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2023 Edition

Medical Coder Practice Test

Try this free AAPC CPC medical coding practice test to see what's on a certification exam for medical coders. The test is also applicable to the AHIMA CCA medical coding exam

Certification as a medical coder demonstrates one's knowledge and skill in the field of medical coding and can help one get a job as a medical coder and earn more in pay. The American Academy of Professional Coders (AAPC) and AHIMA provide training and credentialling for medical coders across the United States. After passing the AAPC medical coding exam, a medical coder earns the Certified Professional Coder (CPC) credential and after passing the AHIMA medical coding exam, the medical coder earns the Certified Coding Associate (CCA) credential. The medical coder exam must be passed to earn certificaiton. The AAPC medical coding exam has 100 multiple choice questions and four hours is given to complete the exam. The AHIMA exam has between 90 and 115 questions and must be completed in two hours.

For a comprehensive practice test, covering both the AAPC CPC exam and the AHIMA CCA exam, use our Medical Coding Practice Test.

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Clinical Classification Systems

1.	A patient presents with CKD stage III, edema and hypertension. The correct ICD-10 CM codes for this chart are:
		a. N18.3, I10, R60.9
		b. N18.9, I10, R60.9
		c. N18.3, I12.9
		d. N18.9, I12.9, R60.9
Per ICD-10CM guidelines do not code signs and symptoms. Edema is a symptom of both hypertension and CKD. ICD-10CM guidelines state there is a casual relationship assumed between CKD and hypertension unless the provider specifically states that the hypertension is not related to the CKD, giving this patient hypertensive chronic kidney disease instead of regular hypertension. Incorrect answer. Please choose another answer.

2.	A 42-year-old female, who is a new patient, presents with foul-smelling urine, frequency, flank pain and fever for 4 days. Patient denies nausea and headache. Patient is not sexually active and is a non-smoker. The provider performs the following exam in addition to patient's height, weight and blood pressure check: General: Well-developed, well nourished, in no acute distress Ears: external ears normal, TM bilaterally intact Neck: Supple, no thyromegaly Extremities: No edema Cardiovascular: RRR, no bruits Lungs: Clear to auscultation The patient is prescribed ciprofloxacin and given a diagnosis of acute cystitis without hematuria. The correct coding for this encounter, using 1997 E/M guidelines is:
		a. 99202, N30.00
		b. 99203, N30.00, R30.0
		c. 99202, N39.0
		d. 99203, N39.0, R30.0
1997 E/M guidelines state that the provider must reach 12 bullet points for a detailed level of exam. Although the patient's chart has a detailed history and moderate medical decision making, the provider only reached 11 bullet points, making this level a 99202. N39.0 is not the most specific code for this chart. Incorrect answer. Please choose another answer.

3.	A patient presents with a cyst at the base of his tailbone. It is swollen and painful for the patient to sit down. The provider drapes the patient in the usual fashion, administers lidocaine and uses a scalpel to excise the 2cm cyst and a subcutaneous extension, rinses it with sterile saline, performs an intermediate repair of the wound with a layered closure. The correct CPT code assignment for this procedure is:
		a. 10080, 12001-59
		b. 10081
		c. 11771
		d. 11770, 12031-59
The provider performs an excision, not an incision, completely removing the cyst. The excision is intermediate because it involves subcutaneous extensions and the repair is included with the procedure. Incorrect answer. Please choose another answer.

4.	A 7-year-old child presents for a series of vaccines. The patient receives MMR and DTaP and counseling on vaccines. The correct CPT code assignment for this procedure is:
		a. 90460, 90461
		b. 90471, 90472
		c. 90460, 90461x5
		d. 90460x2, 90461x4
Pediatric vaccines with counseling are coded per component. Each first component of a vaccine (Measles and Diphtheria in this case) are coded as one unit of 90460. Each additional component to the vaccine (mumps, rubella, tetanus and acellular pertussis) receive another 90461 for an additional component code. Incorrect answer. Please choose another answer.

5.	ICD-10 codes are used:
		a. as procedure codes
		b. in DRGs
		c. as diagnosis codes
		d. All of the above
ICD-10 PCS are used as procedure codes for inpatient visits. DRGs use similar ICD-10CM weights for facility reimbursement and ICD-10CM are used as diagnosis codes for all healthcare settings. Incorrect answer. Please choose another answer.

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6.	For urosepsis, a coder must:
		a. Use the code for severe sepsis
		b. Use the code for sepsis with organ dysfunction
		c. Query the provider
		d. Code first localized sepsis
According to ICD-10CM guidelines, urosepsis is a nonspecific term and has no tabular position. The provider must be queried for clarification. Incorrect answer. Please choose another answer.

