CPC/CCS MEDICAL CODING EXAM – QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES
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Core Domains
Medical Terminology and Anatomy
ICD-10-CM Diagnostic Coding
CPT Procedure Coding (Evaluation and Management, Surgery,
Radiology, Pathology, Medicine)
HCPCS Level II Coding
Healthcare Regulations, Compliance, and Coding Guidelines
Medical Billing, Reimbursement Methodologies, and Payer
Policies
Introduction
The purpose of this examination is to rigorously evaluate the
professional competence and technical proficiency of medical coding
candidates seeking credentialing as certified coding specialists. The
assessment comprehensively tests mastery of diagnostic, procedural,
and HCPCS coding guidelines across diverse clinical specialties and
healthcare settings. Candidates are challenged through a balanced mix
of multiple-choice questions and complex clinical scenarios that
simulate real-world coding environments. Special emphasis is placed
on clinical documentation interpretation, regulatory compliance, ethical
coding standards, and critical decision-making necessary to ensure
accurate reimbursement, data integrity, and adherence to official coding
conventions.
Section One: Questions 1–100
A patient undergoes an open surgical repair of an initial reducible
inguinal hernia with mesh implantation. What is the correct CPT
code for this procedure?
,A. 49505
B. 49525
C. 49550
D. 49650
🟢 A. 49505
🔴 Explanation: Code 49505 describes the repair of an initial inguinal
hernia in a patient age 5 years or older, reducible, utilizing an open
approach. Mesh placement is typically bundled into open hernia repairs
when performed.
Which official coding guideline dictates the reporting of secondary
diagnoses that coexist at the time of admission and develop
during the inpatient stay, impacting patient management and
length of stay?
A. Present on Admission (POA) reporting guidelines
B. Outpatient prospective payment system guidelines
C. Local Coverage Determination (LCD) rules
D. National Correct Coding Initiative (NCCI) guidelines
🟢 A. Present on Admission (POA) reporting guidelines
🔴 Explanation: POA reporting guidelines require hospitals to
designate whether secondary diagnoses were present at the time of
inpatient admission to distinguish hospital-acquired conditions from pre-
existing comorbidities.
A patient presents to the outpatient clinic for removal of a deeply
embedded foreign body in the right forearm, requiring deep
surgical exploration and closure. Which CPT code best
represents this service?
A. 10120
B. 10121
C. 20520
D. 20525
🟢 B. 10121
🔴 Explanation: Code 10121 is utilized for the incision and removal of a
foreign body in the extremity requiring deep surgical exploration and
,closure, distinguishing it from simple subcutaneous foreign body
removal.
When assigning diagnosis codes for a patient admitted with
severe sepsis due to a urinary tract infection, what is the correct
sequencing order under ICD-10-CM official guidelines?
A. Urinary tract infection code followed by severe sepsis code
B. Severe sepsis code followed by systemic inflammatory response
syndrome code
C. Underlying systemic infection code followed by the severe sepsis
code
D. Severe sepsis code followed by the code for the underlying systemic
infection (urinary tract infection)
🟢 D. Severe sepsis code followed by the code for the underlying
systemic infection (urinary tract infection)
🔴 Explanation: ICD-10-CM guidelines mandate that when coding
severe sepsis, the code for the systemic infection underlying the severe
sepsis must be sequenced secondary to the appropriate severe sepsis
code.
A physician performs an office visit for a new patient presenting
with chronic stable angina. The encounter involves a
comprehensive history, comprehensive examination, and medical
decision-making of moderate complexity. Which CPT evaluation
and management code is reported based on 1995/1997
documentation guidelines, or appropriate time/MDM equivalents?
A. 99202
B. 99203
C. 99204
D. 99205
🟢 C. 99204
🔴 Explanation: Code 99204 represents a new patient office visit
requiring a comprehensive history and examination with moderate
complexity medical decision-making, or meeting equivalent time
thresholds under current guidelines.
, Which organization maintains and updates the HCPCS Level II
code set used for billing supplies, injectables, durable medical
equipment, and services not included in CPT?
A. American Medical Association (AMA)
B. Centers for Medicare & Medicaid Services (CMS)
C. World Health Organization (WHO)
D. National Center for Health Statistics (NCHS)
🟢 B. Centers for Medicare & Medicaid Services (CMS)
🔴 Explanation: CMS is responsible for the maintenance, annual
updates, and operational oversight of the HCPCS Level II code set.
