Concepts of Coding

1. Specific information about coding for each CPT section is located in the:
A. index. B. introduction C. guidelines. D. Appendix A.

2. Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is
available?
A. period B. Comma C. Semicolon D. hyphen

3. The term that indicates this is the type of code for which the full code description can be known only if a
previous code is referenced:
A. stand-alone B. indented C. independent D. partial

4. The symbol that indicates an add-on code is:

A. ∆ B. ʘ C. + D. ᴓ

5. When you see the ᴓ symbol next to a code in the CPT manual, you know that:
A. the code is a new code B. new or revised text
C. the code is a modifier -51 exempt code. D. FDA approval pending.

6. What five categories do the central venous access procedures or devices fall into?
A) Insertion, replacement repair, partial, complete replacement, and removal
B) Removal, partial insertion, replacement repair, complete, and non-replacement
C) Insertion, partial insertion, repair, complete replacement, and removal
D) Removal, insertion, non-removal, partial replacement, and minor repair

7. Which organization developed the International Classification of Diseases (ICD-10) manual?

A) Department of Health and Human Services B) Accredited Standards Organization
C) World Health Organization D) National Centers for Health Statistics

8. The abbreviation HIPAA stands for what act?

A) Health Income Portability and Accountability Act
B) Health Insurance Portability and Accountability Act
C) Health Insurance Possibility and Accountability Act
D) Health Income Position and Accountability Act

9. When a physician’s claim form is submitted to an insurance company, which two main components must the
claim link to in order to prove medical necessity?
A) Date of service and work status B) Provider name and address
C) Modifier and place of service D) Diagnosis and procedure code(s)

10. What is the standard claim form that is used to report professional services and supplies to insurance
plans?
A) ANSI ASCX12-N B) CMS-1500 C) CMS-1444 D) UB-04

11. What reimbursement method does the abbreviation RBRVS stand for?
A) Resource Based Relative Value Scale B) Relative Based Resources Value System
C) Revenue Balanced Relative Value Scale D) Resource Balanced Relative Value System

12. What document does an insurance company create and send back to the provider and patient to detail the
results of processing a claim?
A) Fiscal Intermediary Results B) Explanation of Benefits
C) Explanation of Benefactor D) Encounter Form
13. Sickle-cell anemia and thalassemia are both types of:
A) Iron deficiency anemia B) Hereditary hemolytic anemia
C) Aplastic anemia D) Coagulation defects

Modifiers & Practice Management:

14) Which place of service code should be reported on the physician’s claim for a surgical procedure
performed in an ASC?

A. 21 B. 22 C. 24 D. 11

15) What is PHI?

A. Physician-health care interchange B. Private health insurance

C. Personal health information D. Provider identified incident-to

16) Which of the following is a BENEFIT of electronic claims submission?

A. Privacy of claims B. Security of claims

C. Timely submission of claims D. None of the above

17) Which of the following is an example of electronic data?

A. A digital X-ray B. An explanation of benefits

C. An advance beneficiary notice D. A written prescription

18) Which of the following health plans does not fall under HIPAA?

A. Medicaid B. Medicare
C. Workers’ compensation D. Private plans

19) Guidelines from which of the following code sets are included as part of the code set requirements under
HIPAA?

A. CPT® B. ICD-10-CM C. HCPCS Level II D. ADA Dental Codes

20) Local coverage decisions are published to give providers information on which of the following?
A. Information on modifier use with procedure codes
B. A list of CPT® and HCPCS Level II codes representing covered procedures
C. Fee schedule information listed by CPT® code
D. Medical necessity exclusions to coverage

21. Complete the following statement, “Medically necessary services are . . . “

a. Consistent with the symptoms or diagnosis of the illness or injury being treated.
b. Reasonable. That is, in line with mainstream medical practice.
c. Reasonable and necessary for the patient’s condition and not performed primarily for the convenience of the
patient, the attending physician, or the supplier.
d. All of the above.

