,Medical Coding, 2e (Stewart)
Chapter 1 The Certified Professional Coder
1) A clean claim:
A) Guarantees the provider will receive payment
B) Slows the reimbursement process
C) Results in accurate and timely reimbursement
D) Releases the payer from the contractual adjudication time frame
Answer: C
Explanation: A clean claim results in accurate and timely reimbursement for services provided
to the patient and the resources used to provide those services.
Difficulty: 1 Easy
Topic: The CPCs Role in Reimbursement and Compliance
Learning Objective: 01.02 Determine the many roles a coder plays in the reimbursement and
compliance process.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system
ABHES: 7.d Process insurance claims
2) Accounts receivable, denials, and modifiers are examples of ________ language.
A) Provider
B) Payer
C) Compliance
D) Billing
Answer: D
Explanation: Billing language includes terms such as accounts receivable (A/R), clean claims,
denials, modifiers, and advanced beneficiary notices (ABNs).
Difficulty: 1 Easy
Topic: Differentiation of Various Languages In Medical Coding
Learning Objective: 01.01 Differentiate between the various languages used in medical coding.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system; VII.C.1 Define the
following bookkeeping terms; VII.C.1.c accounts receivable; VII.C.1.a. charges; VII.C.1.b.
payments; VII.C.1.d. accounts payable; VII.C.1.e. adjustments
ABHES: 7.d Process insurance claims
1
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
,3) Compliance language includes:
A) Services, procedures, and medical terminology
B) Unbundling, fraud, and abuse
C) Noncovered services, medical necessity, and unbundling
D) Denials, modifiers, and advanced beneficiary notices
Answer: B
Explanation: Compliance language brings terms such as unbundling, fraud, false claim, and
abuse into the translation.
Difficulty: 1 Easy
Topic: Differentiation of Various Languages In Medical Coding
Learning Objective: 01.01 Differentiate between the various languages used in medical coding.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system; VII.C.1 Define the
following bookkeeping terms; VII.C.1.c accounts receivable; VII.C.1.a. charges; VII.C.1.b.
payments; VII.C.1.d. accounts payable; VII.C.1.e. adjustments
ABHES: 7.d Process insurance claims
4) An ICD-10-CM (tenth revision) code represents:
A) the demographics
B) the procedure
C) the service
D) the diagnosis
Answer: D
Explanation: The appropriate ICD-10 (tenth revision) code for the diagnosis or condition must
be linked to the appropriate service or procedure provided.
Difficulty: 1 Easy
Topic: The CPCs Role in Reimbursement and Compliance
Learning Objective: 01.02 Determine the many roles a coder plays in the reimbursement and
compliance process.
Bloom's: Remember
CAAHEP: IX.C.2 Describe how to use the most current diagnostic coding classification system
ABHES: 7.d Process insurance claims
2
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
, 5) The following coding habit would be most likely to trigger a payer audit:
A) Consistently billing the same, low level E/M service code
B) Billing an even distribution of low and high level E/M service codes
C) Consistently billing the same, high level E/M service code
D) Consistently billing the same, low level E/M service code and consistently billing the same,
high level E/M service code
Answer: D
Explanation: Consistent use of the same level of evaluation and management codes are some of
the areas being audited.
Difficulty: 2 Medium
Topic: Medical Coding Credentials and the AAPC
Learning Objective: 01.03 Recognize the benefits of obtaining medical coding credentials and
the importance of AAPC to the medical coder.
Bloom's: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
6) The acronym AAPC stands for:
A) American Academy of Professional Coders
B) Academy of American Physician Coders
C) American Academy of Physician Coders
D) Academy of Auditors and Physician Coders
Answer: A
Explanation: The American Academy of Professional Coders (AAPC) is a credentialing
organization of more than 100,000 members.
Difficulty: 1 Easy
Topic: Medical Coding Credentials and the AAPC
Learning Objective: 01.03 Recognize the benefits of obtaining medical coding credentials and
the importance of AAPC to the medical coder.
