ESTUDYR
AHIMA CCS EXAM PREP UPDATED EXAM WITH MOST TESTED
QUESTIONS AND ANSWERS | GRADED A+ | ASSURED SUCCESS
WITH DETAILED RATIONALES
1. CPT defines a “separate procedure” as:
a. A service always reported together with the primary procedure
b. A procedure that has a unique CPT category
c. A procedure considered integral to a more major service
d. A bilateral procedure requiring two codes
Rationale: Separate procedures are components of major services and not reported
independently.
2. When no combination code exists for two coexisting conditions (e.g., hypertension and acute
renal failure), you should:
a. Use a general combination code
b. Assign separate codes for each condition
c. Omit the less severe condition
d. Use a “not elsewhere classified” code
Rationale: Without a specific combination code, report each diagnosis individually.
3. Which documentation source can be used to assign a Body Mass Index (BMI) code?
a. Surgeon’s operative report only
b. Radiology report only
c. Nursing staff or allied health professional notes
d. Anesthesia record only
Rationale: BMI documented by nursing or allied notes provides specificity for coding.
4. A “Y” Present on Admission (POA) indicator means:
a. Yes, but only if documented by physician
b. Yes, the condition was present at inpatient admission
c. Yearly screening required
d. Yet to be determined
Rationale: “Y” confirms that the diagnosis existed on admission, affecting reimbursement.
5. An “N” POA indicator signifies:
a. Not coded
b. No, the condition was not present at admission
c. Normal finding
d. Needs further review
Rationale: “N” indicates the condition developed during the hospital stay.
,ESTUDYR
6. A “U” POA indicator indicates:
a. Universal diagnosis
b. Urgent condition
c. Unknown—documentation insufficient to determine presence on admission
d. Unrelated to admission
Rationale: “U” is used when it’s unclear from records whether the condition was present.
7. A “W” POA indicator means:
a. Well documented
b. Clinically undetermined at admission
c. Withheld information
d. Wrongly coded
Rationale: “W” applies when the provider cannot clinically determine POA status.
8. An “E” POA indicator stands for:
a. Emergency condition
b. Exempt—diagnosis not applicable for POA reporting
c. Excluded from coding
d. Erroneous
Rationale: Certain conditions (e.g., traumatic injuries) are exempt from POA requirements.
9. POA indicators must be reported for all inpatient diagnosis codes EXCEPT:
a. Principal diagnosis
b. Z-codes
c. Secondary diagnoses
d. Facility address codes
Rationale: POA applies to clinical diagnoses and external cause codes, not administrative data.
10. The Outpatient Code Editor (OCE) is designed to:
a. Assign DRG groups
b. Identify incomplete or incorrect outpatient claims
c. Calculate APC weights
d. Automate ICD-10-CM sequencing
Rationale: OCE enforces coding conventions and edits to reduce billing errors.
11. Medicare’s Local Coverage Determinations (LCDs) define:
a. National coding guidelines
b. Coverage and medical necessity criteria for services
c. Hospital quality metrics
d. Physician fee schedules
Rationale: LCDs specify which services are reimbursable in each jurisdiction.
12. Medically Unlikely Edits (MUEs) are used to:
a. Determine global periods
, ESTUDYR
b. Limit maximum units of service per HCPCS code per beneficiary per day
c. Crosswalk between code sets
d. Exempt certain codes
Rationale: MUEs prevent overbilling by capping units billed.
13. National Correct Coding Initiative (NCCI) Edits are updated:
a. Monthly
b. Annually
c. Quarterly
d. Biannually
Rationale: CMS releases NCCI code-pair edits every quarter to ensure correct code
combinations.
14. The 2000 final rule on the Outpatient Prospective Payment System (OPPS) primarily:
a. Abolished APCs
b. Grouped outpatient services into fixed payment categories
c. Established DRGs for inpatients
d. Linked payments to physician quality scores
Rationale: The rule created Ambulatory Payment Classifications for outpatient reimbursement.
15. Diagnostic-related groups (DRGs) and Ambulatory Payment Classifications (APCs) share that
they are both:
a. Retrospective payment systems
b. Fee-for-service schedules
c. Prospective payment systems
d. Quality reporting frameworks
Rationale: Both classify services into fixed‐rate payment groups.
16. Ambulatory Payment Classifications (APCs) are used to:
a. Pay physicians directly
b. Reimburse outpatient facility services under Medicare OPPS
c. Set inpatient length of stay
d. Adjust DRG weights
Rationale: APCs determine facility payment for outpatient procedures.
17. How is an APC payment calculated?
a. RVU × conversion factor
b. DRG weight × wage index
c. APC relative weight × OPPS conversion factor ± geographic adjustment
d. Flat fee per CPT code
Rationale: Payments use relative weights scaled by a conversion factor and location adjustment.
