MEDICAL CODING EXAM 1 QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
What is coding? - ANSWER The application of a number of systems used to uniformly document and
track health care services delivered.
Used for:
Billing & reimbursement
practice profiling
Quality measurement
importance of documentation - ANSWER required for payment. It provides the justification & support for
the procedures and services you render by making the medical necessity of your service clear to the 3rd
party
Why Code? - ANSWER It's how we get paid.
Optimal Reimbursement
Avoid denials/delay in payment
Avoid audit by coding properly
Documentation must support code
"If it isn't documented, you didn't do it"
ICD-9 CM codes - ANSWER International Classification Of Disease, 9th Revision, Clinical Modifications
Initially developed by the World Health Organization as a way to report morbidity and mortality statistics
worldwide
Not initially meant to be used for billing purposes
Maintained and updated yearly by the National Center for Health Statistics
, ICD-9 characteristics - ANSWER Codes are a series of 3-5 numbers, the last two numbers separated by a
decimal (111.11)
3 digits before decimal = general category
2 digits post decimal = specific description
(4th Digit = Subcategory)
(5th Digit = Subclassification)
Codes are divided into 17 primary chapters
Separated out by body systems etc.
NEC - Not Elsewhere Classifiable - ANSWER can be used in two instances:
1) not enough info available to determine which specific diagnosis code should be used in situations
where ICD-9 provides very specific diagnoses.
2) The coder has specific information about the diagnosis that is not an option in the choice of ICD-9
codes
NOS - Not Otherwise Specified - ANSWER Means Unspecified (don't know yet)
Used when the coder does not have enough information to select a more definitive diagnosis (ie.
Cultures are pending)
Coding Rules - ANSWER *Code to the highest level of certainty at that visit.
*Only code the reason for the encounter, and those conditions that affect the care delivered
*Use the most specific code available (4th=complications of the disease; 5th=clarifies condition)
*Do not use "rule out" or "suspected" diagnosis (codes as a pre-existing condition to insurance co)
Instead use a code from the "symptoms, signs, and ill-defined conditions" chapter.
*Make sure the ICD-9 code supports the CPT code.
AND ANSWERS WITH SOLUTIONS 2024
What is coding? - ANSWER The application of a number of systems used to uniformly document and
track health care services delivered.
Used for:
Billing & reimbursement
practice profiling
Quality measurement
importance of documentation - ANSWER required for payment. It provides the justification & support for
the procedures and services you render by making the medical necessity of your service clear to the 3rd
party
Why Code? - ANSWER It's how we get paid.
Optimal Reimbursement
Avoid denials/delay in payment
Avoid audit by coding properly
Documentation must support code
"If it isn't documented, you didn't do it"
ICD-9 CM codes - ANSWER International Classification Of Disease, 9th Revision, Clinical Modifications
Initially developed by the World Health Organization as a way to report morbidity and mortality statistics
worldwide
Not initially meant to be used for billing purposes
Maintained and updated yearly by the National Center for Health Statistics
, ICD-9 characteristics - ANSWER Codes are a series of 3-5 numbers, the last two numbers separated by a
decimal (111.11)
3 digits before decimal = general category
2 digits post decimal = specific description
(4th Digit = Subcategory)
(5th Digit = Subclassification)
Codes are divided into 17 primary chapters
Separated out by body systems etc.
NEC - Not Elsewhere Classifiable - ANSWER can be used in two instances:
1) not enough info available to determine which specific diagnosis code should be used in situations
where ICD-9 provides very specific diagnoses.
2) The coder has specific information about the diagnosis that is not an option in the choice of ICD-9
codes
NOS - Not Otherwise Specified - ANSWER Means Unspecified (don't know yet)
Used when the coder does not have enough information to select a more definitive diagnosis (ie.
Cultures are pending)
Coding Rules - ANSWER *Code to the highest level of certainty at that visit.
*Only code the reason for the encounter, and those conditions that affect the care delivered
*Use the most specific code available (4th=complications of the disease; 5th=clarifies condition)
*Do not use "rule out" or "suspected" diagnosis (codes as a pre-existing condition to insurance co)
Instead use a code from the "symptoms, signs, and ill-defined conditions" chapter.
*Make sure the ICD-9 code supports the CPT code.
