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Question 1Coding and Classification Systems

In ICD-10-CM, what does the seventh character in a code such as S72.001A primarily convey?

  1. The severity of the condition
  2. The encounter type or episode of care Correct answer.
  3. The anatomical side of the body
  4. The external cause of injury

Explanation

Seventh characters in ICD-10-CM injury and obstetric codes capture the encounter episode, such as initial encounter, subsequent encounter, or sequela. They do not encode laterality, severity, or external cause, which are handled elsewhere.

Question 2Coding and Classification Systems

A coder needs to assign the ICD-10-CM code for a patient with diabetes mellitus who has developed diabetic chronic kidney disease. Which coding convention guides the combination of these conditions?

  1. Code each condition separately with no combination guidance
  2. Assign only the kidney disease code and omit the diabetes
  3. Assign only the diabetes code and omit the kidney disease
  4. Use a combination code that includes both diabetes and the kidney manifestation Correct answer.

Explanation

ICD-10-CM provides combination codes for diabetes with its associated manifestations, and the Alphabetic Index directs coders to a single code that captures both. Both the underlying diabetes and the manifestation are represented in that combination code rather than coded separately.

Question 3Coding and Classification Systems

In CPT, which section contains codes for procedures performed by physicians on the integumentary system?

  1. Category III codes
  2. The Pathology and Laboratory section
  3. The Surgery section Correct answer.
  4. The Medicine section

Explanation

CPT's Surgery section is organized by body system, beginning with the integumentary system, and contains procedure codes for those services. Category III codes are for emerging technology, while Medicine and Pathology sections cover non-surgical and laboratory services.

Question 4Coding and Classification Systems

A physician documents a procedure that is not described by any existing Category I CPT code and involves emerging technology. Which code series is most appropriate to report?

  1. Category III codes Correct answer.
  2. Category I codes
  3. Category II codes
  4. HCPCS Level II codes

Explanation

Category III codes are temporary codes for emerging technology, services, and procedures that lack a Category I code. Category II codes are for performance measurement, and HCPCS Level II covers supplies and non-physician services.

Question 5Coding and Classification Systems

In the ICD-10-CM Alphabetic Index, what does a semicolon in an entry indicate?

  1. The text following the semicolon is a required additional term Correct answer.
  2. The entry should not be used for reimbursement
  3. The entry is a non-essential modifier
  4. The code is a manifestation code only

Explanation

In the ICD-10-CM Alphabetic Index, a semicolon indicates that the terms following it are essential modifiers that further specify the condition. Coders must consider these qualifying terms when selecting the code.

Question 6Coding and Classification Systems

Which organization maintains and publishes the Healthcare Common Procedure Coding System (HCPCS) Level II code set?

  1. The World Health Organization
  2. The Centers for Medicare & Medicaid Services Correct answer.
  3. The National Center for Health Statistics
  4. The American Medical Association

Explanation

CMS maintains HCPCS Level II, which covers supplies, drugs, durable medical equipment, and services not represented in CPT. The AMA maintains CPT, WHO publishes ICD, and NCHS co-maintains ICD-10-CM with CMS.

Question 7Coding and Classification Systems

A patient is seen for a follow-up visit after an initial treatment of a fractured wrist. Which seventh character should be used for the injury code?

  1. S, sequela
  2. D, subsequent encounter Correct answer.
  3. A, initial encounter
  4. No seventh character is needed

Explanation

The seventh character D denotes a subsequent encounter, used for routine care during the healing or recovery phase after the initial treatment. Character A is for the initial encounter, and S is for late effects (sequelae).

Question 8Coding and Classification Systems

In CPT, what does an add-on code typically describe?

  1. A procedure that replaces the primary procedure
  2. A procedure performed only in an inpatient setting
  3. A procedure that cannot be billed with any other code
  4. A procedure performed in addition to a primary procedure Correct answer.

Explanation

Add-on codes describe additional services performed in conjunction with a primary procedure and are generally not reported alone. They are identified by a plus symbol in CPT and are exempt from multiple procedure reduction.

