Medical Coding and Billing Certification
(MCBC) Study Guide I
The services medically necessary for diagnostic code linkage - ANS What must a coder
understand in order to determine the correct diagnosis code assignment?
Correctly identifying primary and secondary insurance policies in order to preserve
coordination of benefits - ANS Avoiding the duplication of benefits paid by the primary and
secondary insurance is achieved by:
Use the combination code - ANS If a combination code is available, a coder should:
blue triangle - ANS When a code is "revised" in the CPT manual, it will be indicated by:
particular radiology service provided is not described by a specific CPT code - ANS A coder
should use an "unlisted' radiology CPT code when:
Code blocks - ANS Major topic headings in the Tabular List of ICD-10-CM are known as:
Healthcare Common Procedure Coding System - ANS Most state Medicaid programs use
what type of system to report professional services, procedures, supplies, and equipment?
always a letter - ANS The first character of ICD-10-CM:
Using a fourth, fifth, sixth or seventh digit when required - ANS Coding to the highest level of
specificity means:
Without - ANS According to the ICD-10-CM conventions, if the documentation is unclear or
does not state that the complication or comorbidity listed in the code description is present with
the condition, the default is:
E/M service codes - ANS Reported in addition to the appropriate casting code when a cast or
splint is intended to be the definitive treatment of a fracture
Subsequent Encounter - ANS Care encounter after the initial care event
Diagnostic codes from encounter form - ANS What information is needed to fill out a
CMS-1500 claim form?
Billing more than the proper fee for a service - ANS Upcoding is:
, It ensures the correct patient data information and procedure codes - ANS Why is a
superbill/encounter form an important document in the office?
EHR should include eight core functions - ANS 1. Health information and data elements
2. Results management
3. Order management
4. Decision support
5. Electronic communications and connectivity
6. Patient support
7. Administrative processes
8. Reporting and population management
Electronic Health Record (EHR) - ANS reflects the data from all sources that have treated the
individual
Personal Health Record (PHR) - ANS maintained and owned by the patient. The patient
makes the decision whether to share the contents with their physician
Ambulatory care - ANS refers to treatment without admission to hospital
Electronic Medical Records (EMR) - ANS are computerized records of one physician's
encounter with a patient over time
Acute care - ANS most often refers to a hospital, treats patients with urgent problems that
cannot be handled
Centers for Medicare and Medicaid Services (CMS) - ANS Which of the following entities is
responsible for implementing the various provisions of HIPAA in Health Care?
Date - ANS Which of the following is not a key component in selecting a level of Evaluation
and Management (E/M) services?
solid circle - ANS New Codes in the CPT Manual are represented by:
False - ANS When a code has less than 6 characters and a 7th character applies, it is
appropriate to leave a space in the code?
True - ANS A sequela of an injury is reported with the code that describes the sequela
followed by the code for the injury with 7th character 'S'.
Volume 3 - The Alphabetical Index. - ANS Karen has been in a car accident and broke her
arm. Which volume will you refer to first to find a code representing her problem?
, Chapter XXI - Factors influencing health status and contact with health services (Z00-Z99) -
ANS Janice has breast cancer and is coming into the office today for Chemotherapy. In which
chapter would you find the code for chemotherapy?
Chapter II Neoplasms - ANS In which chapter would you find a malignant cancer of the
esophagus?
Insufficient tear production - ANS In the diagnostic statement "eye dryness from insufficient
tear production" the primary diagnosis is:
. Outpatient hospital - ANS C codes, in the HCPCS describe some services, such as drugs,
biologicals, devices and supplies that are provided in the ________________ setting?
Indicates the use of code assignment for "other" when a more specific code does not exist -
ANS What do the letters NEC indicate?
malignant - ANS Used to describe a cancerous tumor that grows worse over time
Rule out, suspected, probable - ANS An inconclusive diagnosis is indicated by terms such as:
CPT - ANS Codes that identify the procedures performed for a patient are called:
The correct procedure for assigning accurate diagnosis codes has six steps - ANS 1.Review
complete medical documentation
2.Abstract the medical conditions from the visit documentation
3.Identify the main term for each condition
4.Locate the main term in the alphabetic index
5.Verify the code in the tabular list
6.Check compliance with any applicable Official Guidelines and list codes in appropriate order
Category - ANS Three character alphanumeric code that covers a single disease or related
condition
Sub category - ANS Four or five character alphanumeric subdivision of a category
Punctuation - ANS o { } Brackets enclose synonyms, alternative wording or explanatory
phrases. Brackets identify manifestation codes.
o ( ) Parentheses are used in both the index and tabular list to enclose supplementary words -
non-essential modifiers
o : Colons are used in the Tabular List after an incomplete term which needs one or more of the
modifiers
Most common errors in billing - ANS Billing non-covered services
Billing over limit services
, Upcoding - using a procedure code that provides a higher reimbursement rate than the correct
code
Billing without signatures
Using outdated codes
Which of the following entities is responsible for implementing the various provisions of HIPAA in
Health Care? - ANS D. Centers for Medicare and Medicaid Services (CMS)
Which of the following is not a key component in selecting a level of Evaluation and
Management (E/M) services? - ANS B. Date
When an non-member physician treats an HMO patient, the service rendered is termed: - ANS
D. Out of Plan or out of Network
New Codes in the CPT Manual are represented by: - ANS C. A solid circle
The Medical Program for dependents of active military personnel is called: - ANS B. TRICARE
When a code has less than 6 characters and a 7th character applies, it is appropriate to leave
a space in the code? - ANS False
A sequela of an injury is reported with the code that describes the sequela followed by the
code for the injury with 7th character 'S'. - ANS True
Karen has been in a car accident and broke her arm. Which volume will you refer to first to find
a code representing her problem? - ANS C. Volume 3 - The Alphabetical Index.
In which chapter would you find a malignant cancer of the esophagus? - ANS Chapter XXI -
Factors influencing health status and contact with health services
(Z00-Z99)
In which chapter would you find a malignant cancer of the esophagus? - ANS A. Chapter II
Neoplasms
A veteran's wife needs to go to the doctor. Her husband's leg was cut off due to a explosion in
Afghanistan. Which insurance is she likely to have? - ANS B. CHAMPVA
In the diagnostic statement "eye dryness from insufficient tear production" the primary
diagnosis is - ANS C. Insufficient tear production
Health policies concerning the patient's constitutional right to privacy, confidentiality, and
informed consent are a part of: - ANS Patient's Bill of Rights
Services that are not covered by an insurance plan are referred to as: - ANS D. Exclusions
(MCBC) Study Guide I
The services medically necessary for diagnostic code linkage - ANS What must a coder
understand in order to determine the correct diagnosis code assignment?
Correctly identifying primary and secondary insurance policies in order to preserve
coordination of benefits - ANS Avoiding the duplication of benefits paid by the primary and
secondary insurance is achieved by:
Use the combination code - ANS If a combination code is available, a coder should:
blue triangle - ANS When a code is "revised" in the CPT manual, it will be indicated by:
particular radiology service provided is not described by a specific CPT code - ANS A coder
should use an "unlisted' radiology CPT code when:
Code blocks - ANS Major topic headings in the Tabular List of ICD-10-CM are known as:
Healthcare Common Procedure Coding System - ANS Most state Medicaid programs use
what type of system to report professional services, procedures, supplies, and equipment?
always a letter - ANS The first character of ICD-10-CM:
Using a fourth, fifth, sixth or seventh digit when required - ANS Coding to the highest level of
specificity means:
Without - ANS According to the ICD-10-CM conventions, if the documentation is unclear or
does not state that the complication or comorbidity listed in the code description is present with
the condition, the default is:
E/M service codes - ANS Reported in addition to the appropriate casting code when a cast or
splint is intended to be the definitive treatment of a fracture
Subsequent Encounter - ANS Care encounter after the initial care event
Diagnostic codes from encounter form - ANS What information is needed to fill out a
CMS-1500 claim form?
Billing more than the proper fee for a service - ANS Upcoding is:
, It ensures the correct patient data information and procedure codes - ANS Why is a
superbill/encounter form an important document in the office?
EHR should include eight core functions - ANS 1. Health information and data elements
2. Results management
3. Order management
4. Decision support
5. Electronic communications and connectivity
6. Patient support
7. Administrative processes
8. Reporting and population management
Electronic Health Record (EHR) - ANS reflects the data from all sources that have treated the
individual
Personal Health Record (PHR) - ANS maintained and owned by the patient. The patient
makes the decision whether to share the contents with their physician
Ambulatory care - ANS refers to treatment without admission to hospital
Electronic Medical Records (EMR) - ANS are computerized records of one physician's
encounter with a patient over time
Acute care - ANS most often refers to a hospital, treats patients with urgent problems that
cannot be handled
Centers for Medicare and Medicaid Services (CMS) - ANS Which of the following entities is
responsible for implementing the various provisions of HIPAA in Health Care?
Date - ANS Which of the following is not a key component in selecting a level of Evaluation
and Management (E/M) services?
solid circle - ANS New Codes in the CPT Manual are represented by:
False - ANS When a code has less than 6 characters and a 7th character applies, it is
appropriate to leave a space in the code?
True - ANS A sequela of an injury is reported with the code that describes the sequela
followed by the code for the injury with 7th character 'S'.
Volume 3 - The Alphabetical Index. - ANS Karen has been in a car accident and broke her
arm. Which volume will you refer to first to find a code representing her problem?
, Chapter XXI - Factors influencing health status and contact with health services (Z00-Z99) -
ANS Janice has breast cancer and is coming into the office today for Chemotherapy. In which
chapter would you find the code for chemotherapy?
Chapter II Neoplasms - ANS In which chapter would you find a malignant cancer of the
esophagus?
Insufficient tear production - ANS In the diagnostic statement "eye dryness from insufficient
tear production" the primary diagnosis is:
. Outpatient hospital - ANS C codes, in the HCPCS describe some services, such as drugs,
biologicals, devices and supplies that are provided in the ________________ setting?
Indicates the use of code assignment for "other" when a more specific code does not exist -
ANS What do the letters NEC indicate?
malignant - ANS Used to describe a cancerous tumor that grows worse over time
Rule out, suspected, probable - ANS An inconclusive diagnosis is indicated by terms such as:
CPT - ANS Codes that identify the procedures performed for a patient are called:
The correct procedure for assigning accurate diagnosis codes has six steps - ANS 1.Review
complete medical documentation
2.Abstract the medical conditions from the visit documentation
3.Identify the main term for each condition
4.Locate the main term in the alphabetic index
5.Verify the code in the tabular list
6.Check compliance with any applicable Official Guidelines and list codes in appropriate order
Category - ANS Three character alphanumeric code that covers a single disease or related
condition
Sub category - ANS Four or five character alphanumeric subdivision of a category
Punctuation - ANS o { } Brackets enclose synonyms, alternative wording or explanatory
phrases. Brackets identify manifestation codes.
o ( ) Parentheses are used in both the index and tabular list to enclose supplementary words -
non-essential modifiers
o : Colons are used in the Tabular List after an incomplete term which needs one or more of the
modifiers
Most common errors in billing - ANS Billing non-covered services
Billing over limit services
, Upcoding - using a procedure code that provides a higher reimbursement rate than the correct
code
Billing without signatures
Using outdated codes
Which of the following entities is responsible for implementing the various provisions of HIPAA in
Health Care? - ANS D. Centers for Medicare and Medicaid Services (CMS)
Which of the following is not a key component in selecting a level of Evaluation and
Management (E/M) services? - ANS B. Date
When an non-member physician treats an HMO patient, the service rendered is termed: - ANS
D. Out of Plan or out of Network
New Codes in the CPT Manual are represented by: - ANS C. A solid circle
The Medical Program for dependents of active military personnel is called: - ANS B. TRICARE
When a code has less than 6 characters and a 7th character applies, it is appropriate to leave
a space in the code? - ANS False
A sequela of an injury is reported with the code that describes the sequela followed by the
code for the injury with 7th character 'S'. - ANS True
Karen has been in a car accident and broke her arm. Which volume will you refer to first to find
a code representing her problem? - ANS C. Volume 3 - The Alphabetical Index.
In which chapter would you find a malignant cancer of the esophagus? - ANS Chapter XXI -
Factors influencing health status and contact with health services
(Z00-Z99)
In which chapter would you find a malignant cancer of the esophagus? - ANS A. Chapter II
Neoplasms
A veteran's wife needs to go to the doctor. Her husband's leg was cut off due to a explosion in
Afghanistan. Which insurance is she likely to have? - ANS B. CHAMPVA
In the diagnostic statement "eye dryness from insufficient tear production" the primary
diagnosis is - ANS C. Insufficient tear production
Health policies concerning the patient's constitutional right to privacy, confidentiality, and
informed consent are a part of: - ANS Patient's Bill of Rights
Services that are not covered by an insurance plan are referred to as: - ANS D. Exclusions
