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CERTIFIED PROFESSIONAL CODER CODING TEST 2025-2026|QUESTIONS WITH REAL ANSWERS|A+ RATED
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Coding is the process of translating this written or dictated fmedical record into a series of numeric or alpha-numeric codes Proper code assignment is determined by content of the medical record and by the unique rules that governs each code set what are 3 things that Coder must master
What is APC and who uses it Ambulatory Payment Classification- outpatient facility coders (physician services What is the coder role in a physician's office Extremely important to proper reimbursement and the livelihood of the physican What is a physican degree of education 4 years of college, 4 years of medical school plus 3 to 5 years of residency. What is a mid-level providers and who
Medicare D What is Medicare Part A Covers inpatient hospital care, as well as care provided in skilled nursing facilites, hospice care, and home health care What is Medicare Part B Covered Medically necessary doctors' services, outpatient care, other medical services (including some preventive service not covered under Medicare Part A Medicare Part B is considered what A optional benefit for which the patient must pay a premium and which generally requires a yearly copay Where is Medicare Part B usually used Physician offices (Outpatient Facility)
What is Medicare Part C Combines the benefits of Medicare Part A, Part B, and sometimes Part D. What is Medicare Part C also called Medicare Advantage What is PPO Preferred Provider Organizations What is HMO Health Maintenace Organizations Which plan covers PPO and HMO Medicare Part C What is the CMS-HCC
A health insurance assistance program for some low income people (especially children and pregnant women) sponsored by federal and state governments Medicaid administed on a state-by-state basis and coverage varies- although each of the state programs adheres to certain federal guidelines When is a physican considered a "participating physician" When contracted with a insurance carrier whether that be a private insurance company or a governmental. Participating Providers (Par Providers are required to accept the allowed payment amount determined by the insurance carrier as the fee for payment and follow all other guidelines stipulated by the contract The difference between the physican's fee and the insurance carriers allowed amount is
adjusted by the participating provider Non-participating Providers are
Evaluation and Management services are provided in what standard format SOAP What is SOAP S- Subjective O-Objective A- Asssessment P-Plan What is the definition of S of SOAP subjective- The patient's statment about his or her health, including symptoms What is the definition of O of SOAP objective-The provider assesses and documents the patient's illness using observation, palpation, auscultation and percussion. Test and other services performed may be documented here as well
What is the definition of A of SOAP Assessment-Evaluation and conclusion made by the provider. This is usually where the diagnosis(es) for the services are found What is the definition of P of SOAP Plan-Course of Action. Here, the provider will list eh next steps for the patient, whether it is ordering additional test, or taking over the counter medication What is a operative report a document the detail of a fprocedure performed on a patient What will most operative notes have Header and Body what are some of things that operative header note might include?
What are the 5 most important Coding Tips for operative reports for a coders
the body of the report may not be listed in the header at all. It will help a coder with a place to start What does the third coding tip mean for the operative report for a coder? Look for key words- Key words may include locations ana anatomical structures involved, surgicial approach, procedure method, procedure type, siiz and number and the surgical instruments used during the procedure What does the fourth coding tip mean for the operative report for a coder? Highlight unfamiliar words- Words you are not familiar with should be highlighted and researched for understanding What does the fifth coding tip mean for the operative report for a coder? Ready the body- All procedure reported should be documented with the body of the report. The body may indicate a procedure was abandoned or complicated, possibly indicating the need for a different procedure code or reporting of a modifier
what is MAC Medical Administrative Contractor if a NCD does not exist what are CMS guidelines Where coverage of an item or service is provided for specified indications or circumstances but is not explicitly excluded for others, or where the item or service is not mentioned at all in the CMS Manual System, the Medicare contractor is to make the coverage decision, in consultation with its medical staff and with CMS when appropriate, based on the laws, regulations, ruling and general program instructions. How often do Practices should check policies to maintain compliance Quarterly What does ABN stand for Advance Beneficiary Notice of Noncoverage, or Advance Beneficiary Notice