7.	A patient comes into the office with white fuzzy patches on their tongue and is diagnosed with oral hairy leukoplakia. The provider runs a test for HIV and notates that the patient has HIV in the chart, but does not have a positive lab test yet. The patient is a smoker. What is the correct sequencing of these ICD-10 codes?
		a. B20, K13.3, F17.200
		b. K13.3, R75, Z87.891
		c. B20, K13.3, Z87.891
		d. K13.3, Z21, F17.200
According to chapter guidelines, if a patient is seen for an HIV-related condition, (which oral hairy leukoplakia is), then B20 is coded first, then the complications. Only the provider's statement is needed that the patient has HIV, not a positive lab test. F17.200 is to be assigned when the provider documents "smoker", but gives no further clarification (AHA: 2016, 1Q, 36) Incorrect answer. Please choose another answer.

8.	A 25-year-old patient is 27 weeks and 6 days pregnant. The patient is experiencing dysuria and blood in her urine. She is diagnosed with acute cystitis. What is the correct coding of this patient's chart?
		a. N30.01, Z33.1
		b. O23.32, N39.0, Z3A.27
		c. O23.12, N30.01, Z3A.27
		d. N30.00, Z33.1
Cystitis is an infection of the bladder. The provider must specifically state that the infection or condition is not affecting the pregnancy for an incidental code. The patient is experiencing blood in her urine, which gives us the hematuria portion of the diagnosis. Incorrect answer. Please choose another answer.

9.	A patient comes in after her pressure cooker has exploded and covered her face with boiling soup. She was luckily wearing a sweater which protected her arms. She has partial-thickness burns covering her entire face. What is the correct CPT code to be assigned as the hospital removes chicken, celery and burnt tissue from her face and places dressings on it?
		a. 16020, 97597-59
		b. 11011
		c. 16025
		d. 97597
16025 covers whole face burns and includes debridement. Incorrect answer. Please choose another answer.

10.	A 2-year-old child had their humerus fractured by a falling dresser and requires anesthesia to repair the break because they will not hold still for a reduction. The procedure billed is 24505. What anesthesia service is reported?
		a. 01730 P1
		b. 01742 P1, 99100
		c. 01744 P1
		d. 01756 P1, 99100
Anesthesia for all closed procedures on humerus and elbow. The 99100 code is only used for patients under 1 year old or over 70 years old. 01744 is for open procedures, not closed. Incorrect answer. Please choose another answer.

Confidentiality and Privacy

11.	The Breach Notification Rule, found in the ______ Rule of HIPAA, states that when _____ individuals have had their confidential data exposed and the covered entity has outdated contact information for them, that the covered entity must_____ for ______ days.
		a. Security Rule, less than 200 individuals but more than 5, post a notice in the newspaper for 180 days
		b. Omnibus Rule, less than 500 individuals but more than 10, post a notice on their website for 90 days
		c. Security Rule, 500 or more individuals, post a notice on their website and create a radio ad for 60 days
		d. Privacy Rule, 5 or more individuals, post a notice on their website, in the lobby and send postcards with information at least 3 times over 90 days.
The Omnibus Rule established HITECH and the AARA of 2009 and finalized the Breach Notification Rule, mandating that covered entities who have more than 10 individuals with outdated contact information involved in a data breach must be notified by posting a notice on their website or creating a local ad in the newspaper. For breaches over 500 individuals, major news outlets must be contacted and the Secretary of HHS immediately. Incorrect answer. Please choose another answer.

12.	Sally calls the coding department to contest the duplicate procedures that her adult sister received while admitted to an inpatient mental health facility. Sally has her sister's date of birth, her name but not her ID number. She says her sister is too depressed to advocate for herself and Sally just wants the charges reviewed. What do you do?
		a. Tell Sally you'll review her sister's chart while she was hospitalized and process a corrected claim if needed.
		b. Tell Sally you're sorry, but her sister must call when she gets out of the hospital, HIPAA does not allow you to speak to Sally without her sister's written consent.
		c. Tell Sally her sister's patient ID number so she can better advocate for her sister in other departments
		d. Tell Sally that according to HIPAA she must obtain her sister's written consent in order to discuss any protected health information with her and give her the fax number where she can send the written release.
HIPAA Privacy Rule Section 164.510(b)(3) allows providers to discuss PHI with family members if they determine it is in the patient's best interest for coordination of treatment or payment, unless the patient has expressed wishes that their information is not shared with family. Incorrect answer. Please choose another answer.

13.	You need a second opinion on coding a chart from your Coding Manager, who does not have access to the patient's records. You decide to e-mail a screenshot of the chart to the Coding Manager. What steps must you take to ensure that the patient's data is protected in your email?
		a. Create a confidentiality notice in your email, asking an unintended recipient to delete the information
		b. Follow all company guidelines to encrypt your email
		c. Remove patient's name, date of birth, insurance ID#, SSN, address and patient number before emailing
		d. All of the above
HIPAA HITECH requires that covered entities take reasonable action to protect electronically transmitted information. Removing protected health information, encrypting email and creating confidentiality notices are a multi-layered security approach that is best-practice to prevent breaches of data. Incorrect answer. Please choose another answer.

