ULTIMATE MEDICAL BILLING AND
CODING CERTIFICATION EXAM PACK
2026 2027 CORRECT VERIFIED
ANSWERS WITH RATIONALES GRADE A+
MATERIAL | INSTANT DOWNLOAD | 100%
PASS GUARANTEE
2026/2027 Medical Billing and Coding Certification Practice
Examination
1. A 47-year-old female patient presents to the outpatient
surgical center for a scheduled laparoscopic cholecystectomy
due to symptomatic cholelithiasis. During the procedure, the
surgeon encounters severe, dense intra-abdominal adhesions
surrounding the gallbladder, requiring extensive and
meticulous lysis that extends the total operative time by 65
minutes beyond the typical duration. How should the coding
specialist report this encounter to ensure appropriate
reimbursement?
A) Report the standard laparoscopic cholecystectomy code and append
modifier 22.
B) Report the standard laparoscopic cholecystectomy code and add a
separate code for the lysis of adhesions.
C) Report only the standard laparoscopic cholecystectomy code without
any modifiers.
D) Report an unlisted laparoscopy procedure code instead of the
standard cholecystectomy code.
Correct Answer: A
Rationale: Modifier 22 is used to report procedures that require
increased procedural services significantly greater than those usually
provided. Because the extensive lysis of adhesions extended the
operative time by over an hour, appending modifier 22 to the primary
procedure code is the most appropriate way to represent the increased
complexity. Separate reporting of adhesion lysis is generally bundled
into the primary intra-abdominal procedure unless it is entirely
unrelated or explicitly permitted by NCCI edits.
,2. A patient with a history of chronic obstructive pulmonary
disease (COPD) and coronary artery disease presents to the
emergency department complaining of severe chest tightness
and shortness of breath. The emergency department physician
performs a highly complex evaluation, orders multiple
diagnostic tests including an EKG and cardiac enzymes, and
documents an extensive review of data and a high risk of
complications. Which level of Medical Decision Making
(MDM) is documented, and which CPT code should be
assigned for this emergency department visit?
A) Low MDM; 99283
B) Moderate MDM; 99284
C) High MDM; 99285
D) High MDM; 99291
Correct Answer: C
Rationale: The presentation of an acute exacerbation of chronic
conditions (COPD and coronary artery disease) that poses a threat to
life or bodily function, combined with highly complex data review and
high risk, meets the criteria for High Medical Decision Making.
Emergency department visit code 99285 is reserved for visits requiring
a high level of MDM. Critical care code 99291 would require
documentation of total time spent in critical care, which is not stated.
3. A 62-year-old male undergoes an open reduction and
internal fixation (ORIF) of a fractured left humeral shaft.
Three weeks following the initial surgery, the patient slips on
ice and severely displaces the hardware, necessitating a return
to the operating room for a revision of the internal fixation by
the same orthopedic surgeon. Which modifier must be
appended to the subsequent surgical code to ensure proper
processing by the payer?
A) Modifier 58
B) Modifier 78
C) Modifier 79
D) Modifier 24
Correct Answer: B
Rationale: Modifier 78 represents an unplanned return to the
operating/procedure room etc. following an initial procedure for a
related procedure during the postoperative period. Since the revision of
the hardware is directly related to the initial fracture fixation and
occurs within its global surgical period, modifier 78 is correct. Modifier
,58 is for planned or staged procedures, and modifier 79 is for unrelated
procedures.
4. A patient is admitted to an acute care facility presenting
with acute respiratory failure secondary to severe sepsis from
an untreated urinary tract infection caused by Escherichia
coli. According to the ICD-10-CM Official Guidelines for
Coding and Reporting, what is the correct sequencing order
for the principal and secondary diagnosis codes?
A) Acute respiratory failure, Sepsis due to E. coli, Urinary tract infection
B) Sepsis due to E. coli, Urinary tract infection, Acute respiratory failure
C) Urinary tract infection, Sepsis due to E. coli, Acute respiratory failure
D) Sepsis due to E. coli, Acute respiratory failure, Urinary tract infection
Correct Answer: D
Rationale: ICD-10-CM guidelines dictate that when sepsis causes an
acute organ dysfunction (such as acute respiratory failure), the
systemic infection (sepsis) must be sequenced first, followed by the
localized infection (UTI) and the specific organ dysfunction. Therefore,
the code for sepsis due to E. coli is sequenced as the principal diagnosis,
followed by the acute respiratory failure and the urinary tract
infection.
5. During a routine screening colonoscopy on a 52-year-old
asymptomatic male, the gastroenterologist discovers a 6mm
polyp in the descending colon and successfully removes it
using hot biopsy forceps. No other abnormalities are
identified throughout the remainder of the procedure. How
should this encounter be coded for an outpatient facility?
A) Report the screening colonoscopy code as the primary procedure and
the polyp removal code as secondary.
B) Report the diagnostic colonoscopy code with a screening code as the
primary diagnosis.
