Maryland Certified Professional Coder
Exam Practice Questions And Correct
Answers (Verified Answers) Plus
Rationale 2026 Q&A| Instant Download
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1. A 67-year-old established patient with well-controlled hypertension
and type 2 diabetes presents to a physician's office for a routine
follow-up visit. The physician reviews laboratory results, adjusts one
medication dosage, documents a medically appropriate history and
examination, and performs low-complexity medical decision-making.
Which factor is most important when selecting the appropriate
Evaluation and Management (E/M) code under current CPT
guidelines?
A. The number of body systems reviewed during the encounter
B. The amount of time spent by nursing staff before the visit
C. The level of medical decision-making or total physician time on the date
of service
D. The number of diagnosis codes assigned to the claim
Rationale: Current CPT E/M guidelines for office visits primarily rely on
medical decision-making or total provider time on the date of service.
Extensive history and examination elements are no longer the primary
determinants of code selection for most office visits.
, 2. A professional coder is assigning diagnosis codes for a patient treated
for acute bacterial pneumonia involving the right lower lobe.
According to ICD-10-CM coding conventions, what is the primary
purpose of diagnosis coding?
A. To determine physician salary levels
B. To report the patient's condition, disease, injury, or reason for
healthcare services
C. To calculate hospital construction costs
D. To establish provider licensure requirements
Rationale: ICD-10-CM diagnosis codes communicate the patient's medical
condition, illness, injury, or healthcare encounter reason and support
medical necessity for services provided.
3. During a coding audit, a coder identifies that a procedure code and a
diagnosis code conflict because the diagnosis does not support
medical necessity. What is the most appropriate action?
A. Submit the claim without changes
B. Select a diagnosis code with a higher reimbursement value
C. Delete the procedure code entirely
D. Review provider documentation and query the provider if clarification is
needed
Rationale: Coders must ensure coding accuracy based on documentation.
When documentation is unclear or insufficient, a compliant provider query
is appropriate rather than assuming or altering clinical information.
4. Which coding system is primarily used to report physician procedures
and services in outpatient and office settings?
A. ICD-10-PCS
B. DRG
C. CPT
D. NDC
, Rationale: CPT is the standard coding system used to report physician
services, procedures, and professional healthcare encounters in outpatient
settings.
5. A patient undergoes excision of a benign lesion measuring 2.5 cm on
the trunk. When selecting the CPT code, which measurement is
generally used?
A. Incision length only
B. Pathology specimen size only
C. Greatest lesion diameter plus the narrowest margins required for
excision
D. Scar length after closure
Rationale: Excision coding is based on the lesion diameter plus margins
excised, not the final wound length or pathology measurements.
6. Which anatomical plane divides the body into right and left portions?
A. Coronal plane
B. Transverse plane
C. Oblique plane
D. Sagittal plane
Rationale: The sagittal plane divides the body into right and left sections,
with the midsagittal plane creating equal halves.
7. A claim is denied because a modifier was omitted. What is the primary
purpose of CPT modifiers?
A. To replace diagnosis codes
B. To increase reimbursement automatically
C. To provide additional information about a service or procedure without
changing its definition
D. To identify insurance carriers
Exam Practice Questions And Correct
Answers (Verified Answers) Plus
Rationale 2026 Q&A| Instant Download
1. A 67-year-old established patient with well-controlled hypertension
and type 2 diabetes presents to a physician's office for a routine
follow-up visit. The physician reviews laboratory results, adjusts one
medication dosage, documents a medically appropriate history and
examination, and performs low-complexity medical decision-making.
Which factor is most important when selecting the appropriate
Evaluation and Management (E/M) code under current CPT
guidelines?
A. The number of body systems reviewed during the encounter
B. The amount of time spent by nursing staff before the visit
C. The level of medical decision-making or total physician time on the date
of service
D. The number of diagnosis codes assigned to the claim
Rationale: Current CPT E/M guidelines for office visits primarily rely on
medical decision-making or total provider time on the date of service.
Extensive history and examination elements are no longer the primary
determinants of code selection for most office visits.
, 2. A professional coder is assigning diagnosis codes for a patient treated
for acute bacterial pneumonia involving the right lower lobe.
According to ICD-10-CM coding conventions, what is the primary
purpose of diagnosis coding?
A. To determine physician salary levels
B. To report the patient's condition, disease, injury, or reason for
healthcare services
C. To calculate hospital construction costs
D. To establish provider licensure requirements
Rationale: ICD-10-CM diagnosis codes communicate the patient's medical
condition, illness, injury, or healthcare encounter reason and support
medical necessity for services provided.
3. During a coding audit, a coder identifies that a procedure code and a
diagnosis code conflict because the diagnosis does not support
medical necessity. What is the most appropriate action?
A. Submit the claim without changes
B. Select a diagnosis code with a higher reimbursement value
C. Delete the procedure code entirely
D. Review provider documentation and query the provider if clarification is
needed
Rationale: Coders must ensure coding accuracy based on documentation.
When documentation is unclear or insufficient, a compliant provider query
is appropriate rather than assuming or altering clinical information.
4. Which coding system is primarily used to report physician procedures
and services in outpatient and office settings?
A. ICD-10-PCS
B. DRG
C. CPT
D. NDC
, Rationale: CPT is the standard coding system used to report physician
services, procedures, and professional healthcare encounters in outpatient
settings.
5. A patient undergoes excision of a benign lesion measuring 2.5 cm on
the trunk. When selecting the CPT code, which measurement is
generally used?
A. Incision length only
B. Pathology specimen size only
C. Greatest lesion diameter plus the narrowest margins required for
excision
D. Scar length after closure
Rationale: Excision coding is based on the lesion diameter plus margins
excised, not the final wound length or pathology measurements.
6. Which anatomical plane divides the body into right and left portions?
A. Coronal plane
B. Transverse plane
C. Oblique plane
D. Sagittal plane
Rationale: The sagittal plane divides the body into right and left sections,
with the midsagittal plane creating equal halves.
7. A claim is denied because a modifier was omitted. What is the primary
purpose of CPT modifiers?
A. To replace diagnosis codes
B. To increase reimbursement automatically
C. To provide additional information about a service or procedure without
changing its definition
D. To identify insurance carriers
