CERTIFIED CODING SPECIALIST (CCS)
EXAM PREPARATION QUESTIONS
AND ASNWERS
A data map or crosswalk consists of:
a. Terms used to describe paths between classifications and vocabularies
b. A map of time frames for multiple project completion
c. A descriptive list of data names
d. Normalized data attributes - Answer-a. Terms used to describe paths between
classifications and vocabularies
**There are several definitions of mapping and crosswalks but an important one in
healthcare is that they are used to describe paths between classifications and
terminologies (Palkie 2016, 164-165).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This
was removed via lumpectomy. The patient was found to have 1 of 7 lymph nodes
positive for carcinoma during axillary lymph node dissection. One of the patient's
neighbors who is also a coworker at the hospital called the coding department to get
the patient's diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy -
Answer-d. Explain that discussing the case would violate the patient's right to privacy
** Disclosing information without the patient's written consent violates the patient's
right to privacy (Brodnik 2012, 231, 414; Gordon and Gordon 2016a, 615-616).
The requirements for documentation and record completion (documents such as
history and physicals, discharge summaries, and consultations) as well as penalties
for non-adherence must be specified in:
a. Hospital rules and regulations
b. Conditions of nonparticipation
c. Medical staff bylaws
d. Nursing staff policies - Answer-c. Medical staff bylaws
**The medical staff bylaws are required by accreditation and regulatory organizations
to refer to the timeline required for completion (Malmgren and Solberg 2016, 240;
Brinda 2016, 166).
A bronchoscopy with biopsy of the left bronchus was completed and revealed
adenocarcinoma. What, if any, modifier should be added to the procedure codes?
,a. -50, Bilateral procedure
b. -51, Multiple procedures
c. -LT, Left side
d. No modifiers should be reported. - Answer-d. No modifiers should be reported.
Because the lungs are paired organs, it may seem as though modifier -50 would be
appropriate. However, a modifier would not be assigned because the bronchus is not
a paired organ, and the bronchus is the location of the procedure, not the lungs.
Similarly, it might seem as though modifier -LT would be assigned, but again, this
would not be assigned as the bronchus is not a paired organ. In order to assign the
correct modifier, it is important to note that paired organs include ears, eyes, nostrils,
kidneys, lungs, ovaries, and such (CPT Assistant May 2003).
Using the following evaluation and management map, which answers represent
documentation that should be considered, when assigning an E/M example for
hospital acuity points assignment?
Evaluation and Management Mapping
The following are the points needed to determine the level of CPT code:
Level 1 = 1-20
Level 2 = 21-35
Level 3 = 36-47
Level 4 = 48-60
Level 5 = > 61
Critical Care > 61 with constant physician attendance
CPT Codes
Level 1 = 99281 99281-25 with procedure/laboratory/radiology
Level 2 = 99282 99282-25 with procedure/laboratory/radiology
Level 3 = 99283 99283-25 with procedure/laboratory/radiology
Level 4 = 99284 99284-25 with procedure/laboratory/radiology
Level 5 = 99285 99285-25 with procedure/laboratory/radiology
Emergency Department Acuity Points
5 10 15 20 25
Meds Given 0-2 3-5 6-7 8-9 > 10
Extent of Hx Brief PF EPF Detail Comprehensive
Extent of Exam Brief PF EPF Detail Comprehensive
Number of - Answer-c. Number of tests ordered
**When an question is asked about an outpatient acuity map, the coder must review
the map and determine the relevant elements that make up the means by which a
CPT code and level is assigned. In the case of this map, and in this question, the
number of tests ordered is the answer.
Assign the code(s) for chemotherapy for 3 hours' infusion.
,96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal
anti-neoplastic
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour,
single or initial substance/drug
+96415 Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
−51 Multiple procedures
a. 96413, 96415, 96415
b. 96413, 96415-51
c. 96413, 96413, 96413
d. 96401 - Answer-a. 96413: Chemotherapy administration, intravenous infusion
technique; up to 1 hour, single or initial substance/drug.
+96415: Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
+96415: Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
**Three codes are needed to capture the initial hour and the two additional hours.
Modifier -51 would not be used in this case because modifiers are not used with add-
on codes
To accurately code wound closures, what questions need to be answered?
a. The number of surgical procedures undertaken
b. What type of repair was undertaken: simple, intermediate, or complex and the site
or body part involved, and the extent of the wound?
c. Number of tests ordered and Supplies used
d. What is the length of the repair in centimeters? - Answer-b. What type of repair
was undertaken: simple, intermediate, or complex and the site or body part involved,
and the extent of the wound?
**The answers to these two questions in addition to the length must be known in
order to code repairs correctly (Smith 2016, 69-70; AMA CPT Professional Edition
2017, 75).
The patient was admitted from the emergency department because of chest pain.