Bloom's: Remember
CAAHEP: X.C.5 Discuss licensure and certification as they apply to healthcare providers
ABHES: 1.b Compare and contrast the allied health professions and understand their relation to
medical assisting
3
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
Chapter 1 The Certified Professional Coder
1) A clean claim:
A) Guarantees the provider will receive payment
B) Slows the reimbursement process
C) Results in accurate and timely reimbursement
D) Releases the payer from the contractual adjudication time frame
Answer: C
Explanation: A clean claim results in accurate and timely reimbursement for services provided
to the patient and the resources used to provide those services.
Difficulty: 1 Easy
Topic: The CPCs Role in Reimbursement and Compliance
Learning Objective: 01.02 Determine the many roles a coder plays in the reimbursement and
compliance process.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system
ABHES: 7.d Process insurance claims
2) Accounts receivable, denials, and modifiers are examples of ________ language.
A) Provider
B) Payer
C) Compliance
D) Billing
Answer: D
Explanation: Billing language includes terms such as accounts receivable (A/R), clean claims,
denials, modifiers, and advanced beneficiary notices (ABNs).
Difficulty: 1 Easy
Topic: Differentiation of Various Languages In Medical Coding
Learning Objective: 01.01 Differentiate between the various languages used in medical coding.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system; VII.C.1 Define the
following bookkeeping terms; VII.C.1.c accounts receivable; VII.C.1.a. charges; VII.C.1.b.
payments; VII.C.1.d. accounts payable; VII.C.1.e. adjustments
ABHES: 7.d Process insurance claims
1
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
,3) Compliance language includes:
A) Services, procedures, and medical terminology
B) Unbundling, fraud, and abuse
C) Noncovered services, medical necessity, and unbundling
D) Denials, modifiers, and advanced beneficiary notices
Answer: B
Explanation: Compliance language brings terms such as unbundling, fraud, false claim, and
abuse into the translation.
Difficulty: 1 Easy
Topic: Differentiation of Various Languages In Medical Coding
Learning Objective: 01.01 Differentiate between the various languages used in medical coding.
Bloom's: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.C.2
Describe how to use the most current diagnostic coding classification system; VII.C.1 Define the
following bookkeeping terms; VII.C.1.c accounts receivable; VII.C.1.a. charges; VII.C.1.b.
payments; VII.C.1.d. accounts payable; VII.C.1.e. adjustments
ABHES: 7.d Process insurance claims
4) An ICD-10-CM (tenth revision) code represents:
A) the demographics
B) the procedure
C) the service
D) the diagnosis
Answer: D
Explanation: The appropriate ICD-10 (tenth revision) code for the diagnosis or condition must
be linked to the appropriate service or procedure provided.
Difficulty: 1 Easy
Topic: The CPCs Role in Reimbursement and Compliance
Learning Objective: 01.02 Determine the many roles a coder plays in the reimbursement and
compliance process.
Bloom's: Remember
CAAHEP: IX.C.2 Describe how to use the most current diagnostic coding classification system
ABHES: 7.d Process insurance claims
2
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
, 5) The following coding habit would be most likely to trigger a payer audit:
A) Consistently billing the same, low level E/M service code
B) Billing an even distribution of low and high level E/M service codes
C) Consistently billing the same, high level E/M service code
D) Consistently billing the same, low level E/M service code and consistently billing the same,
high level E/M service code
Answer: D
Explanation: Consistent use of the same level of evaluation and management codes are some of
the areas being audited.
Difficulty: 2 Medium
Topic: Medical Coding Credentials and the AAPC
Learning Objective: 01.03 Recognize the benefits of obtaining medical coding credentials and
the importance of AAPC to the medical coder.
Bloom's: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
6) The acronym AAPC stands for:
A) American Academy of Professional Coders
B) Academy of American Physician Coders
C) American Academy of Physician Coders
D) Academy of Auditors and Physician Coders
Answer: A
Explanation: The American Academy of Professional Coders (AAPC) is a credentialing
organization of more than 100,000 members.
Difficulty: 1 Easy
Topic: Medical Coding Credentials and the AAPC
Learning Objective: 01.03 Recognize the benefits of obtaining medical coding credentials and
the importance of AAPC to the medical coder.
Bloom's: Remember
CAAHEP: X.C.5 Discuss licensure and certification as they apply to healthcare providers
ABHES: 1.b Compare and contrast the allied health professions and understand their relation to
medical assisting
3
Copyright 2019 © McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior
written consent of McGraw-Hill Education.
