MO Metrix CCS EXAM 2025 QUESTIONS
AND ANSWERS
Which of the following is not a covered entity in the HIPAA Privacy rule?
a. The Centers for Disease Control and Prevention
b. Employer-sponsored health plan
c. Third-party billing agency
d. Healthcare provider - ANS a. The Centers for Disease Control and Prevention
Which of the following is a risk adjustment model used by Medicare to predict health care costs
and resource consumption of specific patient populations over time?
a. Risk adjustment factor (RAF)
b. Diagnosis-related groups
c. Outcome and Assessment information set
d. Hierarchical condition category (HCC) coding - ANS d. Hierarchical condition category
(HCC) coding
CPT cod 20650 is a column 2 code that has a National Correct Coding Initiative (NCCI) edit of 1
when paired with CPT code 21813. How would this be interpreted?
a. The two codes are inclusive of each other and can never be billed together.
1
b. If being billed together, only report one unit of each
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c. The two codes are exclusive of each other and can never be billed together
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, d. The two codes can be billed together with an appropriate modifier - ANS d. The two codes
can be billed together with an appropriate modifier
Based on the following documentation, what would the overall medical decision-making be?
Numbered of diagnosis or management options: Minimal
Amount and complexity of data: Moderate
Level of risk: Moderate
a. Straightforward
b. Low complexity
c. Moderate complexity
d. High complexity - ANS c. Moderate complexity
A patient was seen by her gynecologist to remove her intrauterine device. The removal was
attempted but terminated due to excessive bleeding. How should the gynecologist report the
encounter?
a. 58301-53
b. 58301-52
c. 99212-25, 58301
d. 99212, 58301-59 - ANS a. 58301-53
A technician performs an ultrasound of a patient's thyroid at a privately owned family practice
immediately following her annual health screening. The primary care physician determines that
the images are normal and advises the patient to return in one year. How should the primary
care physician report the ultrasound?
a. 76536-26
2
b. 76536-TC
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, c. 76536
d. 76536-TC, 26 - ANS c. 76536
no modifier
Which type of edit identifies the maximum number of units that may be reported for a
CPT/HCPCS code that relates to an individual patient?
a. Medically unlikely edits
b. Add-on-code edits
c. Correspondence edits
d. Procedure-to-procedure coding edits - ANS a. Medically unlikely edits
Which statement best describes a comorbidity?
a. Two or more life-threatening illnesses occurring at the same time
b. Three or more minor injuries occurring at the same time
c. Three or more chronic illness occurring at the same time
d. Two or more unrelated diseases occurring at the same time. - ANS d. Two or more
unrelated diseases occurring at the same time.
A healthcare employee happens to meet a well-known actor during a lunch break. Unknown to
the employee, the actor is currently admitted in the hospital and has chosen to eat in the
cafeteria to not feel cooped up any longer. The employee takes a photo and shares it with his
co-workers and social media. Which AHIMA standard(s) of Ethical Coding has been violated?
a. Protect privacy and confidentiality; protect personal health information; and use technology,
data, and information resources in the way they are intended.
b. Respect the dignity of every person, put the welfare of persons before self-interest.
3
c. Refuse to participate in unethical practices, privacy and confidentiality, respect the dignity of
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every person
@COPYRIGHT BRAINBARTER 2025/2026
, d. None, the act was unintentional - ANS a. Protect privacy and confidentiality; protect
personal health information; and use technology, data, and information resources in the way
they are intended.
The smoking status of a patient should generally be found in which section of a medical record?
a. Chief complaint
b. Plan
c. Examination
d. Social history - ANS d. Social history
Which of the following is not a data element required by the uniform Hospital Discharge Data
set (UHDDS)
a. Location of residence
b. Provider name
c. Family history
d. Total charges for services rendered. - ANS c. Family history
A hospital director repeatedly refuses to accept residents due to a tight budget that limits
training time for students. Which AHIMA Standard(s) of ethical Coding has been violated?
a. Put the welfare of persons before self-interest
b. Mentor colleagues to strengthen the professional workforce
c. Respect the worth of every person.
d. Represent the profession to the public in a positive manner. - ANS b. Mentor colleagues to
strengthen the professional workforce
A physician performs a coronary artery bypass grafting using the left internal mammary artery
4
to the right coronary, and a saphenous vein graft to the circumflex. Which CPT code(s)
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@COPYRIGHT BRAINBARTER 2025/2026
AND ANSWERS
Which of the following is not a covered entity in the HIPAA Privacy rule?