Reimbursement Methodologies

14.	Facility payments are based on:
		a. Fee schedules
		b. ICD-10 PCS codes
		c. IPPS using DRGs
		d. RVUs and conversion factors
The Inpatient Prospective Payment System drives value-based care by paying inpatient stays based on DRGs (Diagnosis-Related Group(s)) which are groups of diagnoses with similar weights in order to determine "how much" a patient's stay ought to cost. These drivers force hospitals to work to be most efficient in their use of resources to come in under what they will be paid in order to avoid losing money. Incorrect answer. Please choose another answer.

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15.	Conversion factors:
		a. Are based on how difficult a procedure is
		b. Depend on the level of education a provider has
		c. Are based on locality
		d. None of the above
RVUs are based off work for each HCPCS. RVUs are multiplied by Geographic Practice Cost Indices (GPCI), which account for physician work, cost of malpractice and practice expenses. A conversion factor, which is a national number that changes annually, is multiplied by the sum of RVUs that are multiplied by the GPCI to calculate payment for professional fee schedules. Incorrect answer. Please choose another answer.

16.	Pressure ulcers, catheter-associated urinary tract infections, falls and head trauma, DVTs and pulmonary embolisms are all examples of:
		a. DRGs that should have a POA indicator
		b. Hospital-acquired conditions that will not be reimbursed
		c. Part of similar weight DRGs
		d. Complications that must be coded to receive full reimbursement
The HAC-POA (Hospital acquired condition, present on admission) program was created by the Deficit Reduction Act of 2005--any of these conditions which are not present on admission and could have reasonably been prevented by following accepted standards of care will not be reimbursed. Usually, adding the DRG weight would have increased the facility's reimbursement, but this forces hospitals to avoid hospital acquired conditions, rather than profit from them. Incorrect answer. Please choose another answer.

17.	Relative Value Units are:
		a. Different for each locality
		b. A weight for procedure codes
		c. Multiplied with conversion factors
		d. All of the above
RVUs multiplied by conversion factor gives you the amount payable for a provider's fee schedule. Incorrect answer. Please choose another answer.

18.	Medicare pays Skilled Nursing Facilities with a prospective payment system. Reimbursement is based on:
		a. Reasonable costs
		b. Per Diem
		c. Based on DRGs
		d. Episode of care
The Balanced Budget Act mandated that SNF-PPS be paid per diem for all costs, which is based on a case-mix of diagnoses. Incorrect answer. Please choose another answer.

19.	For Medicare's OPPS, payment status indicator C indicates that the HCPCS is:
		a. More complicated than usual, requiring increased reimbursement
		b. Part of a series of concurrent procedures that will be performed together
		c. Only performed in inpatient settings
		d. Performed by the Chief surgeon, requiring increased reimbursement.
Payment status indicator C indicates that the HCPCS is only performed in an in-patient setting. Incorrect answer. Please choose another answer.

Health Records and Data Content

20.	CMS requires that the patient's history and physical be completed and documented in the patient's record
		a. Within 24 hours of admission or not greater than 30 days before admission
		b. Immediately upon admission or not greater than 10 days before admission
		c. Within 6 hours of admission or not greater than 15 days before admission
		d. Within 3 hours of admission or not greater than 3 days before admission
CMS conditions of participation require that the patient's history and physical be completed and documented within the patient's record within 24 hours of admission, but not greater than 30 days prior to admission. Incorrect answer. Please choose another answer.

21.	These components create a patient's history:
		a. Reason for Visit, History of Present Illness, Review of Symptoms, Prior History
		b. Chief Complaint, History of Present Illness, Review of Systems, Past Family and Social History
		c. Chronic conditions, History of Present Illness, Review of Symptoms, Reason for Visit, Surgical history
		d. Chief Complaint, History of Present Illness, Review of Symptoms, Past Family and Social History
CC, HPI, ROS and PFSH are the components of a patient history. ROS is performed to make sure the provider did not miss any relevant complaints and can be pulled from the HPI if needed. Incorrect answer. Please choose another answer.

22.	According to CMS, the provider's final authentication of the patient's health record must NOT be by:
		a. Rubber stamp
		b. Electronic signature verified by biometrics
		c. Electronic signature verified by passcodes
		d. Ink signatures in black ink
Rubber stamps were prohibited by CMS in 2015 for provider authentication Incorrect answer. Please choose another answer.

