Deck 1: The Certified Professional Coder

Question 1

Coding and billing language is used to assist _____________________________ in understanding why the patient was seen and what services, procedures, or supplies were provided for the patient.

A) third-party administrators and customer service representatives
B) collection agencies and hospitals
C) patients and collection agencies
D) physician offices and patients

Answer 1

physician offices and patients

Question 2

Accounts receivable, denials, and modifiers are examples of _____________ language.

A) Provider
B) Billing
C) Compliance
D) Payer

Answer 2

Billing

Question 3

Any diagnosis, condition, procedure, or service that is documented in the patient record as having been treated or medically managed demonstrates:

A) medical support
B) medical documentation
C) medical management
D) medical necessity

Answer 3

medical necessity

Question 4

The Certified Professional Coder (CPC) exam tests the coder's skill in translating data from the patient's medical record accurately and completely so that the provider is:

A) Reimbursed correctly and fairly
B) Able to hire additional staff
C) Exempt from audits
D) Reimbursed regardless of compliance guidelines

Question 5

Medical coding is defined as:

A) The process of translating provider documentation into codes
B) Identifying noncovered services
C) Verifying services are covered by a payer prior to providing the services
D) The process of reporting patient index information to payer auditors

Question 6

An ICD-10-CM (tenth revision) code represents:

A) the diagnosis
B) the demographics
C) the service
D) the procedure

Question 7

The CPC exam is an "open code-book" exam. All of the following are approved coding manuals for use during the exam except:

A) ICD
B) HCPCS
C) CPT
D) DSM-5

Question 8

The _____ exam is a 150-question exam that thoroughly tests the coder's ability within a medical coding subset.

A) Certified Coding Specialist
B) National Billing and Insurance Specialist
C) Certified Professional Coder
D) Certified Coding Associate

Question 9

Revenue included in the accounts receivable cycle may be due to the provider from all of the following except:

A) workers' compensation
B) recovery audit contractors
C) health insurance coverage
D) the patient

Question 10

Approximately ____________ percent of members of the American Academy of Professional Coders are credentialed as Certified Professional Coders.

A) 50
B) 60
C) 80
D) 70

Question 11

A diagnosis which may not receive direct treatment during an encounter but which the provider has to consider when determining treatment for other conditions is called a:

A) Medically managed diagnosis
B) Concurrent diagnosis
C) Additional diagnosis
D) Secondary diagnosis

Question 12

The flow of a practice's revenue, which begins when charges for services, procedures, or supplies are incurred and continues until those charges are paid in full or adjusted off the account is called:

A) revenue cycle
B) contractual adjustment cycle
C) accounts payable cycle
D) accounts receivable cycle

Question 13

The CPC exam tests the coder's ability and understanding of which content areas?

A) Radiology, DRGs, Advanced Beneficiary Notices, and Anesthesia
B) DRGs, HCPCS Level II, and Anesthesia
C) HCPCS Level II, Radiology, and DRGs
D) Radiology, Anesthesia, and HCPCS Level II

Question 14

Selection of ICD, CPT, and HCPCS codes is based on _____________ language.

A) provider
B) payer
C) billing
D) compliance

Question 15

The demographic portion of the CMS 1500 form:

A) Contains information such as the services provided on a date of service
B) Is found at the top of the form
C) Is found at the bottom of the form
D) Contains information such as the patient's medical condition

Question 16

The foundation of a coder's role is to:

A) Determine each patient's chief complaint and communicate this to the physician
B) Follow office guidelines and procedures when scheduling patients
C) Make each patient feel comfortable while obtaining vital signs
D) Interpret different languages and correctly translate them into data for the CMS 1500 form

Question 17

Creating a clean claim requires that all involved in its creation have all of the following except:

A) A good working knowledge of each of the patient's medically managed conditions
B) A good working knowledge of government regulations
C) A good working knowledge of payer policies
D) A good working knowledge of the practice/provider-payer contract limitations

Question 18

To be of value to the practices or organizations they work for, medical coders should:

A) Memorize all procedure codes
B) Consistently audit the use of ICD-10 codes
C) Demonstrate strong organizational skills
D) Be diligent in maintaining and updating their knowledge of medical coding and billing policies

Question 19

One of the more common reasons for a coder performing poorly on the exam when he/she knows the material well is:

A) The coder experiences test anxiety
B) The coder forgot to bring No. 2 pencils
C) The coder forgot to bring headphones
D) The coder brought all permitted coding manuals

Question 20

Certified coders, on average, earn _____ percent more than noncertified coders.