Question 9Coding and Classification Systems

What is the primary purpose of the ICD-10-CM Tabular List?

  1. To provide the numeric and alphanumeric codes with their full descriptions and notes Correct answer.
  2. To list only external cause codes
  3. To list procedures by body system
  4. To provide reimbursement amounts for each diagnosis

Explanation

The Tabular List presents codes in alphanumeric order with full descriptions, includes and excludes notes, and coding instructions. The Alphabetic Index is used first to locate codes, which are then verified in the Tabular List.

Question 10Coding and Classification Systems

A coder is assigning an ICD-10-CM code and finds an instruction reading 'code also' beneath a category. What does this instruction mean?

  1. The code should not be used with any other code
  2. The second condition is optional and may be omitted
  3. An additional code should be assigned to fully describe the condition Correct answer.
  4. The code requires a seventh character

Explanation

A 'code also' note indicates that an additional code is needed to provide a more complete picture of the condition, and both codes are reported. It signals a relationship between conditions rather than an optional add-on.

Question 11Coding and Classification Systems

Which coding system is used in the United States for inpatient hospital procedure reporting?

  1. CPT
  2. DSM-5
  3. ICD-10-PCS Correct answer.
  4. HCPCS Level II

Explanation

ICD-10-PCS is the procedure classification used for inpatient hospital reporting in the United States. CPT is used for outpatient and physician procedure reporting, and HCPCS Level II covers supplies and services.

Question 12Coding and Classification Systems

In ICD-10-PCS, the code is built from seven characters. What does the first character represent?

  1. The section of the classification Correct answer.
  2. The body system
  3. The approach used
  4. The root operation

Explanation

The first character of an ICD-10-PCS code identifies the section, such as Medical and Surgical, Obstetrics, or Imaging. Subsequent characters identify body system, root operation, body part, approach, device, and qualifier.

Question 13Coding and Classification Systems

A coder must select the ICD-10-PCS root operation for a procedure in which a surgeon removes the entire gallbladder. Which root operation applies?

  1. Excision
  2. Resection Correct answer.
  3. Extraction
  4. Drainage

Explanation

Resection is defined in ICD-10-PCS as cutting out or off, without replacement, all of a body part. Removing the entire gallbladder meets that definition, whereas excision removes only a portion.

Question 14Coding and Classification Systems

In the ICD-10-CM conventions, what does an 'Excludes1' note indicate?

  1. The two codes cannot be reported together because they are mutually exclusive Correct answer.
  2. The excluded condition is a manifestation of the listed condition
  3. The excluded code is optional and may be reported if desired
  4. The excluded code may be reported as an additional diagnosis

Explanation

An Excludes1 note means the excluded code cannot be used with the code it is listed under because the two conditions are mutually exclusive and cannot occur together. Excludes2, in contrast, permits reporting both codes when both conditions are present.

Question 15Coding and Classification Systems

A patient is diagnosed with both acute bronchitis and chronic obstructive pulmonary disease with acute exacerbation. Which coding approach aligns with ICD-10-CM guidelines?

  1. Code only the acute bronchitis
  2. Code both conditions if the guidelines permit reporting both Correct answer.
  3. Code only the COPD with acute exacerbation
  4. Code neither condition until further testing

Explanation

When a patient has multiple conditions that are separately documented and not mutually exclusive, both may be reported if guidelines permit. Excludes2 notes allow reporting both conditions when both are present, so the coder verifies the relationship in the Tabular List.

Question 16Coding and Classification Systems

In CPT, what does the term 'global surgical package' refer to?

  1. A modifier that increases payment for complex surgery
  2. The bundle of services included with a surgical procedure before and after the operation Correct answer.
  3. A single code covering multiple unrelated procedures
  4. A code used only for outpatient surgery

Explanation

The global surgical package bundles preoperative, intraoperative, and postoperative services into a single payment for the surgical procedure. Services included in the package are not separately reportable.

Question 17Coding and Classification Systems

Which of the following best describes a 'manifestation' in ICD-10-CM coding?