a. The Centers for Disease Control and Prevention
b. Employer-sponsored health plan
c. Third-party billing agency
d. Healthcare provider - ANS a. The Centers for Disease Control and Prevention
Which of the following is a risk adjustment model used by Medicare to predict health care costs
and resource consumption of specific patient populations over time?
a. Risk adjustment factor (RAF)
b. Diagnosis-related groups
c. Outcome and Assessment information set
d. Hierarchical condition category (HCC) coding - ANS d. Hierarchical condition category
(HCC) coding
CPT cod 20650 is a column 2 code that has a National Correct Coding Initiative (NCCI) edit of 1
when paired with CPT code 21813. How would this be interpreted?
a. The two codes are inclusive of each other and can never be billed together.
1
b. If being billed together, only report one unit of each
Page
c. The two codes are exclusive of each other and can never be billed together
@COPYRIGHT BRAINBARTER 2025/2026
, d. The two codes can be billed together with an appropriate modifier - ANS d. The two codes
can be billed together with an appropriate modifier
Based on the following documentation, what would the overall medical decision-making be?
Numbered of diagnosis or management options: Minimal
Amount and complexity of data: Moderate
Level of risk: Moderate
a. Straightforward
b. Low complexity
c. Moderate complexity
d. High complexity - ANS c. Moderate complexity
A patient was seen by her gynecologist to remove her intrauterine device. The removal was
attempted but terminated due to excessive bleeding. How should the gynecologist report the
encounter?
a. 58301-53
b. 58301-52
c. 99212-25, 58301
d. 99212, 58301-59 - ANS a. 58301-53
A technician performs an ultrasound of a patient's thyroid at a privately owned family practice
immediately following her annual health screening. The primary care physician determines that
the images are normal and advises the patient to return in one year. How should the primary
care physician report the ultrasound?
a. 76536-26
2
b. 76536-TC
Page
@COPYRIGHT BRAINBARTER 2025/2026
, c. 76536
d. 76536-TC, 26 - ANS c. 76536
no modifier
Which type of edit identifies the maximum number of units that may be reported for a
CPT/HCPCS code that relates to an individual patient?
a. Medically unlikely edits
b. Add-on-code edits
c. Correspondence edits
d. Procedure-to-procedure coding edits - ANS a. Medically unlikely edits
Which statement best describes a comorbidity?
a. Two or more life-threatening illnesses occurring at the same time
b. Three or more minor injuries occurring at the same time
c. Three or more chronic illness occurring at the same time
d. Two or more unrelated diseases occurring at the same time. - ANS d. Two or more
unrelated diseases occurring at the same time.
A healthcare employee happens to meet a well-known actor during a lunch break. Unknown to
the employee, the actor is currently admitted in the hospital and has chosen to eat in the
cafeteria to not feel cooped up any longer. The employee takes a photo and shares it with his
co-workers and social media. Which AHIMA standard(s) of Ethical Coding has been violated?
a. Protect privacy and confidentiality; protect personal health information; and use technology,
data, and information resources in the way they are intended.
b. Respect the dignity of every person, put the welfare of persons before self-interest.
3
c. Refuse to participate in unethical practices, privacy and confidentiality, respect the dignity of
Page
every person
@COPYRIGHT BRAINBARTER 2025/2026
, d. None, the act was unintentional - ANS a. Protect privacy and confidentiality; protect
personal health information; and use technology, data, and information resources in the way
they are intended.
The smoking status of a patient should generally be found in which section of a medical record?
a. Chief complaint
b. Plan
c. Examination
d. Social history - ANS d. Social history
Which of the following is not a data element required by the uniform Hospital Discharge Data
set (UHDDS)
a. Location of residence
b. Provider name
c. Family history
d. Total charges for services rendered. - ANS c. Family history
A hospital director repeatedly refuses to accept residents due to a tight budget that limits
training time for students. Which AHIMA Standard(s) of ethical Coding has been violated?
a. Put the welfare of persons before self-interest
b. Mentor colleagues to strengthen the professional workforce
c. Respect the worth of every person.
d. Represent the profession to the public in a positive manner. - ANS b. Mentor colleagues to
strengthen the professional workforce
A physician performs a coronary artery bypass grafting using the left internal mammary artery
4
to the right coronary, and a saphenous vein graft to the circumflex. Which CPT code(s)
Page
@COPYRIGHT BRAINBARTER 2025/2026
