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AAPC CPC PRACTICE EXAMS WITH VERIFICATION verified question with correct answers, Exams of Health sciences

Charter Oak State College (COSC)Health sciences

AAPC CPC PRACTICE EXAMS WITH VERIFICATION verified question with correct answers AAPC CPC practice exams CPC exam preparation Certified Professional Coder practice tests CPC exam questions and answers AAPC CPC exam sample questions CPC certification practice tests Medical coding practice exams AAPC CPC study guide CPC exam prep materials CPC exam practice questions Online CPC practice exams CPC test simulation AAPC CPC exam simulator Verified CPC practice exams CPC exam review questions CPC practice test with solutions AAPC exam preparation courses CPC practice quizzes Medical billing and coding practice test AAPC CPC exam tips CPC certification exam resources CPC mock exams online Certified Professional Coder exam guide CPC test preparation tools Practice exams for AAPC CPC certification

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2024/2025

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AAPC OFFICIAL CPC CERTIFICATION STUDY
EXAMS WITH VERIFICATION QUESTIONS AND
CORRECT ANSWERS
__________ _________ provides an alternative view of the contents of ICD-9-CM and contains
the _____ _____ ______ _____ _______
- ANSWERS-Appendix E; 3 digit categories in ICD-9-CM
:
- ANSWERS-colon is used in Volume I (tabular list) after an incomplete term requiring one or more
of the descriptions that follow to make it assignable to a given category
"hold harmless clause"
- ANSWERS-* found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays.
[]
- ANSWERS-Brackets are used to enclose synonyms, alternate wording, or explanatory phrases
282.42 Sickle-cell thalassemia with crisis
** Sickle-cell thalassemia with vaso-occlusive pain
** Thalassemia Hb-S disease with crisis
Use additional code for the type of crisis, such as:
** acute chest syndrome (517.3)
**splenic sequestration (289.52)
correct sequence for sickle-cell thalassemia crisis with acute chest syndrome in correct sequence
are:
- ANSWERS-282.42, 517.3
a combination code indicates
- ANSWERS-a single code is used to classify 2 diagnoses, a diagnosis with an associated
secondary process (manifestation), or a diagnosis with an associated complication
A compliance plan may offer several benefits, including:
- ANSWERS-* more accurate payment of claims
* fewer billing mistakes
* improved documentation and more accurate coding
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Download AAPC CPC PRACTICE EXAMS WITH VERIFICATION verified question with correct answers and more Exams Health sciences in PDF only on Docsity!

AAPC OFFICIAL CPC CERTIFICATION STUDY

EXAMS WITH VERIFICATION QUESTIONS AND

CORRECT ANSWERS

__________ _________ provides an alternative view of the contents of ICD- 9 - CM and contains the _____ _____ ______ _____ _______

  • ANSWERS-Appendix E; 3 digit categories in ICD- 9 - CM :
  • ANSWERS-colon is used in Volume I (tabular list) after an incomplete term requiring one or more of the descriptions that follow to make it assignable to a given category "hold harmless clause"
  • ANSWERS-* found in some non-Medicare health plan contracts
  • prohibits billing to patient for anything beyond deductibles and co-pays. []
  • ANSWERS-Brackets are used to enclose synonyms, alternate wording, or explanatory phrases 282.42 Sickle-cell thalassemia with crisis ** Sickle-cell thalassemia with vaso-occlusive pain ** Thalassemia Hb-S disease with crisis Use additional code for the type of crisis, such as: ** acute chest syndrome (517.3) **splenic sequestration (289.52) correct sequence for sickle-cell thalassemia crisis with acute chest syndrome in correct sequence are:
  • ANSWERS-282.42, 517. a combination code indicates
  • ANSWERS-a single code is used to classify 2 diagnoses, a diagnosis with an associated secondary process (manifestation), or a diagnosis with an associated complication A compliance plan may offer several benefits, including:
  • ANSWERS-* more accurate payment of claims
  • fewer billing mistakes
  • improved documentation and more accurate coding
  • less chance of violating self-referral and anti-kickback status A healthcare clearing house is a
  • ANSWERS-entity that processes nonstandard health information they receive from another entity into a standard format A key provision in HIPAA is the Minimum Necessary requirement. this means
  • ANSWERS-only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the
  • ANSWERS-least radical service/procedure that allows for effective treatment of the patients' complaint or condition A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site?
  • ANSWERS-Leg Abuse consists of
  • ANSWERS-payment for items or services that are billed by providers in error that should not be paid for by Medicare. AMA
  • ANSWERS-American Medical Association An ABN protects the provider's financial interest by
  • ANSWERS-creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what?
  • ANSWERS-Clearinghouse APC
  • ANSWERS-Ambulatory Payment Classification Appendix A
  • ANSWERS-Morphology of Neoplasms Appendix B
  • ANSWERS-Deleted 10/1/2004 - contained Glossary of Mental Disorders. Appendix C
  • ANSWERS-Classification of Drugs by American Hospital Formulary Service List Number and Their ICD- 9 - CM equivalents Appendix C is available to
  • ANSWERS-assist in coding of adverse effects

are written in italics with a note. The note requires the underlying disease (etiology) be recorded first and the particular manifestation be recorded second. This note only appears in the tabular index Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in