Following blood work, it was determined that the patient had elevated CPKs and MB
enzymes. The EKG shows nonspecific ST changes. What type of diagnosis might
this indicate?
a. Unstable angina
b. Myocardial infarction
c. Congestive heart failure
d. Mitral valve stenosis - Answer-b. Myocardial infarction
**The CPK elevation with MB enzymes elevated and the EKG ST changes denote a
possible MI (Leon-Chisen 2017, 386-392).
, Generally, data quality is defined as:
a. Ensuring the greatest amount of data possible is obtained from the medical record
b. Ensuring the accuracy and completeness of an organization's data
c. Ensuring accuracy of the case-mix index
d. Ensuring the optimal reimbursement for each encounter - Answer-b. Ensuring the
accuracy and completeness of an organization's data
**Data quality may have slightly different meanings because there are several
disciplines that work with data in healthcare. Generally, ensuring the accuracy and
completeness of an organization's data is a definition that can be agreed upon by the
organization
The information provided shows that:
a. The payment is higher for patients with DRG 191
b. There are more patients with DRG 191
c. The case-mix index could be increased if more patients in DRG 193 were admitted
d. The case mix would not increase if more patients in DRG 193 were admitted -
Answer-a. The payment is higher for patients with DRG 191
**The MS-DRG weight is higher than the other MS-DRG weights and therefore the
associated MS-DRG pays the most (Castro and Forrestal 2015, 115).
The billing department has requested that copies of the final coding summary with
associated code meanings for Medicare be printed remotely in the admission
department. Currently they request the summaries only when there is an unspecified
procedure. Each time the coding supervisor goes to the admission department, the
coding summaries have been left on a table near the patient entrance. Of the actions
presented here, what would be the best action for the coding supervisor to take?
a. Comply with the request.
b. Refuse to undertake this without further explanation.
c. Ignore the request.
d. Explain to the billing department supervisor that leaving the coding summary in
public view violates the patient's right to privacy. - Answer-d. Explain to the billing
department supervisor that leaving the coding summary in public view violates the
patient's right to privacy.
**Health information should not be left in public view
Databases utilize data models and data dictionaries. Which of the statements below
are true for these two important tools?
a. Data models are entities that store individual data; data dictionaries are an
alphabetic index of all data values
b. Data models are used for relational databases only; data dictionaries are used for
objectoriented databases
EXAM PREPARATION QUESTIONS
AND ASNWERS
A data map or crosswalk consists of:
a. Terms used to describe paths between classifications and vocabularies
b. A map of time frames for multiple project completion
c. A descriptive list of data names
d. Normalized data attributes - Answer-a. Terms used to describe paths between
classifications and vocabularies
**There are several definitions of mapping and crosswalks but an important one in
healthcare is that they are used to describe paths between classifications and
terminologies (Palkie 2016, 164-165).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This
was removed via lumpectomy. The patient was found to have 1 of 7 lymph nodes
positive for carcinoma during axillary lymph node dissection. One of the patient's
neighbors who is also a coworker at the hospital called the coding department to get
the patient's diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy -
Answer-d. Explain that discussing the case would violate the patient's right to privacy
** Disclosing information without the patient's written consent violates the patient's
right to privacy (Brodnik 2012, 231, 414; Gordon and Gordon 2016a, 615-616).
The requirements for documentation and record completion (documents such as
history and physicals, discharge summaries, and consultations) as well as penalties
for non-adherence must be specified in:
a. Hospital rules and regulations
b. Conditions of nonparticipation
c. Medical staff bylaws
d. Nursing staff policies - Answer-c. Medical staff bylaws
**The medical staff bylaws are required by accreditation and regulatory organizations
to refer to the timeline required for completion (Malmgren and Solberg 2016, 240;
Brinda 2016, 166).
A bronchoscopy with biopsy of the left bronchus was completed and revealed
adenocarcinoma. What, if any, modifier should be added to the procedure codes?
,a. -50, Bilateral procedure
b. -51, Multiple procedures
c. -LT, Left side
d. No modifiers should be reported. - Answer-d. No modifiers should be reported.
Because the lungs are paired organs, it may seem as though modifier -50 would be
appropriate. However, a modifier would not be assigned because the bronchus is not
a paired organ, and the bronchus is the location of the procedure, not the lungs.
Similarly, it might seem as though modifier -LT would be assigned, but again, this
would not be assigned as the bronchus is not a paired organ. In order to assign the
correct modifier, it is important to note that paired organs include ears, eyes, nostrils,
kidneys, lungs, ovaries, and such (CPT Assistant May 2003).
Using the following evaluation and management map, which answers represent
documentation that should be considered, when assigning an E/M example for
hospital acuity points assignment?