23.	An open-record review is when:
		a. The patient's record, with PHI removed, is presented at a clinical documentation improvement session for providers
		b. The patient's record is sent to CMS to be audited
		c. When a qualitative analysis of the patient's record is done while the patient is in active treatment
		d. When the patient is given a copy of their chart to ensure everything was documented accurately to the best of their knowledge
An open-record review takes place when a qualitative analysis of the patient's record is done while the patient is in active treatment. The Joint Commission requires these reviews to ensure that documentation standards are met while the patient is still under care. Incorrect answer. Please choose another answer.

24.	Which of the following is NOT a component of Personal Health Information
		a. URL
		b. Zip Code
		c. License plate number
		d. All of the above are PHI elements
There are 18 unique identifiers protected by HIPAA. Only the first 3 digits of a patient's zip code is not PHI, as long as there are more than 20,000 people in the group that forms all zip codes. E.g. 123XX+123XY+123XZ have more than 20,000 people. Otherwise the zip code must be changed to 00000. Incorrect answer. Please choose another answer.

Information Technologies

25.	What is the difference between an EHR and an EMR?
		a. EHRs contain financial information while EMRs only contain clinical information.
		b. EHRs are able to communicate with other systems, but EMRs are not.
		c. EHRs contain images, while EMRs only contained electronic "paper" chart formats.
		d. There is no difference between EHRs and EMRs. It's just a terminology difference.
EHRs are defined by NAHIT as able to communicate and exchange data with multiple systems. EMRs do not have this capacity. Incorrect answer. Please choose another answer.

26.	Which of the following standards are used to create standardized nomenclature within an electronic health record program?
		a. ICD-10 CM
		b. NADA PC
		c. CTNS EHR
		d. SNOMED CT
Systemized Nomenclature of Medicine--Clinical Terminology (SNOMED CT) is the global standard for clinicians and is used to define terms in EHRs around the world. Incorrect answer. Please choose another answer.

27.	Implemented in 2012, what standard changed the way that PHI was submitted electronically?
		a. ASC X12 5010
		b. HL7 4010
		c. SDLC 6040
		d. HIPAA 2020
Under Administrative Simplification, HIPAA standard 5010, using ASC X12, was created and implemented. HIPAA standard 4010 was no longer accepted as of June 30, 2012 Incorrect answer. Please choose another answer.

Compliance

28.	You work at a billing company, coding charts for clients. Your manager sends out claims that have not been coded professionally because your team is 2 months behind and out of compliance with your service line agreement in the contract with your client, but says that it is okay because the provider has coded the claims at the time of service and the client does not want to pay for extra coding. Which of the following statements is true?
		a. This is fine because the provider coded the claim to the best of their ability and therefore cannot be held liable.
		b. Billing companies have liability for fraudulent claims that they submit, including undercoding, so this is not acceptable.
		c. Only overcoding is fraudulent, so this is acceptable.
		d. The providers mostly under-code their services, so it's really saving the insurance money and saving us work!
The OIG states that billing companies who submit fraudulent claims (as well as the person who submitted them!) are just as responsible as the provider who rendered the services. Both undercoding and overcoding are examples of fraudulent claims, the claim submitted must accurately represent the services rendered. Incorrect answer. Please choose another answer.

29.	Which of the following are considered fraudulent:
		a. Use of modifier -59 to report a distinct and separate service that would otherwise be prohibited by NCCI guidelines.
		b. Changing the code on a claim because the provider did not meet documentation standards.
		c. Use of modifier -25 on a minor evaluation and management service that is coded with a related procedure.
		d. All of the above are acceptable practices.
Procedures include a minor evaluation and management service. If the patient complains of an abscess and a I&D is performed, only the procedure should be reported. If the patient comes in complaining of hypertension and an abscess is discovered, then it would be acceptable to report an evaluation and management service. Incorrect answer. Please choose another answer.

30.	Which of the following is an example of a compliant query to a physician:
		a. 06/30: Dr. Brown, can you add documentation for the procedure you did on for Mrs. Parks 5/22? We've billed it out but I'm worried that there isn't enough documentation to support it. We know you did the procedure, but just need a little something extra!
		b. 6/30: Dr. Brown, can you clarify in the patient's chart Mrs. Cramb's diagnosis for 6/27 given the positive rapid strep test that was uploaded?
		c. 6/30 Dr. Pepper, can you add acute sinusitis (if that's what he had!) to Mr. Meltzer's record--all we have is nasal congestion, headache and malaise and I see you prescribed him antibiotics. Thanks!
		d. 6/30 Dr. Pepper, I see that you gave Mr. Evans a diagnosis of unspecified loss of kidney function, but we would get paid a bit more if it were Chronic Kidney Disease, would that be an appropriate diagnosis to code for this patient?
Physician queries must be non-leading, not based on reimbursement, for the purpose of improving patient care and open-ended, or Yes/No questions. Providers must not add documentation solely for the purpose of being reimbursed and it must be within a reasonable time frame. Incorrect answer. Please choose another answer.

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