Tennessee Medical Coding Auditor Exam
Question and correct answers (verified
answers 100%)
Q&A 2026/2027 INSTANT DOWNLOAD PDF
1. What is the primary purpose of a medical coding audit?
A. To increase patient visits
B. To identify coding accuracy and compliance issues
C. To replace medical coders
D. To eliminate documentation requirements
Correct Answer: B
Rationale: A medical coding audit evaluates coding accuracy, identifies errors,
ensures compliance with regulations, and helps prevent improper billing practices.
2. Which organization publishes ICD-10-CM coding guidelines in the United
States?
A. American Medical Association (AMA)
B. Centers for Medicare & Medicaid Services (CMS)
C. Occupational Safety and Health Administration (OSHA)
D. Food and Drug Administration (FDA)
Correct Answer: B
Rationale: CMS and the National Center for Health Statistics (NCHS) maintain and
publish official ICD-10-CM coding guidelines.
,3. A coding auditor discovers that a diagnosis code is unsupported by physician
documentation. What should the auditor recommend?
A. Add the diagnosis automatically
B. Query the provider for clarification
C. Ignore the issue
D. Change the code without approval
Correct Answer: B
Rationale: Auditors must not assign unsupported codes. Provider clarification
through a compliant query is required.
4. Which code set is primarily used to report physician procedures and services?
A. ICD-10-CM
B. CPT
C. DRG
D. HCPCS Level II
Correct Answer: B
Rationale: CPT codes describe physician and outpatient procedures, services, and
evaluations.
5. What is the main responsibility of a medical coding auditor?
A. Performing patient examinations
B. Reviewing coding accuracy and compliance
C. Approving insurance claims
D. Scheduling appointments
Correct Answer: B
Rationale: Coding auditors examine records to ensure accurate code assignment
and regulatory compliance.
,6. Which federal law addresses healthcare fraud and abuse prevention?
A. Clean Air Act
B. False Claims Act
C. Fair Labor Standards Act
D. Sherman Act
Correct Answer: B
Rationale: The False Claims Act protects against fraudulent billing and improper
claims submitted to government healthcare programs.
7. What does CPT modifier -25 indicate?
A. Bilateral procedure
B. Separate evaluation and management service on the same day
C. Discontinued procedure
D. Emergency service
Correct Answer: B
Rationale: Modifier -25 identifies a significant, separately identifiable E/M service
performed on the same day as another procedure.
8. Which document provides official rules for assigning ICD-10-CM codes?
A. Coding textbook only
B. Official ICD-10-CM Guidelines
C. Insurance contracts
D. Patient satisfaction surveys
Correct Answer: B
Rationale: Official coding guidelines provide standardized instructions for accurate
diagnosis coding.
, 9. What is upcoding?
A. Using a lower-paying code intentionally
B. Reporting a higher-level service than performed
C. Correcting a coding error
D. Removing duplicate claims
Correct Answer: B
Rationale: Upcoding occurs when a provider reports a more expensive service or
diagnosis than supported by documentation.
10. What is the purpose of a compliance plan in a healthcare organization?
A. Increase patient charges
B. Prevent violations and promote ethical practices
C. Eliminate medical records
D. Reduce documentation standards
Correct Answer: B
Rationale: Compliance programs help organizations follow healthcare laws,
regulations, and ethical coding practices.
11. Which code system is used for reporting durable medical equipment?
A. CPT
B. ICD-10-PCS
C. HCPCS Level II
D. DRG
Correct Answer: C
Rationale: HCPCS Level II codes are used for supplies, medications, and durable
medical equipment.
Question and correct answers (verified
answers 100%)
Q&A 2026/2027 INSTANT DOWNLOAD PDF
1. What is the primary purpose of a medical coding audit?
A. To increase patient visits
B. To identify coding accuracy and compliance issues
C. To replace medical coders
D. To eliminate documentation requirements
Correct Answer: B
Rationale: A medical coding audit evaluates coding accuracy, identifies errors,
ensures compliance with regulations, and helps prevent improper billing practices.
2. Which organization publishes ICD-10-CM coding guidelines in the United
States?
A. American Medical Association (AMA)
B. Centers for Medicare & Medicaid Services (CMS)
C. Occupational Safety and Health Administration (OSHA)
D. Food and Drug Administration (FDA)
Correct Answer: B
Rationale: CMS and the National Center for Health Statistics (NCHS) maintain and
publish official ICD-10-CM coding guidelines.
,3. A coding auditor discovers that a diagnosis code is unsupported by physician
documentation. What should the auditor recommend?
A. Add the diagnosis automatically
B. Query the provider for clarification
C. Ignore the issue
D. Change the code without approval
Correct Answer: B
Rationale: Auditors must not assign unsupported codes. Provider clarification
through a compliant query is required.
4. Which code set is primarily used to report physician procedures and services?
A. ICD-10-CM
B. CPT
C. DRG
D. HCPCS Level II
Correct Answer: B
Rationale: CPT codes describe physician and outpatient procedures, services, and
evaluations.
5. What is the main responsibility of a medical coding auditor?
A. Performing patient examinations
B. Reviewing coding accuracy and compliance
C. Approving insurance claims
D. Scheduling appointments
Correct Answer: B
Rationale: Coding auditors examine records to ensure accurate code assignment
and regulatory compliance.
,6. Which federal law addresses healthcare fraud and abuse prevention?
A. Clean Air Act
B. False Claims Act
C. Fair Labor Standards Act
D. Sherman Act
Correct Answer: B
Rationale: The False Claims Act protects against fraudulent billing and improper
claims submitted to government healthcare programs.
7. What does CPT modifier -25 indicate?
A. Bilateral procedure
B. Separate evaluation and management service on the same day
C. Discontinued procedure
D. Emergency service
Correct Answer: B
Rationale: Modifier -25 identifies a significant, separately identifiable E/M service
performed on the same day as another procedure.
8. Which document provides official rules for assigning ICD-10-CM codes?
A. Coding textbook only
B. Official ICD-10-CM Guidelines
C. Insurance contracts
D. Patient satisfaction surveys
Correct Answer: B
Rationale: Official coding guidelines provide standardized instructions for accurate
diagnosis coding.
, 9. What is upcoding?
A. Using a lower-paying code intentionally
B. Reporting a higher-level service than performed
C. Correcting a coding error
D. Removing duplicate claims
Correct Answer: B
Rationale: Upcoding occurs when a provider reports a more expensive service or
diagnosis than supported by documentation.
10. What is the purpose of a compliance plan in a healthcare organization?
A. Increase patient charges
B. Prevent violations and promote ethical practices
C. Eliminate medical records
D. Reduce documentation standards
Correct Answer: B
Rationale: Compliance programs help organizations follow healthcare laws,
regulations, and ethical coding practices.
11. Which code system is used for reporting durable medical equipment?
A. CPT
B. ICD-10-PCS
C. HCPCS Level II
D. DRG
Correct Answer: C
Rationale: HCPCS Level II codes are used for supplies, medications, and durable
medical equipment.
