CERTIFIED PROFESSIONAL CODER (CPC) EXAMINATION
QUESTIONS AND CORRECT ANSWER WITH
EXPLANATION GRADED A+ STUDY GUIDE SOUTHERN
NEW HAMPSHIRE UNIVERSITY
1. Medical coding is the process of:
A. Translating medical diagnoses and procedures into standardized codes
B. Treating patients
C. Performing surgery
D. Dispensing medication
Answer: A
Rationale: Coding converts medical services into standardized alphanumeric codes.
2. The CPT code set is maintained by:
A. American Medical Association (AMA)
B. WHO
C. CDC
D. FDA
Answer: A
Rationale: AMA maintains Current Procedural Terminology codes.
3. ICD-10-CM is used to code:
A. Diagnoses
B. Surgical tools
C. Hospital billing systems only
D. Insurance companies
Answer: A
Rationale: ICD-10-CM classifies diseases and conditions.
4. HCPCS Level II codes are used for:
,A. Medical supplies and services not in CPT
B. Diagnoses only
C. Surgery techniques
D. Hospital staffing
Answer: A
Rationale: Covers equipment, supplies, and non-physician services.
5. A coder must ensure codes are:
A. Accurate and supported by documentation
B. Randomly assigned
C. Based on guesswork
D. Chosen for higher payment only
Answer: A
Rationale: Coding must reflect medical records.
6. Upcoding refers to:
A. Assigning a higher-level code than supported
B. Correct coding
C. Missing documentation
D. Deleting codes
Answer: A
Rationale: Fraudulent practice of inflating claims.
7. Downcoding is:
A. Assigning lower-level codes than documented
B. Correct coding
C. Adding procedures
D. Increasing reimbursement
Answer: A
Rationale: Leads to underpayment or errors.
8. The main purpose of medical coding is to:
, A. Enable billing and reporting
B. Treat diseases
C. Perform lab tests
D. Manage hospital construction
Answer: A
Rationale: Supports billing and data analysis.
9. A coder relies primarily on:
A. Physician documentation
B. Patient opinion
C. Insurance preference
D. Hospital size
Answer: A
Rationale: Documentation is the legal source.
10. Modifier in CPT coding is used to:
A. Describe special circumstances of a procedure
B. Change diagnosis
C. Replace ICD codes
D. Delete claims
Answer: A
Rationale: Adds extra detail to procedures.
11. Modifier -25 indicates:
A. Significant, separately identifiable E/M service
B. Bilateral procedure
C. Repeated procedure
D. Unlisted service
Answer: A
Rationale: Used for separate evaluation service.
12. Medical necessity means:
QUESTIONS AND CORRECT ANSWER WITH
EXPLANATION GRADED A+ STUDY GUIDE SOUTHERN
NEW HAMPSHIRE UNIVERSITY
1. Medical coding is the process of:
A. Translating medical diagnoses and procedures into standardized codes
B. Treating patients
C. Performing surgery
D. Dispensing medication
Answer: A
Rationale: Coding converts medical services into standardized alphanumeric codes.
2. The CPT code set is maintained by:
A. American Medical Association (AMA)
B. WHO
C. CDC
D. FDA
Answer: A
Rationale: AMA maintains Current Procedural Terminology codes.
3. ICD-10-CM is used to code:
A. Diagnoses
B. Surgical tools
C. Hospital billing systems only
D. Insurance companies
Answer: A
Rationale: ICD-10-CM classifies diseases and conditions.
4. HCPCS Level II codes are used for:
,A. Medical supplies and services not in CPT
B. Diagnoses only
C. Surgery techniques
D. Hospital staffing
Answer: A
Rationale: Covers equipment, supplies, and non-physician services.
5. A coder must ensure codes are:
A. Accurate and supported by documentation
B. Randomly assigned
C. Based on guesswork
D. Chosen for higher payment only
Answer: A
Rationale: Coding must reflect medical records.
6. Upcoding refers to:
A. Assigning a higher-level code than supported
B. Correct coding
C. Missing documentation
D. Deleting codes
Answer: A
Rationale: Fraudulent practice of inflating claims.
7. Downcoding is:
A. Assigning lower-level codes than documented
B. Correct coding
C. Adding procedures
D. Increasing reimbursement
Answer: A
Rationale: Leads to underpayment or errors.
8. The main purpose of medical coding is to:
, A. Enable billing and reporting
B. Treat diseases
C. Perform lab tests
D. Manage hospital construction
Answer: A
Rationale: Supports billing and data analysis.
9. A coder relies primarily on:
A. Physician documentation
B. Patient opinion
C. Insurance preference
D. Hospital size
Answer: A
Rationale: Documentation is the legal source.
10. Modifier in CPT coding is used to:
A. Describe special circumstances of a procedure
B. Change diagnosis
C. Replace ICD codes
D. Delete claims
Answer: A
Rationale: Adds extra detail to procedures.
11. Modifier -25 indicates:
A. Significant, separately identifiable E/M service
B. Bilateral procedure
C. Repeated procedure
D. Unlisted service
Answer: A
Rationale: Used for separate evaluation service.
12. Medical necessity means:
