CERTIFIED CODING SPECIALIST EXAM
Questions and Correct Detailed Answers
ALREADY GRADED A+ Latest Versions
2025
VERSION A
**While Medicare may specify that a given condition is not acceptable, if that condition
is what is documented, the coder has no other option but to code what is documented
even though the insurer may not pay the claim (Leon-Chisen 2017, 39-40).
The insured may not necessarily be the patient seen for the medical service. -
ANSWERTrue
Personal insurance is usually less expensive than other health insurance. -
ANSWERFalse
Time limits stated in individual health insurance policies about an insurance company's
obligation to pay benefits are the same for all insurance companies. - ANSWERFalse
There is standardization of format for the explanation of benefit document for all private
insurance carriers. - ANSWERFalse
What organization publishes diagnostic and procedure coding competencies for
outpatient services and diagnostic coding and reporting requirements for physician
billing? - ANSWERAmerican Health Information Management Association (AHIMA)
Medical etiquette refers to: - ANSWERConsideration of others
CPT codes are assigned to which of these? - ANSWERCoding procedures and services
Exceptions to the right of privacy rule include: - ANSWERGunshot wound cases
A common format for medical record documentation is called: - ANSWERSOAP
Most physician/patient contracts are: - ANSWERImplied
An inventory of body systems for which the patient complains of signs and symptoms is
called? - ANSWERROS
When coding a front torso burn, which percentage of body would be indicated? -
ANSWER18%
,To which of the following would be assigned CPT code? - ANSWERTonsillectomy
Urine moves through the kidneys to the bladder through the: - ANSWERUreters
Which box of the CMS-1500 Form would be completed with codes for procedures,
services or supplies? - ANSWERBox 24d
Which of these is considered PHI? - ANSWERPhotographic images, even in profile
This means "Let the Master Answer"? - ANSWERRespondeat Superior
Patient sees the physician for a regular office visit which is charged at $90. The
allowable amount for the patient's insurance company covers the office visit in full, with
a $10 copay, and the patient has not met the $125 deductible. How much does the
patient owe? - ANSWER$90
Using SOAP notes, what would be found in the Assessment portion of the record? -
ANSWERDiagnosis
If a Medicare patient wants a procedure that is a non-covered benefit, what form do they
need to sign that indicates they are aware it is not covered? - ANSWERAdvanced
Beneficiary Notice
Who is responsible for entering proper medical documentation to support
reimbursement of procedures and services? - ANSWERClinician
The primary function of the spleen is: - ANSWERProduction and removal of blood cells
as part of the immune system
The pre-established percentage of expenses paid by the patient, or another insurance
carrier, after the primary insurance has made payment, and the deductible is met:
Select one: - ANSWERCoinsurance
What happens with information that is abstracted from the medical record? -
ANSWERCoded and forwarded to the insurance
The significant reason for which a patient is admitted to the hospital is coded using the:
- ANSWERPrincipal Diagnosis
Which of these is a common abbreviation for the test that assesses the electrical activity
of the heart? - ANSWERECG
Confidential information about patients should never be discussed with: -
ANSWERFamily
Coworkers
,Friends
Name the correct procedure for keeping an industrial patient's financial and health
records when the same physician is also seeing the patient as a private patient -
ANSWERSeparate financial and health records must be used
Patient presents with abdominal pain. In what part of documentation would the duration
and symptoms be indicated? - ANSWERHPI
The statutes for workers' compensation laws fall under: - ANSWERFederal and state
compensation laws
Which of these is the result of a claim that is submitted electronically with an old
insurance policy number? - ANSWERDenial
An NAS is a: - ANSWERCertification from a military hospital stating that it cannot
provide the necessary care
A coding book that contains codes for products and supplies is: - ANSWERHCPCS
Releasing, giving access to, or transferring PHI to an outside person or organization is
called: - ANSWERDisclosure
Which portion of HIPAA protects integrity and confidentiality of patients' e-PHI? -
ANSWERHIPAA Security rule
What organization manages and updates CPT changes? - ANSWERAMA
Which of the following would NOT be documented in the Social History area of the
medical chart? - ANSWERFamily history of colon polyps
The Medicaid time limit to appeal a claim varies from state to state, but it is usually: -
ANSWER30-60 days
If a patient has a Gastropexy, what is occurring? - ANSWERSurgical fixation of the
stomach to the abdominal wall or diaphragm
Payments to hospitals for Medicare services are classified according to: -
ANSWERDRG'S
An examination of a knee joint via small incision and optical device would be: -
ANSWERArthroscopy
Which of these would describe the common method for sorting of an Aging report? -
ANSWERBy date
, Some senior HMOs may provide services not covered by Medicare, such as: -
ANSWEREyeglasses and prescription drugs
Which of these must be obtained by the patient prior to the provider rendering medical
treatment? - ANSWERConsent
Which of these limits access to patient information based on the user's position in an
organization: - ANSWERRole-Based Access
A DME provider has a contract with an insurance company to accept their allowed
amount as payment in full. The provider bills $125 and the insurance approves $100.