18. APC Status Indicator “C” denotes:
a. Packaged ancillary service
AHIMA CCS EXAM PREP UPDATED EXAM WITH MOST TESTED
QUESTIONS AND ANSWERS | GRADED A+ | ASSURED SUCCESS
WITH DETAILED RATIONALES
1. CPT defines a “separate procedure” as:
a. A service always reported together with the primary procedure
b. A procedure that has a unique CPT category
c. A procedure considered integral to a more major service
d. A bilateral procedure requiring two codes
Rationale: Separate procedures are components of major services and not reported
independently.
2. When no combination code exists for two coexisting conditions (e.g., hypertension and acute
renal failure), you should:
a. Use a general combination code
b. Assign separate codes for each condition
c. Omit the less severe condition
d. Use a “not elsewhere classified” code
Rationale: Without a specific combination code, report each diagnosis individually.
3. Which documentation source can be used to assign a Body Mass Index (BMI) code?
a. Surgeon’s operative report only
b. Radiology report only
c. Nursing staff or allied health professional notes
d. Anesthesia record only
Rationale: BMI documented by nursing or allied notes provides specificity for coding.
4. A “Y” Present on Admission (POA) indicator means:
a. Yes, but only if documented by physician
b. Yes, the condition was present at inpatient admission
c. Yearly screening required
d. Yet to be determined
Rationale: “Y” confirms that the diagnosis existed on admission, affecting reimbursement.
5. An “N” POA indicator signifies:
a. Not coded
b. No, the condition was not present at admission
c. Normal finding
d. Needs further review
Rationale: “N” indicates the condition developed during the hospital stay.
,ESTUDYR
6. A “U” POA indicator indicates:
a. Universal diagnosis
b. Urgent condition
c. Unknown—documentation insufficient to determine presence on admission
d. Unrelated to admission
Rationale: “U” is used when it’s unclear from records whether the condition was present.
7. A “W” POA indicator means:
a. Well documented
b. Clinically undetermined at admission
c. Withheld information
d. Wrongly coded
Rationale: “W” applies when the provider cannot clinically determine POA status.
8. An “E” POA indicator stands for:
a. Emergency condition
b. Exempt—diagnosis not applicable for POA reporting
c. Excluded from coding
d. Erroneous
Rationale: Certain conditions (e.g., traumatic injuries) are exempt from POA requirements.
9. POA indicators must be reported for all inpatient diagnosis codes EXCEPT:
a. Principal diagnosis
b. Z-codes
c. Secondary diagnoses
d. Facility address codes
Rationale: POA applies to clinical diagnoses and external cause codes, not administrative data.
10. The Outpatient Code Editor (OCE) is designed to:
a. Assign DRG groups
b. Identify incomplete or incorrect outpatient claims
c. Calculate APC weights
d. Automate ICD-10-CM sequencing
Rationale: OCE enforces coding conventions and edits to reduce billing errors.
11. Medicare’s Local Coverage Determinations (LCDs) define:
a. National coding guidelines
b. Coverage and medical necessity criteria for services
c. Hospital quality metrics
d. Physician fee schedules
Rationale: LCDs specify which services are reimbursable in each jurisdiction.
12. Medically Unlikely Edits (MUEs) are used to:
a. Determine global periods
, ESTUDYR
b. Limit maximum units of service per HCPCS code per beneficiary per day
c. Crosswalk between code sets
d. Exempt certain codes
Rationale: MUEs prevent overbilling by capping units billed.
13. National Correct Coding Initiative (NCCI) Edits are updated:
a. Monthly
b. Annually
c. Quarterly
d. Biannually
Rationale: CMS releases NCCI code-pair edits every quarter to ensure correct code
combinations.
14. The 2000 final rule on the Outpatient Prospective Payment System (OPPS) primarily:
a. Abolished APCs
b. Grouped outpatient services into fixed payment categories
c. Established DRGs for inpatients
d. Linked payments to physician quality scores
Rationale: The rule created Ambulatory Payment Classifications for outpatient reimbursement.
15. Diagnostic-related groups (DRGs) and Ambulatory Payment Classifications (APCs) share that
they are both:
a. Retrospective payment systems
b. Fee-for-service schedules
c. Prospective payment systems
d. Quality reporting frameworks
Rationale: Both classify services into fixed‐rate payment groups.
16. Ambulatory Payment Classifications (APCs) are used to:
a. Pay physicians directly
b. Reimburse outpatient facility services under Medicare OPPS
c. Set inpatient length of stay
d. Adjust DRG weights
Rationale: APCs determine facility payment for outpatient procedures.
17. How is an APC payment calculated?
a. RVU × conversion factor
b. DRG weight × wage index
c. APC relative weight × OPPS conversion factor ± geographic adjustment
d. Flat fee per CPT code
Rationale: Payments use relative weights scaled by a conversion factor and location adjustment.
18. APC Status Indicator “C” denotes:
a. Packaged ancillary service