22. Which of the following means “to destroy or break down”?

a. -pnea b. –lysis c. ambi- d. iso-

23. What is the crackling sound heard when bone or irregular cartilage surfaces rub together?
a. Bradycardia b. Bruit c. Crepitation d. Croupous
24. How could a hiatal hernia be described?
a. A protrusion of part of the stomach through the diaphragm
b. A protrusion of part of the esophagus through the larynx
c. A protrusion of part of the stomach through the rectum
d. A protrusion of part of the esophagus through the oropharynx

25. The intentional misrepresentation by either providers or beneficiaries to obtain or receive payment for
services is referred to as:
a. Unbundling b. Fraud c. Limiting Charges d. All of the above

26. The prefix “path” means:

a. System b. Organ c. Disease d. Cell

27. One of the three bones that constitutes the pelvic girdle is called:
a. iIleum b. Lunette c. Coccyx d. Ilium

28. A laryngoscopy is:

a. A visual examination of the larynx
b. The inflammation of the larynx
c. The defective development of the larynx
d. An instrument used to examine the membrane of the larynx

29. The term “carcinoma in situ” refers to:

a. A malignant neoplasm found at the original site
b. A secondary or metastasized neoplasm
c. Malignancies that are confined or noninvasive
d. Tissue that is beginning to exhibit neoplastic behavior

30. A 6-year-old girl fell on the playground at school. An x-ray revealed a distal radial fracture.
Where is this located?
a. Thumb side of lower forearmb. Outside lower leg
c. Just below elbow on the thumb sided. Lower part of the upper arm

31. Which term describes the most important reason for the care provided to the patient; that is, the first
diagnosis code listed on the insurance form?
a. Complicationsb. Adverse effect
c. Primary diagnosisd. Symptoms

32. The term “adverse effect” means:

a. Secondary diagnosis code used to identify the external cause for a condition for which thepatient is being
seen
b. A morbid phenomenon or departure from the normal structure, function, or sensation experienced by the
patient and indicative of the disease
c. The term denoting name of the disease or syndrome a person has or is believed to have
d. None of the above

33. Which of the following is a FALSE statement?

a. When only ancillary services are provided, list the appropriate Z code first and the problem or condition
second.
b. Code the primary diagnosis code first followed by the secondary, tertiary, and so on. Code any co-existing
conditions that affect the treatment of the patient for the visit or procedure as supplementary information.
c. Only code a chronic diagnosis once, as it is not applicable to the patient’s current treatment.
d. Identify the service(s) or visit(s) for circumstances other than the disease or injury such as follow-up care

34. The symbol [ ] indicates:

a. Synonyms, alternate wording, or explanatory phrases
b. Supplementary words that may be present or absent without affecting the code assignment
c. A series of terms, each of which is modified by the statement appearing to the right
d. The code is specified

35. The central nervous system consist of the

a. Cerebellum and cortex b. Nerves and receptors
c. Brain and Spinal cord d. Frontal, parietal, temporal & occipital lobes

36. A 16-year-old female was admitted to the ER for abdominal pain, nausea and vomiting, and diarrhea. Upon
discharge, she was diagnosed with a ruptured ovarian cyst.
a. R10.9 b. N83.20 c. R10.31, R11.2 d. N83.20, R11.2

37. A superficial burn to the right shoulder.

a. T21.43XA b. T22.30XA c. T22.159A d. L55.9

38. A four-week-old infant who is admitted for pyloric stenosis.

a.Q40.0 b. K31.1 c. P92.8 d. R11.10

39. In the CPT-4 text, what does the bullet symbol (•) represent?
a. Revised codes b. New codes
c. Add-on codes d. Service includes surgical procedure only

40. When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable
procedure, each surgeon should report his/her distinct operative work by adding which of the following
modifiers?
a. –54 b. –66 c. –59 d. –62

41. When a patient is in a postoperative period and returns to the operating room for an unrelated procedure by
the same physician, which of the following modifiers would you attach to the procedure being performed?
a. –59 b. –24 c. –78 d.–79

42. Evaluation and Management services were performed on an established patient in which the decision to
perform a major surgery scheduled for the following morning was made. The patient was counseled for 15
minutes regarding treatment options, risks, and projected outcome. Which of the following modifiers would be
appended to the service performed?
a. –56 b. –52 c. –50 d. –57