A) 30
B) 20
C) 15
D) 10

Question 21

The CPC exam tests the coder's ability and understanding of which content areas?

A) Digestive, Psychology, and Musculoskeletal
B) Respiratory, Musculoskeletal, and Digestive
C) Respiratory, Psychology, and Digestive
D) Psychology, Respiratory, and Musculoskeletal

Question 22

The CPC exam tests the coder's ability and understanding of all of the following except:

A) Practice management
B) ICD-10-PCS
C) Evaluation and management
D) Medical terminology

Question 23

The CPC exam tests the coder's ability and understanding of which content areas?

A) Hemic and Lymphatic, Laboratory, and ICD-10-CM
B) MCCs/CCs, Laboratory, and ICD-10-CM
C) Hemic and Lymphatic, Laboratory, and MCCs/CCs
D) MCCs/CCs, Hemic and Lymphatic, and ICD-10-CM

Question 24

The CPC exam tests the coder's ability and understanding of all of the following except:

A) Male/female genital
B) Pharmacology
C) Eye and ocular adnexa
D) Anatomy and physiology

Question 25

The CPC exam tests the coder's ability and understanding of all of the following body systems except:

A) Digestive
B) Psychology
C) Musculoskeletal
D) Respiratory

Question 26

A complete and current list of non-approved manuals for use during certification testing can be found at:

A) www.cpc.com
B) www.aapc.com
C) www.ahima.org
D) www.cms.gov

Question 27

A Certified Professional Coder is an individual who has demonstrated his or her knowledge of medical coding by successfully completing the _____________ exam:

A) PAC
B) CPA
C) CPC
D) APC

Question 28

The CPC exam tests the coder's ability and understanding of all of the following except:

A) Maternity and delivery
B) Coding guidelines
C) Revenue cycle
D) Pathology

Question 29

The CPC exam has _________ questions.

A) 175
B) 100
C) 150
D) 200

Question 30

When a charge is paid in full, the revenue cycle:

A) Moves to the submission phase of the cycle
B) Begins
C) Moves to the charge phase of the cycle
D) Concludes

Question 31

The CPC exam tests the coder's ability and understanding of which content areas?

A) Risk adjustment, Pathology, and Maternity and Delivery
B) Maternity and Delivery, Pathology, and general coding guidelines
C) General coding guidelines, Maternity and Delivery, and risk adjustment
D) Pathology, general coding guidelines, and risk adjustment

Question 32

A clean claim:

A) Slows the reimbursement process
B) Results in accurate and timely reimbursement
C) Releases the payer from the contractual adjudication time frame
D) Guarantees the provider will receive payment

Question 33

Medical practices contract with multiple insurance payers for all of the following reasons except:

A) To ensure the uninsured receive services
B) Facilitate payment for patients covered by diverse insurance plans
C) To maintain the number of patients they serve
D) To increase the number of patients they serve

Question 34

The process of translating provider documentation and medical terminology into codes that illustrate the procedures and services performed by medical professionals is:

A) medical coding
B) provider language
C) payer language
D) medical management

Question 35

The CPC exam is an "open code-book" exam. Approved books to use during the exam include:

A) DSM IV, HCPCS, and ICD
B) HCPCS, CPT, and DSM IV
C) CPT, HCPCS, and ICD
D) CPT, HCPCS, and DSM IV

Question 36

The time allowed for completing the CPC exam is:

A) 5 hours 40 minutes
B) 6 hours
C) 5 hours
D) 5 hours 30 minutes

Question 37

The CPC exam tests the coder's ability and understanding of all of the following except:

A) ICD-10-CM
B) Hemic and lymphatic
C) Laboratory
D) ICD-10-PCS

Question 38

The adjudication period begins upon:

A) Receipt of a clean claim
B) Submission of a claim to the payer
C) Receipt of a claim
D) Providing services

Question 39

Provider language includes terms such as:

A) medical terminology, procedures, and services
B) accounts receivable, procedures, and services
C) noncovered services, medical terminology, and procedures
D) false claim, modifiers, and denials

Question 40

Coding and billing language is used to assist the following except:

A) patients
B) collectors
C) hospitals
D) physician offices

Question 41

Physicians need to be aware of what is necessary in their documentation in all of the following medical documents except:

A) superbill
B) CMS 1500 form
C) handwritten notes in charts
D) dictated reports

Question 42

The CPC exam tests the coder's ability and understanding of which content areas?

