A patient presents with hematemesis and is diagnosed with esophagitis. The provider states that the hematemesis is due to erosion in the esophagus. Assign the correct ICD-10-CM codes.
3.
A 42-year-old female, who is a new patient, presents with foul-smelling urine, frequency, flank pain and fever for 4 days. Patient denies nausea and headache. Patient is not sexually active and is a non-smoker. The provider performs the following exam in addition to patient's height, weight and blood pressure check:
General: Well-developed, well nourished, in no acute distress Ears: external ears normal, TM bilaterally intact Neck: Supple, no thyromegaly Extremities: No edema Cardiovascular: RRR, no bruits Lungs: Clear to auscultation
The patient is prescribed ciprofloxacin and given a diagnosis of acute cystitis without hematuria. The correct coding for this encounter, using 1997 E/M guidelines is:
4.
A patient presents to the operating room with chronic pelvic pain and left renal vein impingement. The surgeon performs a renal to ovarian vein transposition to relieve the pressure. What is the correct code assignment?
5.
A patient presents with a cyst at the base of his tailbone. It is swollen and painful for the patient to sit down. The provider drapes the patient in the usual fashion, administers lidocaine and uses a scalpel to excise the 2cm cyst and a subcutaneous extension, rinses it with sterile saline, performs an intermediate repair of the wound with a layered closure. The correct CPT code assignment for this procedure is:
6.
A patient is placed under general anesthesia for an emergency surgery due to a severe brain bleed and receives a craniotomy. The patient's blood pressure has also spiked drastically and is declared in a hypertensive emergency. Which anesthesia codes would be billed?
7.
A 7-year-old child presents for a series of vaccines. The patient receives MMR and DTaP and counseling on vaccines. The correct CPT code assignment for this procedure is:
8.
How should an internal presacral abscess and an intra-abdominal abscess be coded when the patient's history includes complex continuing diverticulitis that caused a sigmoid colectomy resulting in an end colostomy, and repeated pelvic abscesses?
9.
ICD-10 codes are used:
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10.
For urosepsis, a coder must:
Confidentiality and Privacy
11.
Stacey finds a particularly scandalous story told in the patient's medical record, filled with plot twists and jealous neighbors and occasional commentary on the situation by the patient's physician. She calls her supervisor over to see the drastic outcome (and the reason the patient is in the hospital). Is this allowed, per HIPAA?
12.
Which of the following organizations are not a covered entity under HIPAA?
Clinical Classification Systems
13.
A patient comes into the office with white fuzzy patches on their tongue and is diagnosed with oral hairy leukoplakia. The provider runs a test for HIV and notates that the patient has HIV in the chart, but does not have a positive lab test yet. The patient is a smoker. What is the correct sequencing of these ICD-10 codes?
14.
A 25-year-old patient is 27 weeks and 6 days pregnant. The patient is experiencing dysuria and blood in her urine. She is diagnosed with acute cystitis. What is the correct coding of this patient's chart?
15.
A patient comes in after her pressure cooker has exploded and covered her face with boiling soup. She was luckily wearing a sweater which protected her arms. She has partial-thickness burns covering her entire face. What is the correct CPT code to be assigned as the hospital removes chicken, celery and burnt tissue from her face and places dressings on it?
16.
A 2-year-old child had their humerus fractured by a falling dresser and requires anesthesia to repair the break because they will not hold still for a reduction. The procedure billed is 24505. What anesthesia service is reported?
Confidentiality and Privacy
17.
The Breach Notification Rule, found in the ______ Rule of HIPAA, states that when _____ individuals have had their confidential data exposed and the covered entity has outdated contact information for them, that the covered entity must_____ for ______ days.
18.
Sally calls the coding department to contest the duplicate procedures that her adult sister received while admitted to an inpatient mental health facility. Sally has her sister's date of birth, her name but not her ID number. She says her sister is too depressed to advocate for herself and Sally just wants the charges reviewed. What do you do?
19.
You need a second opinion on coding a chart from your Coding Manager, who does not have access to the patient's records. You decide to e-mail a screenshot of the chart to the Coding Manager. What steps must you take to ensure that the patient's data is protected in your email?
Reimbursem*nt Methodologies
20.
Facility payments are based on:
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21.
Conversion factors:
22.
Pressure ulcers, catheter-associated urinary tract infections, falls and head trauma, DVTs and pulmonary embolisms are all examples of:
23.
Relative Value Units are:
24.
Medicare pays Skilled Nursing Facilities with a prospective payment system. Reimbursem*nt is based on:
25.
