Medical Coding And Billing Sample Certification Questions

4.   Which one of the following statements accurately represents the practice known as unbundling?

   A. Combination codes are assigned separately in ICD-10-CM.   B. Codes that should be grouped into one code are broken into separate codes to maximize physician reimbursement.   C. ICD-10-PCS codes are broken into separate codes for congruent assignment.   D. Codes listed as separate procedures are assigned individually. 

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5.   Placing a catheter into the aorta or directly into an artery or vein is called

   A. brachiocephalic manipulation.   B. third order placement.   C. selective catheter placement.   D. nonselective catheter placement. 

6.   What ICD-10-CM code would be assigned for a patient with acute tubule-interstitial nephritis?

   A. L50.0   B. Z02.6   C. N10   D. B96.2 

7.   The suffix -sis means

   A. inflammation.   B. drooping.   C. condition.   D. process. 

8.   The concept of meaningful use pertains to

   A. medical office protocol and document organization.   B. electronic health record implementation.   C. resource management in the inpatient setting.   D. categorization of patient information. 

9.   In what CPT code range is Surgical Pathology found?

   A. 88400–80499   B. 88000–80299   C. 88300–88309   D. 88515–88598 

10.   According to the CMS National Physician Fee Schedule, what is the conversion factor for basic life support mileage?

   A. $32.4726   B. $34.5741   C. $28.8457   D. $36.0666 

11.   A patient who was involved in a motor vehicle accident is taken to the hospital by ambulance and admitted to the hospital in critical care. The physician sees the patient for 74 minutes in critical care. The physician leaves to attend to other patients in the ICU and the NICU of the same hospital. Five hours later, the physician returns to the patient and continues to treat the patient in critical care for an additional 30 minutes. The patient spends a total of 104 minutes in critical care. What codes are assigned?

   A. 99291, 99292   B. 99292, 99293   C. 99291, 99291   D. 99292, 99292, 99293 

12.   The prefix endo- means

   A. beneath.   B. outside of.   C. adjacent to.   D. within. 

13.   What is the CPT code for a three-view x-ray of the mandible?

   A. 70200   B. 70100   C. 70150   D. 70240 

14.   Rules of evidence control the

   A. amount of evidence that may be admitted during a civil trial.   B. processes and procedures for question and answer sessions.   C. documents that can be considered during jury trial.   D. length of criminal court proceedings, but not civil court proceedings. 

15.   The ampulla, isthmus, interstitium, and fimbria are examples of

   A. implantation sites of ectopic pregnancy.   B. incision sites for pacemaker insertion.   C. membranes in the abdomen.   D. bones in the ankle. 

16.   Code J9165 is assigned for intravenous diethylstilbestrol diphosphate. According to the code description, what dosage was administered?

   A. 20 mg   B. 50 mg   C. Up to 0.5 mg   D. 250 mg 

17.   Members of the uniformed services, their families and survivors, and retired members and their families qualify for

   A. TRICARE.   B. OIG Recovery.   C. Medicare.   D. Medicaid. 

18.   A patient comes to the emergency room complaining of abdominal pain. She was previously diagnosed with type I diabetes. She also complains of watery eyes, congestion, pressure in the sinuses, and difficulty breathing. Her final diagnoses are right lower quadrant abdominal pain, type I diabetes, acute sinusitis, and asthma. What CPT and ICD-10-CM codes are assigned?

   A. 99222, R18.91, E16.9, J01.91, J45.919   B. 99221, R17.41, E17.9, J01.90, J45.909   C. 99221, R10.31, E10.9, J01.90, J45.909   D. 99223, R14.31, E15.9, J01.90, J45.929 

19.   Under HIPAA, health care facilities must

   A. follow up with patients who repeatedly miss scheduled appointments for mandatory services.   B. keep records of patients who refill prescriptions more than once within a three-month timeframe.   C. maintain a clean, safe working environment.   D. choose a privacy officer in accordance with HIPAA policies and procedures. 

