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AMCA BCSC practice questions

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Question 1Medical Coding

Which code set is used to report diagnoses on a medical claim in the United States?

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

Explanation

ICD-10-CM is the diagnosis code set used for outpatient and physician reporting. CPT and HCPCS Level II describe procedures, supplies, and services. ICD-10-PCS is an inpatient procedure code set.

Question 2Medical Coding

In medical coding, what does the abbreviation CPT stand for?

  1. Current Procedural Terminology Correct answer.
  2. Certified Physician Treatment
  3. Coded Procedure Table
  4. Clinical Procedure Terminology

Explanation

CPT stands for Current Procedural Terminology and is maintained by the American Medical Association. It is used to report medical services and procedures.

Question 3Medical Coding

A coder is selecting an ICD-10-CM code and the alphabetic index entry is followed by a closed bracket containing another code. What does the bracketed code represent?

  1. A code requiring a fourth character
  2. A code that must never be reported
  3. An alternate code for the same condition
  4. A manifestation code to be sequenced second Correct answer.

Explanation

In the ICD-10-CM index, a code in brackets is a manifestation code that is reported in addition to the underlying condition code. The manifestation code is typically sequenced after the etiology code.

Question 4Medical Coding

Which type of code is reported for durable medical equipment such as a walker provided to a patient?

  1. HCPCS Level II Correct answer.
  2. CPT Category III
  3. ICD-10-PCS
  4. CPT Category I

Explanation

HCPCS Level II codes begin with a letter and cover supplies, equipment, and drugs, including durable medical equipment. CPT Category I codes are five-digit numeric procedure codes.

Question 5Medical Coding

A claim is submitted with a diagnosis code that has an unspecified seventh character where a more specific option existed in the medical record. What coding principle has been violated?

  1. The principle of sequencing by organ system
  2. The principle of using only the primary diagnosis
  3. The principle of reporting the highest level of specificity Correct answer.
  4. The principle of coding only confirmed conditions

Explanation

Coders must assign the most specific code supported by documentation, including the highest number of characters available. Choosing an unspecified code when documentation supports specificity is a coding error.

Question 6Medical Coding

What is the purpose of the ICD-10-CM Official Guidelines for Coding and Reporting?

  1. To define hospital licensure standards
  2. To list every CPT modifier
  3. To set physician payment rates
  4. To provide rules for selecting and sequencing diagnosis codes Correct answer.

Explanation

The official guidelines provide the conventions and rules for assigning and sequencing ICD-10-CM diagnosis codes. They do not set payment rates or procedure modifiers.

Question 7Medical Coding

Which organization maintains and publishes the CPT code set?

  1. CMS
  2. The Joint Commission
  3. The American Medical Association Correct answer.
  4. The World Health Organization

Explanation

The American Medical Association owns and maintains CPT. CMS adopts CPT for Medicare reporting but does not publish it.

Question 8Medical Coding

A CPT code descriptor includes the term 'separate procedure.' What does this designation generally indicate?

  1. The service is normally part of a larger procedure and not separately reported when performed with it Correct answer.
  2. The service is always payable with any other code
  3. The service is restricted to inpatient settings
  4. The service must be performed bilaterally

Explanation

A 'separate procedure' designation means the service is usually bundled with a more comprehensive procedure in the same area. It is not reported separately when performed as part of that larger service.

Question 9Medical Coding

Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?

  1. -LT Correct answer.
  2. -RT
  3. -50
  4. -59

Explanation

Modifier LT designates the left side of the body. Modifier RT designates the right side, and modifier 50 is used for bilateral procedures.

Question 10Medical Coding

A physician performs a procedure that is discontinued before completion because the patient experienced a reaction to anesthesia. Which modifier should be reported?

  1. -53 Correct answer.
  2. -26
  3. -22
  4. -52

Explanation

Modifier 53 is used when a procedure is discontinued due to extenuating circumstances or a threat to the patient's well-being. Modifier 52 is for reduced services without such circumstances.

Question 11Medical Coding

What does appending modifier 26 to a CPT code indicate?

  1. The professional component of a service was provided Correct answer.
  2. The service was performed in an emergency department
  3. The technical component of a service was provided
  4. The service was performed bilaterally

Explanation

Modifier 26 identifies the professional component of a service that has both professional and technical parts, such as interpretation of a diagnostic test. The technical component is reported with modifier TC.

