CPC Class 2 – Important Questions & Answers

 Since we completed Class 1 & 2 CPC course is generally the Medical Coding Basics / Healthcare & Coding Fundamentals foundation, these questions focus on medical coding concepts, CPT, ICD-10-CM, HCPCS, modifiers, documentation, and basic coding terminology.

At the end we will discuss 15 CPC style scenarios questions.

 

Part 1: Medical Coding Basics

1. What is medical coding?

A. Treating a patient
B. Converting medical documentation into standardized codes
C. Prescribing medication
D. Scheduling appointments

Answer: B – Converting medical documentation into standardized codes

2. What are the three major code sets used in professional medical coding?

A. CPT, ICD-10-CM, HCPCS Level II
B. DRG, NDC, EMR
C. ICD-9, ICD-10, DRG
D. CPT, DRG, E/M

Answer: A

Remember:
CPT → Procedures/services
ICD-10-CM → Diagnoses
HCPCS Level II → Supplies, drugs, equipment and certain services

3. What does ICD stand for?

A. International Classification of Diseases
B. International Code Directory
C. Insurance Classification Database
D. International Clinical Diagnosis

Answer: A – International Classification of Diseases

4. What does ICD-10-CM stand for?

A. International Classification of Diseases, Tenth Revision, Clinical Modification
B. International Coding Database, Tenth Revision
C. International Clinical Diagnosis, Tenth Edition
D. Insurance Coding Documentation, Clinical Modification

Answer: A

5. What is the primary purpose of ICD-10-CM?

A. Reporting procedures
B. Reporting diagnoses and conditions
C. Reporting physician fees
D. Reporting medical supplies

Answer: B – Reporting diagnoses and conditions

6. What does CPT stand for?

A. Current Procedural Terminology
B. Clinical Procedure Terminology
C. Current Patient Treatment
D. Certified Procedure Terminology

Answer: A – Current Procedural Terminology

7. What is CPT primarily used to report?

A. Diagnoses
B. Procedures and professional services
C. Patient allergies
D. Hospital rooms

Answer: B

8. Who maintains CPT?

A. CMS
B. AMA
C. CDC
D. WHO

Answer: B – American Medical Association (AMA)

9. What is HCPCS?

A. Healthcare Common Procedure Coding System
B. Healthcare Clinical Patient Coding System
C. Hospital Common Procedure Classification System
D. Healthcare Coding Procedure System

Answer: A

10. What is HCPCS Level II primarily used for?

A. Diagnoses
B. Procedures only
C. Supplies, equipment, drugs and certain services
D. Laboratory diagnoses only

Answer: C

Part 2: ICD-10-CM Basics

11. Which code set is used to report a patient’s diagnosis?

A. CPT
B. ICD-10-CM
C. HCPCS Level II
D. NDC only

Answer: B – ICD-10-CM

12. Where should a coder begin when looking up an ICD-10-CM diagnosis?

A. Tabular List
B. Alphabetic Index
C. Encoder only
D. CPT Index

Answer: B – Alphabetic Index

Exam tip:
Index → Tabular List → Verify instructions

13. Why must the Tabular List be reviewed after locating a diagnosis in the Alphabetic Index?

A. To find the physician’s name
B. To verify the complete code and coding instructions
C. To determine the patient’s insurance
D. To select a CPT code

Answer: B

14. What does an Excludes1 note generally indicate?

A. The two conditions can always be coded together
B. The excluded condition should not be coded with the code containing the note
C. The condition is optional
D. The code is deleted

Answer: B

15. What does an Excludes2 note generally mean?

A. The condition is never coded
B. The excluded condition is not part of the condition represented by the code, and both may be coded when appropriate
C. The code is invalid
D. The code must be sequenced first

Answer: B

16. What is a placeholder character in ICD-10-CM?

A. A character used to maintain the required position of another character
B. A modifier
C. A diagnosis
D. A CPT character

Answer: A

17. Which character is commonly used as an ICD-10-CM placeholder?

A. A
B. X
C. Z
D. Q

Answer: B – X

18. What is the purpose of a 7th character in ICD-10-CM?

A. To identify the physician
B. To provide additional information such as encounter or healing status when required
C. To identify insurance
D. To identify CPT category

