ALABAMA MEDICAL CODING SPECIALIST
EXAMINATION COMPLETE QUESTIONS AND
DETAILED SOLUTIONS LATEST UPDATE THIS YEAR
JUST RELEASED
1. A patient presents to a physician with fever, cough, and shortness of breath,
and the provider documents pneumonia without identifying a specific organism.
Which coding approach is most appropriate?
A. Code the documented pneumonia without assuming an organism
B. Code bacterial pneumonia because fever is present
C. Code viral pneumonia because coughing is present
D. Code respiratory failure instead of pneumonia
Answer: A
Rationale: Coders should report the diagnosis documented by the provider and
should not infer a causative organism from symptoms alone.
2. During an outpatient encounter, the physician documents hypertension and
chronic kidney disease but does not state whether the conditions are related.
What should the coder do?
A. Assume the hypertension caused the kidney disease
B. Code only the kidney disease
C. Apply documented coding guidelines for the relationship when applicable
D. Query the patient directly about the relationship
Answer: C
Rationale: ICD-10-CM contains combination coding conventions for certain
,documented relationships, and coders must follow those conventions rather than
independently determining causation.
3. A surgeon performs a procedure using an endoscope and documents removal
of a lesion during the same operative session. Which resource should primarily be
consulted to identify the procedure code?
A. ICD-10-CM Alphabetic Index only
B. CPT codebook and associated guidelines
C. HCPCS Level II book only
D. MS-DRG grouper only
Answer: B
Rationale: CPT is used to report physician and outpatient procedures and
services, while ICD-10-CM primarily describes diagnoses and conditions.
4. A patient receives an injectable medication in a physician office, and the
medication itself must be separately reported using a national supply code. Which
code set is generally appropriate?
A. ICD-10-CM
B. ICD-10-PCS
C. HCPCS Level II
D. DRG
Answer: C
Rationale: HCPCS Level II contains many codes for drugs, biologicals, supplies,
ambulance services, and other products not represented by CPT.
,5. A provider documents that a patient has diabetes mellitus with diabetic
neuropathy. What is the coder's most important initial step when selecting the
diagnosis code?
A. Search the Alphabetic Index for diabetes
B. Search the CPT Index for neuropathy
C. Assign neuropathy as the principal diagnosis automatically
D. Use a symptom code instead
Answer: A
Rationale: Coding begins with the Alphabetic Index, followed by verification in the
Tabular List and application of applicable instructional notes.
6. A medical record contains conflicting documentation regarding whether a
patient's abdominal pain is caused by appendicitis. What is the most appropriate
action for the coder?
A. Select the diagnosis that appears most frequently
B. Choose the more severe diagnosis
C. Follow facility policy and obtain clarification when necessary
D. Code both diagnoses as confirmed
Answer: C
Rationale: Conflicting clinical documentation may require clarification from the
provider so the reported codes accurately represent the patient's documented
condition.
7. An established patient receives a medically necessary evaluation and
management service, and the physician also performs a separately identifiable
procedure. Which modifier may be appropriate when requirements are satisfied?
A. Modifier 25
B. Modifier 50
, C. Modifier 59 only
D. Modifier 91
Answer: A
Rationale: Modifier 25 identifies a significant, separately identifiable E/M service
performed on the same day as another procedure or service.
8. A bilateral procedure is performed during one operative session, and the CPT
code does not already indicate that bilateral reporting is included. Which modifier
may be appropriate?
A. 22
B. 25
C. 50
D. 59
Answer: C
Rationale: Modifier 50 is used for bilateral procedures when the circumstances
and CPT instructions permit bilateral reporting.
9. A laboratory test is repeated on the same patient because the first result was
abnormal and confirmation is medically necessary. Which modifier may be
applicable when the payer and code requirements permit it?
A. 24
B. 26
C. 91
D. 95
Answer: C
Rationale: Modifier 91 identifies repeat clinical diagnostic laboratory testing
performed to obtain medically necessary additional results.
