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CCA (ASA) practice questions

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Question 1Coding Knowledge and Skills

In ICD-10-CM, a code that requires a seventh character but has no applicable sixth character is completed using:

  1. the placeholder character X Correct answer.
  2. the letter Z
  3. a hyphen
  4. the placeholder numeral 0

Explanation

When a code requires a seventh character and no sixth character applies, the letter X fills the sixth position so the code keeps its full length before the seventh character is added.

Question 2Coding Knowledge and Skills

An Excludes1 note beneath an ICD-10-CM code means that the excluded condition:

  1. applies only to inpatient records
  2. is never reported with the code it is excluded from Correct answer.
  3. is reported only as an additional diagnosis
  4. may be reported with the code when documented together

Explanation

Excludes1 is a pure exclusion: the two conditions are mutually exclusive, so the excluded condition cannot be coded on the same record as the code bearing the note.

Question 3Coding Knowledge and Skills

CPT Category II codes exist to:

  1. report emerging technology procedures pending approval
  2. describe supplies and durable medical equipment
  3. track performance measures and quality data Correct answer.
  4. identify surgical procedures performed in outpatient settings

Explanation

Category II codes are four-character codes ending in F that capture quality and performance measurement data and are not used for reimbursement.

Question 4Coding Knowledge and Skills

A HCPCS Level II code is formatted as:

  1. one alphabetic character followed by four digits Correct answer.
  2. five numeric digits
  3. four digits followed by the letter T
  4. four digits followed by the letter F

Explanation

HCPCS Level II codes begin with a single letter followed by four digits, distinguishing them from the all-numeric five-digit CPT codes of Level I.

Question 5Coding Knowledge and Skills

Which section appears first in the CPT codebook?

  1. Evaluation and Management Correct answer.
  2. Pathology and Laboratory
  3. Surgery
  4. Anesthesia

Explanation

The CPT codebook opens with Evaluation and Management, followed in order by Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.

Question 6Coding Knowledge and Skills

After locating a term in the ICD-10-CM Alphabetic Index, the coder confirms the code in the:

  1. Tabular List Correct answer.
  2. Neoplasm Table
  3. External Cause Index
  4. Table of Drugs and Chemicals

Explanation

The Alphabetic Index is only an entry point; the code must be verified in the Tabular List, which carries the full descriptions, notes, and conventions.

Question 7Coding Knowledge and Skills

ICD-10-CM codes for conditions of the eye, ear, and limbs generally require the coder to know the:

  1. patient's age only
  2. provider's specialty
  3. encounter setting only
  4. side of the body affected Correct answer.

Explanation

Many codes for paired organs and limbs are divided by laterality, so the record must specify right, left, or bilateral to select the correct code.

Question 8Coding Knowledge and Skills

The principal diagnosis on an inpatient claim is the condition that:

  1. generated the highest facility charge
  2. after study is chiefly responsible for the admission Correct answer.
  3. the patient mentioned first at registration
  4. was present on admission but not treated

Explanation

The principal diagnosis is defined as the condition established after study to be chiefly responsible for occasioning the admission.

Question 9Coding Knowledge and Skills

An Excludes2 note beneath an ICD-10-CM code indicates that the excluded condition:

  1. may be reported in addition when both are documented Correct answer.
  2. can never be reported on the same record as the code
  3. must be sequenced ahead of the code it is excluded from
  4. applies only to external cause codes

Explanation

Excludes2 means the excluded condition is not part of the condition represented by the code, but both may be reported when each is separately documented.

Question 10Coding Knowledge and Skills

A 'code first' note in the ICD-10-CM Tabular List directs the coder to:

  1. report the underlying condition as an additional diagnosis
  2. sequence the underlying condition before the condition being coded Correct answer.
  3. sequence conditions in the order the physician listed them
  4. report both conditions only when documented as related

Explanation

A 'code first' note signals an underlying-cause or etiology relationship, so the condition named in the note is sequenced before the condition being coded.

