CERTIFIED PROFESSIONAL CODER
CODING TEST QUESTIONS WITH
COMPLETE SOLUTIONS
What is the tasked for a coder with an operative report - Answer-to break down the
information and applying the correct code.
What are the 5 most important Coding Tips for operative reports for a coders -
Answer-1. Diagnosis code reporting
2. Start with the procedures listed
3. Look for key words
4. Highlight unfamiliar words
5. Read the body
What does the first coding tip mean for the operative report for a coder ? - Answer-
Diagnosis code reporting- Use the post-operative diagnosis for coding unless there
are further defined diagnoses or additional diagnoses found in the body or finding of
the operative report.
What does the second coding tip mean for the operative report for a coder? -
Answer-Start with the procedures listed- For the coder who is new to coding a
procedure , one way of quickly starting the research process is by focusing on the
procedures listed in the header. Read the note in its entirety to verify the procedures
performed. Procedures listed in the header may not be listed correctly and
procedures documented with the body of the report may not be listed in the header
at all. It will help a coder with a place to start
What does the third coding tip mean for the operative report for a coder? - Answer-
Look for key words- Key words may include locations ana anatomical structures
involved, surgicial approach, procedure method, procedure type, siiz and number
and the surgical instruments used during the procedure
What does the fourth coding tip mean for the operative report for a coder? - Answer-
Highlight unfamiliar words- Words you are not familiar with should be highlighted and
researched for understanding
What does the fifth coding tip mean for the operative report for a coder? - Answer-
Ready the body- All procedure reported should be documented with the body of the
report. The body may indicate a procedure was abandoned or complicated, possibly
indicating the need for a different procedure code or reporting of a modifier
what is medical necessity relates to - Answer-whether a procedure or service is
considered appropriate in a given circumstance
,Generally what a medically-necessary service is - Answer-the least radical
service/procedure that allows for effective treatment of the patient's complaint or
condition
Under what regulations is medically necessity found under - Answer-Title XVIII 1862
(a) (1) of the Social Security Act
What is the National Coverage Determinations Manual - Answer-Describes whether
specific medical items, services, treatment procedures or technologies can be paid
under Medicare
What is the difference between Covered and Non-covered items - Answer-1.
Covered items-services and procedures are covered only when linked to designated,
approved diagnosis
2. Non-covered items are deemed "not reasonable or necessary
Medicare and many insurance plan may deny payment for a service that is - Answer-
not reasonable or necessary according to the Medicare reimbursement rules.
What is NCD and what does it do - Answer-1. National Coverage Determinations
2. Explains when Medicare will pay for items or services
What is LCD and What is it - Answer-1. Local Coverage Determinations
2. MAC is responsible for interpreting national policies into regional policies. The
LCDs further define what codes are needs and when an item or service will be coved
. LCD have jurisdiction only with their regional area
what is MAC - Answer-Medical Administrative Contractor
if a NCD does not exist what are CMS guidelines - Answer-Where coverage of an
item or service is provided for specified indications or circumstances but is not
explicitly excluded for others, or where the item or service is not mentioned at all in
the CMS Manual System, the Medicare contractor is to make the coverage decision,
in consultation with its medical staff and with CMS when appropriate, based on the
laws, regulations, ruling and general program instructions.
How often do Practices should check policies to maintain compliance - Answer-
Quarterly
What does ABN stand for - Answer-Advance Beneficiary Notice of Noncoverage, or
Advance Beneficiary Notice
What is ABN - Answer-A standardized form that explains to the patient why medicare
may deny the particular service or procedure.
What does ABN protect - Answer-The provider's financial interest by creating a
paper trail that CMS requires before a provider can bill the patient for payment if
Medicare denies coverage for the stated service or procedure
, What must the provider must complete (in regards to ABN) - Answer-1. Complete
one-page form in full
2. giveing the patient an explanation as to why Medicare is likely to refuse vocerage
for proposed procedure or service
What are some of the common reason why Medicare may deny a procedure and
service - Answer-1. Medicare does not pay for the procedure/service for the patient's
condition
2. Medicare does not pay for the procedure/service as frequently as proposed
3. Medicare dod not pay for experimental procedure/services
What must the provider present to the patient on the ABN for a proposed procedure
or service - Answer-Cost Estimate
What does the CMS-HCC provide - Answer-Risk adjument model provides adjusted
payment based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider
may lose out on what - Answer-additional reimbursement for which he/she is entitled.
What is Medicare Part D - Answer-Prescription drug coverage program available to
all Medicare beneficiaries. Private companies approved by Medicare provide the
coverage.
What is Medicaid - Answer-A health insurance assistance program for some low
income people (especially children and pregnant women) sponsored by federal and
state governments
Medicaid administed on - Answer-a state-by-state basis and coverage varies-
although each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" - Answer-When
contracted with a insurance carrier whether that be a private insurance company or a
governmental.
Participating Providers (Par Providers are required to accept - Answer-the allowed
payment amount determined by the insurance carrier as the fee for payment and
follow all other guidelines stipulated by the contract
The difference between the physican's fee and the insurance carriers allowed
amount is - Answer-adjusted by the participating provider
Non-participating Providers are - Answer-1. providers not contracted with the
insurance carriers
2. not required to make the adjustment
What is limiting charge - Answer-Limits set on what can be charged for each CPT
code, no matter if the physican is Par or Non-Par
CODING TEST QUESTIONS WITH
COMPLETE SOLUTIONS
What is the tasked for a coder with an operative report - Answer-to break down the
information and applying the correct code.
