Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
Which coding system is used to report medical procedures and services for outpatient and
physician office settings?
✔✔CPT (Current Procedural Terminology).
Which coding system is used for inpatient hospital procedures in the United States?
✔✔ICD-10-PCS (Procedure Coding System).
What does the abbreviation HCPCS stand for?
✔✔Healthcare Common Procedure Coding System.
Why is accurate medical coding essential for healthcare reimbursement?
✔✔Because payers rely on precise codes to determine coverage, payment, and prevent claim
denials or fraud.
What type of code identifies a patient’s medical condition or disease?
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,✔✔Diagnosis code.
What type of code identifies a medical service, procedure, or treatment performed?
✔✔Procedure code.
What is the difference between CPT Category I and Category II codes?
✔✔Category I codes describe standard procedures and services; Category II codes are optional
tracking codes for quality measures.
When coding for an outpatient visit, which codes are used to describe the evaluation and
management service?
✔✔CPT E/M codes.
What is a modifier in medical coding?
✔✔A two-character code added to a CPT or HCPCS code to indicate a special circumstance
affecting a service or procedure.
What does a "primary diagnosis" indicate in medical coding?
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, ✔✔The main condition or reason for the patient’s visit or encounter.
What is the significance of the “place of service” code on a claim?
✔✔It indicates the location where the healthcare service was provided, affecting reimbursement.
What is the difference between upcoding and downcoding?
✔✔Upcoding is coding for a higher-level service than performed to increase reimbursement;
downcoding is coding for a lower-level service, usually by an insurer.
Which code set would be used to report durable medical equipment (DME) to Medicare?
✔✔HCPCS Level II codes.
Why are ICD-10 codes alphanumeric instead of numeric?
✔✔Alphanumeric structure allows for greater specificity and more detailed classification of
conditions.
What is a “combination code” in ICD-10-CM?
✔✔A code that represents both a diagnosis and a related complication or manifestation.
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