Question 11Coding Knowledge and Skills

A patient with type 2 diabetes is documented with diabetic chronic kidney disease. Under ICD-10-CM guidelines the coder should:

  1. assign only the CKD code, because it is the more specific condition
  2. query the physician to confirm the relationship before coding
  3. assign a combination code plus a code for the CKD stage Correct answer.
  4. assign only the diabetes code, since CKD is integral to it

Explanation

ICD-10-CM presumes a cause-and-effect relationship between diabetes and CKD when both are documented, so a combination code for diabetic kidney disease is assigned with an additional code identifying the CKD stage.

Question 12Coding Knowledge and Skills

Modifier 25 is appended to an E/M service to show that the service was:

  1. performed by a physician other than the one who performed the procedure
  2. repeated on the same day for a change in the patient's condition
  3. provided in a facility rather than an office setting
  4. separately identifiable and above the usual preoperative care Correct answer.

Explanation

Modifier 25 identifies a significant, separately identifiable E/M service performed by the same physician on the same day as a procedure or other service.

Question 13Coding Knowledge and Skills

Modifier 59 indicates that a procedure was:

  1. performed bilaterally in the same session
  2. discontinued before completion due to patient risk
  3. performed on a patient younger than one year
  4. distinct and independent from other procedures that day Correct answer.

Explanation

Modifier 59 shows that a procedure or service was distinct and independent from other procedures or services reported on the same date.

Question 14Coding Knowledge and Skills

A 'use additional code' note in the ICD-10-CM Tabular List instructs the coder to:

  1. report an extra code that gives more detail about the condition Correct answer.
  2. replace the main code with a more specific one
  3. report the condition only when a second condition is also present
  4. sequence the additional code before the main code

Explanation

A 'use additional code' note directs the coder to assign another code, often for the causative organism or a related manifestation, to supply detail the main code lacks.

Question 15Coding Knowledge and Skills

A patient is seen only to receive intravenous chemotherapy for breast cancer. The correct ICD-10-CM reporting is:

  1. the chemotherapy encounter code first, then the neoplasm code Correct answer.
  2. only the malignant neoplasm code
  3. only the chemotherapy encounter code
  4. the malignant neoplasm first, then the chemotherapy code

Explanation

When the encounter is solely for chemotherapy administration, the chemotherapy encounter code is first-listed and the malignancy is reported as an additional diagnosis.

Question 16Coding Knowledge and Skills

A patient returns for a follow-up visit for a fracture that is healing normally. The seventh character of the fracture code should indicate:

  1. subsequent encounter with delayed healing
  2. initial encounter for a closed fracture
  3. initial encounter for an open fracture
  4. subsequent encounter with routine healing Correct answer.

Explanation

The seventh character identifies the encounter stage and healing status; a follow-up visit with normal progress is coded as a subsequent encounter with routine healing.

Question 17Coding Knowledge and Skills

When the health record documentation of a diagnosis is ambiguous, the coder should:

  1. code from the diagnosis list of a previous admission
  2. assign the code suggested by the clinical findings
  3. query the provider for clarification before assigning a code Correct answer.
  4. assign the unspecified code and add an internal note

Explanation

Coders may not infer a diagnosis; ambiguous documentation requires a physician query so that coded data reflect conditions the provider has documented.

Question 18Coding Knowledge and Skills

Under HIPAA, the adopted standard code set for reporting diagnoses in all U.S. health care settings is:

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

Explanation

ICD-10-CM is the HIPAA-adopted code set for diagnoses across all settings, while ICD-10-PCS is used for inpatient procedures.

Question 19Coding Knowledge and Skills

In the outpatient setting, the first-listed diagnosis is the condition that is:

  1. the most severe condition documented
  2. chiefly responsible for the services provided Correct answer.
  3. responsible for the most resource use
  4. present on admission but untreated

Explanation

For outpatient reporting the first-listed diagnosis is the condition chiefly responsible for the services provided, which may not be the most severe condition in the record.

Question 20Coding Knowledge and Skills

A patient with residual hemiplegia from an old cerebrovascular accident is coded by reporting:

  1. the hemiplegia code alone
  2. the cerebrovascular accident code first, then the hemiplegia
  3. the cerebrovascular accident code alone
  4. the hemiplegia code first, then the cerebrovascular accident Correct answer.