EXAMINATION COMPLETE QUESTIONS AND
DETAILED SOLUTIONS LATEST UPDATE THIS YEAR
JUST RELEASED
1. A patient presents to a physician with fever, cough, and shortness of breath,
and the provider documents pneumonia without identifying a specific organism.
Which coding approach is most appropriate?
A. Code the documented pneumonia without assuming an organism
B. Code bacterial pneumonia because fever is present
C. Code viral pneumonia because coughing is present
D. Code respiratory failure instead of pneumonia
Answer: A
Rationale: Coders should report the diagnosis documented by the provider and
should not infer a causative organism from symptoms alone.
2. During an outpatient encounter, the physician documents hypertension and
chronic kidney disease but does not state whether the conditions are related.
What should the coder do?
A. Assume the hypertension caused the kidney disease
B. Code only the kidney disease
C. Apply documented coding guidelines for the relationship when applicable
D. Query the patient directly about the relationship
Answer: C
Rationale: ICD-10-CM contains combination coding conventions for certain
,documented relationships, and coders must follow those conventions rather than
independently determining causation.
3. A surgeon performs a procedure using an endoscope and documents removal
of a lesion during the same operative session. Which resource should primarily be
consulted to identify the procedure code?
A. ICD-10-CM Alphabetic Index only
B. CPT codebook and associated guidelines
C. HCPCS Level II book only
D. MS-DRG grouper only
Answer: B
Rationale: CPT is used to report physician and outpatient procedures and
services, while ICD-10-CM primarily describes diagnoses and conditions.
4. A patient receives an injectable medication in a physician office, and the
medication itself must be separately reported using a national supply code. Which
code set is generally appropriate?
A. ICD-10-CM
B. ICD-10-PCS
C. HCPCS Level II
D. DRG
Answer: C
Rationale: HCPCS Level II contains many codes for drugs, biologicals, supplies,
ambulance services, and other products not represented by CPT.
,5. A provider documents that a patient has diabetes mellitus with diabetic
neuropathy. What is the coder's most important initial step when selecting the
diagnosis code?
A. Search the Alphabetic Index for diabetes
B. Search the CPT Index for neuropathy
C. Assign neuropathy as the principal diagnosis automatically
D. Use a symptom code instead
Answer: A
Rationale: Coding begins with the Alphabetic Index, followed by verification in the
Tabular List and application of applicable instructional notes.
6. A medical record contains conflicting documentation regarding whether a
patient's abdominal pain is caused by appendicitis. What is the most appropriate
action for the coder?
A. Select the diagnosis that appears most frequently
B. Choose the more severe diagnosis
C. Follow facility policy and obtain clarification when necessary
D. Code both diagnoses as confirmed
Answer: C
Rationale: Conflicting clinical documentation may require clarification from the
provider so the reported codes accurately represent the patient's documented
condition.
7. An established patient receives a medically necessary evaluation and
management service, and the physician also performs a separately identifiable
procedure. Which modifier may be appropriate when requirements are satisfied?
A. Modifier 25
B. Modifier 50
, C. Modifier 59 only
D. Modifier 91
Answer: A
Rationale: Modifier 25 identifies a significant, separately identifiable E/M service
performed on the same day as another procedure or service.
8. A bilateral procedure is performed during one operative session, and the CPT
code does not already indicate that bilateral reporting is included. Which modifier
may be appropriate?
A. 22
B. 25
C. 50
D. 59
Answer: C
Rationale: Modifier 50 is used for bilateral procedures when the circumstances
and CPT instructions permit bilateral reporting.
9. A laboratory test is repeated on the same patient because the first result was
abnormal and confirmation is medically necessary. Which modifier may be
applicable when the payer and code requirements permit it?
A. 24
B. 26
C. 91
D. 95
Answer: C
Rationale: Modifier 91 identifies repeat clinical diagnostic laboratory testing
performed to obtain medically necessary additional results.