What are the 5 most important Coding Tips for operative reports for a coders -
Answer-1. Diagnosis code reporting
2. Start with the procedures listed
3. Look for key words
4. Highlight unfamiliar words
5. Read the body
What does the first coding tip mean for the operative report for a coder ? - Answer-
Diagnosis code reporting- Use the post-operative diagnosis for coding unless there
are further defined diagnoses or additional diagnoses found in the body or finding of
the operative report.
What does the second coding tip mean for the operative report for a coder? -
Answer-Start with the procedures listed- For the coder who is new to coding a
procedure , one way of quickly starting the research process is by focusing on the
procedures listed in the header. Read the note in its entirety to verify the procedures
performed. Procedures listed in the header may not be listed correctly and
procedures documented with the body of the report may not be listed in the header
at all. It will help a coder with a place to start
What does the third coding tip mean for the operative report for a coder? - Answer-
Look for key words- Key words may include locations ana anatomical structures
involved, surgicial approach, procedure method, procedure type, siiz and number
and the surgical instruments used during the procedure
What does the fourth coding tip mean for the operative report for a coder? - Answer-
Highlight unfamiliar words- Words you are not familiar with should be highlighted and
researched for understanding
What does the fifth coding tip mean for the operative report for a coder? - Answer-
Ready the body- All procedure reported should be documented with the body of the
report. The body may indicate a procedure was abandoned or complicated, possibly
indicating the need for a different procedure code or reporting of a modifier
what is medical necessity relates to - Answer-whether a procedure or service is
considered appropriate in a given circumstance
,Generally what a medically-necessary service is - Answer-the least radical
service/procedure that allows for effective treatment of the patient's complaint or
condition
Under what regulations is medically necessity found under - Answer-Title XVIII 1862
(a) (1) of the Social Security Act
What is the National Coverage Determinations Manual - Answer-Describes whether
specific medical items, services, treatment procedures or technologies can be paid
under Medicare
What is the difference between Covered and Non-covered items - Answer-1.
Covered items-services and procedures are covered only when linked to designated,
approved diagnosis
2. Non-covered items are deemed "not reasonable or necessary
Medicare and many insurance plan may deny payment for a service that is - Answer-
not reasonable or necessary according to the Medicare reimbursement rules.
What is NCD and what does it do - Answer-1. National Coverage Determinations
2. Explains when Medicare will pay for items or services
What is LCD and What is it - Answer-1. Local Coverage Determinations
2. MAC is responsible for interpreting national policies into regional policies. The
LCDs further define what codes are needs and when an item or service will be coved
. LCD have jurisdiction only with their regional area
what is MAC - Answer-Medical Administrative Contractor
if a NCD does not exist what are CMS guidelines - Answer-Where coverage of an
item or service is provided for specified indications or circumstances but is not
explicitly excluded for others, or where the item or service is not mentioned at all in
the CMS Manual System, the Medicare contractor is to make the coverage decision,
in consultation with its medical staff and with CMS when appropriate, based on the
laws, regulations, ruling and general program instructions.
How often do Practices should check policies to maintain compliance - Answer-
Quarterly
What does ABN stand for - Answer-Advance Beneficiary Notice of Noncoverage, or
Advance Beneficiary Notice
What is ABN - Answer-A standardized form that explains to the patient why medicare
may deny the particular service or procedure.
What does ABN protect - Answer-The provider's financial interest by creating a
paper trail that CMS requires before a provider can bill the patient for payment if
Medicare denies coverage for the stated service or procedure
, What must the provider must complete (in regards to ABN) - Answer-1. Complete
one-page form in full
2. giveing the patient an explanation as to why Medicare is likely to refuse vocerage
for proposed procedure or service
What are some of the common reason why Medicare may deny a procedure and
service - Answer-1. Medicare does not pay for the procedure/service for the patient's
condition
2. Medicare does not pay for the procedure/service as frequently as proposed
3. Medicare dod not pay for experimental procedure/services
What must the provider present to the patient on the ABN for a proposed procedure
or service - Answer-Cost Estimate
What does the CMS-HCC provide - Answer-Risk adjument model provides adjusted
payment based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider
may lose out on what - Answer-additional reimbursement for which he/she is entitled.
What is Medicare Part D - Answer-Prescription drug coverage program available to
all Medicare beneficiaries. Private companies approved by Medicare provide the
coverage.
What is Medicaid - Answer-A health insurance assistance program for some low
income people (especially children and pregnant women) sponsored by federal and
state governments
Medicaid administed on - Answer-a state-by-state basis and coverage varies-
although each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" - Answer-When
contracted with a insurance carrier whether that be a private insurance company or a
governmental.
Participating Providers (Par Providers are required to accept - Answer-the allowed
payment amount determined by the insurance carrier as the fee for payment and
follow all other guidelines stipulated by the contract
The difference between the physican's fee and the insurance carriers allowed
amount is - Answer-adjusted by the participating provider
Non-participating Providers are - Answer-1. providers not contracted with the
insurance carriers
2. not required to make the adjustment
What is limiting charge - Answer-Limits set on what can be charged for each CPT
code, no matter if the physican is Par or Non-Par