A) ICD-10-PCS, practice management, and medical terminology
B) Evaluation and management, ICD-10-PCS, and practice management
C) Medical terminology, ICD-10-PCS, and evaluation and management
D) Medical terminology, practice management, and evaluation and management

Question 43

The following coding habit would be most likely to trigger a payer audit:

A) Consistently billing the same, low level E/M service code
B) Consistently billing the same, high level E/M service code
C) Billing an even distribution of low and high level E/M service codes
D) Consistently billing the same, low level E/M service code and consistently billing the same, high level E/M service code

Question 44

When taking the CPC exam, it is best to do all of the following except:

A) Leave questions you are unsure of blank
B) Follow all instructions the proctor gives
C) Complete questions about which you are more confident first
D) Make your best attempt to answer a question then move on

Question 45

An individual who has demonstrated his or her knowledge of medical coding by successfully completing the CPC exam is known as:

A) Certified Coding Specialist
B) Certified Professional Coder
C) Certified Coding Professional
D) Certified Coding Association

Question 46

All of the following are benefits of becoming a certified coder except:

A) certified coders are more likely to pursue continuing education
B) certified coders may make medical necessity determinations
C) certified coders earn more salary on average than noncertified coders
D) certified coders are typically eligible for various career opportunities

Question 47

A CMS 1500 claim that is complete and accurate from the demographic portion to the diagnosis and procedure is a:

A) advanced beneficiary notice
B) modifier
C) false claim
D) clean claim

Question 48

The __________ form becomes the source of the statistical medical data for the practice, payer, and governing bodies.

A) Billing language
B) Advanced Beneficiary Notice (ABN)
C) UB-04
D) CMS 1500

Question 49

Which of the following are areas being audited by payers:

A) all of these
B) medical necessity
C) duplicate claims
D) incorrect use of modifiers

Question 50

The CPC exam tests the coder's ability and understanding of which content areas?

A) Anatomy and physiology, pharmacology, and Eye and Ocular Adnexa
B) Pharmacology, anatomy and physiology, and Male/Female Genital
C) Anatomy and physiology, Eye and Ocular Adnexa, and Male/Female Genital
D) Eye and Ocular Adnexa, Male/Female Genital, and pharmacology

Question 51

All of the following are areas being audited by payers except:

A) consistent use of the same level of evaluation and management codes
B) use of invalid codes
C) consistent use of the same procedural codes
D) unbundling

Question 52

One of the more common reasons for a coder performing poorly on the exam when he/she knows the material well is:

A) The coder studied for weeks leading up to the exam date
B) The coder ran out of time to take the exam
C) The coder got lost on the way to the test site
D) The coder forgot to bring food to the test site

Question 53

Billing language includes terms such as:

A) unbundling, abuse, and fraud
B) noncovered services, compliance language, and unbundling
C) medical terminology and anatomy and physiology
D) accounts receivable, denials, and modifiers

Question 54

ICD-10 codes are reported in field ______ of the CMS form.

A) 22
B) 25
C) 21
D) 18

Question 55

The code set(s) used to translate the specific services, procedures, and supplies performed on a date of service is/are:

A) ICD, HCPCS
B) ICD, CPT
C) HCPCS Level II, CPT
D) CPT

Question 56

Revenue that is due to the practice or provider for services or procedures rendered to the patient is:

A) accounts payable
B) remittance advice
C) accounts receivable
D) adjudication

Question 57

Errors in the medical records may be corrected by doing which of the following?