Question 12Medical Coding

In the CPT surgery section, codes are generally organized according to which structure?

  1. By patient age group
  2. Alphabetically by procedure name
  3. By anatomic site within body systems Correct answer.
  4. By insurance payer type

Explanation

Surgical CPT codes are arranged by body system and then by anatomic site, with related procedures grouped together. This structure guides coders to the correct section.

Question 13Medical Coding

A coder reviews a record where the physician documents 'probable pneumonia' but no confirmatory testing is performed. How should this be coded in an outpatient setting?

  1. Code pneumonia and an uncertainty modifier
  2. Code pneumonia with a query flag
  3. Do not code pneumonia; code only signs and symptoms Correct answer.
  4. Code pneumonia as confirmed

Explanation

In outpatient settings, uncertain diagnoses such as 'probable' or 'rule out' are not coded as confirmed. The coder reports the presenting signs and symptoms that prompted the visit instead.

Question 14Medical Coding

Which of the following best describes a 'first-listed' diagnosis on an outpatient claim?

  1. The most severe condition regardless of reason for visit
  2. The condition listed first in the alphabetic index
  3. The chronic condition with the longest history
  4. The condition chiefly responsible for the services provided Correct answer.

Explanation

The first-listed diagnosis is the condition chiefly responsible for the encounter or services provided. Severity or chronicity does not determine first-listed status.

Question 15Medical Coding

What is the primary purpose of the National Correct Coding Initiative (NCCI) edits?

  1. To assign diagnosis codes to procedures
  2. To credential providers for Medicare
  3. To set the fee schedule for each CPT code
  4. To prevent improper payment for code pairs that should not be billed together Correct answer.

Explanation

NCCI edits identify code combinations that are typically not payable together, preventing improper unbundling. They support correct coding rather than setting fees.

Question 16Medical Coding

A provider performs two procedures on the same day that are subject to an NCCI procedure-to-procedure edit with a modifier indicator of 1. What does this indicator allow?

  1. A modifier may be used to bypass the edit when the services are distinct Correct answer.
  2. The codes can never be billed together
  3. The claim must be split across two dates of service
  4. The second procedure is automatically paid at 100 percent

Explanation

A modifier indicator of 1 means the edit can be overridden with an appropriate modifier when documentation supports distinct services. An indicator of 0 means no modifier will bypass the edit.

Question 17Medical Coding

Which term describes the process of assigning codes to a patient's medical record after reviewing documentation?

  1. Charge capture
  2. Coding Correct answer.
  3. Reimbursement
  4. Credentialing

Explanation

Coding is the process of translating documented diagnoses and procedures into standardized codes. Charge capture and reimbursement are separate revenue cycle functions.

Question 18Medical Coding

A physician documents a laceration repair of 2.5 cm on the forearm requiring layered closure. Which factor most directly determines the correct CPT code selection?

  1. The patient's age
  2. The length of the wound and type of repair Correct answer.
  3. The time of day the service was performed
  4. The payer's fee schedule

Explanation

Repair codes are selected by anatomic site, wound length, and complexity of repair such as simple, intermediate, or complex. Age and time of day do not determine repair code selection.

Question 19Medical Coding

What does the abbreviation E/M stand for in CPT coding?

  1. Emergency Management
  2. External Monitoring
  3. Evaluation and Management Correct answer.
  4. Extended Measurement

Explanation

E/M stands for Evaluation and Management, the CPT section covering office visits, hospital visits, and other cognitive services.

Question 20Medical Coding

A coder is assigning an E/M level for an office visit and must consider three key components when documentation supports them. Which set correctly identifies the traditional key components?

  1. Chief complaint, referral, and authorization
  2. Time, place of service, and payer
  3. History, examination, and medical decision making Correct answer.
  4. Diagnosis, procedure, and modifier

Explanation

The traditional key components of E/M level selection are history, examination, and medical decision making. Time may be used as a controlling factor when applicable.

Question 21Medical Coding

Which code set would a hospital use to report an inpatient surgical procedure for a facility claim?

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

Explanation

ICD-10-PCS is used by inpatient facilities to report procedures. CPT is used by physicians and outpatient facilities for procedure reporting.

Question 22Medical Coding

In ICD-10-PCS, how many characters does a complete procedure code contain?

  1. Seven Correct answer.
  2. Five
  3. Nine
  4. Six

Explanation

ICD-10-PCS codes are alphanumeric and always seven characters in length. Each character position represents a defined component of the procedure.