  1. A condition that results from another underlying condition Correct answer.
  2. A symptom that has no known cause
  3. An external cause of injury
  4. The underlying cause of a disease

Explanation

A manifestation is a condition that develops as a result of an underlying etiology, and coding rules generally require the etiology code first followed by the manifestation code. The manifestation code often appears as an 'in diseases classified elsewhere' code.

Question 18Coding and Classification Systems

In HCPCS Level II, which letter series is used for codes identifying durable medical equipment?

  1. A-codes
  2. E-codes Correct answer.
  3. L-codes
  4. J-codes

Explanation

HCPCS Level II E-codes identify durable medical equipment such as walkers and wheelchairs. A-codes cover transportation and miscellaneous supplies, J-codes cover drugs, and L-codes cover orthotics and prosthetics.

Question 19Coding and Classification Systems

What is the correct order of steps when assigning an ICD-10-CM diagnosis code?

  1. Consult the Tabular List first, then the Alphabetic Index
  2. Use only the Tabular List and skip the index
  3. Consult the Alphabetic Index first, then verify in the Tabular List Correct answer.
  4. Use only the Alphabetic Index and skip the Tabular List

Explanation

The standard coding process is to locate the term in the Alphabetic Index first, then verify the code in the Tabular List for specificity and instructions. The Tabular List verification step ensures notes and additional characters are applied correctly.

Question 20Coding and Classification Systems

In ICD-10-CM, what does the term 'laterality' refer to in code assignment?

  1. Whether the condition is acute or chronic
  2. The sequence in which codes are reported
  3. Which side of the body is affected Correct answer.
  4. Whether the condition is a primary or secondary diagnosis

Explanation

Laterality distinguishes the right side from the left side of the body and is captured by specific characters in many ICD-10-CM codes. Accurate laterality improves clinical specificity and supports appropriate reporting.

Question 21Coding and Classification Systems

A coder is reviewing a record where the physician documents 'rule out myocardial infarction.' According to outpatient coding guidelines, how should this be coded?

  1. Code as a confirmed myocardial infarction
  2. Code the myocardial infarction as probable
  3. Code the signs and symptoms that prompted the encounter Correct answer.
  4. Do not assign any code

Explanation

In outpatient settings, uncertain diagnoses such as 'rule out' or 'probable' are not coded as confirmed. Instead, the coder reports the signs and symptoms that prompted the encounter, such as chest pain.

Question 22Coding and Classification Systems

Which of the following is a characteristic of CPT Category II codes?

  1. They are used to report emerging technology procedures
  2. They are required for all Medicare claims
  3. They replace Category I codes when a procedure is bundled
  4. They are optional performance measurement tracking codes Correct answer.

Explanation

Category II codes are optional tracking codes used to support performance measurement and quality reporting. They do not replace Category I codes and are not used for emerging technology.

Question 23Coding and Classification Systems

In ICD-10-PCS, which root operation describes cutting into a body part without draining fluids and without removing the body part?

  1. Division
  2. Incision Correct answer.
  3. Release
  4. Drainage

Explanation

Incision is defined as cutting into a body part without draining fluids and without removing the body part. Drainage involves letting out fluids, Division cuts into or separates a body part, and Release frees a body part from constraint.

Question 24Coding and Classification Systems

What is the function of a CPT modifier?

  1. To indicate the patient's diagnosis
  2. To provide additional information about a service without changing its definition Correct answer.
  3. To replace the primary procedure code
  4. To convert a Category I code to a Category III code

Explanation

Modifiers add information that clarifies or adjusts a service, such as laterality, multiple procedures, or distinct services, without altering the code's fundamental definition. They support accurate reporting and payment.

Question 25Coding and Classification Systems

A coder is choosing between two similar ICD-10-CM codes and one includes a note stating 'use additional code for any associated condition.' What is the coder's obligation?