The patient has a coinsurance amount of $20, and there is no deductible. How much
does the provider write off? - ANSWER$25
Which portion of the medical record would contain the diagnosis code used for billing? -
ANSWERHistory and Physical
What is the name of the act designed to address the collection practices of third-party
debt collectors and attorneys who regularly collect debts for others? - ANSWERFair
Debt Collection Practices Act
To ensure appropriate insurance coverage for an outpatient procedure, which of these
should be obtained? - ANSWERPre-Certification
What does bundling mean? - ANSWERGrouping codes that are related to a procedure
An insurance claim submitted with errors is referred to as: - ANSWERDirty Claim
A clearinghouse is: - ANSWERAn entity that receives transmission of insurance claims,
separates the claims, and sends each one electronically to the correct insurance payer
If a payment problem develops with an insurance company and the company ignores
claims and exceeds time limits to pay a claim, it is prudent to contact the: -
ANSWERState insurance commissioner
When down coding occurs, payment will: - ANSWERBe less
Which payer is responsible for covering charges related to the inhalation of toxic fumes
in a place of employment, due to improper ventilation? - ANSWERworkers
compensation
The UB-04 form is used for: - ANSWERBilling hospital services
You see that an unauthorized individual has gained access to patient records (either
paper or electronic), what action would you take? - ANSWERcontact the privacy officer
Questions and Correct Detailed Answers
ALREADY GRADED A+ Latest Versions
2025
VERSION A
**While Medicare may specify that a given condition is not acceptable, if that condition
is what is documented, the coder has no other option but to code what is documented
even though the insurer may not pay the claim (Leon-Chisen 2017, 39-40).
The insured may not necessarily be the patient seen for the medical service. -
ANSWERTrue
Personal insurance is usually less expensive than other health insurance. -
ANSWERFalse
Time limits stated in individual health insurance policies about an insurance company's
obligation to pay benefits are the same for all insurance companies. - ANSWERFalse
There is standardization of format for the explanation of benefit document for all private
insurance carriers. - ANSWERFalse
What organization publishes diagnostic and procedure coding competencies for
outpatient services and diagnostic coding and reporting requirements for physician
billing? - ANSWERAmerican Health Information Management Association (AHIMA)
Medical etiquette refers to: - ANSWERConsideration of others
CPT codes are assigned to which of these? - ANSWERCoding procedures and services
Exceptions to the right of privacy rule include: - ANSWERGunshot wound cases
A common format for medical record documentation is called: - ANSWERSOAP
Most physician/patient contracts are: - ANSWERImplied
An inventory of body systems for which the patient complains of signs and symptoms is
called? - ANSWERROS
When coding a front torso burn, which percentage of body would be indicated? -
ANSWER18%
,To which of the following would be assigned CPT code? - ANSWERTonsillectomy
Urine moves through the kidneys to the bladder through the: - ANSWERUreters
Which box of the CMS-1500 Form would be completed with codes for procedures,
services or supplies? - ANSWERBox 24d
Which of these is considered PHI? - ANSWERPhotographic images, even in profile
This means "Let the Master Answer"? - ANSWERRespondeat Superior
Patient sees the physician for a regular office visit which is charged at $90. The
allowable amount for the patient's insurance company covers the office visit in full, with
a $10 copay, and the patient has not met the $125 deductible. How much does the
patient owe? - ANSWER$90
Using SOAP notes, what would be found in the Assessment portion of the record? -
ANSWERDiagnosis
If a Medicare patient wants a procedure that is a non-covered benefit, what form do they
need to sign that indicates they are aware it is not covered? - ANSWERAdvanced
Beneficiary Notice
Who is responsible for entering proper medical documentation to support
reimbursement of procedures and services? - ANSWERClinician
The primary function of the spleen is: - ANSWERProduction and removal of blood cells
as part of the immune system
