2026 UPDATED QUESTIONS DOWNLOAD
NURS 5337 Billing and Coding Quiz
NURS 5337 Billing and Coding Master Quiz
1. What is the primary function of an ICD-10-CM code?
A. To list the procedures performed.
B. To provide a standardized code for the medical diagnosis.
C. To track the time spent with the patient.
D. To identify the supplies used during a visit.
Rationale: ICD-10 codes document the "why" of the visit (diagnosis), justifying the
medical necessity of the services provided.
2. Which CPT code series is used for a New Patient office visit?
A. 99211–99215
B. 99202–99205
C. 99241–99245
D. 99381–99397
Rationale: The 9920x series is designated for Evaluation and Management (E/M) of
new outpatients.
3. Under the 2021/2023 guidelines, what determines the level of an E/M office
visit?
A. The number of physical exam "bullets."
B. Medical Decision Making (MDM) or Total Time.
C. The patient’s insurance type.
D. The length of the History of Present Illness (HPI).
Rationale: Modern coding allows providers to level a visit based on either
the complexity of the decision-making or the total time spent on the date of
the encounter.
4. What defines "Medical Necessity"?
A. The patient's request for a test.
B. Clinical justification for a service based on the diagnosis and standard of care.
,2026 UPDATED QUESTIONS DOWNLOAD
C. The total cost of the visit.
D. The provider's preference for a specific lab.
Rationale: Services must be "reasonable and necessary" for the diagnosis;
otherwise, payers will deny the claim.
5. A patient with a single, stable chronic condition (e.g., controlled HTN)
represents which MDM level?
A. Straightforward.
B. Low Complexity.
C. Moderate Complexity.
D. High Complexity.
Rationale: One stable chronic illness falls under Low Complexity (Level 3) for the
"Number and Complexity of Problems" element.
6. Which modifier is used to bill for an E/M visit performed on the same day as a
procedure?
A. -50
B. -25
C. -59
D. -95
Rationale: Modifier -25 indicates a "significant, separately identifiable" E/M service
was performed beyond the usual work associated with a procedure.
7. When coding by "Time," which activity can the NP count?
A. Only face-to-face time.
B. All work on the day of the encounter, including charting and record review.
C. Time spent by the nurse taking vitals.
D. Commuting to the office.
Rationale: Total Time includes all personal work by the NP related to that patient
on that specific calendar day.
8. An established patient visit for a simple viral URI (uncomplicated) is typically
billed as:
A. 99212
B. 99213
C. 99214
D. 99215
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: An acute uncomplicated illness is considered Low Complexity, which
maps to a Level 3 visit (99213).
9. CPT defines an "Established Patient" as someone seen by the practice
specialty within:
A. 1 year.
B. 2 years.
C. 3 years.
D. 5 years.
Rationale: If a patient has not received professional services from the provider or
group in 36 months, they are "New" again.
10. What are the three elements of Medical Decision Making (MDM)?
A. History, Physical, and Time.
B. Problems, Data, and Risk.
C. Vitals, Subjective, and Objective.
D. Diagnosis, Treatment, and Follow-up.
Rationale: MDM is calculated using the Number/Complexity of
Problems, Amount of Data Analyzed, and Risk of Management.
11. A Level 4 office visit (99214) requires which MDM complexity?
A. Low.
B. Moderate.
C. High.
D. Minimal.
Rationale: 99214 and 99204 are tied to Moderate Complexity decision-making.
12. What does CPT stand for?
A. Clinical Patient Tracking.
B. Current Procedural Terminology.
C. Certified Provider Terms.
D. Common Procedure Table.
Rationale: CPT codes (Level I HCPCS) are used to report services and procedures.
13. In the MDM "Risk" column, prescription drug management is considered:
A. Low Risk.
B. Moderate Risk.
NURS 5337 Billing and Coding Quiz
NURS 5337 Billing and Coding Master Quiz
1. What is the primary function of an ICD-10-CM code?
A. To list the procedures performed.
B. To provide a standardized code for the medical diagnosis.
C. To track the time spent with the patient.
D. To identify the supplies used during a visit.
Rationale: ICD-10 codes document the "why" of the visit (diagnosis), justifying the
medical necessity of the services provided.
2. Which CPT code series is used for a New Patient office visit?
A. 99211–99215
B. 99202–99205
C. 99241–99245
D. 99381–99397
Rationale: The 9920x series is designated for Evaluation and Management (E/M) of
new outpatients.
3. Under the 2021/2023 guidelines, what determines the level of an E/M office
visit?
A. The number of physical exam "bullets."
B. Medical Decision Making (MDM) or Total Time.
C. The patient’s insurance type.
D. The length of the History of Present Illness (HPI).
Rationale: Modern coding allows providers to level a visit based on either
the complexity of the decision-making or the total time spent on the date of
the encounter.
4. What defines "Medical Necessity"?
A. The patient's request for a test.
B. Clinical justification for a service based on the diagnosis and standard of care.
,2026 UPDATED QUESTIONS DOWNLOAD
C. The total cost of the visit.
D. The provider's preference for a specific lab.
Rationale: Services must be "reasonable and necessary" for the diagnosis;
otherwise, payers will deny the claim.
5. A patient with a single, stable chronic condition (e.g., controlled HTN)
represents which MDM level?
A. Straightforward.
B. Low Complexity.
C. Moderate Complexity.
D. High Complexity.
Rationale: One stable chronic illness falls under Low Complexity (Level 3) for the
"Number and Complexity of Problems" element.
6. Which modifier is used to bill for an E/M visit performed on the same day as a
procedure?
A. -50
B. -25
C. -59
D. -95
Rationale: Modifier -25 indicates a "significant, separately identifiable" E/M service
was performed beyond the usual work associated with a procedure.
7. When coding by "Time," which activity can the NP count?
A. Only face-to-face time.
B. All work on the day of the encounter, including charting and record review.
C. Time spent by the nurse taking vitals.
D. Commuting to the office.
Rationale: Total Time includes all personal work by the NP related to that patient
on that specific calendar day.
8. An established patient visit for a simple viral URI (uncomplicated) is typically
billed as:
A. 99212
B. 99213
C. 99214
D. 99215
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: An acute uncomplicated illness is considered Low Complexity, which
maps to a Level 3 visit (99213).
9. CPT defines an "Established Patient" as someone seen by the practice
specialty within:
A. 1 year.
B. 2 years.
C. 3 years.
D. 5 years.
Rationale: If a patient has not received professional services from the provider or
group in 36 months, they are "New" again.
10. What are the three elements of Medical Decision Making (MDM)?
A. History, Physical, and Time.
B. Problems, Data, and Risk.
C. Vitals, Subjective, and Objective.
D. Diagnosis, Treatment, and Follow-up.
Rationale: MDM is calculated using the Number/Complexity of
Problems, Amount of Data Analyzed, and Risk of Management.
11. A Level 4 office visit (99214) requires which MDM complexity?
A. Low.
B. Moderate.
C. High.
D. Minimal.
Rationale: 99214 and 99204 are tied to Moderate Complexity decision-making.
12. What does CPT stand for?
A. Clinical Patient Tracking.
B. Current Procedural Terminology.
C. Certified Provider Terms.
D. Common Procedure Table.
Rationale: CPT codes (Level I HCPCS) are used to report services and procedures.
13. In the MDM "Risk" column, prescription drug management is considered:
A. Low Risk.
B. Moderate Risk.
