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

AAPC - Medical Coding Questions and Answers | Latest Version | 2025/2026 | Correct & Verified What is the primary purpose of medical coding in healthcare? To translate medical procedures, diagnoses, and services into standardized codes for billing, reporting, and record-keeping. Which coding system is used for inpatient hospital procedures in the U.S.? ICD-10-PCS What type of codes are found in the ICD-10-CM? Diagnosis codes What is the difference between ICD-10-CM and ICD-10-PCS? ICD-10-CM is for diagnoses, ICD-10-PCS is for inpatient procedures. What does HCPCS Level II codes primarily cover? Supplies, equipment, and non-physician services not included in CPT. 2 How often is the CPT code set updated? Annually What is the main function of a coding audit? To ensure accuracy and compliance in medical coding for billing and documentation. What is the term for assigning codes to medical services and procedures? Medical coding What is an E/M code used for? To bill for evaluation and management services provided by healthcare professionals. When coding for multiple procedures, what rule determines the primary code? The procedure with the highest relative value or complexity is coded first. What does "modifier" indicate in coding? 3 A modifier provides additional information about a procedure without changing its definition. What is the meaning of "unbundling" in coding? Separating a single comprehensive procedure into multiple codes to increase reimbursement improperly. Which organization maintains the CPT code set? American Medical Association (AMA) What is the purpose of the NCCI edits? To prevent improper coding combinations and ensure correct payment. What does the term "upcoding" refer to? Assigning a code that reflects a higher level of service than actually provided for increased reimbursement. When coding for telehealth services, what should be considered? 4 The place of service, type of communication, and CPT or HCPCS codes designated for telehealth. What is a principal diagnosis? The condition chiefly responsible for the patient’s admission to the hospital. How are secondary diagnoses different from principal diagnoses? Secondary diagnoses describe additional conditions that coexist at the time of admission or develop during the stay. What is the main difference between CPT Category I, II, and III codes? Category I: procedures and services; Category II: performance measurement; Category III: emerging technology. What is meant by "medical necessity" in coding? The justification that a service or procedure is required for diagnosis or treatment of a condition. What type of code would you use for a broken arm? 5 ICD-10-CM diagnosis code for the specific fracture Which code set is required for reporting inpatient procedures to Medicare? ICD-10-PCS When documenting E/M services, what elements must be included for accurate coding? History, examination, medical decision making, and time if relevant. What is a "bundled code"? A code that includes multiple services or procedures into a single code. How do you code for a bilateral procedure? Use a modifier or bilateral code