For Medicare's OPPS, payment status indicator C indicates that the HCPCS is:
26.
Risk Adjustment payment involves payments between which of the following entities?
27.
Which of the following circ*mstances would indicate a payment over the usual IPPS (Inpatient Prospective Payment System) reimbursem*nt amount?
28.
Which of the following is the condition established after study to be chiefly responsible for the patient's admission to the hospital and drives the payment the hospital will receive?
29.
Medicare reimburses on GPCI as part of the calculation for the Medicare Physician Fee Schedule (MPFS). The GPCI is multiplied by the RVU to determine pricing amounts. What is the GPCI?
Health Records and Data Content
30.
CMS requires that the patient's history and physical be completed and documented in the patient's record:
31.
These components create a patient's history:
32.
According to CMS, the provider's final authentication of the patient's health record must NOT be by:
33.
An open-record review is when:
34.
Which of the following is NOT a component of Personal Health Information
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35.
Which of the following data sets must a home healthcare provider adhere to?
36.
Dr. Johns wants to make a correction to the patient's medical record from this morning. You advise him:
37.
Where would you find this statement in the patient's medical record: "Continue Mounjaro. Increase dosage of metformin and continue to monitor."
38.
An electronic signature at the end of the provider's note which locks the health record is called:
Information Technologies
39.
What is the difference between an EHR and an EMR?
40.
Which of the following standards are used to create standardized nomenclature within an electronic health record program?
41.
Implemented in 2012, what standard changed the way that PHI was submitted electronically?
42.
Which of the following might a coder use on a daily basis to access health information?
43.
Which of the following is a software tool that coders may use to find the appropriate diagnosis or procedure code?
44.
What is the small piece of data that remembers you have visited a website called?
45.
An EHR stores all information about patients on an online database. This is an example of:
Compliance
46.
You work at a billing company, coding charts for clients. Your manager sends out claims that have not been coded professionally because your team is 2 months behind and out of compliance with your service line agreement in the contract with your client, but says that it is okay because the provider has coded the claims at the time of service and the client does not want to pay for extra coding. Which of the following statements is true?
47.
Which of the following are considered fraudulent?
48.
Which of the following is an example of a compliant query to a physician:
49.
Pass-through billing for laboratories occurs when:
50.
The best place to learn about the most up-to-date rules and regulations that have been recently passed concerning healthcare is:
The certification exam for medical coding and billing can be challenging, but certainly not impossible—over 70% of examinees passed in 2022. However, preparation and practice are vital for passing the exam, which is why MedCerts offers the Medical Coder & Biller Certification Course to help you succeed.
There's no doubt about it, the CPC® exam is tough. A variety of sources show that ONLY about 50% of coders receive the necessary 70% score to pass the CPC® Exam on the first try. That means that half of all test-takers need a second shot at passing.
Learning complex medical terminologies and coding systems on your own can be daunting. Moreover, although you can gain knowledge through self-study, you may still need to undergo formal training or certifications to meet job qualifications or get certified as a medical coder.
The hardest phase is the beginning when you're still familiarizing yourself with the codes and terminology while also having to think critically so that you can organize them accordingly. It's enjoyable working to solve the puzzle.
Yes, you can technically take the CPC exam without going to school. However, it is not recommended. The exam covers highly specific material, medical coding procedures, and codes. Without having studied medical coding, you may have a more difficult time passing the exam.
Go through a question as quickly as you can and trust your first educated answer. The last thing you want is to get trapped in over-thinking. Remember — keeping the pace means answering more exam questions, which means a better score. You can go back to questions if time permits.
Multiple organizations offer free medical billing and coding courses online. However, to start your career you usually need professional certification, which free courses do not prepare you for. But you can still find low-cost medical billing and coding certification courses online.
Medical billing and coding professionals can choose from a variety of certifications offered by several organizations. Exam fees vary but tend to range from $199 to $499. Additionally, test takers are responsible for costs such as purchasing code manuals.
You can be career-ready in only 4 to 12 months. Online certification training programs are also more affordable than a 2- or 4-year degree program. Learning medical coding online is an effective training option to prepare for the certification employers require.
The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursem*nts to payers when a conflict with a claim arises.
If you're considering medical coding training, you're probably wondering how hard it is. The answer? It depends on the program you choose and your own dedication and work ethic. However, medical coding is a challenging field that can be very rewarding.
Yes, you can technically take the CPC exam without going to school. However, it is not recommended. The exam covers highly specific material, medical coding procedures, and codes. Without having studied medical coding, you may have a more difficult time passing the exam.
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