Question 23Medical Coding

A coder must sequence a diagnosis code for a condition that is described in the ICD-10-CM tabular list with the instruction 'code first.' What does this instruction mean?

  1. Only the etiology code is reported
  2. The instruction may be ignored
  3. The underlying etiology should be sequenced before the manifestation Correct answer.
  4. The manifestation should be sequenced before the etiology

Explanation

A 'code first' note under a manifestation instructs the coder to sequence the underlying cause first, followed by the manifestation code. This reflects the etiology-manifestation convention.

Question 24Medical Coding

Which of the following is an example of an external cause code in ICD-10-CM?

  1. A code describing a fracture of the radius
  2. A code describing a surgical approach
  3. A code describing the mechanism of injury such as a fall Correct answer.
  4. A code describing a laboratory result

Explanation

External cause codes describe how and where an injury occurred, such as a fall or motor vehicle collision. They supplement injury codes and do not replace them.

Question 25Medical Coding

A coder identifies that a payer denies a claim because the diagnosis does not support the procedure performed. Which concept does this denial most directly relate to?

  1. Laterality
  2. Modifier sequencing
  3. Medical necessity Correct answer.
  4. Place of service

Explanation

Medical necessity denials occur when the reported diagnosis does not justify the service. Payers use diagnosis-to-procedure edits to evaluate whether the service is appropriate.

Question 26Medical Coding

Which modifier is used to indicate that a procedure was performed on the right side of the body?

  1. 51
  2. LT
  3. 50
  4. RT Correct answer.

Explanation

Modifier RT is the HCPCS Level II modifier for the right side of the body. LT is used for the left side, 50 for bilateral procedures, and 51 for multiple procedures.

Question 27Medical Coding

What is the correct ICD-10-CM code for a patient diagnosed with essential (primary) hypertension?

  1. I15.9
  2. I11.9
  3. I10 Correct answer.
  4. I12.9

Explanation

I10 is the ICD-10-CM code for essential (primary) hypertension. I11.9 is hypertensive heart disease without heart failure, I12.9 is hypertensive chronic kidney disease with stage 1-4 CKD, and I15.9 is secondary hypertension.

Question 28Medical Coding

Which of the following is a valid HCPCS Level II code?

  1. 11042
  2. I10
  3. 99213
  4. J1100 Correct answer.

Explanation

HCPCS Level II codes are alphanumeric and start with a letter, such as J1100 (injection, dexamethasone sodium phosphate). 99213 and 11042 are CPT codes, and I10 is an ICD-10-CM code.

Question 29Medical Coding

In medical coding, what does the abbreviation 'NEC' stand for?

  1. Not Elsewhere Coded
  2. No Exact Code
  3. Not Elsewhere Classified Correct answer.
  4. Non-Essential Condition

Explanation

NEC stands for Not Elsewhere Classified, which is used in ICD-10-CM when a condition cannot be assigned to a more specific code. It indicates that the code may not fully describe the condition.

Question 30Medical Coding

Which of the following is an example of a CPT code for an established patient office visit?

  1. 99283
  2. 99213 Correct answer.
  3. 99223
  4. 99203

Explanation

99213 is a CPT code for an office or other outpatient visit for an established patient, typically requiring two of three key components. 99203 is for a new patient, 99223 is for initial hospital care, and 99283 is for emergency department visit.

Question 31Medical Coding

What is the first step in the coding process?

  1. Review the medical record documentation Correct answer.
  2. Verify insurance eligibility
  3. Assign the diagnosis codes
  4. Assign the procedure codes

Explanation

The first step in coding is to review the medical record documentation to understand the patient's conditions and services provided. Only after reviewing documentation can accurate diagnosis and procedure codes be assigned.

Question 32Medical Coding

Which of the following is a common coding compliance risk?

  1. Verifying patient demographics
  2. Documenting in the record
  3. Upcoding services Correct answer.
  4. Using current code books

Explanation

Upcoding, which is assigning a higher-level code than is supported by documentation, is a common compliance risk and can be considered fraud. Using current code books, documenting in the record, and verifying demographics are proper practices.

Question 33Medical Coding

Which of the following is an example of a code that would be reported with modifier 25?