Explanation

For a sequela, the residual condition is sequenced first and the code for the original condition that caused it follows.

Question 21Coding Knowledge and Skills

In an ICD-10-CM code title, the word 'and' (as in 'diabetic cataract and retinopathy') means:

  1. only the first condition listed must be documented
  2. both conditions must always be documented together
  3. either condition or both conditions may be present Correct answer.
  4. the code applies only with a documented cause-effect link

Explanation

ICD-10-CM guidelines state that 'and' in a code title is read as 'and/or', so the code may be assigned when either condition or both are present.

Question 22Coding Knowledge and Skills

A patient is admitted with sepsis caused by Staphylococcus aureus pneumonia. Under ICD-10-CM guidelines, the coder sequences first the code for the:

  1. patient's underlying chronic conditions
  2. systemic infection, sepsis Correct answer.
  3. localized infection, staphylococcal pneumonia
  4. infectious organism as a single code

Explanation

The sepsis guidelines direct the coder to sequence the systemic infection first, followed by the localized infection and, when applicable, the organism.

Question 23Coding Knowledge and Skills

For a delivery episode, ICD-10-CM guidelines require the maternal record to include:

  1. the outcome of delivery on the newborn record only
  2. the weeks of gestation only when the delivery is preterm
  3. the outcome of delivery only when the infant is discharged alive
  4. the weeks of gestation and the outcome of delivery Correct answer.

Explanation

Obstetric coding requires codes for the weeks of gestation and the outcome of delivery on the maternal record in addition to codes describing the delivery episode.

Question 24Coding Knowledge and Skills

For CPT evaluation and management coding, a patient is established if the physician, or another physician of the same specialty in the same group practice, has provided a professional service within the past:

  1. twelve months
  2. thirty-six months Correct answer.
  3. twenty-four months
  4. six months

Explanation

The established-patient definition uses a three-year look-back for services from the physician or a physician of the same specialty in the same group practice.

Question 25Coding Knowledge and Skills

Which service is included in the surgical package of a CPT procedure code?

  1. a complication requiring a return to the operating room
  2. routine postoperative care by the surgeon Correct answer.
  3. services of another physician in a different specialty
  4. an unrelated E/M service for a new problem

Explanation

The surgical package bundles the procedure, local anesthesia when used, and routine postoperative care by the surgeon during the global period.

Question 26Coding Knowledge and Skills

A chest X-ray, two views, is reported with a code from which CPT section?

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

Explanation

CPT is divided into sections, and radiology codes cover diagnostic imaging such as X-rays. The section is chosen based on the type of service performed.

Question 27Coding Knowledge and Skills

Which item is reported using a HCPCS Level II code?

  1. A walker prescribed for a patient Correct answer.
  2. A routine office visit
  3. A complete blood count
  4. A surgical incision and drainage

Explanation

HCPCS Level II codes cover supplies, equipment, and drugs not represented in CPT, such as durable medical equipment. A prescribed walker is durable medical equipment.

Question 28Coding Knowledge and Skills

The place of service code on a CMS-1500 claim identifies:

  1. The provider's specialty
  2. The setting where the service was provided Correct answer.
  3. The type of health insurance plan
  4. The patient's home address

Explanation

Place of service codes indicate the location where the health care service was furnished, such as an office or hospital. They are not used for addresses, plan types, or specialties.

Question 29Coding Knowledge and Skills

A patient with no acute complaints presents for a routine annual physical. The appropriate E/M service is:

  1. An emergency department visit
  2. An office visit for a new problem
  3. A surgical procedure
  4. A preventive medicine evaluation Correct answer.

Explanation

Preventive medicine E/M codes are used for routine checkups without acute problems. The encounter is focused on health maintenance rather than treatment of illness.