C) Report the colonoscopy with removal of tumor/polyp by hot biopsy
forceps, using the screening code as the primary diagnosis and the polyp
code as secondary.
D) Report only the screening colonoscopy code and code the polyp as an
incidental finding.
Correct Answer: C
Rationale: When a screening colonoscopy results in the removal of a
polyp, the procedure is coded as a therapeutic colonoscopy (removal by
hot biopsy forceps). According to ICD-10-CM guidelines and ACA
, regulations, the primary diagnosis code must be the screening code
(Z12.11) to indicate the initial intent of the visit, with the findings
(benign polyp code) listed as a secondary diagnosis.
6. A coder is reviewing a medical record where a physician
performed an excision of a 1.5 cm malignant lesion on the
patient's left forearm. The surgical documentation notes that
the physician excised the lesion with 0.5 cm margins on all
sides, and performed an intermediate repair of the resulting
2.5 cm defect. What is the correct method to calculate the
lesion size and assign the CPT codes?
A) Code for a 1.5 cm malignant lesion excision and a separate code for
the 2.5 cm intermediate repair.
B) Code for a 2.5 cm malignant lesion excision and a separate code for
the 2.5 cm intermediate repair.
C) Code for a 2.5 cm malignant lesion excision only, as intermediate
repairs are bundled.
D) Code for a 3.5 cm malignant lesion excision and a separate code for
an intermediate repair.
Correct Answer: B
Rationale: For excision of lesions, the diameter is calculated by taking
the size of the lesion (1.5 cm) plus twice the narrowest margin (0.5 cm +
0.5 cm = 1.0 cm), yielding a total excised diameter of 2.5 cm. CPT
guidelines state that intermediate and complex repairs may be coded
separately in addition to the lesion excision; only simple repairs are
bundled.
7. A 35-year-old pregnant female at 28 weeks gestation
presents with gestational diabetes that is currently being
managed and controlled entirely with regular insulin
injections. Which combination of ICD-10-CM codes is most
accurate for reporting this specific clinical scenario?
A) Gestational diabetes mellitus in pregnancy (insulin controlled), Long-
term current use of insulin
B) Diabetes mellitus in pregnancy, Type 2 diabetes mellitus, Long-term
current use of insulin
C) Gestational diabetes mellitus in pregnancy (diet controlled)
D) High-risk pregnancy due to diabetes, Long-term current use of
insulin
Correct Answer: A
Rationale: ICD-10-CM provides highly specific codes for gestational
CODING CERTIFICATION EXAM PACK
2026 2027 CORRECT VERIFIED
ANSWERS WITH RATIONALES GRADE A+
MATERIAL | INSTANT DOWNLOAD | 100%
PASS GUARANTEE
2026/2027 Medical Billing and Coding Certification Practice
Examination
1. A 47-year-old female patient presents to the outpatient
surgical center for a scheduled laparoscopic cholecystectomy
due to symptomatic cholelithiasis. During the procedure, the
surgeon encounters severe, dense intra-abdominal adhesions
surrounding the gallbladder, requiring extensive and
meticulous lysis that extends the total operative time by 65
minutes beyond the typical duration. How should the coding
specialist report this encounter to ensure appropriate
reimbursement?
A) Report the standard laparoscopic cholecystectomy code and append
modifier 22.
B) Report the standard laparoscopic cholecystectomy code and add a
separate code for the lysis of adhesions.
C) Report only the standard laparoscopic cholecystectomy code without
any modifiers.
D) Report an unlisted laparoscopy procedure code instead of the
standard cholecystectomy code.
Correct Answer: A
Rationale: Modifier 22 is used to report procedures that require
increased procedural services significantly greater than those usually
provided. Because the extensive lysis of adhesions extended the
operative time by over an hour, appending modifier 22 to the primary
procedure code is the most appropriate way to represent the increased
complexity. Separate reporting of adhesion lysis is generally bundled
into the primary intra-abdominal procedure unless it is entirely
unrelated or explicitly permitted by NCCI edits.
,2. A patient with a history of chronic obstructive pulmonary
disease (COPD) and coronary artery disease presents to the
emergency department complaining of severe chest tightness
and shortness of breath. The emergency department physician
performs a highly complex evaluation, orders multiple
diagnostic tests including an EKG and cardiac enzymes, and
documents an extensive review of data and a high risk of
complications. Which level of Medical Decision Making
(MDM) is documented, and which CPT code should be
assigned for this emergency department visit?
A) Low MDM; 99283
B) Moderate MDM; 99284
C) High MDM; 99285
D) High MDM; 99291
Correct Answer: C
Rationale: The presentation of an acute exacerbation of chronic
conditions (COPD and coronary artery disease) that poses a threat to
life or bodily function, combined with highly complex data review and
high risk, meets the criteria for High Medical Decision Making.
Emergency department visit code 99285 is reserved for visits requiring
a high level of MDM. Critical care code 99291 would require
documentation of total time spent in critical care, which is not stated.
