive medicine code with modifier 22 to reflect the additional work of the problem evaluation
• B. Report the preventive medicine code plus the appropriate problem-oriented E/M code with modifier 25
• C. Report only the preventive medicine code, because any problem addressed during a wellness visit is included
• D. Report only the problem-oriented E/M code at a higher level to account for the preventive counseling

80. A patient is within the global postoperative period of a prior unrelated surgery performed by the same physician and presents with a new, unrelated problem that the physician evaluates and manages during an office visit. Which modifier is appended to the E/M code to indicate the visit is unrelated to the prior surgery's global period?

• A. Modifier 24
• B. Modifier 79
• C. Modifier 58
• D. Modifier 78

81. A physician evaluates a patient at the request of another physician seeking a specialist's opinion on a specific problem, and sends a written report of findings back to the requesting physician. Which three elements must generally be present to support reporting this encounter as a consultation?

• A. Request, refusal of the opinion, and re-evaluation by the requesting provider
• B. Referral for transfer of care, treatment, and a discharge summary sent to the primary provider
• C. Registration, review of the outside records, and reimbursement by the requesting provider
• D. Request, render (an opinion or service), and report back to the requesting provider

82. In a hospital outpatient setting, a physician and a qualified nonphysician practitioner from the same group each personally perform and document a portion of the same patient encounter on the same date. What is this reporting arrangement called?

• A. A split or shared visit
• B. A consultation
• C. A global surgical package
• D. An incident-to service

83. Which pair of modifiers distinguishes the professional component from the technical component of a diagnostic service?

• A. Modifier 91 for the professional component and modifier 76 for the technical component
• B. Modifier 51 for the professional component and modifier 50 for the technical component
• C. Modifier 26 for the professional component and modifier TC for the technical component
• D. Modifier TC for the professional component and modifier 26 for the technical component

84. A patient undergoes a diagnostic imaging study interpreted by one radiologist, and later the same day a covering radiologist from a different practice repeats the same study and provides a new interpretation. Which modifier does the covering radiologist append to indicate the service was repeated by a different physician?

• A. Modifier 76
• B. Modifier 59
• C. Modifier 25
• D. Modifier 77

85. The suffix "-ectomy" in a procedure description indicates what?

• A. Creation of an artificial opening
• B. Surgical repair or reconstruction
• C. Surgical removal or excision
• D. Visual examination with a scope

86. Which prefix means "around" or "surrounding"?

• A. Endo-
• B. Epi-
• C. Hypo-
• D. Peri-

87. A diagnosis is documented using a medical term ending in the suffix '-itis,' such as appendicitis or bronchitis. What does this suffix indicate about the condition?

• A. Surgical removal
• B. Inflammation
• C. Abnormal narrowing
• D. Formation of a new opening

88. A procedure note documents a 'nephrectomy.' Based on the medical terminology root, which organ was removed?

• A. The bladder
• B. The spleen
• C. The kidney
• D. The liver

89. A wound repair is documented as requiring layered closure of deeper subcutaneous tissue and superficial fascia. How is this classified for CPT purposes?

• A. Adjacent tissue transfer
• B. Intermediate repair
• C. Simple repair
• D. Complex repair

90. When coding multiple wound repairs of the same classification and anatomic group, how are the lengths handled?

• A. Average the lengths and report the code for the mean length with modifier 22 for the extra work
• B. Report each wound with its own code, appending modifier 59 to every repair after the first
• C. Add the lengths together and report a single code for the combined length
• D. Report only the longest wound, because the smaller repairs are included in the larger one

91. A dermatologist excises a biopsy-proven basal cell carcinoma from the left forearm. The lesion measures 1.5 cm at its widest point, the surgeon takes 0.3 cm margins on each side, and the defect is closed with a single-layer closure. Which CPT reporting is correct?

• A. 11603 plus 12002, reporting the single-layer closure of the 2.1 cm excision site as a separate simple repair
• B. 11602, because the lesion itself measures 1.5 cm and falls in the 1.1 to 2.0 cm tier of the malignant series
• C. 11403, because the excised diameter of 2.1 cm is reported from the benign series for the trunk, arms or legs
• D. 11603, because the excised diameter is 2.1 cm (1.5 cm lesion plus 0.3 cm margins on each side) in the malignant series

92. In the emergency department a physician performs single-layer closures of a 2.5 cm laceration of the scalp and a 4.0 cm laceration of the right forearm. No debridement, undermining or layered closure is documented. How is the repair reported?

