Free NCMA Medical Billing and Coding Questions and Answers 1 — Questions and Answers
Question 1: What is the primary purpose of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set?
- To report medical procedures and services performed by a provider.
- To classify diagnoses, symptoms, and reasons for a patient encounter. (Correct answer)
- To identify medical supplies and equipment.
- To document a patient's consent for treatment.
Correct answer: To classify diagnoses, symptoms, and reasons for a patient encounter.
ICD-10-CM codes are used to report diagnoses and describe a patient's medical condition. This allows for accurate tracking of diseases, health statistics, and provides the medical necessity for services billed.
Question 2: A patient visit for a routine annual physical would be coded using which category of CPT codes?
- Anesthesia
- Surgery
- Evaluation and Management (Correct answer)
- Radiology
Correct answer: Evaluation and Management
Evaluation and Management (E/M) codes are a section of CPT used to report services like office visits, consultations, and preventive medicine check-ups. An annual physical is a form of preventive E/M service.
Question 3: In many ICD-10-CM codes, particularly for injuries, what does the 7th character extension typically signify?
- The severity of the disease (mild, moderate, severe).
- The anatomical location of the injury (e.g., left vs. right).
- The patient's age group.
- The episode of care (e.g., initial, subsequent, sequela). (Correct answer)
Correct answer: The episode of care (e.g., initial, subsequent, sequela).
The 7th character provides information about the episode of care for the condition. 'A' often stands for the initial encounter, 'D' for a subsequent encounter, and 'S' for sequela (a late effect of the injury).
Question 4: A provider performs a minor surgical procedure during the same visit as a significant, separately identifiable Evaluation and Management (E/M) service. Which CPT modifier should be appended to the E/M code?
- -51 (Multiple Procedures)
- -25 (Significant, Separately Identifiable E/M Service) (Correct answer)
- -59 (Distinct Procedural Service)
- -24 (Unrelated E/M Service by the Same Physician During a Postoperative Period)
Correct answer: -25 (Significant, Separately Identifiable E/M Service)
Modifier -25 is used to indicate that on the day a procedure was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided. This allows for both the procedure and the E/M service to be billed.
Question 5: Intentionally using a code to bill for a more complex and expensive service than the one that was actually performed is known as what?
- Bundling
- Downcoding
- Upcoding (Correct answer)
- Auditing
Correct answer: Upcoding
Upcoding is a form of fraudulent billing where the provider submits codes for more serious or complex services than were actually rendered to receive higher reimbursement. This is illegal and can result in severe penalties.
Question 6: Which code set would be used to report a vaccination administration and the vaccine itself?
- Only ICD-10-CM codes
- Only HCPCS Level II codes
- CPT codes (Correct answer)
- Both ICD-10-CM and DSM-5 codes
Correct answer: CPT codes
CPT codes are used to report the administration service (the act of giving the shot). The specific vaccine product (e.g., influenza, Tdap) is reported using its own CPT or HCPCS Level II code, but both fall under the procedural coding system.