  1. Report the additional code only if it affects reimbursement
  2. Assign the additional code to fully capture associated conditions Correct answer.
  3. Choose the code without the note to avoid extra work
  4. Ignore the note because it is advisory only

Explanation

Notes directing the use of an additional code are instructional and require the coder to report the associated condition when documented. This ensures the coded data fully reflect the patient's clinical picture.

Question 26Coding and Classification Systems

Which coding system provides the classification used to report diagnoses on inpatient hospital claims in the United States?

  1. ICD-10-PCS
  2. CPT
  3. HCPCS Level II
  4. ICD-10-CM Correct answer.

Explanation

ICD-10-CM is the diagnosis classification used for reporting morbidity diagnoses in all U.S. healthcare settings, including inpatient claims. CPT and HCPCS Level II report services and supplies, and ICD-10-PCS reports inpatient procedures.

Question 27Coding and Classification Systems

In CPT, which section contains codes for laboratory tests such as a complete blood count?

  1. Radiology
  2. Medicine
  3. Pathology and Laboratory Correct answer.
  4. Evaluation and Management

Explanation

The Pathology and Laboratory section of CPT holds codes for laboratory and pathology services. Evaluation and Management covers visits, Medicine covers non-surgical services such as immunizations, and Radiology covers imaging.

Question 28Coding and Classification Systems

In ICD-10-CM, what does the placeholder character 'X' accomplish when it appears in a code?

  1. It holds a position so the code reaches the required length. Correct answer.
  2. It indicates the diagnosis is unconfirmed.
  3. It signals that the code is exempt from seventh-character requirements.
  4. It marks the code as a manifestation code.

Explanation

The letter X is used as a placeholder to maintain the required code length when a character position has no applicable value. It does not change the clinical meaning of the code.

Question 29Coding and Classification Systems

Which HCPCS Level II letter series is used for codes describing drugs administered other than by oral route?

  1. V codes
  2. J codes Correct answer.
  3. L codes
  4. E codes

Explanation

J codes in HCPCS Level II identify injectable and other non-oral drugs and biologicals. E codes cover durable medical equipment, L codes cover orthotics and prosthetics, and V codes cover vision and hearing items.

Question 30Coding and Classification Systems

Which of the following best describes a CPT Category III code?

  1. A code used only for inpatient hospital procedures
  2. A temporary code for emerging technology or services Correct answer.
  3. A code that replaces a deleted Category I code permanently
  4. A code used to report patient outcomes measures

Explanation

Category III codes are temporary tracking codes assigned to emerging technologies, services, and procedures until they meet criteria for Category I. They expire unless renewed and are not used for performance measurement.

Question 31Coding and Classification Systems

What is the purpose of the ICD-10-CM Alphabetic Index?

  1. To define the root operations used in procedure coding
  2. To serve as the starting point for locating a diagnosis code by main term Correct answer.
  3. To list codes by body system only
  4. To provide the official coding guidelines

Explanation

The Alphabetic Index is organized by main terms and is the first place a coder looks to identify a candidate diagnosis code, which is then verified in the Tabular List. Official guidelines are published separately, and root operations belong to ICD-10-PCS.

Question 32Coding and Classification Systems

In ICD-10-PCS, which character position identifies the body system involved in the procedure?

  1. Second Correct answer.
  2. Fifth
  3. Fourth
  4. Third

Explanation

The second character of an ICD-10-PCS code represents the body system. The first character is the section, the third is the root operation, and the fourth is the body part.

Question 33Coding and Classification Systems

Which organization develops and maintains the CPT code set?

  1. American Medical Association Correct answer.
  2. World Health Organization
  3. Centers for Medicare & Medicaid Services
  4. National Center for Health Statistics

Explanation

CPT is owned and maintained by the American Medical Association. CMS administers HCPCS Level II and payment policy, WHO publishes ICD, and NCHS co-maintains ICD-10-CM with CMS.

Question 34Coding and Classification Systems

A coder is selecting a code from the ICD-10-CM Tabular List and encounters the word 'and' in a code title. How should the coder interpret it?

  1. It means only the first condition listed is coded.
  2. It means 'and/or' when the code title describes a combination. Correct answer.
  3. It requires documentation of both conditions before coding.
  4. It means the code is invalid as written.