20.   What is the ICD-10-CM code for unspecified acute pericarditis?

   A. I30.89   B. I30.9   C. I30   D. I30.79 

21.   What is the full code description for 25515?

   A. Open treatment of radial shaft fracture, includes internal fixation, when performed   B. Closed treatment of ulnar shaft fracture; without manipulation   C. Closed treatment of radial shaft fracture; without manipulation   D. Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex 

22.   Which of the following anatomical locations would contain the diaphysis?

   A. Metatarsal   B. Diaphragm   C. Septum   D. Tibia 

23.   A patient recently became eligible for health insurance through her employer. Her health insurance is considered to be an 80-20 policy. Under the terms of an 80-20 policy, the insurer pays 80 percent and the insured pays 20 percent of expenses. This 80-20 policy is an example of

   A. coinsurance.   B. prospective payment.   C. capitation.   D. case management. 

24.   The Outpatient Prospective Payment System (OPPS) pays

   A. an established rate for outpatient services in specific hospitals.   B. a percentage of the national average for the same surgery performed in a different geographic location.   C. 65% of the schedule C rate for all surgeries.   D. subsidies to contain health care costs in rural facilities.  

25.   The study of disease is called

   A. physiology.   B. pathology.   C. urology.   D. neurology. 

26.   Superficial injuries such as abrasions or contusions are

   A. not coded when associated with more severe injuries of the same site.   B. queried to determine if the injuries are confined to the same site.   C. coded when associated with more severe injuries of the same site.   D. coded only when debridement is performed. 

27.   Another name for XXY syndrome is

   A. Turner’s syndrome.   B. Cooley’s anemia.   C. Klinefelter syndrome.   D. Huntington’s chorea. 

28.   The method that physicians use to bill for each service or visit individually rather than on a pre-paid basis is called

   A. fee-for-service.   B. capitation.   C. pre-paid care.   D. managed care. 

29.   A physician has a meeting with a pharmaceutical sales representative. During the course of the conversation, the physician reveals the diagnosis and past family, medical, and social history of a patient currently being treated with one of the medications that the sales representative is selling. In this situation, the doctor could be sued for

   A. invasion of privacy.   B. malfeasance.   C. undue harm and fraud.   D. malice. 

30.   A patient is prescribed a medication that narrows the blood vessels and raises her blood pressure. The medication is most likely a

   A. tranquilizer.   B. cardiogenic.   C. vasoconstrictor.   D. cardiotonic 

31.   Physicians typically refer to anatomical locations using directional terms, which are often

   A. paired in opposites.   B. used primarily by chiropractors.   C. used to describe surgical incisions.   D. referenced horizontally.  

32.   The study of tissue disease using macroscopic or microscopic analysis is called

   A. immunology.   B. histopathology.   C. cytopathology.   D. microbiology. 

33.   A physician obtains cells from the bone marrow cavity using a needle and a syringe. How would this procedure be coded?

   A. 36575   B. 37328   C. 38220   D. 35092 

34.   What is Medicare Part D?

   A. The component of Medicare Part A that covers outpatient surgeries   B. Add-on coverage for prescription drugs provided through insurance companies approved by Medicare   C. Supplemental coverage for war veterans and their dependents   D. Add-on coverage for dental procedures 

35.   A female patient is seen for her annual gynecological examination. During the examination, the physician performs a test to detect cervical cancer. This test is called a/an

   A. immunoassay test.   B. Pap smear.   C. carcinoembryonic antigen test.   D. mycobacterial culture. 

36.   A physician is called to the intensive care unit for a patient with second-degree burns sustained on 55% of his body while cooking in the kitchen where he works. The physician sees the patient in the critical care unit for two hours, leaves the unit, and returns later the same day to provide an additional hour of critical care. What ICD-10-CM and CPT codes would be assigned?