  1. A procedure discontinued due to patient safety
  2. An E/M service performed on the same day as a minor procedure Correct answer.
  3. A procedure performed on the left side
  4. A surgical procedure performed bilaterally

Explanation

Modifier 25 is appended to an E/M service to indicate that it was significant and separately identifiable from a procedure performed on the same day. Modifier 50 is for bilateral, 53 for discontinued, and LT for left side.

Question 34Medical Coding

A patient is seen for a new complaint of chest pain. The physician documents a detailed history, detailed examination, and medical decision making of moderate complexity. Which E/M level is supported for a new patient?

  1. 99214
  2. 99203 Correct answer.
  3. 99213
  4. 99204

Explanation

For a new patient, 99203 requires at least detailed history, detailed examination, and medical decision making of low complexity; 99204 requires comprehensive history, comprehensive exam, and moderate MDM. Since only detailed history and exam are documented, 99203 is supported.

Question 35Medical Coding

A coder is assigning an ICD-10-CM code for a patient with pneumonia due to Streptococcus pneumoniae. What is the correct code?

  1. J15.9
  2. J12.9
  3. J18.9
  4. J13 Correct answer.

Explanation

J13 is the ICD-10-CM code for pneumonia due to Streptococcus pneumoniae. J15.9 is bacterial pneumonia, unspecified; J18.9 is pneumonia, unspecified organism; and J12.9 is viral pneumonia, unspecified.

Question 36Medical Coding

When a patient is seen for a preoperative evaluation only, which modifier is appropriate to append to the E/M code?

  1. Modifier 56 Correct answer.
  2. Modifier 32
  3. Modifier 57
  4. Modifier 25

Explanation

Modifier 56 is used for preoperative management only. Modifier 57 is for an E/M service that resulted in the initial decision to perform surgery, 32 is for mandated services, and 25 is for a significant, separately identifiable E/M service on the same day as a procedure.

Question 37Medical Coding

Which of the following best describes the purpose of the ICD-10-CM Tabular List?

  1. It contains only the external cause codes.
  2. It provides guidelines for procedure coding.
  3. It provides the numerical list of codes with full descriptions and instructional notes. Correct answer.
  4. It lists all codes in alphabetical order by diagnosis.

Explanation

The Tabular List is the numerical list of ICD-10-CM codes organized by chapter, with full code descriptions and instructional notes. The Alphabetic Index is the alphabetical list, and procedure coding guidelines are in ICD-10-PCS or CPT.

Question 38Medical Coding

A patient is admitted with dehydration and is found to have gastroenteritis. The physician documents that the gastroenteritis is the reason for admission and the dehydration is a result of the gastroenteritis. How should the codes be sequenced?

  1. Gastroenteritis first, dehydration second Correct answer.
  2. Only gastroenteritis is coded
  3. Dehydration first, gastroenteritis second
  4. Only dehydration is coded

Explanation

When dehydration is due to gastroenteritis, the gastroenteritis is the principal diagnosis because it is the underlying cause. The dehydration is coded as an additional diagnosis.

Question 39Medical Coding

Which of the following is a valid reason to use an unlisted procedure code?

  1. The procedure is new and has no specific code Correct answer.
  2. The procedure is performed bilaterally
  3. The procedure is performed on the left side
  4. The procedure is discontinued

Explanation

Unlisted procedure codes are used when a specific CPT code does not exist for the procedure performed, such as for new or experimental procedures. Bilateral, discontinued, and laterality are handled with modifiers, not unlisted codes.

Question 40Medical Coding

What is the correct ICD-10-CM code for a patient with type 2 diabetes mellitus with diabetic chronic kidney disease?

  1. E11.21
  2. E11.22 Correct answer.
  3. E11.29
  4. E11.9

Explanation

E11.22 is the code for type 2 diabetes mellitus with diabetic chronic kidney disease. E11.9 is type 2 diabetes without complications, E11.21 is with diabetic nephropathy, and E11.29 is with other diabetic kidney complication.

Question 41Medical Coding

A physician performs a surgical procedure and documents that it was performed on both sides. Which modifier should be appended?

  1. 52
  2. 51
  3. 53
  4. 50 Correct answer.

Explanation

Modifier 50 is used for bilateral procedures. Modifier 51 is for multiple procedures, 52 for reduced services, and 53 for discontinued procedures.

Question 42Medical Coding

Which of the following is an example of a code that would be reported with modifier 59?