3. A 62-year-old male undergoes an open reduction and
internal fixation (ORIF) of a fractured left humeral shaft.
Three weeks following the initial surgery, the patient slips on
ice and severely displaces the hardware, necessitating a return
to the operating room for a revision of the internal fixation by
the same orthopedic surgeon. Which modifier must be
appended to the subsequent surgical code to ensure proper
processing by the payer?
A) Modifier 58
B) Modifier 78
C) Modifier 79
D) Modifier 24
Correct Answer: B
Rationale: Modifier 78 represents an unplanned return to the
operating/procedure room etc. following an initial procedure for a
related procedure during the postoperative period. Since the revision of
the hardware is directly related to the initial fracture fixation and
occurs within its global surgical period, modifier 78 is correct. Modifier
,58 is for planned or staged procedures, and modifier 79 is for unrelated
procedures.
4. A patient is admitted to an acute care facility presenting
with acute respiratory failure secondary to severe sepsis from
an untreated urinary tract infection caused by Escherichia
coli. According to the ICD-10-CM Official Guidelines for
Coding and Reporting, what is the correct sequencing order
for the principal and secondary diagnosis codes?
A) Acute respiratory failure, Sepsis due to E. coli, Urinary tract infection
B) Sepsis due to E. coli, Urinary tract infection, Acute respiratory failure
C) Urinary tract infection, Sepsis due to E. coli, Acute respiratory failure
D) Sepsis due to E. coli, Acute respiratory failure, Urinary tract infection
Correct Answer: D
Rationale: ICD-10-CM guidelines dictate that when sepsis causes an
acute organ dysfunction (such as acute respiratory failure), the
systemic infection (sepsis) must be sequenced first, followed by the
localized infection (UTI) and the specific organ dysfunction. Therefore,
the code for sepsis due to E. coli is sequenced as the principal diagnosis,
followed by the acute respiratory failure and the urinary tract
infection.
5. During a routine screening colonoscopy on a 52-year-old
asymptomatic male, the gastroenterologist discovers a 6mm
polyp in the descending colon and successfully removes it
using hot biopsy forceps. No other abnormalities are
identified throughout the remainder of the procedure. How
should this encounter be coded for an outpatient facility?
A) Report the screening colonoscopy code as the primary procedure and
the polyp removal code as secondary.
B) Report the diagnostic colonoscopy code with a screening code as the
primary diagnosis.
C) Report the colonoscopy with removal of tumor/polyp by hot biopsy
forceps, using the screening code as the primary diagnosis and the polyp
code as secondary.
D) Report only the screening colonoscopy code and code the polyp as an
incidental finding.
Correct Answer: C
Rationale: When a screening colonoscopy results in the removal of a
polyp, the procedure is coded as a therapeutic colonoscopy (removal by
hot biopsy forceps). According to ICD-10-CM guidelines and ACA
, regulations, the primary diagnosis code must be the screening code
(Z12.11) to indicate the initial intent of the visit, with the findings
(benign polyp code) listed as a secondary diagnosis.
6. A coder is reviewing a medical record where a physician
performed an excision of a 1.5 cm malignant lesion on the
patient's left forearm. The surgical documentation notes that
the physician excised the lesion with 0.5 cm margins on all
sides, and performed an intermediate repair of the resulting
2.5 cm defect. What is the correct method to calculate the
lesion size and assign the CPT codes?
A) Code for a 1.5 cm malignant lesion excision and a separate code for
the 2.5 cm intermediate repair.
B) Code for a 2.5 cm malignant lesion excision and a separate code for
the 2.5 cm intermediate repair.
C) Code for a 2.5 cm malignant lesion excision only, as intermediate
repairs are bundled.
D) Code for a 3.5 cm malignant lesion excision and a separate code for
an intermediate repair.
Correct Answer: B
Rationale: For excision of lesions, the diameter is calculated by taking
the size of the lesion (1.5 cm) plus twice the narrowest margin (0.5 cm +
0.5 cm = 1.0 cm), yielding a total excised diameter of 2.5 cm. CPT
guidelines state that intermediate and complex repairs may be coded
separately in addition to the lesion excision; only simple repairs are
bundled.
7. A 35-year-old pregnant female at 28 weeks gestation
presents with gestational diabetes that is currently being
managed and controlled entirely with regular insulin
injections. Which combination of ICD-10-CM codes is most
accurate for reporting this specific clinical scenario?
A) Gestational diabetes mellitus in pregnancy (insulin controlled), Long-
term current use of insulin
B) Diabetes mellitus in pregnancy, Type 2 diabetes mellitus, Long-term
current use of insulin
C) Gestational diabetes mellitus in pregnancy (diet controlled)
D) High-risk pregnancy due to diabetes, Long-term current use of
insulin
Correct Answer: A
Rationale: ICD-10-CM provides highly specific codes for gestational