43. In the CPT-4 text, what does the following symbol represent (+)?
a. Revised codes b. New codes
c. Add-on codes d. Service includes surgical procedure only

44. The index in the CPT-4 text is arranged with main term entries. These main term entries will fall into one or
more of four categories. Identify the four categories.
a. The procedure or service performed; the anatomical site involved; the condition; the modifying term.
b. The procedure or service performed; the organ or anatomical site; the code range; the synonym, eponym, or
abbreviation.
c. The procedure or service performed; the organ or other anatomical site; the condition; the synonym,
eponym, or abbreviation.
d. The modifying terms; the anatomical site; the disease; the synonyms, eponyms, or abbreviations.
Coding guidelines and compliance

1.C. The guidelines of the CPT contain specific information about coding for each CPT section.

2.D. The hyphen is located between two codes in the index of the CPT manual, indicating a range of codes is
available.

3.B. The indented code indicates this is the type of code for which the full code description can be known only if
a previous code is referenced.

4.C. The + symbol indicates an add-on code.

5.C. modifier -51 exempt code
6.A
7.“c” The World Health Organization (WHO) developed the International Classification of Diseases to classify
morbidity and mortality information for statistical purposes.
8.“b” In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) due to
concerns about insurance fraud.
9.“d” Medical necessity involves linking every procedure or service to a diagnosis that will justify the necessity
for performing the reported procedure or service.
10.“b” The CMS-1500 form is the standard form essential to file claims with insurance carriers.
11.“a” Resource-Based Relative Value Scale (RBRVS) system reimburses physicians based on these three
components: physician work, practice expense, and malpractice insurance expenses.
12.“b” An Explanation of Benefits (EOB) is created by insurance companies to detail processed claims.
13.“b”

14.C Place of service codes are reported on the CMS-1500 to identify the location where a service was
provided. In the front of the CPT® is a list of all place of service codes. A service provided in an ASC is
reported with POS code 24.

15. C Protected health information under the Health Information Portability and Accountability Act (HIPAA) is
any information, whether oral or recorded, in any form or medium that is created or received by a health care
provider, health plan, public health authority, employer, life insurer, school or university, or health care
clearinghouse relating to the past, present, or future physical or mental health or condition of an individual, the
provision of health services to that individual, or payment around those services. Only health information at the
individual level is covered; health information of groups is not.

16.C HIPAA’s provisions protect the privacy and security of electronic claims submission, so these two are not
benefits. Timely submission of claims - as well as lower cost - are both benefits of electronic claims submission.
Further, data analytics are greatly enabled by electronic transmission and storage of data.

17.A While B, C, or D might be done electronically, by definition they aren’t required to be done electronically. A
digital X-ray is an X-ray with an image that is stored electronically rather than on film, and so A is the correct
answer.

18. C Workers’ compensation is excluded from the definition of a health plan under the Health Insurance
Portability and Accountability Act (HIPAA). Therefore, Workers Comp plans are not required to meet HIPAA
standards for privacy, security or code sets.

19.B ICD-9-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the
use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information
is found in the guidelines at the front of your ICD-9-CM code book: These guidelines are a set of rules that
have been developed to accompany and complement the official conventions and instructions provided within
the ICD-9-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and
III of ICD-9-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-9-CM
diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act
(HIPAA).
20.D Local Coverage Decisions are Medicare Administrative Contractor rules that link procedure codes to
diagnoses that are not considered medically necessary for a specific procedure. Most LCDs also provide a list
of diagnosis codes for which a procedure may be covered; however, because other issues factor into payment,
coverage is not guaranteed. Modifier guidelines and fee schedule information is included in the annual
Medicare Physician Fee Schedule.

21.D
22. B
23. C
24. A
25. B
26. C
27. D
28. A
29. C
30. A
31. C
32. B
33. C
34. A
35. C
36. B
37. C
38. A
39. B
40. D
41. D
42. D
43. C
44. C