Medical Coding Training – CPC Exam Prep with Practice Questions and
Key Concepts for AAPC Certification 2024–2025
This training guide is tailored for students preparing for the Certified
Professional Coder (CPC) exam by AAPC. It includes practice questions, coding
scenarios, and key concept reviews for CPT, ICD-10-CM, and HCPCS Level II
codes. The content covers coding guidelines, medical terminology, anatomy, and
regulatory compliance, making it ideal for 2024–2025 CPC certification
preparation.
1. Which statement below describes a medically necessary service?
A. Performing a procedure/service based on cost to eliminate wasteful ser-
vices.
B. Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
C. Using the closest facility to perform a service or procedure.
D. Using the appropriate course of treatment to fit within the patient's
lifestyle.-: B. Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
Rationale: Medical necessity is using the least radical services/procedure that
allows for effective treatment of the patient's complaint or condition.
,2. According to the example LCD from Novitas Solutions, measurement of
vitamin D levels is indicated for patients with condition?
A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness: C. hypertension
Rationale: According to the LCD, measurement of vitamin D levels is indicated for
patients with fibromyalgia.
3. What form is provided to a patient to indicate a service may not be covered
by Medicare and the patient may be responsible for the charges?
A. LCD
B. CMS-1500
C. UB-04
D. ABN: D. ABN
Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
beneficiary requests or agrees to receive a procedure or service that Medicare
may not cover. This form notifies the patient of potential out of pocket costs for the
patient.
4. Select the true statement regarding ABNs.
A. ABNs may not be recognized by non-Medicare payers.
B. ABNs must be signed for emergency or urgent care.
C. ABNs are not required to include an estimate cost for the service.
D. ABNs should be routinely signed by Medicare beneficiaries in case
Medicare does not cover a service.: A. ABNs may not be recognized by non-
Medicare payers.
Rationale: ABNs may not be recognized by non-Medicare payers. Providers should
review their contracts to determine which payers will accept an ABN for services not
covered.
, 5. When presenting a cost estimate on an ABN for a potentially noncovered
service, the cost estimate should be within what range of the actual cost?
A. $25 or 10%
B. $100 or 10%
C. $100 or 25%
D. An exact amount.: C. $100 or 25%
"Notifiers must make a good faith effort to insert a reasonable estimate...the
estimate should be within $100 or 25 percent of the actual costs, whichever is
greater."
Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to
insert a reasonable estimate...the estimate should be within $100 or 25 percent of
the actual costs, whichever is greater."
6. Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMOs
C. Clearinghouse
D. Patient: D. Patient
Rationale: Covered entities in relation to HIPAA include healthcare providers, health
plans, and healthcare clearinghouses. The patient is not considered a covered
entity although it is the patient's data that is protected.
7. Under HIPAA, what would be a policy requirement for "Minimum
Necessary?"
A. Only individuals whose job requires it may have access to protected health
information.
B. Only the patient has access to protected health information.
C. Only the treatment physician has access to protected health information.
D. Anyone within the provider's office can have access to protected health
information.: A. Only individuals whose job requires it may have access to
protected health information.
Key Concepts for AAPC Certification 2024–2025
This training guide is tailored for students preparing for the Certified
Professional Coder (CPC) exam by AAPC. It includes practice questions, coding
scenarios, and key concept reviews for CPT, ICD-10-CM, and HCPCS Level II
codes. The content covers coding guidelines, medical terminology, anatomy, and
regulatory compliance, making it ideal for 2024–2025 CPC certification
preparation.
1. Which statement below describes a medically necessary service?
A. Performing a procedure/service based on cost to eliminate wasteful ser-
vices.
B. Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
C. Using the closest facility to perform a service or procedure.
D. Using the appropriate course of treatment to fit within the patient's
lifestyle.-: B. Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
Rationale: Medical necessity is using the least radical services/procedure that
allows for effective treatment of the patient's complaint or condition.
,2. According to the example LCD from Novitas Solutions, measurement of
vitamin D levels is indicated for patients with condition?
A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness: C. hypertension
Rationale: According to the LCD, measurement of vitamin D levels is indicated for
patients with fibromyalgia.
3. What form is provided to a patient to indicate a service may not be covered
by Medicare and the patient may be responsible for the charges?
A. LCD
B. CMS-1500
C. UB-04
D. ABN: D. ABN
Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
beneficiary requests or agrees to receive a procedure or service that Medicare
may not cover. This form notifies the patient of potential out of pocket costs for the
patient.
4. Select the true statement regarding ABNs.
A. ABNs may not be recognized by non-Medicare payers.
B. ABNs must be signed for emergency or urgent care.
C. ABNs are not required to include an estimate cost for the service.
D. ABNs should be routinely signed by Medicare beneficiaries in case
Medicare does not cover a service.: A. ABNs may not be recognized by non-
Medicare payers.
Rationale: ABNs may not be recognized by non-Medicare payers. Providers should
review their contracts to determine which payers will accept an ABN for services not
covered.
, 5. When presenting a cost estimate on an ABN for a potentially noncovered
service, the cost estimate should be within what range of the actual cost?
A. $25 or 10%
B. $100 or 10%
C. $100 or 25%
D. An exact amount.: C. $100 or 25%
"Notifiers must make a good faith effort to insert a reasonable estimate...the
estimate should be within $100 or 25 percent of the actual costs, whichever is
greater."
Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to
insert a reasonable estimate...the estimate should be within $100 or 25 percent of
the actual costs, whichever is greater."
6. Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMOs
C. Clearinghouse
D. Patient: D. Patient
Rationale: Covered entities in relation to HIPAA include healthcare providers, health
plans, and healthcare clearinghouses. The patient is not considered a covered
entity although it is the patient's data that is protected.
7. Under HIPAA, what would be a policy requirement for "Minimum
Necessary?"
A. Only individuals whose job requires it may have access to protected health
information.
B. Only the patient has access to protected health information.
C. Only the treatment physician has access to protected health information.
D. Anyone within the provider's office can have access to protected health
information.: A. Only individuals whose job requires it may have access to
protected health information.
