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CERTIFIED PROFESSIONAL CODER CODING TEST QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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CERTIFIED PROFESSIONAL CODER CODING TEST QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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CERTIFIED PROFESSIONAL CODERCODING TEST QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
Coding is - ANSWER the process of translating this written or dictated fmedical record into a series of
numeric or alpha-numeric codes
Proper code assignment is determined by - ANSWER content of the medical record and by the unique
rules that governs each code set
what are 3 things that Coder must master - ANSWER 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what - ANSWER 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
The classification system determines what - ANSWER the amount health care providers will be
reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the
system
A coder must evaluate the medical record for - ANSWER 1. completeness and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or obtain
additonal PT info.
Techicians who speciallize in coding inpatient hospital services are referred as - ANSWER 1. Health
information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
,What is MS-DRGs and what is it - ANSWER 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR - ANSWER Electronic health record
Skill coders may become - ANSWER consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services - ANSWER 1. Outpatient coding (physician
services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
What is APC and who uses it - ANSWER Ambulatory Payment Classification- outpatient facility coders
(physician services
What is the coder role in a physician's office - ANSWER Extremely important to proper reimbursement
and the livelihood of the physican
What is a physican degree of education - ANSWER 4 years of college, 4 years of medical school plus 3 to
5 years of residency.
What is a mid-level providers and who - ANSWER 1. Mid-level providers are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what - ANSWER 1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
NP must have - ANSWER A Master Degree in Nursing
How many payers in the most simplest form? - ANSWER 2
,Private insurance plans and government insurance plans
Commerical carriers are considered what - ANSWER Private payers that offer both group and individual
plans.
Private Payers contracts may - ANSWER Vary but may include hospitalization, basic and major medical
coverage.
What is the most significant government insurer - ANSWER Medicare
What is Medicare - ANSWER Federal health insurance program- Administerd by the Center for Medicare
&Medicaid Services (CMS)
What is CMS and what does it provide - ANSWER Center for Medicare & Medicaid Services (CMS)
provides coverage for people over the age of 65, blind, or disabled individuals, people with end -stage
renal disease
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-Medicare
payers alike - ANSWER Last
What are the parts of Medicare - ANSWER Medicare A
Medicare B
Medicare C
Medicare D
What is Medicare Part A - ANSWER Covers inpatient hospital care, as well as care provided in skilled
nursing facilites, hospice care, and home health care
What is Medicare Part B - ANSWER Covered Medically necessary doctors' services, outpatient care, other
medical services (including some preventive service not covered under Medicare Part A
, Medicare Part B is considered what - ANSWER A optional benefit for which the patient must pay a
premium and which generally requires a yearly copay
Where is Medicare Part B usually used - ANSWER Physician offices (Outpatient Facility)
What is Medicare Part C - ANSWER Combines the benefits of Medicare Part A, Part B, and sometimes
Part D.
What is Medicare Part C also called - ANSWER Medicare Advantage
What is PPO - ANSWER Preferred Provider Organizations
What is HMO - ANSWER Health Maintenace Organizations
Which plan covers PPO and HMO - ANSWER Medicare Part C
What is the CMS-HCC - ANSWER Center for Medicare & Medicaid Services-Hierarchical condition
category
What does the CMS-HCC provide - ANSWER Risk adjument model provides adjusted payment based on a
patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out on
what - ANSWER additional reimbursement for which he/she is entitled.
What is Medicare Part D - ANSWER Prescription drug coverage program available to all Medicare
beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid - ANSWER A health insurance assistance program for some low income people
(especially children and pregnant women) sponsored by federal and state governments
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