Answer: B

19. A coder finds a code that requires a 7th character. What should the coder do?

A. Ignore it
B. Assign the code without it
C. Follow the Tabular List instructions and assign the required 7th character
D. Replace it with a modifier

Answer: C

20. What does “code first” mean?

A. Code the condition first before the associated manifestation/other condition as instructed
B. Code the procedure first
C. Code the patient’s age first
D. Code the CPT first

Answer: A

Part 3: CPT Basics

21. How many digits are generally in a standard CPT code?

A. 3
B. 4
C. 5
D. 7

Answer: C – 5 digits

22. What does an unlisted CPT code generally represent?

A. A procedure that has no specific CPT code
B. A deleted code
C. An ICD diagnosis
D. A modifier

Answer: A

23. What are CPT Category I codes?

A. Temporary codes only
B. Five-digit codes representing established procedures/services
C. Diagnosis codes
D. HCPCS codes

Answer: B

24. What are CPT Category II codes primarily used for?

A. Performance measurement/tracking
B. Diagnosis reporting
C. Durable medical equipment
D. Inpatient procedures

Answer: A

25. What are CPT Category III codes used for?

A. Emerging technology, procedures and services
B. Diagnoses
C. Medications only
D. Office supplies

Answer: A

Part 4: Modifiers

26. What is a CPT modifier?

A. A two-character addition that provides additional information about a service or procedure
B. A diagnosis code
C. A replacement for CPT
D. A DRG

Answer: A

27. What does modifier 25 indicate?

A. Bilateral procedure
B. Significant, separately identifiable E/M service on the same day as another procedure/service, when requirements are met
C. Reduced service
D. Assistant surgeon

Answer: B

28. What does modifier 50 indicate?

A. Bilateral procedure
B. Repeat procedure
C. Reduced service
D. Emergency service

Answer: A – Bilateral procedure

29. What does modifier 51 generally indicate?

A. Multiple procedures
B. Bilateral procedure
C. Unrelated procedure
D. Repeat procedure

Answer: A

30. What does modifier 52 indicate?

A. Increased procedural service
B. Reduced services
C. Bilateral procedure
D. Separate structure

Answer: B – Reduced services

31. What does modifier 53 indicate?

A. Discontinued procedure
B. Bilateral procedure
C. Repeat procedure
D. Assistant surgeon

Answer: A – Discontinued procedure

32. What does modifier 59 indicate?

A. Bilateral procedure
B. Distinct procedural service
C. Reduced service
D. Global surgery

Answer: B

33. Which modifiers are the X{EPSU} modifiers?

A. XE, XP, XS, XU
B. XA, XB, XC, XD
C. XT, XR, XS, XQ
D. X1, X2, X3, X4

Answer: A

34. What does modifier XE indicate?

A. Separate encounter
B. Separate practitioner
C. Separate structure
D. Unusual service

Answer: A

35. What does modifier XP indicate?

A. Separate practitioner
B. Separate encounter
C. Separate structure
D. Unusual non-overlapping service

Answer: A

36. What does modifier XS indicate?

A. Separate encounter
B. Separate practitioner
C. Separate structure
D. Unrelated diagnosis

Answer: C

37. What does modifier XU indicate?

A. Unusual non-overlapping service
B. Separate practitioner
C. Separate encounter
D. Bilateral procedure

Answer: A

Part 5: Documentation & Coding

38. What is the most important source for assigning a diagnosis code?

A. Patient’s insurance card
B. Provider documentation/medical record
C. Patient’s occupation
D. CPT book only

Answer: B – Provider documentation/medical record

39. Can a coder assume a diagnosis that is not documented?

A. Yes
B. No
C. Only for inpatient coding
D. Only for outpatient coding

Answer: B – No

Very important:
Code what is documented and supported; do not make unsupported assumptions.

