Medical Billing and Coding Lesson 16
Verified Q&A for Exam Prep
Comprehensive Study Guide for Certification Success
Date: June 29, 2025
Prepared by: Medical Coding Education Team
,Contents
1 Introduction to Medical Billing and Coding – Lesson 16 . . . . . . . . . . . . . 2
1.1 Key Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Advanced Coding Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 ICD-10-CM Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 CPT and HCPCS Conventions . . . . . . . . . . . . . . . . . . . . . . . 2
3 Modifiers in Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1 Common Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.2 Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Claim Submission and Denials Management . . . . . . . . . . . . . . . . . . . 3
4.1 Claim Submission Process . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.2 Denials Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5 Compliance and Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.1 Key Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.2 Ethical Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6 Practical Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6.1 Scenario 1: Office Visit with Procedure . . . . . . . . . . . . . . . . . . . 4
6.2 Scenario 2: Bilateral Knee Injection . . . . . . . . . . . . . . . . . . . . . 4
6.3 Scenario 3: Diabetic Supplies . . . . . . . . . . . . . . . . . . . . . . . . 4
6.4 Scenario 4: Colonoscopy with Biopsy . . . . . . . . . . . . . . . . . . . . 4
7 Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
8 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1
, 1 Introduction to Medical Billing and Coding – Lesson 16
Lesson 16 builds on foundational concepts from earlier lessons, delving into interme-
diate topics such as advanced coding conventions, use of modifiers, claim submission
processes, and compliance with healthcare regulations. This study guide provides 120
verified questions and answers, each with detailed explanations, clinical examples, and
practical applications, to prepare learners for certification exams like the CPC or CCS.
The content is aligned with Quizlet resources and industry standards to ensure accuracy
and exam relevance.
1.1 Key Objectives
• Master advanced coding conventions for ICD-10-CM, CPT, and HCPCS.
• Understand the application of modifiers in complex scenarios.
• Learn the intricacies of claim submission and denials management.
• Apply compliance and ethical standards to coding practices.
2 Advanced Coding Conventions
Lesson 16 emphasizes precise coding practices to ensure accuracy and compliance in
medical billing.
2.1 ICD-10-CM Conventions
• Combination Codes: Single codes capturing multiple conditions (e.g., E11.21 for
type 2 diabetes with nephropathy).
• Sequencing: Principal diagnosis (primary condition) listed first, followed by sec-
ondary conditions.
• Laterality: Specifying right, left, or bilateral (e.g., M17.11 for unilateral primary
osteoarthritis, right knee).
2.2 CPT and HCPCS Conventions
• CPT Modifiers: Clarify procedures (e.g., -59 for distinct procedural service).
• HCPCS Specificity: Detailed codes for supplies (e.g., A7034 for CPAP nasal inter-
face).
2
Verified Q&A for Exam Prep
Comprehensive Study Guide for Certification Success
Date: June 29, 2025
Prepared by: Medical Coding Education Team
,Contents
1 Introduction to Medical Billing and Coding – Lesson 16 . . . . . . . . . . . . . 2
1.1 Key Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Advanced Coding Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 ICD-10-CM Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 CPT and HCPCS Conventions . . . . . . . . . . . . . . . . . . . . . . . 2
3 Modifiers in Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1 Common Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.2 Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Claim Submission and Denials Management . . . . . . . . . . . . . . . . . . . 3
4.1 Claim Submission Process . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.2 Denials Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5 Compliance and Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.1 Key Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.2 Ethical Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6 Practical Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6.1 Scenario 1: Office Visit with Procedure . . . . . . . . . . . . . . . . . . . 4
6.2 Scenario 2: Bilateral Knee Injection . . . . . . . . . . . . . . . . . . . . . 4
6.3 Scenario 3: Diabetic Supplies . . . . . . . . . . . . . . . . . . . . . . . . 4
6.4 Scenario 4: Colonoscopy with Biopsy . . . . . . . . . . . . . . . . . . . . 4
7 Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
8 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1
, 1 Introduction to Medical Billing and Coding – Lesson 16
Lesson 16 builds on foundational concepts from earlier lessons, delving into interme-
diate topics such as advanced coding conventions, use of modifiers, claim submission
processes, and compliance with healthcare regulations. This study guide provides 120
verified questions and answers, each with detailed explanations, clinical examples, and
practical applications, to prepare learners for certification exams like the CPC or CCS.
The content is aligned with Quizlet resources and industry standards to ensure accuracy
and exam relevance.
1.1 Key Objectives
• Master advanced coding conventions for ICD-10-CM, CPT, and HCPCS.
• Understand the application of modifiers in complex scenarios.
• Learn the intricacies of claim submission and denials management.
• Apply compliance and ethical standards to coding practices.
2 Advanced Coding Conventions
Lesson 16 emphasizes precise coding practices to ensure accuracy and compliance in
medical billing.
2.1 ICD-10-CM Conventions
• Combination Codes: Single codes capturing multiple conditions (e.g., E11.21 for
type 2 diabetes with nephropathy).
• Sequencing: Principal diagnosis (primary condition) listed first, followed by sec-
ondary conditions.
• Laterality: Specifying right, left, or bilateral (e.g., M17.11 for unilateral primary
osteoarthritis, right knee).
2.2 CPT and HCPCS Conventions
• CPT Modifiers: Clarify procedures (e.g., -59 for distinct procedural service).
• HCPCS Specificity: Detailed codes for supplies (e.g., A7034 for CPAP nasal inter-
face).
2