  • ANSWERS-private contracts between the payer and practice or provider compliance plan
  • ANSWERS-a written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found. CPT
  • ANSWERS-Current Procedural Terminology CY 2013 Conversion Factor
  • ANSWERS-$25. Does Medicare Part B generally require a yearly deductable and copayment?
  • ANSWERS-yes DRG
  • ANSWERS-Diagnosis Related Group E codes are used to report
  • ANSWERS-how an injury occurred and where the injury occurred. E/M OR E&M
  • ANSWERS-Evaluation and Management EHR
  • ANSWERS-Electronic Health Record eponym
  • ANSWERS-this term indicates the code describes a disease or syndrome named after a person examples of common reasons to report V codes:
  • ANSWERS-screening tests routine physicals personal or family history of a disease or disorder excludes
  • ANSWERS-terms following "excludes" notes are to be reported with a code from another category. Formula for Calculating Facility Payment amounts
  • ANSWERS-[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF

Formula for Non-Facility Pricing Amount

  • ANSWERS-[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF) fraud
  • ANSWERS-to purposely bill for srevices that were never given or to bill for a service that has a higher reimbursement than the service provided. GPCI
  • ANSWERS-Geographic Practice Cost Index GPCI is used to
  • ANSWERS-realize the varying cost based on geographic location HCPCS
  • ANSWERS-Healthcare Common Procedure Coding System Hemiplegia is a disorder caused by a defect in which anatomic system?
  • ANSWERS-nervous HHS
  • ANSWERS-Department of Health and Human Services HICN
  • ANSWERS-Health Insurance Claim Number HIPAA provides federal protections for
  • ANSWERS-personal health information when held by covered entities. HIPAA stands for
  • ANSWERS-Health Insurance Portability and Accountability Act of 1996 HITECH
  • ANSWERS-The Health Information Technology for Economic and Clinical Health Act HITECH allows patients to request
  • ANSWERS-an audit trail showing all disclosures of their health information made through an electronic record. HITECH requires that an individual be notified if
  • ANSWERS-there is an unauthorized disclosure or use of his or her health information. HITECH was enacted as part of
  • ANSWERS-the American Recovery and Reinvestment Act of 2009 (ARRA) HMO
  • ANSWERS-Health Maintenence Organization

Incus, stapes, _____

  • ANSWERS-malleus Information required by payers to determine the need for care
  • ANSWERS-1. knowledge of the emergent nature or severity of the patient's complaint or condition
  1. All signs, symptoms, complaints, or background facts describing the reason for care, such as required follow-up care. Intentional billing of services not provided is considered
  • ANSWERS- Italicized type
  • ANSWERS-used for all exclusion notes and to identify codes that should not be used for describing the primary diagnosis LCD
  • ANSWERS-Local Coverage Determinations LCDs give guidance when
  • ANSWERS-* a given service is indicated or necessary,
  • give guidance on coverage limitations
  • describe the specific CPT codes to which the policy applies
  • lists IICD- 9 - CM codes that support medical necessity for the given service or procedure LCDs have jurisdiction only within
  • ANSWERS-their regional area Maintenance of hte ICD- 9 - CM is performed by
  • ANSWERS-the Coordination and Maintenance Committee Medicaid is a
  • ANSWERS-a health insurance assistance program for some low-income people Medicaid is adminisitered on a
  • ANSWERS-state by state basis adhering to certain federal guidelines. Medicare part A helps to cover:
  • ANSWERS-inpatient hospital care care provided in skilled nursing facilities hospice care home health care Medicare Part B helps to cover
  • ANSWERS-medically necessary physicians' services

ouptatient care other medical services (including some preventative services) not covered under Part A Medicare Part B premiums are paid by

  • ANSWERS-the patient Medicare Part C combines the benefits of
  • ANSWERS-Part A and Part B and sometimes Part D Medicare Part C is also called
  • ANSWERS-Medicare Advantage Medicare Part C plans are managed by
  • ANSWERS-private insurers approved by Medicare. Medicare Part D is a
  • ANSWERS-prescription drug coverage program Medicare Part D is a coverage provided by
  • ANSWERS-private companies approved by Medicare Medicare Part D is available to
  • ANSWERS-all Medicare beneficiaries. Medicare payments for physician services are standardized using a
  • ANSWERS-resource-based relative value scale (RBRVS) modifiers
  • ANSWERS-essential modifiers are subterms listed below the main term in alphabetical order, and are indented 2 spaces Morphology codes consist of ___ digits
  • ANSWERS- 5 MP
  • ANSWERS-Malpractice MS-DRG
  • ANSWERS-Medical Severity-Diagnosis Related Group NCD
  • ANSWERS-National Coverage Determinations NCD explain
  • ANSWERS-when Medicare will pay for items or services.

