Medical Coding Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

Medical Coding Questions and Answers | Latest Version | 2025/2026 | Correct & Verified What is the primary purpose of medical coding in healthcare? To accurately translate patient diagnoses, procedures, and services into standardized codes for billing and record-keeping. Which coding system is used primarily for diagnoses in the United States? ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification). Which coding system is used primarily for procedures in hospitals in the United States? ICD-10-PCS (Procedure Coding System). What does CPT stand for in medical coding? Current Procedural Terminology. Which coding system is used for outpatient procedures and physician services? CPT (Current Procedural Terminology). 2 What is HCPCS Level II used for? To code medical supplies, equipment, and certain drugs not included in CPT. What does the abbreviation “E/M” stand for in medical coding? Evaluation and Management. Why is proper documentation essential for accurate medical coding? Because coders rely on physician notes to assign correct codes, ensuring accurate billing and legal compliance. What is the difference between a primary diagnosis and a secondary diagnosis in coding? The primary diagnosis is the main reason for the patient encounter, while secondary diagnoses are additional conditions that affect care or treatment. What is the role of a medical coder in preventing claim denials? To ensure all codes are accurate, supported by documentation, and comply with payer guidelines. 3 What is a modifier in CPT coding? A two-digit code added to a CPT code to indicate a service was altered without changing its definition. What is the purpose of a Z code in ICD-10-CM? To indicate factors influencing health status and reasons for healthcare encounters other than disease or injury. What is the difference between upcoding and downcoding? Upcoding is reporting a higher-level code than justified, while downcoding is reporting a lower-level code than justified. Why is it important to use the most specific ICD-10 code available? Because it ensures accurate representation of the patient’s condition and supports proper reimbursement. What does the term “encounter” mean in medical coding? A healthcare visit or interaction where services are provided to the patient. 4 What is the difference between inpatient and outpatient coding? Inpatient coding uses ICD-10-CM and ICD-10-PCS for hospital stays, while outpatient coding uses ICD-10-CM and CPT/HCPCS for physician and clinic services. What does the CPT code range 10000–19999 represent? Surgical procedures involving the integumentary system (skin). What is the purpose of an E/M code in an office visit? To report the level of evaluation and management service provided. What is the difference between a code set and a code book? A code set is a group of standardized codes, while a code