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AMB-BC practice questions

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Question 1Clinical Practice and Direct Patient Care

When documenting the chief complaint for an outpatient encounter, what is required?

  1. A complete list of every medication the patient has ever taken
  2. The physician's final diagnosis code
  3. A summary of the patient's family medical history
  4. A brief statement of the symptom in the patient's own words Correct answer.

Explanation

The chief complaint is a brief statement, ideally in the patient's own words, describing the symptom or problem that prompted the encounter. It is a required element of the history and helps establish medical necessity.

Question 2Clinical Practice and Direct Patient Care

In ICD-10-CM, how is laterality reported for a condition affecting a limb?

  1. It is always omitted for outpatient claims
  2. It is captured using a CPT modifier instead of the diagnosis code
  3. A separate code character identifies the right or left side Correct answer.
  4. Laterality is reported only with an external cause code

Explanation

ICD-10-CM includes laterality characters in many musculoskeletal and injury code categories so the right or left side is captured in the diagnosis code itself.

Question 3Clinical Practice and Direct Patient Care

Which set of vital signs is within generally accepted adult normal resting ranges?

  1. Temperature 37.0°C, pulse 72, respirations 16, BP 120/80 Correct answer.
  2. Temperature 39.5°C, pulse 120, respirations 28, BP 150/95
  3. Temperature 38.9°C, pulse 105, respirations 24, BP 135/88
  4. Temperature 35.0°C, pulse 45, respirations 8, BP 85/55

Explanation

A normal adult resting temperature is about 36.1-37.2°C, pulse 60-100 beats/min, respirations 12-20/min, and blood pressure around 120/80 mmHg. The values in the correct set fall within these ranges.

Question 4Clinical Practice and Direct Patient Care

A patient is documented as a current cigarette smoker with no dependence diagnosis. Which ICD-10-CM code is most appropriate?

  1. F17.200
  2. Z87.891
  3. Z72.0 Correct answer.
  4. F17.210

Explanation

Z72.0 is used for tobacco use without documentation of dependence. Nicotine dependence is coded with F17.- codes when dependence is documented.

Question 5Clinical Practice and Direct Patient Care

Which code set is used to report the administration of a vaccine?

  1. HCPCS Level II J-codes for the vaccine product
  2. Immunization administration CPT codes Correct answer.
  3. CPT surgical procedure codes for the injection site
  4. ICD-10-CM code Z23 for immunization status

Explanation

Vaccine administration is reported with CPT immunization administration codes, while the vaccine product itself is reported with a CPT or HCPCS code. ICD-10-CM Z23 is used only to identify the reason for the encounter.

Question 6Clinical Practice and Direct Patient Care

Which ICD-10-CM code is used to report an adult body mass index of 32.0-32.9?

  1. Z71.3
  2. R63.5
  3. E66.9
  4. Z68.32 Correct answer.

Explanation

Adult BMI is reported with codes in category Z68, and Z68.32 specifically represents a BMI of 32.0-32.9. BMI codes are secondary codes and require a documented BMI.

Question 7Clinical Practice and Direct Patient Care

Under HIPAA, which of the following is a permitted use or disclosure of protected health information without patient authorization?

  1. Posting patient names on a public website
  2. Sharing PHI with a patient's employer for marketing
  3. Disclosure for treatment, payment, or operations Correct answer.
  4. Selling PHI to a data broker

Explanation

HIPAA permits disclosure of PHI without authorization for treatment, payment, and health care operations. Other uses generally require patient authorization or fall under a specific exception.

Question 8Clinical Practice and Direct Patient Care

What is the primary purpose of clinical documentation in the billing process?

  1. To replace the patient's informed consent form
  2. To support billed codes and medical necessity Correct answer.
  3. To determine the patient's insurance eligibility
  4. To serve as a marketing tool for the practice

Explanation

Clinical documentation must support the medical necessity and the specific codes reported on the claim. Accurate documentation is the basis for code assignment and claim defense.

Question 9Clinical Practice and Direct Patient Care

A patient comes in for a scheduled annual wellness visit and, during the same encounter, the provider evaluates a new complaint of chest pain. Which modifier supports billing the problem-oriented E/M service separately?

  1. 57
  2. 59
  3. 25 Correct answer.
  4. 24

Explanation

Modifier 25 is appended to a significant, separately identifiable E/M service performed on the same day as a procedure or other service. It indicates that the E/M service was distinct from the other service.

Question 10Clinical Practice and Direct Patient Care

A surgeon performs a procedure with a 90-day global period. Which service is included in the global surgical package?

