Medical Coding Chapter 1 Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

Medical Coding Chapter 1 Questions and Answers | Latest Version | 2025/2026 | Correct & Verified What does the term “upcoding” refer to? Assigning a code that represents a more severe diagnosis or more expensive procedure than what was documented. What is “downcoding” in medical coding? Assigning a code that represents a less severe diagnosis or less expensive procedure than what was documented. How often are ICD-10-CM codes updated? Annually, with updates published by the Centers for Medicare & Medicaid Services (CMS). What is the primary role of a coding compliance officer? To ensure that all coding practices adhere to federal regulations and organizational policies. What is a “charge capture” in healthcare coding? 2 The process of recording services and procedures to generate billing claims. Which organization develops the ICD-10-CM coding system used in the United States? The World Health Organization (WHO) develops ICD codes, but the U.S. uses a modified version called ICD-10-CM. Why is accurate medical coding important for healthcare providers? It ensures proper reimbursement, compliance with regulations, and accurate patient records. What type of information is captured in ICD-10-CM codes? Diagnoses, diseases, and medical conditions. What type of information is captured in CPT codes? Medical procedures, services, and treatments performed by healthcare providers. What is HCPCS used for in medical coding? To code products, supplies, and services not included in CPT codes, such as ambulance services and durable medical equipment. 3 What is the difference between ICD-10-CM and ICD-10-PCS? ICD-10-CM is used for diagnoses, while ICD-10-PCS is used for inpatient procedures. Who is responsible for assigning medical codes in a healthcare setting? Medical coders. What does the term “compliance” mean in medical coding? Following laws, regulations, and guidelines to ensure accurate coding and billing. What is a “coding audit”? A review process to check the accuracy and completeness of coded medical records. Why are modifiers used in CPT coding? To provide additional information about a service or procedure without changing the code itself. What is the difference between inpatient and outpatient coding? 4 Inpatient coding uses ICD-10-CM and ICD-10-PCS for hospital stays, while outpatient coding uses ICD-10-CM and CPT/HCPCS for clinic or physician services. Why is documentation important for medical coding? It provides the basis for accurate code assignment and justifies billing. What does “E/M coding” refer to? Evaluation and Management coding, used for office visits, consultations, and patient encounters. What does the abbreviation “NPI” stand for? National Provider Identifier. What is the difference between HCPCS Level I and Level II codes? Level I is CPT codes for procedures, Level II is codes for non-physician services, supplies, and equipment. What is the main purpose of the Official Coding Guidelines? 5 To provide rules and instructions for correct ICD-10-CM