   A. L91.8, 99291 × 2, 99292 × 4   B. R53.81, 99291, 99293 × 5   C. Z30.09, 99293, 99294 × 2   D. T31.50, 99291, 99292 × 4 

37.   A change in the tissues and cells within a specific area on or in the body is called a

   A. lesion.   B. cyst.   C. neoplasm.   D. tumor. 

38.   Information about a patient can becan be released for research under the terms of HIPAA, only if

   A. the patient signs an authorization immediately upon admission.   B. the research is critical for technological development.   C. the patient has authorized the release and only a limited amount of information is released.   D. researchers obtain authorization from the admitting physician. 

39.   A patient is diagnosed with breast cancer and undergoes a partial mastectomy. What CPT code would be assigned?

   A. 19305   B. 19307   C. 19304   D. 19301 

40.   To conform to the HIPAA Privacy Rule, which of the following safeguards must be maintained in health care facilities?

   A. Immunization and injection safeguards   B. Reasonable administrative, technical, and physical safeguards   C. ICD-7 provisional safeguards   D. Hazardous waste protection safeguards 

41.   A patient sustains a fracture of the femur while playing football in a nearby park. What ICD-10-CM code would be assigned?

   A. S72.001A   B. S72.009A   C. S72.003A   D. S49.006A 

42.   According to the guidelines for medical records outlined in the Health Insurance Portability and Accountability Act (HIPAA), patients

   A. have the right to have errors reviewed by a hospital administrator.   B. have the right to correct errors in identification data only.   C. have the right to have errors in their medical records corrected.   D. do not have the right to have errors corrected, as the data has been previously verified by the physician.  

43.   Modifier -23 indicates that

   A. two surgeons performed a procedure.   B. a procedure was performed bilaterally.   C. a physician reviewed and interpreted a radiology procedure.   D. the patient received general anesthesia for a procedure that would ordinarily be performed with local or no anesthesia. 

44.   The Health Insurance Portability and Accountability Act (HIPAA) was created for the purpose of

   A. streamlining claims processing and reducing paperwork through electronic transmission.   B. stabilizing administrative costs and productivity.   C. decreasing employee turnover and reducing the volume of new hire paperwork.   D. modifying legal and ethical issues surrounding medical records retention. 

45.   A patient is seen in the emergency room complaining of abdominal pain in the left lower quadrant. It’s determined that the patient is experiencing inflammation of the pancreas, which is also called

   A. pancreaticoduodonal arcade.   B. pancreatitis.   C. pancreatolysis.   D. pancreatonia. 

46.   A 55-year-old patient was injured while working as a carpenter on a construction site. While framing the roof of a two-story house, he fell and hit his head. He was diagnosed with a concussion to the left side of his head, and underwent a right frontal parietal craniotomy with removal of a subdural hematoma. During the patient’s period of recovery, he was given a medication that resulted in a rash on his abdomen. The physician conducted an expanded problem focused history and exam, with straightforward medical decision making. What CPT code(s) should be assigned?

   A. 99251   B. 99252   C. 99292, 99291   D. 99253 

47.   Taking certain steps to protect PHI from being accidentally released to individuals who don’t need to know the information is called the

   A. minimum necessary standard.   B. privacy management statute.   C. health information guardianship guideline.   D. information provision standard. 

48.   The main term represents the most basic aspect of a disease or condition. For example, the main term of a diagnosis involving a broken arm is

   A. broken.   B. break.   C. fracture.   D. arm. 

49.   Performing a daily check for viruses and malware is one of the

   A. requirements of the Help Desk.   B. routine aspects of software maintenance.   C. sensible guidelines for Internet use in health care facilities.   D. functions of HIM encoders. 

50.   A coder overhears a confidential statement made outside of the court, and then, when called to testify, repeats the statement as being truth. This is an example of

   A. cross-examination.   B. hearsay.   C. speculation.   D. a direct quote. 

51.   A patient receives two venous pressure clamps for hemodialysis. What HCPCS Level II code is assigned?

   A. A4751   B. A4751 × 2   C. A4918 × 2   D. A4918  

52.   The process of removing tissue for histopathology is called

   A. shaving.   B. debridement.   C. excision.   D. biopsy. 

53.   A coder would assign modifier -53 to report

   A. dental procedures.   B. repeat procedures.   C. anesthesia administration.   D. procedures cancelled due to the patient’s condition. 

