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CERTIFIED PROFESSIONAL CODER CODING EXAM
2025|QS WITH AS|100% PASS
Under HIPAA, what would be a policy requirement for "minimum necessary"? Only individuals whose job requires it may have access to protected health information What is true regarding ABNs? ABNs may not be recognized by non-Medicare payers. Which act was enacted as part f the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? HITECH Which statement describes a medically necessary service? Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition
What document assists provider offices with the development of Compliance Manuals? OIG Compliance Program Guidance What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of services? OIG Work Plan What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? ABN When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost? $100 or 25%
Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent? Subjective, Objective, Assessment, Plan What is medical necessity? Refers to whether a procedure or service is considered appropriate in a given circumstance What is not a common reason Medicare may deny a service? Covered service Under the Privacy Rule, the minimum necessary standard does not apply to what type of disclosure? Disclosures to the individual who is the subject of the individual
Which is not one of the seven key components of an integral compliance plan? Conduct training but not perform education on practice standards and procedures EHR stands for: Electronic health record What does CMS-HCC stand for? Centers for Medicare and Medicaid Services - Hierarchical Condition Category When are providers responsible for obtaining an ABN for a service not considered medically necessary? Prior to providing a service or item to a beneficiary Local Coverage Determinations are administered by whom? Each regional MAC
What is not considered a covered entity under HIPAA? Workers' Compensation What is the purpose of National Coverage Determinations? To explain CMS policies on when Medicare will pay for items or services LCDs only have jurisdiction in their ______ region What type of health insurance provides coverage for low-income families? Medicaid The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are _______. Consistent and appropriate
Which statement is true regarding the Merit-Based incentive Program (MIPS)? Providers are excluded from MIPS if they are enrolled in a qualifying APM program What does the abbreviation MAC stand for? Medicare Administrative Contractor A covered entity does not include: Patients A covered entity may obtain consent from an individual to use or disclose protected health information to carry out all of the following except: Research Which of the following is not. component of the MIPS program? Readmission Rates
Which of the following is a benefit of electronic transactions. Timely submission of claims Which coding manuals do outpatient coders focus on learning? CPT, HCPCS Level II, and ICD-10-CM Which structure is responsible for moistening, warming, and filtering inspired air? Nose Which part of the large intestine is between the hepatic flexure and the splnic flexure? Transverse Colon Which type of membrane is found lining the interior walls of the digestive system?
Mucous membrane The lymphatic ducts empty their contents into what structure? Subclavian Veins Based on word parts, what structure does paronychia refer to? Nail What is the medical term for a congenital defect in which the urethra opens on the dorsum of the penis? Epispadias What is an example of a long bone? Metacarpals
Documentation: The posterior vaginal fornix and outer cervical os were prepped with a cleansing solution In this statement, what does "os" stand for? Ostium (opening) Hysterosalpingogram report: "right cornual contour abnormality" Where is the cornu (pleural cornual) found anatomically for this case? Where the fallopian tubes connect to the fundus Surgical procedure: Myringotomy What anatomic location os being operated on? Ear Documentation: There was no cleft of the uvula or submucosal palate by visual and palpable exam. What is being examined? Oral cavity
Documentation: Recession of left inferior rectus muscle, 5 mm What anatomic location is being operated on? Eye Diagnosis: Kyphosis What anatomic location does this diagnosis most often refer to? Thoracic Spine Documentation: Suprapatellar recess showed no evidence of loose bodies or joint pathology What anatomic location does this refer to? knee (above the patella) Colles;' fracture What anatomic location does this refer to?
Femur Which one of the following is true about the tympanic membrane? It separates the external ear from the middle ear An ectopic pregnancy is a complication in which the fertilized ovum is implanted in any tissue other than the _____. Uterine wall Upon leaving the stomach, nutrients move through the small intestine in what order? Duodenum, jejunum, ileum Which chamber of the heart is considered the one working the hardest? Left ventricle
Which one of the following is significant of an abdominal aortic aneurysm? It is a weakness in a large artery and rupture can be deadly Which respiratory structure is comprised of cartilage and ligaments? Trachea The term hemic specifically refers to what bodily fluid? Blood What is the bowman's capsule? C-shaped structure partially surrounding the glomerulus Bone marrow harvesting is a procedure to obtain bone marrow from a donor. Bone marrow collected from a close relative is: Allogenic
Unequal vision in the two eyes What is the Rinne test? Test measuring hearing using bone conduction and air conduction Splenorrhaphy is: suturing a wound of the spleen The process of preserving cells or whole tissues at extremely low temperatures is known as: Cryopreservation The meaning of the root blephar/o is: eyelid Adrenomegaly is defined as:
Enlargement of the adrenal gland A dacryocystectomy is an: Excision of lacrimal sac Derm/o skin dermat/o skin Hidr/o sweat, perspiration Kerat/o keratin, horny layer of the skin