PA

  • ANSWERS-Physician Assistant PE
  • ANSWERS-Physician Expense PFS
  • ANSWERS-Physician Fee Schedule PHI
  • ANSWERS-protected health information PLI
  • ANSWERS-Professional Liability Insurance Published conversion factor for CY 2011
  • ANSWERS-$33. Published Conversion factor for CY 2012
  • ANSWERS-$34. RBRVS
  • ANSWERS-Resource Based Relative Value System Resource costs for RBRVS are divided into three componentes:
  • ANSWERS-physican work practice expense professional liability insurance RUC
  • ANSWERS-Relative Value Update Committee Sebacious glands are a part of which anatomic system?
  • ANSWERS-Integumentary Section I of the official guidelines includes
  • ANSWERS-conventions, general coding guidelines, and chapter specific guidelines Selecting a code with the NEC classification means
  • ANSWERS-the provider documented more specific information regarding the patient's condition, but there is not a code in ICD- 9 - CM that reports the condition accurately slanted brackets
  • ANSWERS-indicate multiple codes are required

The ___ is used after an incomplete term which requires one or more of the descriptions that follow to make it assignable to a given category

  • ANSWERS-:, colon The ABN form is entitled
  • ANSWERS-Revised ABN CMS-R-131 and is available with instructions as a free download on the CMS website. The ABN is a standardized form that
  • ANSWERS-explains to the patient why Medicare may deny the particular service or procedure. The amount on an ABN should be within how much of the cost to the patient?
  • ANSWERS-$100 or 25% of cost RATIONALE: CMS instructions stipulate, "Notifires msut make a good faith effort to insert a reasonable estimate....the estimate should be within $100 or 25% of the actual costs, whichever is greater. The fifth digit in a morphology code indicates
  • ANSWERS-behavior of the neoplasm The first 4 digits of a morphology code identify the
  • ANSWERS-histological type of the neoplasm The first step in 3rd party reimbursement is
  • ANSWERS-establishing medical necessity The ICD- 9 - CM Coordination and Maintenance Committee, which is co-chaired by the
  • ANSWERS-NCHS (National Centers for Health Statistics) and the CMS (Centers for Medicare & Medicaid Services) The myocardium is thickest around which chamber of the heart?
  • ANSWERS-left ventricle The OIG is mandated by public law to engage in activities to test
  • ANSWERS-the efficiency and economy of government programs to include investigation of suspected health care fraud or abuse. The term "medical necessity refers to
  • ANSWERS-whether a procedure or service is considered appropriate in a given circumstance. The tunica vaginalis is part of which system?
  • ANSWERS-male reproductive Under the Privacy rule, the minimum necessary standard of HIPAA does not apply to
  • ANSWERS-* disclosures to or requests by a health care provider for treatment purposes

When does the OIG release a work plan outlining its priorities for the fiscal year ahead?

  • ANSWERS-October When seeing the instruction to use additional code, which code goes first?
  • ANSWERS-When sequencing codes, the codes listed under the "use additional code" are secondary When should an ABN be signed?
  • ANSWERS-When a service is not expecgted to be covered by Medicare. RATIONALE: This form explains to the patient why a service MAY be denied by Medicare. The ABN form should be completed for services potentially con-covered by Medicare to advise the patient of potential financial responsibility. Which of the following has a refraction function in the eye? macula retina lens iris
  • ANSWERS-lens Which of the following is a function of the pancreas?
  • supplies digestive enzymes manufactures melatonin
  • stimulates growth
  • secretes vasopressin
  • ANSWERS-supplies digestive enzymes Which of the following is a renal calculus?
  • Pyelectasia
  • Hydroureter
  • Nephrolithiasis
  • Pyonephrosis
  • ANSWERS-Nephrolithiasis Who is responsible for interpreting national policies into regional polices, called LCDs?
  • ANSWERS-each MAC (Medicare Administrative Contractor) Whose responsibility is it to develop and implement policies, best suited to its particular circumstances, to meet HIPAA requirements.
  • ANSWERS-the entity covered by HIPAA

Work RVUs reflect

  • ANSWERS-The relative levels of time and intensity associated with furnishing a Medicare PFS service and account for ~50% of the total payment associated with a service.