54.   Alternative dispute resolution (ADR) allows

   A. resolving medical malpractice suits by submitting pretrial depositions.   B. lawyer-to-lawyer mediation during trial recess.   C. mediating disputes with a judge in the presence of the bailiff.   D. litigants to resolve disputes prior to or after the start of litigation. 

55.   Code range 99231–99233 pertains to

   A. initial hospital care.   B. subsequent hospital care.   C. consultation services.   D. hospital discharge services. 

56.   A patient comes to the emergency room complaining of abdominal pain, nausea, and intractable vomiting. Unable to pinpoint the source of the patient’s complaints, the physician decides to admit the patient to the hospital. After conducting a complete history and examination, the patient’s final diagnosis is determined to be chronic duodenal ulcer. The patient remains hospitalized for three days. The physician sees the patient on the day of discharge. What ICD-10 and CPT codes are assigned?

   A. 99234, N17.9   B. 99223, I48.91   C. 99238, K26.7   D. 99291, D63.1 

57.   The specific guidelines that constitute a valid release of information under the HIPAA Privacy Rule are described as

   A. OIG specifications.   B. E/M levels.   C. considerations in relation to risk management.   D. core elements. 

58.   The suffix –centesis means

   A. abnormal condition.   B. calculus or stone.   C. a surgical puncture for fluid removal.   D. separation, breakdown, destruction. 

59.   The code for an ESWL would be found in the

   A. Urinary and Male Genital Systems of CPT.   B. Chemotherapy section of HCPCS.   C. Digestive System of CPT.   D. Cardiovascular System of CPT. 

60.   A female patient is diagnosed with breast cancer of the lower-inner quadrant of the right breast. The patient undergoes a modified radical mastectomy of the right breast in an attempt to circumvent the spread of the cancer to any secondary anatomical sites. The procedure was performed in three stages. In addition to the radical mastectomy, the physician also performed a right breast biopsy to treat the breast tumor in the lower-inner quadrant. What ICD-10-CM and CPT codes are assigned?

   A. 19307-58-RT, 19101-59-RT, C50.311   B. 15852-58, Z48.01   C. 11602, 15240, C50.312   D. 19307-RT, 19101-RT, C50.211 

61.   A patient comes to the ambulatory surgery center for a fusion of the cervical spine. Prior to the beginning of the surgery, the patient suffers an allergic reaction to the anesthesia shortly after it’s administered. Because of this reaction, the surgery is not performed. What code would be assigned as the first-listed diagnosis?

   A. The observation code   B. The reason that the surgery was scheduled to be performed   C. The allergy code   D. The anesthesia administration 

62.   Anti-inflammatory drugs applied to the skin to relieve skin disorders are called

   A. topical corticosteroids.   B. antiseptics.   C. keratolytics.   D. astringents. 

63.   The _______ nerve sends visual data to the occipital lobe of the brain.

   A. abducens   B. trochlear   C. optic   D. oculomotor 

64.   The root word OBSTETR/O means

   A. pregnancy.   B. cesarean.   C. midwife.   D. birth. 

65.   The root word ENTER/O means

   A. tooth.   B. stomach.   C. intestine.   D. secretion.  

66.   What code would be assigned for gastropathy?

   A. K29.7   B. K41.31   C. K31.9   D. K41.2 

67.   A patient comes to the physician’s office complaining of neck irritation. The physician examines her neck and notes that she has a 15 cm neck scar. Upon further examination, the physician notes that the neck scar requires extensive debridement and retention sutures. The physician performs a dermabrasion to treat the neck scar and then closes the complex wound with the sutures. What ICD-10 and CPT codes are assigned?

   A. 13132, 13133 × 2, L90.5   B. 13132, 13133 × 3, H81.09, L92.9   C. 13133-51, 13131-79, L60.0   D. 13132, L76.82 

68.   The bulbourethral gland is found in the _______ system.

   A. neurological   B. cardiovascular   C. male genital   D. female genital 

69.   A tethered health record allows patients to

   A. restructure insurance copayments.   B. use a secure portal to access their own records.   C. compare their health records to the records of patients with similar diagnoses.   D. amend the diagnoses listed in the health record. 