  1. A procedure discontinued due to patient safety
  2. A procedure performed on the left side
  3. A distinct procedural service performed on the same day as another procedure Correct answer.
  4. A bilateral procedure

Explanation

Modifier 59 is used to indicate that a procedure or service was distinct and independent from other procedures performed on the same day. It is not used for laterality, discontinued procedures, or bilateral procedures.

Question 43Medical Coding

What is the primary difference between CPT and HCPCS Level II codes?

  1. CPT codes are used for diagnoses and HCPCS Level II codes for procedures.
  2. CPT codes are numeric and HCPCS Level II codes are alphanumeric. Correct answer.
  3. CPT codes are maintained by CMS and HCPCS Level II by the AMA.
  4. CPT codes are only for inpatient and HCPCS Level II for outpatient.

Explanation

CPT codes are numeric (with some alphanumeric in Category II and III) and are maintained by the AMA. HCPCS Level II codes are alphanumeric and are maintained by CMS for supplies, drugs, and services not in CPT.

Question 44Medical Coding

A patient is seen in the emergency department for a deep laceration of the right hand. The physician performs a layered closure of a 3 cm wound. Which code would be reported?

  1. 12002 Correct answer.
  2. 12004
  3. 13100
  4. 12001

Explanation

CPT code 12002 is for simple repair of superficial wounds of the extremities (including hands) measuring 2.6 to 7.5 cm. 12001 is for wounds 2.5 cm or less, 12004 is for 7.6 to 12.5 cm, and 13100 is for complex repair of the trunk.

Question 45Medical Coding

Which of the following is a key component of the National Correct Coding Initiative (NCCI) edits?

  1. Procedure-to-procedure edits Correct answer.
  2. Modifier-to-modifier edits
  3. Place-of-service edits
  4. Diagnosis-to-procedure edits

Explanation

NCCI includes procedure-to-procedure (PTP) edits that prevent payment for codes that should not be billed together. Diagnosis-to-procedure edits are part of the Medicare Code Edits (MCE), not NCCI.

Question 46Medical Coding

A patient is admitted with a principal diagnosis of congestive heart failure. During the stay, the patient also develops a urinary tract infection. How should the UTI be coded?

  1. As an external cause code
  2. It should not be coded
  3. As the principal diagnosis
  4. As a secondary diagnosis Correct answer.

Explanation

The UTI developed during the hospital stay and is not the reason for admission, so it is coded as a secondary diagnosis. The principal diagnosis is the condition established after study to be chiefly responsible for admission.

Question 47Medical Coding

In ICD-10-PCS, what does the first character of a code represent?

  1. Section Correct answer.
  2. Root operation
  3. Body part
  4. Body system

Explanation

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

Question 48Medical Coding

A patient is seen for a follow-up visit after surgery. The physician documents that the wound is healing well and there are no complications. The visit is unrelated to the surgical procedure. Which modifier should be appended to the E/M code?

  1. 57
  2. 25
  3. 24 Correct answer.
  4. 79

Explanation

Modifier 24 is used for an unrelated E/M service during a postoperative period. Modifier 25 is for a significant, separately identifiable E/M service on the same day as a procedure, 57 is for the decision for surgery, and 79 is for an unrelated procedure during the postoperative period.

Question 49Medical Coding

A coder is reviewing a record where the physician documents 'acute exacerbation of chronic obstructive pulmonary disease' and 'acute bronchitis'. What is the correct ICD-10-CM coding?

  1. J44.0
  2. J44.9
  3. J44.1 Correct answer.
  4. J20.9

Explanation

J44.1 is for chronic obstructive pulmonary disease with acute exacerbation. J44.0 includes acute lower respiratory infection, but the documentation specifies acute bronchitis, which is not a lower respiratory infection in this context. J44.9 is unspecified COPD, and J20.9 is acute bronchitis without COPD.

Question 50Medical Coding

A patient undergoes a laparoscopic cholecystectomy. The physician documents that during the procedure, a cholangiogram was performed. Which coding is appropriate?

  1. Cholecystectomy with exploration (47570)
  2. Cholecystectomy with cholangiogram (47564) Correct answer.
  3. Cholangiogram alone (74320)
  4. Cholecystectomy alone (47562)

Explanation

CPT code 47564 includes laparoscopic cholecystectomy with intraoperative cholangiogram. If a cholangiogram is performed during the same operative session, it is not separately coded. 47562 is cholecystectomy without cholangiogram, 74320 is a radiological cholangiogram, and 47570 is open cholecystectomy with exploration.