  1. A return to the operating room for a new, unrelated procedure
  2. An E/M visit for a new, unrelated problem during the global period
  3. Routine postoperative follow-up visits related to the surgery Correct answer.
  4. A separate procedure for an unrelated diagnosis 30 days later

Explanation

The global surgical package includes the preoperative, intraoperative, and routine postoperative care, including routine follow-up visits related to the surgery. Unrelated services during the global period may be billed separately with the appropriate modifier.

Question 11Clinical Practice and Direct Patient Care

Under the 2021 office/outpatient E/M guidelines, when time is used to select the level of service, which time is counted?

  1. Time the physician or NPP spends on the encounter date Correct answer.
  2. The time the patient spends waiting in the lobby
  3. Only the time spent performing the hands-on physical examination
  4. The total time the patient spends in the building

Explanation

When time is used to select an office/outpatient E/M level, it is the total time the physician or non-physician practitioner spends on the date of the encounter. This includes face-to-face and non-face-to-face activities related to the encounter.

Question 12Clinical Practice and Direct Patient Care

Which of the following is an element of the history of present illness?

  1. Duration of the symptom Correct answer.
  2. Review of systems
  3. Past medical history
  4. Family history

Explanation

The history of present illness describes the development of the patient's current problem and includes elements such as location, quality, severity, duration, timing, context, and modifying factors. Duration is one of these elements.

Question 13Clinical Practice and Direct Patient Care

A patient with type 2 diabetes develops diabetic chronic kidney disease. How should this be coded in ICD-10-CM?

  1. Only the CKD code
  2. The CKD code first, followed by the diabetes code
  3. Only the diabetes code
  4. The diabetes code first, followed by the CKD code Correct answer.

Explanation

ICD-10-CM presumes a causal relationship between diabetes and chronic kidney disease. A combination code such as E11.22 is assigned, with the diabetes code sequenced first, followed by the CKD code.

Question 14Clinical Practice and Direct Patient Care

Which documentation detail is required to assign an ICD-10-CM code for a pressure ulcer?

  1. The number of prior hospitalizations
  2. Anatomic site and stage of the ulcer Correct answer.
  3. The patient's occupation
  4. The type of dressing used

Explanation

Pressure ulcer codes require the anatomic site and the stage to be documented. The stage reflects the depth of tissue involvement and drives code selection.

Question 15Clinical Practice and Direct Patient Care

Which modifier is commonly appended to a Medicare telehealth service to indicate that the service was furnished via telecommunications?

  1. 26
  2. 50
  3. TC
  4. 95 Correct answer.

Explanation

Modifier 95 is used with CPT codes to indicate that a service was furnished via synchronous real-time audio-video telecommunications. Payer requirements vary, but 95 is the standard telehealth modifier.

Question 16Clinical Practice and Direct Patient Care

A patient with no acute complaints presents for a routine preventive examination. Which code set should be reported for the preventive service?

  1. Preventive medicine E/M codes Correct answer.
  2. Emergency department E/M codes
  3. Anesthesia codes
  4. Surgical procedure codes

Explanation

Routine preventive examinations are reported with preventive medicine E/M codes, which are distinct from problem-oriented E/M codes. If a problem is addressed at the same visit, modifier 25 may be needed.

Question 17Clinical Practice and Direct Patient Care

When is modifier 59 appropriate?

  1. To report a service performed on the left side
  2. To identify a distinct procedural service not normally bundled Correct answer.
  3. To show that a patient was seen in the emergency department
  4. When a procedure is performed bilaterally

Explanation

Modifier 59 identifies a distinct procedural service that is not ordinarily reported together with another procedure on the same day. It should be used only when the services are truly distinct and not adequately described by another modifier.

Question 18Clinical Practice and Direct Patient Care

When coding sepsis in ICD-10-CM, which sequence is correct when the organism is documented?

  1. The organism code first, then sepsis
  2. Sepsis code first, then the specific organism code Correct answer.
  3. The sepsis code only, with no organism code
  4. The local infection code only

Explanation

ICD-10-CM requires the sepsis code to be sequenced first, followed by the code for the specific organism when documented. The local infection code may also be reported if applicable.

Question 19Clinical Practice and Direct Patient Care

Which CPT code is reported when a provider collects a venous blood specimen by venipuncture for laboratory testing?

  1. The laboratory test code only
  2. An E/M code only
  3. The venipuncture collection code Correct answer.
  4. A surgical code

Explanation

Venipuncture for specimen collection is reported with the appropriate CPT collection code, separate from the laboratory test code. The test itself is billed by the performing laboratory.