The pre-established percentage of expenses paid by the patient, or another insurance
carrier, after the primary insurance has made payment, and the deductible is met:
Select one: - ANSWERCoinsurance
What happens with information that is abstracted from the medical record? -
ANSWERCoded and forwarded to the insurance
The significant reason for which a patient is admitted to the hospital is coded using the:
- ANSWERPrincipal Diagnosis
Which of these is a common abbreviation for the test that assesses the electrical activity
of the heart? - ANSWERECG
Confidential information about patients should never be discussed with: -
ANSWERFamily
Coworkers
,Friends
Name the correct procedure for keeping an industrial patient's financial and health
records when the same physician is also seeing the patient as a private patient -
ANSWERSeparate financial and health records must be used
Patient presents with abdominal pain. In what part of documentation would the duration
and symptoms be indicated? - ANSWERHPI
The statutes for workers' compensation laws fall under: - ANSWERFederal and state
compensation laws
Which of these is the result of a claim that is submitted electronically with an old
insurance policy number? - ANSWERDenial
An NAS is a: - ANSWERCertification from a military hospital stating that it cannot
provide the necessary care
A coding book that contains codes for products and supplies is: - ANSWERHCPCS
Releasing, giving access to, or transferring PHI to an outside person or organization is
called: - ANSWERDisclosure
Which portion of HIPAA protects integrity and confidentiality of patients' e-PHI? -
ANSWERHIPAA Security rule
What organization manages and updates CPT changes? - ANSWERAMA
Which of the following would NOT be documented in the Social History area of the
medical chart? - ANSWERFamily history of colon polyps
The Medicaid time limit to appeal a claim varies from state to state, but it is usually: -
ANSWER30-60 days
If a patient has a Gastropexy, what is occurring? - ANSWERSurgical fixation of the
stomach to the abdominal wall or diaphragm
Payments to hospitals for Medicare services are classified according to: -
ANSWERDRG'S
An examination of a knee joint via small incision and optical device would be: -
ANSWERArthroscopy
Which of these would describe the common method for sorting of an Aging report? -
ANSWERBy date
, Some senior HMOs may provide services not covered by Medicare, such as: -
ANSWEREyeglasses and prescription drugs
Which of these must be obtained by the patient prior to the provider rendering medical
treatment? - ANSWERConsent
Which of these limits access to patient information based on the user's position in an
organization: - ANSWERRole-Based Access
A DME provider has a contract with an insurance company to accept their allowed
amount as payment in full. The provider bills $125 and the insurance approves $100.
The patient has a coinsurance amount of $20, and there is no deductible. How much
does the provider write off? - ANSWER$25
Which portion of the medical record would contain the diagnosis code used for billing? -
ANSWERHistory and Physical
What is the name of the act designed to address the collection practices of third-party
debt collectors and attorneys who regularly collect debts for others? - ANSWERFair
Debt Collection Practices Act
To ensure appropriate insurance coverage for an outpatient procedure, which of these
should be obtained? - ANSWERPre-Certification
What does bundling mean? - ANSWERGrouping codes that are related to a procedure
An insurance claim submitted with errors is referred to as: - ANSWERDirty Claim
A clearinghouse is: - ANSWERAn entity that receives transmission of insurance claims,
separates the claims, and sends each one electronically to the correct insurance payer
If a payment problem develops with an insurance company and the company ignores
claims and exceeds time limits to pay a claim, it is prudent to contact the: -
ANSWERState insurance commissioner
When down coding occurs, payment will: - ANSWERBe less
Which payer is responsible for covering charges related to the inhalation of toxic fumes
in a place of employment, due to improper ventilation? - ANSWERworkers
compensation
The UB-04 form is used for: - ANSWERBilling hospital services
You see that an unauthorized individual has gained access to patient records (either
paper or electronic), what action would you take? - ANSWERcontact the privacy officer