Explanation

In ICD-10-CM code titles, 'and' means 'and/or' unless the code title or an instructional note specifies otherwise. The coder need not require documentation of both conditions.

Question 35Coding and Classification Systems

A physician documents a bilateral procedure. In CPT, which modifier is applied to indicate that the service was performed on both sides?

  1. Modifier 50 Correct answer.
  2. Modifier 26
  3. Modifier 59
  4. Modifier 51

Explanation

Modifier 50 identifies a bilateral procedure performed on both sides during the same operative session. Modifier 51 indicates multiple procedures, 26 identifies the professional component, and 59 indicates a distinct procedural service.

Question 36Coding and Classification Systems

A coder is assigning an ICD-10-CM code for a condition and finds a 'code first' note beneath the code. What does this instruction require?

  1. The underlying condition is sequenced before the code bearing the note. Correct answer.
  2. The code bearing the note is sequenced first.
  3. The code is reported only on inpatient claims.
  4. An additional code is optional.

Explanation

A 'code first' note indicates that the underlying etiology or cause must be sequenced before the code carrying the note. It is used with codes that are not themselves the primary reason for the encounter.

Question 37Coding and Classification Systems

In ICD-10-PCS, which root operation is used when a physician takes out a small sample of tissue for examination without removing the entire body part?

  1. Resection
  2. Drainage
  3. Excision
  4. Biopsy Correct answer.

Explanation

Biopsy is the root operation for removing a sample of tissue for diagnostic examination. Excision removes a portion of a body part, drainage removes fluid, and resection removes the entire body part.

Question 38Coding and Classification Systems

A coder reports a procedure that includes both a professional and technical component. Which modifier identifies only the professional component?

  1. Modifier 51
  2. Modifier TC
  3. Modifier 26 Correct answer.
  4. Modifier 22

Explanation

Modifier 26 identifies the professional component of a diagnostic or therapeutic service. Modifier TC identifies the technical component, 51 indicates multiple procedures, and 22 indicates increased procedural services.

Question 39Coding and Classification Systems

A coder is coding an ICD-10-CM diagnosis and the code requires a seventh character. What does the seventh character typically convey?

  1. The encounter type or episode of care Correct answer.
  2. The body system involved
  3. The laterality of the condition
  4. The severity of the condition

Explanation

The seventh character in ICD-10-CM codes typically identifies the encounter type, such as initial encounter, subsequent encounter, or sequela. Laterality and severity are conveyed by other characters.

Question 40Coding and Classification Systems

In HCPCS Level II, which code range is used to identify orthotic and prosthetic devices?

  1. A codes
  2. L codes Correct answer.
  3. E codes
  4. C codes

Explanation

L codes in HCPCS Level II identify orthotic and prosthetic procedures and devices. A codes cover transportation and miscellaneous supplies, E codes cover durable medical equipment, and C codes cover outpatient prospective payment system items.

Question 41Coding and Classification Systems

A coder is assigning a CPT code for a service and finds that the code is marked with a '+' symbol. What does this symbol indicate?

  1. The code is exempt from modifier use.
  2. The code is a temporary code for emerging technology.
  3. The code is an add-on code reported in addition to a primary procedure. Correct answer.
  4. The code is a Category II performance measure.

Explanation

A '+' symbol identifies an add-on code that must be reported in addition to a primary procedure and is never reported alone. Temporary codes are shown in Category III, and performance measures are Category II.

Question 42Coding and Classification Systems

A coder is selecting an ICD-10-CM code and finds an 'Excludes2' note beneath a category. What does this note indicate?

  1. The excluded condition must be sequenced first.
  2. The excluded condition is not part of the condition represented and may be reported separately. Correct answer.
  3. The excluded condition is a manifestation of the coded condition.
  4. The excluded condition cannot be reported with the code.

Explanation

An Excludes2 note indicates that the excluded condition is not included in the code's definition but may be reported separately when present. In contrast, Excludes1 means the two conditions cannot be coded together.