Question 20Clinical Practice and Direct Patient Care

Which factor is used to calculate anesthesia reimbursement?

  1. Base units plus time units times the conversion factor Correct answer.
  2. The patient's height and weight
  3. The number of operating room staff present
  4. The type of suture used during the procedure

Explanation

Anesthesia payment is calculated from base units assigned to the procedure plus time units, multiplied by the anesthesia conversion factor. Special modifiers and physical status may also affect payment.

Question 21Clinical Practice and Direct Patient Care

A patient has hypertension and chronic kidney disease. According to ICD-10-CM guidelines, how should these be coded?

  1. Only the hypertension code
  2. A combination code for hypertensive CKD when one exists Correct answer.
  3. An external cause code
  4. Only the CKD code

Explanation

ICD-10-CM provides combination codes for hypertensive chronic kidney disease, such as I12.-, which capture both conditions in one code. When a combination code exists, it should be used rather than separate codes.

Question 22Clinical Practice and Direct Patient Care

Under the 2021 office/outpatient E/M guidelines, which element determines the level of medical decision making?

  1. Problems addressed, data reviewed, and risk of complications Correct answer.
  2. The length of the physical examination
  3. The number of diagnoses documented
  4. The patient's insurance plan type

Explanation

The level of medical decision making is determined by the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications, morbidity, or mortality. Two of these three elements must be met or exceeded for a given level.

Question 23Clinical Practice and Direct Patient Care

A patient is treated for a closed fracture with a cast application in the office. How is fracture care reported?

  1. The fracture care code, which includes the initial cast application Correct answer.
  2. Only an E/M code
  3. Both the fracture care code and a separate E/M code for the same encounter
  4. Only the cast application code

Explanation

Initial fracture care includes the application of the initial cast or splint, so the cast application is not billed separately. An E/M service on the same day is generally included unless it is significant and separately identifiable.

Question 24Clinical Practice and Direct Patient Care

A physician in an office where the practice owns the X-ray equipment performs and interprets an X-ray. How should the service be reported?

  1. Modifier 26 and TC separately
  2. Modifier 26 only
  3. Modifier TC only
  4. The global code with no modifier Correct answer.

Explanation

When a practice owns the equipment and the same physician performs and interprets the diagnostic study, the global code is reported without a component modifier. Modifiers 26 and TC are used only when the professional and technical components are split.

Question 25Clinical Practice and Direct Patient Care

Which code set is used to report inpatient hospital procedures?

  1. CPT for outpatient and physician services
  2. HCPCS Level II for supplies and drugs
  3. ICD-10-CM for inpatient diagnoses
  4. ICD-10-PCS for inpatient procedures Correct answer.

Explanation

ICD-10-PCS is the code set used for inpatient hospital procedure reporting. CPT and HCPCS are used for outpatient and physician services.

Question 26Clinical Practice and Direct Patient Care

A patient returns to a group practice for an office visit after receiving no services from any physician in that group for the past four years. How should the patient be classified for E/M coding?

  1. New patient Correct answer.
  2. Referral patient
  3. Established patient
  4. Consultation patient

Explanation

A new patient has not received professional services from the physician or another physician of the same specialty in the same group practice within the previous three years. Four years exceeds that interval, so the patient is new.

Question 27Clinical Practice and Direct Patient Care

A physician performs a minor procedure and, during the same visit, provides a significant, separately identifiable E/M service for a different problem. Which modifier should be appended to the E/M code?

  1. 57
  2. 24
  3. 59
  4. 25 Correct answer.

Explanation

Modifier 25 indicates that a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure or other service. It is used only when the E/M is above and beyond the usual preoperative and postoperative work of the procedure.

Question 28Clinical Practice and Direct Patient Care

Which place-of-service code is reported when a telehealth service is furnished to a patient located in their home?

  1. 10 Correct answer.
  2. 11
  3. 02
  4. 12

Explanation

Place of service 10 designates telehealth services provided in the patient's home. POS 02 is used for telehealth services furnished from a location other than the patient's home.

Question 29Clinical Practice and Direct Patient Care

Which modifier indicates that only the professional component of a diagnostic service was provided?

  1. 50
  2. TC
  3. 26 Correct answer.
  4. 51

Explanation

Modifier 26 identifies the professional component of a diagnostic test, such as physician interpretation. Modifier TC identifies the technical component.

