Certified Professional Coder Coding Test
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Coding is - CORRECT ANSWER - the process of translating this written or dictated
fmedical record into a series of numeric or alpha-numeric codes
Proper code assignment is determined by - CORRECT ANSWER - content of the medical
record and by the unique rules that governs each code set
what are 3 things that Coder must master - CORRECT ANSWER - 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what - CORRECT ANSWER - 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
The classification system determines what - CORRECT ANSWER - the amount health
care providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other
insurance programs using the system
A coder must evaluate the medical record for - CORRECT ANSWER - 1. completeness
and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or
obtain additonal PT info.
Techicians who speciallize in coding inpatient hospital services are referred as - CORRECT
ANSWER - 1. Health information coders
2. medical record coders
,3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what is it - CORRECT ANSWER - 1. Medicare Severity-
Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR - CORRECT ANSWER - Electronic health record
Skill coders may become - CORRECT ANSWER - consulatants, educators or medical
auditors
What is the difference between Hospital and Physican Services - CORRECT ANSWER -
1. Outpatient coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes
Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-
DRGS
What is APC and who uses it - CORRECT ANSWER - Ambulatory Payment
Classification- outpatient facility coders (physician services
What is the coder role in a physician's office - CORRECT ANSWER - Extremely
important to proper reimbursement and the livelihood of the physican
What is a physican degree of education - CORRECT ANSWER - 4 years of college, 4
years of medical school plus 3 to 5 years of residency.
What is a mid-level providers and who - CORRECT ANSWER - 1. Mid-level providers
are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
,What are the requirement for a PA and what - CORRECT ANSWER - 1. 26 1/2 month to
complete
2. Lincense to practice medicine with physician supervision
NP must have - CORRECT ANSWER - A Master Degree in Nursing
How many payers in the most simplest form? - CORRECT ANSWER -2
Private insurance plans and government insurance plans
Commerical carriers are considered what - CORRECT ANSWER - Private payers that
offer both group and individual plans.
Private Payers contracts may - CORRECT ANSWER - Vary but may include
hospitalization, basic and major medical coverage.
What is the most significant government insurer - CORRECT ANSWER - Medicare
What is Medicare - CORRECT ANSWER - Federal health insurance program-
Administerd by the Center for Medicare &Medicaid Services (CMS)
What is CMS and what does it provide - CORRECT ANSWER - Center for Medicare &
Medicaid Services (CMS) provides coverage for people over the age of 65, blind, or disabled
individuals, people with end -stage renal disease
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-
Medicare payers alike - CORRECT ANSWER - Last
What are the parts of Medicare - CORRECT ANSWER - Medicare A
Medicare B
, Medicare C
Medicare D
What is Medicare Part A - CORRECT ANSWER - Covers inpatient hospital care, as well
as care provided in skilled nursing facilites, hospice care, and home health care
What is Medicare Part B - CORRECT ANSWER - Covered Medically necessary doctors'
services, outpatient care, other medical services (including some preventive service not covered
under Medicare Part A
Medicare Part B is considered what - CORRECT ANSWER - A optional benefit for which
the patient must pay a premium and which generally requires a yearly copay
Where is Medicare Part B usually used - CORRECT ANSWER - Physician offices
(Outpatient Facility)
What is Medicare Part C - CORRECT ANSWER - Combines the benefits of Medicare
Part A, Part B, and sometimes Part D.
What is Medicare Part C also called - CORRECT ANSWER - Medicare Advantage
What is PPO - CORRECT ANSWER - Preferred Provider Organizations
What is HMO - CORRECT ANSWER - Health Maintenace Organizations
Which plan covers PPO and HMO - CORRECT ANSWER - Medicare Part C
What is the CMS-HCC - CORRECT ANSWER - Center for Medicare & Medicaid
Services-Hierarchical condition category
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Coding is - CORRECT ANSWER - the process of translating this written or dictated
fmedical record into a series of numeric or alpha-numeric codes
Proper code assignment is determined by - CORRECT ANSWER - content of the medical
record and by the unique rules that governs each code set
what are 3 things that Coder must master - CORRECT ANSWER - 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what - CORRECT ANSWER - 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
The classification system determines what - CORRECT ANSWER - the amount health
care providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other
insurance programs using the system
A coder must evaluate the medical record for - CORRECT ANSWER - 1. completeness
and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or
obtain additonal PT info.
Techicians who speciallize in coding inpatient hospital services are referred as - CORRECT
ANSWER - 1. Health information coders
2. medical record coders
,3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what is it - CORRECT ANSWER - 1. Medicare Severity-
Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR - CORRECT ANSWER - Electronic health record
Skill coders may become - CORRECT ANSWER - consulatants, educators or medical
auditors
What is the difference between Hospital and Physican Services - CORRECT ANSWER -
1. Outpatient coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes
Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-
DRGS
What is APC and who uses it - CORRECT ANSWER - Ambulatory Payment
Classification- outpatient facility coders (physician services
What is the coder role in a physician's office - CORRECT ANSWER - Extremely
important to proper reimbursement and the livelihood of the physican
What is a physican degree of education - CORRECT ANSWER - 4 years of college, 4
years of medical school plus 3 to 5 years of residency.
What is a mid-level providers and who - CORRECT ANSWER - 1. Mid-level providers
are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
,What are the requirement for a PA and what - CORRECT ANSWER - 1. 26 1/2 month to
complete
2. Lincense to practice medicine with physician supervision
NP must have - CORRECT ANSWER - A Master Degree in Nursing
How many payers in the most simplest form? - CORRECT ANSWER -2
Private insurance plans and government insurance plans
Commerical carriers are considered what - CORRECT ANSWER - Private payers that
offer both group and individual plans.
Private Payers contracts may - CORRECT ANSWER - Vary but may include
hospitalization, basic and major medical coverage.
What is the most significant government insurer - CORRECT ANSWER - Medicare
What is Medicare - CORRECT ANSWER - Federal health insurance program-
Administerd by the Center for Medicare &Medicaid Services (CMS)
What is CMS and what does it provide - CORRECT ANSWER - Center for Medicare &
Medicaid Services (CMS) provides coverage for people over the age of 65, blind, or disabled
individuals, people with end -stage renal disease
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-
Medicare payers alike - CORRECT ANSWER - Last
What are the parts of Medicare - CORRECT ANSWER - Medicare A
Medicare B
, Medicare C
Medicare D
What is Medicare Part A - CORRECT ANSWER - Covers inpatient hospital care, as well
as care provided in skilled nursing facilites, hospice care, and home health care
What is Medicare Part B - CORRECT ANSWER - Covered Medically necessary doctors'
services, outpatient care, other medical services (including some preventive service not covered
under Medicare Part A
Medicare Part B is considered what - CORRECT ANSWER - A optional benefit for which
the patient must pay a premium and which generally requires a yearly copay
Where is Medicare Part B usually used - CORRECT ANSWER - Physician offices
(Outpatient Facility)
What is Medicare Part C - CORRECT ANSWER - Combines the benefits of Medicare
Part A, Part B, and sometimes Part D.
What is Medicare Part C also called - CORRECT ANSWER - Medicare Advantage
What is PPO - CORRECT ANSWER - Preferred Provider Organizations
What is HMO - CORRECT ANSWER - Health Maintenace Organizations
Which plan covers PPO and HMO - CORRECT ANSWER - Medicare Part C
What is the CMS-HCC - CORRECT ANSWER - Center for Medicare & Medicaid
Services-Hierarchical condition category