Evaluation and Management Mapping
The following are the points needed to determine the level of CPT code:
Level 1 = 1-20
Level 2 = 21-35
Level 3 = 36-47
Level 4 = 48-60
Level 5 = > 61
Critical Care > 61 with constant physician attendance
CPT Codes
Level 1 = 99281 99281-25 with procedure/laboratory/radiology
Level 2 = 99282 99282-25 with procedure/laboratory/radiology
Level 3 = 99283 99283-25 with procedure/laboratory/radiology
Level 4 = 99284 99284-25 with procedure/laboratory/radiology
Level 5 = 99285 99285-25 with procedure/laboratory/radiology
Emergency Department Acuity Points
5 10 15 20 25
Meds Given 0-2 3-5 6-7 8-9 > 10
Extent of Hx Brief PF EPF Detail Comprehensive
Extent of Exam Brief PF EPF Detail Comprehensive
Number of - Answer-c. Number of tests ordered
**When an question is asked about an outpatient acuity map, the coder must review
the map and determine the relevant elements that make up the means by which a
CPT code and level is assigned. In the case of this map, and in this question, the
number of tests ordered is the answer.
Assign the code(s) for chemotherapy for 3 hours' infusion.
,96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal
anti-neoplastic
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour,
single or initial substance/drug
+96415 Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
−51 Multiple procedures
a. 96413, 96415, 96415
b. 96413, 96415-51
c. 96413, 96413, 96413
d. 96401 - Answer-a. 96413: Chemotherapy administration, intravenous infusion
technique; up to 1 hour, single or initial substance/drug.
+96415: Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
+96415: Chemotherapy administration, intravenous infusion technique; each
additional hour (List separately in addition to code for primary procedure.)
**Three codes are needed to capture the initial hour and the two additional hours.
Modifier -51 would not be used in this case because modifiers are not used with add-
on codes
To accurately code wound closures, what questions need to be answered?
a. The number of surgical procedures undertaken
b. What type of repair was undertaken: simple, intermediate, or complex and the site
or body part involved, and the extent of the wound?
c. Number of tests ordered and Supplies used
d. What is the length of the repair in centimeters? - Answer-b. What type of repair
was undertaken: simple, intermediate, or complex and the site or body part involved,
and the extent of the wound?
**The answers to these two questions in addition to the length must be known in
order to code repairs correctly (Smith 2016, 69-70; AMA CPT Professional Edition
2017, 75).
The patient was admitted from the emergency department because of chest pain.
Following blood work, it was determined that the patient had elevated CPKs and MB
enzymes. The EKG shows nonspecific ST changes. What type of diagnosis might
this indicate?
a. Unstable angina
b. Myocardial infarction
c. Congestive heart failure
d. Mitral valve stenosis - Answer-b. Myocardial infarction
**The CPK elevation with MB enzymes elevated and the EKG ST changes denote a
possible MI (Leon-Chisen 2017, 386-392).
, Generally, data quality is defined as:
a. Ensuring the greatest amount of data possible is obtained from the medical record
b. Ensuring the accuracy and completeness of an organization's data
c. Ensuring accuracy of the case-mix index
d. Ensuring the optimal reimbursement for each encounter - Answer-b. Ensuring the
accuracy and completeness of an organization's data
**Data quality may have slightly different meanings because there are several
disciplines that work with data in healthcare. Generally, ensuring the accuracy and
completeness of an organization's data is a definition that can be agreed upon by the
organization
The information provided shows that:
a. The payment is higher for patients with DRG 191
b. There are more patients with DRG 191
c. The case-mix index could be increased if more patients in DRG 193 were admitted
d. The case mix would not increase if more patients in DRG 193 were admitted -
Answer-a. The payment is higher for patients with DRG 191
**The MS-DRG weight is higher than the other MS-DRG weights and therefore the
associated MS-DRG pays the most (Castro and Forrestal 2015, 115).
The billing department has requested that copies of the final coding summary with
associated code meanings for Medicare be printed remotely in the admission
department. Currently they request the summaries only when there is an unspecified
procedure. Each time the coding supervisor goes to the admission department, the
coding summaries have been left on a table near the patient entrance. Of the actions
presented here, what would be the best action for the coding supervisor to take?
a. Comply with the request.
b. Refuse to undertake this without further explanation.
c. Ignore the request.
d. Explain to the billing department supervisor that leaving the coding summary in
public view violates the patient's right to privacy. - Answer-d. Explain to the billing
department supervisor that leaving the coding summary in public view violates the
patient's right to privacy.
**Health information should not be left in public view
Databases utilize data models and data dictionaries. Which of the statements below
are true for these two important tools?
a. Data models are entities that store individual data; data dictionaries are an
alphabetic index of all data values
b. Data models are used for relational databases only; data dictionaries are used for
objectoriented databases