Question 30Clinical Practice and Direct Patient Care

An Advance Beneficiary Notice of Noncoverage (ABN) is given to a Medicare beneficiary to:

  1. Notify the patient that a service is bundled with another service
  2. Transfer the claim to a secondary payer
  3. Request prior authorization from Medicare before a covered service is furnished
  4. Explain possible noncoverage and patient liability Correct answer.

Explanation

An ABN explains that Medicare may not pay for an item or service and allows the beneficiary to choose whether to receive it and accept financial responsibility. It is not an authorization or a bundling notice.

Question 31Clinical Practice and Direct Patient Care

Which modifier is appended to a procedure performed only on the left side of the body?

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

Explanation

Modifier LT identifies a procedure performed on the left side. Modifier RT identifies the right side, and modifier 50 is used for bilateral procedures.

Question 32Clinical Practice and Direct Patient Care

A physician administers a drug in the office that is purchased by the practice. Which code set includes the J codes used to report the drug product?

  1. CPT Category I
  2. CDT
  3. ICD-10-CM diagnosis codes
  4. HCPCS Level II Correct answer.

Explanation

HCPCS Level II includes J codes that report drugs and biologicals administered in outpatient settings. CPT Category I reports procedures and services, not drug products.

Question 33Clinical Practice and Direct Patient Care

What does modifier 51 indicate when appended to a procedure code?

  1. Multiple procedures in one session Correct answer.
  2. The procedure was repeated
  3. The procedure was discontinued
  4. The procedure was performed bilaterally

Explanation

Modifier 51 identifies additional procedures performed during the same operative session and is used to support multiple-procedure payment reduction. It does not describe laterality, discontinuation, or repetition.

Question 34Clinical Practice and Direct Patient Care

A patient returns to the office 10 days after a procedure with a 10-day global period for an E/M service unrelated to the procedure. Which modifier is appended to the E/M code?

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

Explanation

Modifier 24 is used for an unrelated E/M service provided by the same physician during a postoperative global period. The service must be for a condition unrelated to the procedure.

Question 35Clinical Practice and Direct Patient Care

A physician evaluates a patient in the office and determines that surgery is needed, then performs the surgery the following day. Which modifier is appended to the preoperative E/M code?

  1. 25
  2. 57 Correct answer.
  3. 24
  4. 26

Explanation

Modifier 57 indicates that the E/M service resulted in the initial decision to perform surgery. It is reported on the E/M code when the decision for surgery occurs on the day of or the day before a major procedure.

Question 36Clinical Practice and Direct Patient Care

Which requirement must be met to bill a service as incident-to a physician?

  1. The service must be performed in a hospital
  2. The service must be a surgical procedure
  3. The patient must be new to the practice and have no prior visits
  4. Physician establishes and remains involved in care Correct answer.

Explanation

Incident-to billing requires that the service be part of the physician's established plan of care, that the physician remain actively involved, and that the patient be established for that problem. It is not limited to hospital settings or procedures.

Question 37Clinical Practice and Direct Patient Care

For transitional care management, the initial interactive contact with the patient must occur within how many business days after discharge?

  1. 3 business days
  2. 2 business days Correct answer.
  3. 1 business day
  4. 5 business days

Explanation

TCM requires an interactive contact within two business days of discharge, followed by a face-to-face visit within the required timeframe based on complexity. The contact may be by telephone, email, or face-to-face.

Question 38Clinical Practice and Direct Patient Care

Which modifier set was developed by CMS as a more specific alternative to modifier 59?

  1. 51
  2. 24
  3. X{EPSU} Correct answer.
  4. 50

Explanation

The X{EPSU} modifiers (XE, XP, XS, XU) provide more specific reasons for distinct services and are preferred over modifier 59 when appropriate. Modifier 59 remains available but should be used only when no more specific modifier fits.

Question 39Clinical Practice and Direct Patient Care

A 3.5 cm scalp laceration is closed with a simple, single-layer repair. How is this repair classified for CPT coding?

  1. Complex repair
  2. Layered repair
  3. Simple repair Correct answer.
  4. Intermediate repair

Explanation

Simple repair includes superficial wounds requiring only simple closure, such as a single-layer closure of a scalp laceration. Intermediate and complex repairs require layered closure or extensive cleaning and revision.

Question 40Clinical Practice and Direct Patient Care

A patient is seen for an initial encounter for a wrist fracture caused by a fall from a ladder. How should external cause codes be reported?

  1. They are omitted for fractures
  2. As the principal diagnosis
  3. As secondary codes Correct answer.
  4. Only for inpatient admissions

Explanation

External cause codes describe how an injury occurred and are reported as secondary diagnoses, not as the principal diagnosis. They are used in both outpatient and inpatient settings when applicable.