Question 43Coding and Classification Systems

In ICD-10-PCS, which character position identifies the approach used to reach the procedure site?

  1. Fourth
  2. Sixth
  3. Fifth Correct answer.
  4. Third

Explanation

The fifth character of an ICD-10-PCS code identifies the approach, such as open, percutaneous, or percutaneous endoscopic. The third character is the root operation, the fourth is the body part, and the sixth is the device.

Question 44Coding and Classification Systems

A patient presents for an initial visit for a condition that later requires a subsequent encounter for the same condition. Which seventh-character value in ICD-10-CM typically identifies the subsequent encounter?

  1. D Correct answer.
  2. B
  3. S
  4. A

Explanation

In many ICD-10-CM code families, the seventh character D designates a subsequent encounter for routine care during the healing phase. A denotes an initial encounter, S denotes a sequela, and B is not a standard seventh-character value.

Question 45Coding and Classification Systems

A coder is reviewing an operative report and must decide between two ICD-10-PCS root operations. The surgeon removed a portion of the liver but not the entire organ. Which root operation applies?

  1. Release
  2. Resection
  3. Extraction
  4. Excision Correct answer.

Explanation

Excision is the root operation for cutting out or off a portion of a body part without removing the entire structure. Resection would require removal of the entire body part.

Question 46Coding and Classification Systems

Which of the following is the correct use of the ICD-10-CM official guidelines for outpatient coding when a diagnosis is documented as 'probable'?

  1. Code the probable condition as confirmed.
  2. Do not code the probable condition; code the symptoms instead. Correct answer.
  3. Assign a code from the signs and symptoms chapter only.
  4. Code the condition as if it exists for inpatient reporting only.

Explanation

In outpatient coding, a condition documented as probable, suspected, or rule out is not coded as confirmed. The coder reports the signs and symptoms that prompted the encounter instead.

Question 47Coding and Classification Systems

A coder needs to report a CPT code for a procedure that has been deleted from the current CPT code set. Which action is most appropriate?

  1. Report the deleted code until the payer updates its system.
  2. Use the replacement code identified in CPT or the payer guidance. Correct answer.
  3. Report the deleted code with modifier 59.
  4. Report an unlisted procedure code without further documentation.

Explanation

When a code is deleted, CPT identifies a replacement or crosswalk code, and the coder should use the replacement code as directed by CPT and payer guidance. Deleted codes are not reported after their effective deletion date.

Question 48Coding and Classification Systems

In ICD-10-CM, a coder is assigning a code that requires both an etiology code and a manifestation code. According to the conventions, which code is sequenced first?

  1. The code with the lowest numeric value
  2. The etiology code Correct answer.
  3. The manifestation code
  4. Either code, depending on payer preference

Explanation

In an etiology/manifestation pair, the etiology (underlying cause) code is sequenced first, followed by the manifestation code. The manifestation code is typically in italics in the Tabular List.

Question 49Coding and Classification Systems

A coder is assigning an ICD-10-PCS code and must identify the qualifier character. What does the qualifier character represent?

  1. The anesthesia type used during the procedure
  2. The device left in place after the procedure
  3. The body system involved in the procedure
  4. A distinct attribute of the procedure, such as a diagnostic or drainage qualifier Correct answer.

Explanation

The seventh character of an ICD-10-PCS code is the qualifier, which specifies a distinct attribute of the procedure such as whether it was diagnostic or involved drainage. Device is the sixth character, and body system is the second.

Question 50Coding and Classification Systems

A coder is reviewing a record in which the physician documents a condition that is an integral part of a surgical procedure. Under CPT guidelines, how should the condition be reported?

  1. Report the condition with modifier 51.
  2. Report the condition separately with modifier 59.
  3. Report the condition only if it is the primary reason for the encounter.
  4. Do not report the condition separately because it is integral to the procedure. Correct answer.

Explanation

Conditions that are integral to a surgical procedure are not reported separately because they are part of the procedure's global package. Reporting them separately would constitute unbundling.