A) Creating an addendum to the record that is dated and legibly signed
B) Drawing a strike-through line through the error, writing the correction beside it, and initialing or creating an addendum to the record that is dated and legibly signed
C) Drawing a strike-through line through the error, writing the correction beside it, and initialing
D) Erasing the error, writing the correction in its place, and initialing

Question 58

The most effective way to increase revenue at a physician practice is to:

A) Increase patient workload
B) Remain aware of billing and coding guidelines
C) Hire more office staff
D) Hire more physicians

Question 59

_______________ validate the knowledge and expertise of the individual who holds them.

A) Speaking opportunities
B) Credentials
C) Licensure
D) Continuing education credits

Question 60

The CPC exam tests the coder's ability and understanding of which of the following areas:

A) HCPCS Level II
B) All of these
C) Anesthesia
D) Radiology

Question 61

Payer language includes terms such as:

A) compliance language, unbundling, and medical necessity
B) medical necessity, clean claims, and denials
C) accounts receivable, medical necessity, and unbundling
D) advanced beneficiary notices, fraud, and abuse

Question 62

The diagnostic portion of the CMS 1500 form:

A) Includes information such as the patient's name and date of birth
B) Includes information such as the patient's medical condition
C) Is found at the bottom of the form
D) Is found at the top of the form

Question 63

Medical necessity is:

A) Documented in the patient's chart and is not a translated piece of provider information
B) Any diagnosis, condition, procedure, or service documented in the patient record as having been treated or medically managed
C) Represented by a HCPCS code on the CMS 1500 claim form
D) Determined by the Certified Professional Coder

Question 64

The CPC exam tests on the following code sets:

A) ICD, CPT, HCPCS Level II
B) ICD, CPT
C) ICD, HCPCS Level II
D) ICD

Question 65

The code set(s) used to translate the specific services, procedures, and supplies performed on a date of service is/are:

A) ICD, CPT
B) CPT
C) ICD, HCPCS
D) HCPCS Level II, CPT

Question 66

The CPC exam tests the coder's ability and understanding of which of the following areas:

A) HCPCS Level II
B) Anesthesia
C) All of these
D) Radiology

Question 67

Medical coding is defined as:

A) The process of reporting patient index information to payer auditors
B) Verifying services are covered by a payer prior to providing the services
C) The process of translating provider documentation into codes
D) Identifying noncovered services

Question 68

The __________ form becomes the source of the statistical medical data for the practice, payer, and governing bodies.

A) UB-04
B) CMS 1500
C) Advanced Beneficiary Notice (ABN)
D) Billing language

Question 69

The CPC exam tests the coder's ability and understanding of all of the following except:

A) Pharmacology
B) Anatomy and physiology
C) Male/female genital
D) Eye and ocular adnexa

Question 70

Revenue that is due to the practice or provider for services or procedures rendered to the patient is:

A) accounts receivable
B) accounts payable
C) adjudication
D) remittance advice

Question 71

Creating a clean claim requires that all involved in its creation have all of the following except:

A) A good working knowledge of payer policies
B) A good working knowledge of each of the patient's medically managed conditions
C) A good working knowledge of the practice/provider-payer contract limitations
D) A good working knowledge of government regulations

Question 72

Certified coders, on average, earn _____ percent more than noncertified coders.

A) 30
B) 10
C) 20
D) 15

Question 73

A Certified Professional Coder is an individual who has demonstrated his or her knowledge of medical coding by successfully completing the _____________ exam:

A) PAC
B) APC
C) CPA
D) CPC

Question 74

One of the more common reasons for a coder performing poorly on the exam when he/she knows the material well is:

A) The coder experiences test anxiety
B) The coder forgot to bring headphones
C) The coder forgot to bring No. 2 pencils
D) The coder brought all permitted coding manuals

Question 75

The CPC exam is an "open code-book" exam. Approved books to use during the exam include:

A) DSM IV, HCPCS, and ICD
B) CPT, HCPCS, and DSM IV
C) CPT, HCPCS, and ICD
D) HCPCS, CPT, and DSM IV

Question 76

Coding and billing language is used to assist the following except:

A) physician offices
B) collectors
C) hospitals
D) patients

Question 77

The CPC exam tests the coder's ability and understanding of all of the following except:

A) Laboratory
B) Hemic and lymphatic
C) ICD-10-PCS
D) ICD-10-CM

Question 78

The CPC exam has _________ questions.

A) 150
B) 175
C) 100
D) 200

Question 79

The AAPC supports its members by providing all of the following except:

A) coding education
B) resume writing assistance
C) offering networking opportunities
D) identifying job opportunities

Question 80

Payer language includes terms such as:

A) medical necessity, clean claims, and denials
B) advanced beneficiary notices, fraud, and abuse
C) accounts receivable, medical necessity, and unbundling
D) compliance language, unbundling, and medical necessity