40. What should a coder do when documentation is unclear or conflicting?

A. Guess
B. Ignore the documentation
C. Follow applicable coding guidance and seek clarification/query when appropriate
D. Automatically choose the most expensive code

Answer: C

41. What is a compliant physician query used for?

A. Changing the patient’s diagnosis for reimbursement
B. Obtaining clarification when documentation is incomplete, ambiguous, conflicting or clinically unclear
C. Increasing payment
D. Selecting a CPT code without documentation

Answer: B

Part 6: Medical Necessity

42. What does medical necessity generally mean?

A. The service is appropriate and necessary for the patient’s condition under applicable requirements
B. The patient requested the service
C. The service is expensive
D. The provider prefers the service

Answer: A

43. Which code set is generally used to support the reason a service was performed?

A. ICD-10-CM
B. CPT only
C. HCPCS only
D. DRG only

Answer: A – ICD-10-CM

44. Which code generally describes what service was performed?

A. ICD-10-CM
B. CPT/HCPCS
C. Diagnosis-related group only
D. POA indicator

Answer: B

Part 7: E/M Basics

45. What does E/M stand for?

A. Evaluation and Management
B. Examination and Medicine
C. Emergency Management
D. Evaluation and Medication

Answer: A

46. E/M codes are primarily used to report:

A. Physician/qualified healthcare professional evaluation and management services
B. Diagnoses
C. Medical supplies only
D. Laboratory equipment

Answer: A

47. Which of the following is an example of an E/M setting?

A. Office visit
B. Appendectomy
C. MRI machine
D. Surgical instrument

Answer: A

Part 8: HCPCS Level II

48. HCPCS Level II codes generally begin with:

A. A–V
B. 1–9 only
C. C only
D. Z only

Answer: A – A through V

49. Which code set commonly reports durable medical equipment?

A. ICD-10-CM
B. CPT only
C. HCPCS Level II
D. DRG

Answer: C

50. A patient receives a medical supply that is reported with a HCPCS Level II code. Which code set should the coder review?

A. ICD-10-CM
B. HCPCS Level II
C. ICD-10-PCS only
D. CPT Category II only

Answer: B

15 CPC-Style Scenario Questions

51. A patient is diagnosed with diabetes mellitus. Which code set should be used to report the diagnosis?

A. CPT
B. ICD-10-CM
C. HCPCS
D. CPT Category III

Answer: B – ICD-10-CM

52. A physician performs a surgical procedure. Which code set generally reports the procedure?

A. ICD-10-CM
B. CPT
C. Diagnosis code only
D. Z code

Answer: B – CPT

53. A patient receives a wheelchair. Which code set would generally be reviewed for reporting the equipment?

A. ICD-10-CM
B. HCPCS Level II
C. CPT Category II
D. ICD-10-CM procedure codes

Answer: B – HCPCS Level II

54. A procedure was performed bilaterally and the applicable coding rules allow reporting with modifier 50. Which modifier is appropriate?

A. 25
B. 50
C. 52
D. 59

Answer: B – 50

55. A physician performed only part of a procedure and the circumstances meet the requirements for reduced services. Which modifier may apply?

A. 50
B. 52
C. 53
D. 59

Answer: B – 52

56. Two procedures were performed during the same encounter and are distinct because they involved separate structures. Which X modifier may be appropriate when requirements are met?

A. XE
B. XP
C. XS
D. XU

Answer: C – XS

57. A procedure was stopped because of the patient’s condition after it had begun. Which modifier may be considered when applicable?

A. 50
B. 52
C. 53
D. 59

Answer: C – 53

58. The coder finds a diagnosis in the Alphabetic Index. What should be done next?

A. Submit the code immediately
B. Verify it in the Tabular List
C. Add modifier 59
D. Look in HCPCS

Answer: B

59. The Tabular List contains an “Excludes1” note. What should the coder do?

A. Ignore it
B. Follow the instruction and do not code the excluded condition together with that code when the note applies
C. Always code both
D. Use modifier 25

Answer: B

60. The provider’s documentation is unclear regarding the diagnosis. What should the coder do?

A. Guess the diagnosis
B. Select the highest-paying diagnosis
C. Follow applicable guidelines and query the provider when appropriate
D. Delete the encounter

Answer: C