Question 30Coding Knowledge and Skills

When health record documentation is unclear for coding, the coder should:

  1. Query the physician for clarification Correct answer.
  2. Leave the diagnosis blank
  3. Assign the most likely code based on clinical knowledge
  4. Use the patient's chief complaint as the diagnosis

Explanation

Coders must not assume diagnoses; they should query the provider to clarify ambiguous documentation. The query should be specific and supported by the record.

Question 31Coding Knowledge and Skills

The primary purpose of a coding audit is to:

  1. Negotiate insurance contracts
  2. Increase physician productivity
  3. Reduce patient wait times
  4. Ensure coding accuracy and compliance with regulations Correct answer.

Explanation

Coding audits evaluate whether codes are supported by documentation and comply with official guidelines. They help identify errors and improve compliance.

Question 32Coding Knowledge and Skills

A surgeon performs a bilateral knee arthroscopy. Which modifier should be reported?

  1. 76
  2. 50 Correct answer.
  3. 26
  4. 59

Explanation

Modifier 50 indicates a bilateral procedure performed on both sides. It is used when the same procedure is performed bilaterally during the same session.

Question 33Coding Knowledge and Skills

ICD-10-CM Z codes are used to report:

  1. Injuries
  2. Factors influencing health status and contact with health services Correct answer.
  3. Neoplasms
  4. Infectious diseases

Explanation

Z codes are not for illness but for reasons such as screenings, immunizations, or patient status. They describe factors that influence health status or contact with the health system.

Question 34Coding Knowledge and Skills

In ICD-10-CM, the placeholder character "X" is used to:

  1. Show that the code is exempt from HIPAA
  2. Identify a code as a manifestation code
  3. Allow for future expansion and maintain code length Correct answer.
  4. Indicate that a code is not otherwise specified

Explanation

ICD-10-CM codes must be 3 to 7 characters; the placeholder X fills unused positions to maintain standard length and allow future expansion. It does not change the meaning of the code.

Question 35Coding Knowledge and Skills

Modifier 26 is appended to a CPT radiology code to indicate:

  1. A bilateral procedure
  2. The professional component only Correct answer.
  3. A reduced service
  4. The technical component only

Explanation

Modifier 26 identifies the professional component of a diagnostic test, such as physician interpretation. The technical component is identified with modifier TC.

Question 36Coding Knowledge and Skills

A hospital performs the technical component of an MRI while the physician's interpretation is billed separately. The hospital should report the MRI code with:

  1. No modifier
  2. Modifier 50
  3. Modifier TC Correct answer.
  4. Modifier 26

Explanation

Modifier TC indicates the technical component, which includes equipment, supplies, and technologist services, when the professional component is billed separately. This prevents duplicate billing of the global service.

Question 37Coding Knowledge and Skills

A physician performs a reduced level of a service compared with the full procedure. The appropriate modifier is:

  1. 52 Correct answer.
  2. 51
  3. 22
  4. 53

Explanation

Modifier 52 indicates reduced services when a procedure is partially performed or performed to a lesser extent. Documentation should support the reduction.

Question 38Coding Knowledge and Skills

National Correct Coding Initiative (NCCI) edits are used to:

  1. Prevent improper payment when two procedures are bundled Correct answer.
  2. Assign diagnosis codes to procedures
  3. Set the fee schedule for Medicaid
  4. Determine the medical necessity of a service

Explanation

NCCI edits define code pairs that should not be billed together because one is integral to the other, preventing duplicate payment. They support correct coding and payment integrity.

Question 39Coding Knowledge and Skills

On a UB-04 claim, the type of bill is a three-digit code that identifies:

  1. The attending physician's NPI
  2. The facility type and frequency of the bill Correct answer.
  3. The revenue code for each line item
  4. The patient's diagnosis

Explanation

The type of bill combines facility type, bill classification, and frequency to identify the claim. It helps payers route and process the claim correctly.

Question 40Coding Knowledge and Skills

In ICD-10-PCS, the root operation "Excision" is defined as:

  1. Taking out a body part entirely
  2. Repairing a body part
  3. Cutting out a portion of a body part without replacement Correct answer.
  4. Putting in a biological substance

Explanation

Excision means cutting out or off a portion of a body part without replacement. Resection, by contrast, removes the entire body part.