Question 41Clinical Practice and Direct Patient Care

A patient presents with chest pain, and after evaluation the provider documents no definitive diagnosis. What should be coded?

  1. Chest pain Correct answer.
  2. Myocardial infarction
  3. Rule-out myocardial infarction
  4. Unspecified chest condition

Explanation

When a definitive diagnosis is not established in the outpatient setting, code the sign or symptom that prompted the visit. 'Rule-out' conditions are not coded in outpatient records.

Question 42Clinical Practice and Direct Patient Care

An outpatient report documents 'probable pneumonia.' What action should the coder take before assigning a diagnosis code?

  1. Assign a symptom code only
  2. Assign an unspecified pneumonia code
  3. Query the provider for clarification Correct answer.
  4. Code pneumonia as confirmed

Explanation

Outpatient coding requires a definitive diagnosis; uncertain diagnoses such as 'probable' are not coded. The coder should query the provider to clarify the diagnosis before assigning a code.

Question 43Clinical Practice and Direct Patient Care

Which level of supervision requires a physician to be physically present in the office suite while a service is furnished?

  1. Personal supervision
  2. General supervision
  3. Direct supervision Correct answer.
  4. Incident-to supervision

Explanation

Direct supervision requires the physician to be present in the office suite and immediately available to furnish assistance and direction. General supervision does not require physical presence, and personal supervision requires the physician to be in the room.

Question 44Clinical Practice and Direct Patient Care

When a physician administers a vaccine in the office, how are the vaccine product and administration reported?

  1. The vaccine product code only, without an administration code
  2. A single combined vaccine code
  3. Product code plus administration code Correct answer.
  4. The administration code only, without a product code

Explanation

Vaccine product and administration are reported separately using the appropriate product code and administration code. The administration code is selected based on the route and age of the patient.

Question 45Clinical Practice and Direct Patient Care

Which is a requirement for billing chronic care management services?

  1. At least 20 minutes of clinical staff time and a care plan Correct answer.
  2. The patient must have only one chronic condition that is managed by a single provider
  3. At least 10 minutes of clinical staff time is required
  4. The patient must be admitted as an inpatient

Explanation

CCM requires at least two chronic conditions, a comprehensive care plan, and at least 20 minutes of clinical staff time in a calendar month. It is furnished in the outpatient setting, not to inpatients.

Question 46Clinical Practice and Direct Patient Care

A Medicare beneficiary signs an ABN before receiving a service that the provider expects Medicare may deny as not reasonable and necessary. Which modifier is reported on the claim?

  1. GX
  2. GA Correct answer.
  3. GZ
  4. GY

Explanation

Modifier GA indicates that an ABN was signed and is on file for an item or service expected to be denied. Modifier GZ is used when an ABN was not obtained, and GX is used for statutorily excluded services.

Question 47Clinical Practice and Direct Patient Care

A patient requires a staged procedure during the postoperative period. The second procedure is planned and related to the first. Which modifier is appended to the second procedure?

  1. 58 Correct answer.
  2. 79
  3. 78
  4. 24

Explanation

Modifier 58 reports a staged or related procedure performed by the same physician during the postoperative period. It indicates the procedure was planned or anticipated.

Question 48Clinical Practice and Direct Patient Care

A patient with cancer presents to the office solely for chemotherapy administration. What is the first-listed diagnosis?

  1. A personal history code for cancer
  2. Z51.11 Encounter for antineoplastic chemotherapy Correct answer.
  3. A symptom code for nausea and vomiting
  4. The underlying neoplasm as the first-listed diagnosis

Explanation

When the encounter is solely for chemotherapy administration, the first-listed diagnosis is Z51.11. The underlying neoplasm is reported as an additional diagnosis.

Question 49Clinical Practice and Direct Patient Care

A patient develops a wound infection after surgery and is seen in the office during the postoperative period. Which diagnosis is sequenced first?

  1. A symptom code for pain
  2. A history code for the surgery
  3. The wound infection Correct answer.
  4. The original surgical condition

Explanation

When a complication occurs, the complication code is sequenced first, followed by the code for the original condition if relevant. The wound infection is the reason for the encounter.

Question 50Clinical Practice and Direct Patient Care

A patient undergoes an unplanned return to the operating room for a related procedure during the postoperative global period. Which modifier is appended to the procedure code?

  1. 78 Correct answer.
  2. 79
  3. 24
  4. 58

Explanation

Modifier 78 reports an unplanned return to the operating room for a related procedure during the postoperative period. Modifier 79 reports an unrelated procedure during the global period.