70.   A patient is diagnosed with lymphocytic lymphoma. Another patient is seen several weeks later and is diagnosed with histiocytic lymphoma. Both of these diagnoses are examples of _______ lymphoma.

   A. basic   B. Hodgkin’s   C. non-Hodgkin’s   D. Burkitt’s 

71.   A patient receives a blood glucose monitor. What HCPCS Level II code would be assigned?

   A. E0976   B. E0607   C. E0562   D. E4752 

72.   A good compliance program in the health care setting includes

   A. HHS surveillance.   B. regular tracking and monitoring of coding activities.   C. meetings with compliance officers.   D. regular audit consultations with trustees of the AAPC. 

73.   A patient with numerous symptoms is seen in the laboratory for a general health panel to gauge her overall physical well-being. What CPT code would be assigned for a general health panel?

   A. 80051   B. 82136   C. 84135   D. 80050 

74.   Code 71030-TC indicates a/an

   A. complete chest x-ray, four views, technical component only.   B. incomplete chest x-ray, two views, technical and professional component.   C. complete chest x-ray, two views, technical component only.   D. incomplete chest x-ray, three views, technical and professional component 

75.   If patients choose to obtain copies of their medical records, under the terms of HIPAA, providers can

   A. also fulfill requests for prescription data.   B. reschedule office visits to allow time to update medical records.   C. complete employee paperwork.   D. charge a reasonable fee for providing copies of those records. 

76.   A patient comes to the clinic complaining of fever, diarrhea, nausea, and vomiting. The patient is diagnosed with salmonella meningitis. What ICD-10-CM code would be assigned?

   A. A23.24   B. A02.21   C. A05.26   D. A07.21 

77.   A patient comes to the emergency room complaining of right knee pain. He states that he was playing baseball the previous evening and accidentally fell when sliding into first base. The physician obtains an expanded problem focused history and examination, as well as a two-view x-ray of the right knee. The physician reviews the x-ray, as well as the notes in the medical record, and renders a diagnosis of osteoarthritis of the knee. The physician performs a patellofemoral arthroplasty to repair the knee. What ICD-10-CM and CPT codes are assigned?

   A. 27477, M17.12   B. 27506-RT, N17.11   C. 27477-RT, D17.39   D. 27447-RT, M17.11 

78.   Provision of security against a hurt, loss, or damage with specific cash payments is called

   A. copayment.   B. protection.   C. indemnity.   D. secured loss. 

79.   HCPCS modifier –E2 indicates that the patient had a surgical procedure performed on the

   A. lower left eyelid.   B. upper left eyelid.   C. upper right eyelid.   D. lower right eyelid. 

80.   When is code 58120 assigned?

   A. The code is assigned for permanent pacemaker insertion.   B. The code has been deleted and cannot be assigned.   C. The code is assigned for a patient undergoing dilatation and curettage.   D. The code is assigned as an add-on code.  

81.   Epithelial tissue that secretes its products directly into the bloodstream is made of

   A. extracellular matrix.   B. endocrine gland cells.   C. endoplasmic reticulum.   D. columnar epithelial cells. 

82.   Which of the following modifiers would be assigned for a moribund patient?

   A. P4   B. P1   C. P5   D. P3 

83.   The anatomical location of the calyx is the

   A. spine.   B. brain.   C. arm.   D. kidney. 

84.   Which one of the following requirements is outlined in the guidelines established in HIPAA’s Privacy Rule?

   A. Hospital administrators must encrypt data within older data files.   B. Physicians must not disclose patient information to consulting physicians.   C. Patients must receive notice if their information will be used or disclosed to third parties.   D. Managers must secure medical records immediately following patient admission. 

85.   The I-10 helps coders classify patient

   A. morbidity and mortality.   B. management information.   C. evaluation files.   D. reimbursement data. 

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