CPC Exam Prep & Practice Questions
and Answers 2025| Reviewed 100%
What part of Medicare covers prescription drug services Part D
A healthcare provider is selected for a coding audit. Which of the following is most likely the
goal of the audit?
To verify the accuracy of code assignments and ensure compliance with payer policies
What is the primary purpose of using modifiers in medical coding?
To provide additional information about a service or procedure that was performed
In the context of reimbursement, what does the term “payer” refer to?
The insurance company or government entity that pays for healthcare services
Which modifier would be used to indicate that a procedure was performed multiple times during
the same session?
Modifier 76
What is the most common reason for an insurance company to deny a claim after an audit?
The services were not deemed medically necessary or were incorrectly coded
What does the term “overcoding” refer to?
1
, Assigning a code for a service or procedure that is more extensive or expensive than what
was actually performed
What action should a coder take if a procedure was documented in the medical record but not
coded?
Review the documentation to assign the correct code and ensure compliance with coding
guidelines
Which of the following is an example of a modifier used for increased procedural difficulty or
time?
Modifier 22
Under HIPAA regulations, what is the primary focus of compliance in medical billing and
coding?
Protecting patient privacy and ensuring secure transmission of healthcare data
What is the purpose of the National Correct Coding Initiative (NCCI)?
To prevent improper coding that leads to inappropriate payment for services
A coder uses a modifier to indicate that a procedure was altered by a specific circumstance. What
is this modifier called?
Modifier 22
2
, Which of the following is a key compliance requirement for healthcare providers when
submitting claims for reimbursement?
Accurate and truthful representation of services provided, in accordance with the
documentation
A claim was denied due to incorrect use of a modifier. Which of the following is likely the
reason?
The modifier was not appropriate for the service or procedure performed
What is the purpose of the CMS-1500 claim form in the reimbursement process?
It is used to submit healthcare claims for reimbursement to insurance companies and
Medicare
A coder notices that the patient's medical record lacks documentation for a service provided.
What should the coder do?
Query the provider for clarification and additional documentation to support the claim
What modifier would be used to indicate that a procedure was performed in a bilateral fashion?
Modifier 50
What does the term "under coding" refer to in the medical billing and coding process?
Assigning a code for a service or procedure that is less extensive or expensive than what was
actually performed
3
and Answers 2025| Reviewed 100%
What part of Medicare covers prescription drug services Part D
A healthcare provider is selected for a coding audit. Which of the following is most likely the
goal of the audit?
To verify the accuracy of code assignments and ensure compliance with payer policies
What is the primary purpose of using modifiers in medical coding?
To provide additional information about a service or procedure that was performed
In the context of reimbursement, what does the term “payer” refer to?
The insurance company or government entity that pays for healthcare services
Which modifier would be used to indicate that a procedure was performed multiple times during
the same session?
Modifier 76
What is the most common reason for an insurance company to deny a claim after an audit?
The services were not deemed medically necessary or were incorrectly coded
What does the term “overcoding” refer to?
1
, Assigning a code for a service or procedure that is more extensive or expensive than what
was actually performed
What action should a coder take if a procedure was documented in the medical record but not
coded?
Review the documentation to assign the correct code and ensure compliance with coding
guidelines
Which of the following is an example of a modifier used for increased procedural difficulty or
time?
Modifier 22
Under HIPAA regulations, what is the primary focus of compliance in medical billing and
coding?
Protecting patient privacy and ensuring secure transmission of healthcare data
What is the purpose of the National Correct Coding Initiative (NCCI)?
To prevent improper coding that leads to inappropriate payment for services
A coder uses a modifier to indicate that a procedure was altered by a specific circumstance. What
is this modifier called?
Modifier 22
2
, Which of the following is a key compliance requirement for healthcare providers when
submitting claims for reimbursement?
Accurate and truthful representation of services provided, in accordance with the
documentation
A claim was denied due to incorrect use of a modifier. Which of the following is likely the
reason?
The modifier was not appropriate for the service or procedure performed
What is the purpose of the CMS-1500 claim form in the reimbursement process?
It is used to submit healthcare claims for reimbursement to insurance companies and
Medicare
A coder notices that the patient's medical record lacks documentation for a service provided.
What should the coder do?
Query the provider for clarification and additional documentation to support the claim
What modifier would be used to indicate that a procedure was performed in a bilateral fashion?
Modifier 50
What does the term "under coding" refer to in the medical billing and coding process?
Assigning a code for a service or procedure that is less extensive or expensive than what was
actually performed
3