Question 41Coding Knowledge and Skills

A patient is seen for rehabilitation following a stroke that occurred six months ago. The correct coding approach is to:

  1. Use an acute stroke code
  2. Code the late effect (sequela) first and the residual condition as secondary Correct answer.
  3. Code only the stroke as the principal diagnosis
  4. Code only the rehabilitation service

Explanation

Late effect coding requires sequencing the residual condition first, followed by the late effect code such as sequela of cerebrovascular disease. The acute stroke code is not used for an old event.

Question 42Coding Knowledge and Skills

ICD-10-CM combination codes are used when:

  1. The coder cannot find a specific code
  2. Only one diagnosis is documented
  3. Two diagnoses are unrelated
  4. A single code describes two diagnoses or a diagnosis with a complication Correct answer.

Explanation

Combination codes capture multiple conditions or a condition with a manifestation in one code, reducing the need for additional codes. They improve specificity and accuracy.

Question 43Coding Knowledge and Skills

An Advance Beneficiary Notice (ABN) is used to:

  1. Verify insurance eligibility
  2. Appeal a denied claim
  3. Obtain prior authorization from Medicare
  4. Inform a patient that a service may not be covered and obtain financial responsibility Correct answer.

Explanation

An ABN is a Medicare form given when a service may be denied as not medically necessary, shifting liability to the patient if they choose to proceed. It documents the patient's informed choice.

Question 44Coding Knowledge and Skills

Modifier 51 is used to indicate:

  1. Multiple procedures performed during the same session Correct answer.
  2. A professional component only
  3. A discontinued procedure
  4. A bilateral procedure

Explanation

Modifier 51 indicates multiple procedures and is appended to additional procedures to reduce payment. It is used when multiple surgical procedures are performed during the same session.

Question 45Coding Knowledge and Skills

External cause codes in ICD-10-CM are used to:

  1. Identify the cause of an injury or poisoning Correct answer.
  2. Report the patient's occupation only
  3. Indicate the facility type
  4. Code a routine physical

Explanation

External cause codes capture how and where an injury occurred and are secondary to the injury code. They provide public health data and are not used for routine encounters.

Question 46Coding Knowledge and Skills

In an ICD-10-PCS code, the fifth character represents the:

  1. Root operation
  2. Approach Correct answer.
  3. Body system
  4. Device

Explanation

The seven characters of ICD-10-PCS are section, body system, root operation, body part, approach, device, and qualifier. Each character position has a defined meaning.

Question 47Coding Knowledge and Skills

A surgeon performs a procedure that is significantly more complex than usual due to unexpected adhesions. The appropriate modifier is:

  1. 22 Correct answer.
  2. 53
  3. 50
  4. 51

Explanation

Modifier 22 indicates increased procedural services and requires documentation of the extra work. It is used when the procedure is more complex than typically required.

Question 48Coding Knowledge and Skills

A patient returns to the operating room for a related procedure during the postoperative period. The appropriate modifier is:

  1. 77
  2. 79
  3. 76
  4. 78 Correct answer.

Explanation

Modifier 78 indicates a return to the operating room for a related procedure during the postoperative period. It is used when the subsequent procedure is related to the original surgery.

Question 49Coding Knowledge and Skills

A "code also" note in the ICD-10-CM Tabular List instructs the coder to:

  1. Avoid using the code with other codes
  2. Report an additional code for a related condition Correct answer.
  3. Code the underlying condition first
  4. Use the code only for inpatient admissions

Explanation

A "code also" note indicates that an additional code should be used to provide a complete description, but sequencing may vary. It differs from a "code first" note, which directs sequencing.

Question 50Coding Knowledge and Skills

In anesthesia coding, qualifying circumstances are reported with:

  1. A separate anesthesia code
  2. An ICD-10-CM code
  3. A CPT add-on code Correct answer.
  4. A HCPCS Level II modifier

Explanation

Qualifying circumstances such as extreme age or emergency conditions are reported with CPT add-on codes in the 99100 series. These codes are added to the base anesthesia code.