MEDICAL BILLING CODING FINAL EXAM 2026/2027
QUESTIONS AND ANSWERS RATED A+
✔✔SUB CATEGORY - ✔✔In ICD-9-CM, a four-digit code number that provides more
information or specificity
✔✔NCHS - ✔✔National Center for Health Statistics
✔✔QUALIFIED DIAGNOSIS - ✔✔a working diagnosis which is not yet established
✔✔HEALTH CARE CLEARINGHOUSE - ✔✔An entity that standardizes health
information data in a standard billing format.
✔✔DX - ✔✔DIAGNOSE
✔✔COORDINATION OF BENEFITS - ✔✔Health insurance policy clause that applies to
an individual covered by more than one medical insurance policy that explains how the
policy will pay if more than one insurance policy applies to the claim.
✔✔ERA - ✔✔ELECTRONIC REMITTANCE ADVICE
✔✔MEDICAL NECESSITY - ✔✔Linking every procedure or service code reported on
the claim to an ICD-9 condition code t hat justifies the necessity for performing that
procedure or service
✔✔MODIFIER - ✔✔MODIFIER TO CPT TREATMENT CODE
✔✔POS - ✔✔POINT OF SERVICE PLAN
✔✔HIPAA PRIVACY RULE - ✔✔Law that regulates the use and disclosure of patients'
protected health information (PHI).
✔✔SAAS - ✔✔Software as a Service
✔✔TRICARE - ✔✔A government health program that serves dependents of active-duty
service members, military retirees and their families, some former spouses, and
survivors of deceased military members; formerly called CHAMPUS.
✔✔UB04 - ✔✔a commonly accepted hospital claim form
✔✔UPIN - ✔✔Unique Physician Identification Number
✔✔UCR - ✔✔usual, customary, and reasonable
, ✔✔UTILIZATION LIMIT - ✔✔Always between zero and one.
✔✔ANCILLARY SERVICES - ✔✔Professional services by a hospital or inpatient facility.
Xrays, drugs, labs, etc.
✔✔ADJUSTED CLAIM - ✔✔payment correction resulting in additional payments to
provider
✔✔ CPT - ✔✔CURRENT PROCEDURAL TERMINOLOGY
✔✔CPT IS PUBLISHED BY - ✔✔(AMA) AMERICAN AMERICAN MEDICAL
ASSOCIATION
✔✔CPT HAS SIX SECTIONS - ✔✔1.Evaluation and Management codes starts with
99201 - 9999. 2. Anesthesia is 01001 - 09999. 3. Surgery is 10010 - 69999. 4.
Radiology is 70010 - 79999. 5. Lab/Test is 81000 - 89999. 6. Medicare is 90090 - 90999
✔✔CPT CODES ARE USED FOR - ✔✔SERVICE AND PROCEDURES/ ALSO
WHERE PATIENT IS GOING AND WHAT DOCTOR IS DOING.
✔✔CPT - ✔✔ONLY HAS 5 DIGITS IN THERE CODE
✔✔PCP - ✔✔Primary Care Physician
✔✔PPO - ✔✔Preferred Provider Organization
✔✔EPO - ✔✔Exclusive Provider Organization
✔✔HMO - ✔✔Health Maintenance Organization
✔✔DME - ✔✔Durable Medical Equipment
✔✔CHF - ✔✔CONGESTIVE HEART FAILURE
✔✔UTI - ✔✔Urinary Tract Infection
✔✔URI - ✔✔UPPER RESPIRATORY INFECTION
✔✔NP - ✔✔NEW PATIENT
✔✔OP - ✔✔OUT-PATIENT
✔✔EMC - ✔✔ELECTRONIC MEDICAL CLAIM
QUESTIONS AND ANSWERS RATED A+
✔✔SUB CATEGORY - ✔✔In ICD-9-CM, a four-digit code number that provides more
information or specificity
✔✔NCHS - ✔✔National Center for Health Statistics
✔✔QUALIFIED DIAGNOSIS - ✔✔a working diagnosis which is not yet established
✔✔HEALTH CARE CLEARINGHOUSE - ✔✔An entity that standardizes health
information data in a standard billing format.
✔✔DX - ✔✔DIAGNOSE
✔✔COORDINATION OF BENEFITS - ✔✔Health insurance policy clause that applies to
an individual covered by more than one medical insurance policy that explains how the
policy will pay if more than one insurance policy applies to the claim.
✔✔ERA - ✔✔ELECTRONIC REMITTANCE ADVICE
✔✔MEDICAL NECESSITY - ✔✔Linking every procedure or service code reported on
the claim to an ICD-9 condition code t hat justifies the necessity for performing that
procedure or service
✔✔MODIFIER - ✔✔MODIFIER TO CPT TREATMENT CODE
✔✔POS - ✔✔POINT OF SERVICE PLAN
✔✔HIPAA PRIVACY RULE - ✔✔Law that regulates the use and disclosure of patients'
protected health information (PHI).
✔✔SAAS - ✔✔Software as a Service
✔✔TRICARE - ✔✔A government health program that serves dependents of active-duty
service members, military retirees and their families, some former spouses, and
survivors of deceased military members; formerly called CHAMPUS.
✔✔UB04 - ✔✔a commonly accepted hospital claim form
✔✔UPIN - ✔✔Unique Physician Identification Number
✔✔UCR - ✔✔usual, customary, and reasonable
, ✔✔UTILIZATION LIMIT - ✔✔Always between zero and one.
✔✔ANCILLARY SERVICES - ✔✔Professional services by a hospital or inpatient facility.
Xrays, drugs, labs, etc.
✔✔ADJUSTED CLAIM - ✔✔payment correction resulting in additional payments to
provider
✔✔ CPT - ✔✔CURRENT PROCEDURAL TERMINOLOGY
✔✔CPT IS PUBLISHED BY - ✔✔(AMA) AMERICAN AMERICAN MEDICAL
ASSOCIATION
✔✔CPT HAS SIX SECTIONS - ✔✔1.Evaluation and Management codes starts with
99201 - 9999. 2. Anesthesia is 01001 - 09999. 3. Surgery is 10010 - 69999. 4.
Radiology is 70010 - 79999. 5. Lab/Test is 81000 - 89999. 6. Medicare is 90090 - 90999
✔✔CPT CODES ARE USED FOR - ✔✔SERVICE AND PROCEDURES/ ALSO
WHERE PATIENT IS GOING AND WHAT DOCTOR IS DOING.
✔✔CPT - ✔✔ONLY HAS 5 DIGITS IN THERE CODE
✔✔PCP - ✔✔Primary Care Physician
✔✔PPO - ✔✔Preferred Provider Organization
✔✔EPO - ✔✔Exclusive Provider Organization
✔✔HMO - ✔✔Health Maintenance Organization
✔✔DME - ✔✔Durable Medical Equipment
✔✔CHF - ✔✔CONGESTIVE HEART FAILURE
✔✔UTI - ✔✔Urinary Tract Infection
✔✔URI - ✔✔UPPER RESPIRATORY INFECTION
✔✔NP - ✔✔NEW PATIENT
✔✔OP - ✔✔OUT-PATIENT
✔✔EMC - ✔✔ELECTRONIC MEDICAL CLAIM