• A. 12004, because two wounds closed in one session are reported at the next higher length tier
• B. 12001 for the 2.5 cm scalp wound plus 12002 for the 4.0 cm forearm wound, listed as two repairs
• C. 12002 for the forearm plus 12011 for the scalp, because the scalp is a separate anatomic site
• D. 12002, one code for the summed 6.5 cm of simple repair in the same anatomic grouping

93. A wound-care physician documents sharp surgical debridement of necrotic subcutaneous tissue from a sacral pressure ulcer measuring 6 cm by 8 cm (48 sq cm). Muscle, fascia and bone are not involved. Which codes are reported?

• A. 97597 plus 97598, selective debridement of an open wound, first 20 sq cm and each additional 20 sq cm
• B. 11042 for the first 20 sq cm plus 11045 with two units for the remaining 28 sq cm of subcutaneous debridement
• C. 11042 with three units, one unit for each 20 sq cm segment of the 48 sq cm wound surface
• D. 11043 plus 11046, because a pressure ulcer of this size is assumed to extend into the muscle layer

94. During one office visit a dermatologist performs a punch biopsy of a suspicious lesion on the back and a tangential (shave) biopsy of a different lesion on the left arm; both specimens are sent to pathology. What is reported for the biopsies?

• A. 11104 for the punch biopsy and 11102 for the tangential biopsy, each as a primary code with modifier 59 on the second
• B. 11102 for the tangential biopsy plus add-on 11105 for the punch biopsy of the second lesion
• C. 11104 with two units, because both lesions were sampled with a full-thickness biopsy technique
• D. 11104 for the punch biopsy plus add-on 11103 for the tangential biopsy of the second lesion

95. A patient has seven actinic keratoses on the face and the dorsum of both hands destroyed with liquid nitrogen cryosurgery during a single office visit. Which CPT codes and units are reported?

• A. 17110 with one unit, because destruction of up to 14 lesions by any method is reported by lesion count
• B. 17000 with seven units, one unit for each premalignant lesion that was destroyed
• C. 17004, the code for destruction of premalignant lesions when more than five lesions are treated
• D. 17000 for the first lesion plus 17003 with six units for the second through seventh lesions

96. A radiologist performs a percutaneous core needle biopsy of a single 1.2 cm right breast mass under ultrasound guidance, places a marker clip at the biopsy site, and images the specimen. Which code describes the service?

• A. 19083, biopsy of breast with ultrasound guidance, first lesion, including localization device placement and imaging of the specimen
• B. 19100 plus 76942, percutaneous needle core biopsy without imaging guidance plus ultrasonic guidance for needle placement
• C. 19081, biopsy of breast with stereotactic guidance, first lesion, including localization device placement when performed
• D. 19083 plus 76942 plus 19499, reporting the ultrasound guidance and the clip placement as separately identifiable services

97. An orthopedist performs a closed reduction of a displaced distal radius fracture under sedation, confirms alignment with fluoroscopy, and applies a short arm cast. The same surgeon will provide all follow-up care. What is reported?

• A. 25600 plus 29075, closed treatment without manipulation plus application of the short arm cast
• B. 25605 alone; the initial cast application is included in the fracture treatment code
• C. 25605 plus 29075, closed treatment with manipulation plus the short arm cast applied at the same session
• D. 25607, because a displaced fracture that requires reduction is reported with the open treatment code

98. During right knee arthroscopy the surgeon performs a partial medial meniscectomy and also shaves fibrillated articular cartilage (chondroplasty) in the lateral compartment of the same knee. No loose body is removed. What is reported?

• A. 29881 plus G0289, the Medicare code for chondroplasty in a different compartment of the same knee
• B. 29880, because surgical work was performed in both the medial and the lateral compartments
• C. 29881 plus 29877 with modifier 59, because the chondroplasty was performed in a separate compartment
• D. 29881 alone; the code includes chondroplasty in the same or a separate compartment when performed

99. A physician injects 40 mg of triamcinolone acetonide into the right knee joint using real-time ultrasound guidance; the guidance image is permanently recorded and a report is documented. Which codes are reported for the service?

• A. 20610 for the major joint injection plus 76942 for the ultrasound guidance plus J3301 with four units
• B. 20606 for the intermediate joint injection with ultrasound guidance plus J3301 with one unit for the 40 mg dose
• C. 20611 plus 76942, because the permanent recording of the guidance image is a separately reportable service
• D. 20611 for the injection with ultrasound guidance plus J3301 with four units for the drug

100. A pain physician injects trigger points in the right trapezius, the right levator scapulae and the right rhomboid major muscles during one session. How is the service reported?

• A. 20553 with one unit, injection of single or multiple trigger points in three or more muscles
• B. 20553 with three units, because the descriptor counts each muscle group separately
• C. 20552 with three units, one unit for each muscle that received an injection
• D. 20552 for the first two muscles plus 20553 for the third muscle injected