Study Guide 2025/2026 (Certified
Medical Coding and Billing Specialist) |
Exam Questions and Verified Solutions
UB04 form is used for Hospice, Ambulatory Surgery Centers, Home Health Care
patient confidentiality is? treating patient's medical information as private and not for
publication
What is the primary function of the ICD-10-CM codes?
To classify patient diagnoses for insurance billing and medical records
When should you use CPT modifier 22?
When a procedure requires significantly more work than usual
What is the difference between CPT and HCPCS Level II codes?
CPT codes describe physician services, while HCPCS Level II codes cover supplies and non-
physician services
Which entity oversees the National Correct Coding Initiative (NCCI) edits?
Centers for Medicare and Medicaid Services (CMS)
How does the global period affect billing for postoperative services?
1
, Follow-up care within the global period is included in the original procedure code
What is the purpose of an Explanation of Benefits (EOB)?
To provide details of the insurance company’s claim decision and patient financial
responsibility
In ICD-10-CM, what does the seventh character signify in fracture coding?
Episode of care, such as initial, subsequent, or sequela encounter
When would you use CPT modifier 25?
For a significant, separately identifiable E/M service on the same day as another procedure
What is the purpose of a clearinghouse in medical billing?
To review and process claims for errors before submission to insurance payers
When coding for laboratory services, what does a panel code represent?
A group of related tests bundled into a single code
What is an Advance Beneficiary Notice (ABN) used for?
To inform Medicare patients of possible out-of-pocket costs for a non-covered service
Which type of code should be used if no exact match for a diagnosis exists in ICD-10-CM?
2
Medical Coding and Billing Specialist) |
Exam Questions and Verified Solutions
UB04 form is used for Hospice, Ambulatory Surgery Centers, Home Health Care
patient confidentiality is? treating patient's medical information as private and not for
publication
What is the primary function of the ICD-10-CM codes?
To classify patient diagnoses for insurance billing and medical records
When should you use CPT modifier 22?
When a procedure requires significantly more work than usual
What is the difference between CPT and HCPCS Level II codes?
CPT codes describe physician services, while HCPCS Level II codes cover supplies and non-
physician services
Which entity oversees the National Correct Coding Initiative (NCCI) edits?
Centers for Medicare and Medicaid Services (CMS)
How does the global period affect billing for postoperative services?
1
, Follow-up care within the global period is included in the original procedure code
What is the purpose of an Explanation of Benefits (EOB)?
To provide details of the insurance company’s claim decision and patient financial
responsibility
In ICD-10-CM, what does the seventh character signify in fracture coding?
Episode of care, such as initial, subsequent, or sequela encounter
When would you use CPT modifier 25?
For a significant, separately identifiable E/M service on the same day as another procedure
What is the purpose of a clearinghouse in medical billing?
To review and process claims for errors before submission to insurance payers
When coding for laboratory services, what does a panel code represent?
A group of related tests bundled into a single code
What is an Advance Beneficiary Notice (ABN) used for?
To inform Medicare patients of possible out-of-pocket costs for a non-covered service
Which type of code should be used if no exact match for a diagnosis exists in ICD-10-CM?
2