A patient undergoes an arthroscopic surgical repair of a torn
rotator cuff of the shoulder. Which CPT code describes this
arthroscopic procedure?
A. 29807
B. 29827
C. 29881
D. 29888
🟢 B. 29827
🔴 Explanation: Code 29827 represents arthroscopic shoulder surgery
involving rotator cuff repair. Code 29807 is for Bankart repair, 29881 is
for knee meniscectomy, and 29888 is for anterior cruciate ligament
reconstruction.
Under the HIPAA Privacy Rule, which entity is primarily
responsible for establishing safeguards to protect the
confidentiality, integrity, and availability of electronic protected
health information (ePHI)?
A. Office of Inspector General (OIG)
B. Covered entities and business associates
C. State medical licensing boards
D. American Health Information Management Association (AHIMA)
🟢 B. Covered entities and business associates
🔴 Explanation: Covered entities and their business associates must
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES
| GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Medical Terminology and Anatomy
ICD-10-CM Diagnostic Coding
CPT Procedure Coding (Evaluation and Management, Surgery,
Radiology, Pathology, Medicine)
HCPCS Level II Coding
Healthcare Regulations, Compliance, and Coding Guidelines
Medical Billing, Reimbursement Methodologies, and Payer
Policies
Introduction
The purpose of this examination is to rigorously evaluate the
professional competence and technical proficiency of medical coding
candidates seeking credentialing as certified coding specialists. The
assessment comprehensively tests mastery of diagnostic, procedural,
and HCPCS coding guidelines across diverse clinical specialties and
healthcare settings. Candidates are challenged through a balanced mix
of multiple-choice questions and complex clinical scenarios that
simulate real-world coding environments. Special emphasis is placed
on clinical documentation interpretation, regulatory compliance, ethical
coding standards, and critical decision-making necessary to ensure
accurate reimbursement, data integrity, and adherence to official coding
conventions.
Section One: Questions 1–100
A patient undergoes an open surgical repair of an initial reducible
inguinal hernia with mesh implantation. What is the correct CPT
code for this procedure?
,A. 49505
B. 49525
C. 49550
D. 49650
🟢 A. 49505
🔴 Explanation: Code 49505 describes the repair of an initial inguinal
hernia in a patient age 5 years or older, reducible, utilizing an open
approach. Mesh placement is typically bundled into open hernia repairs
when performed.
Which official coding guideline dictates the reporting of secondary
diagnoses that coexist at the time of admission and develop
during the inpatient stay, impacting patient management and
length of stay?
A. Present on Admission (POA) reporting guidelines
B. Outpatient prospective payment system guidelines
C. Local Coverage Determination (LCD) rules
D. National Correct Coding Initiative (NCCI) guidelines
🟢 A. Present on Admission (POA) reporting guidelines
🔴 Explanation: POA reporting guidelines require hospitals to
designate whether secondary diagnoses were present at the time of
inpatient admission to distinguish hospital-acquired conditions from pre-
existing comorbidities.
A patient presents to the outpatient clinic for removal of a deeply
embedded foreign body in the right forearm, requiring deep
surgical exploration and closure. Which CPT code best
represents this service?
A. 10120
B. 10121
C. 20520
D. 20525
🟢 B. 10121
🔴 Explanation: Code 10121 is utilized for the incision and removal of a
foreign body in the extremity requiring deep surgical exploration and
,closure, distinguishing it from simple subcutaneous foreign body
removal.
When assigning diagnosis codes for a patient admitted with
severe sepsis due to a urinary tract infection, what is the correct
sequencing order under ICD-10-CM official guidelines?
A. Urinary tract infection code followed by severe sepsis code
B. Severe sepsis code followed by systemic inflammatory response
syndrome code
C. Underlying systemic infection code followed by the severe sepsis
code
D. Severe sepsis code followed by the code for the underlying systemic
infection (urinary tract infection)
🟢 D. Severe sepsis code followed by the code for the underlying
systemic infection (urinary tract infection)
🔴 Explanation: ICD-10-CM guidelines mandate that when coding
severe sepsis, the code for the systemic infection underlying the severe
sepsis must be sequenced secondary to the appropriate severe sepsis
code.
A physician performs an office visit for a new patient presenting
with chronic stable angina. The encounter involves a
comprehensive history, comprehensive examination, and medical
decision-making of moderate complexity. Which CPT evaluation
and management code is reported based on 1995/1997
documentation guidelines, or appropriate time/MDM equivalents?
A. 99202
B. 99203
C. 99204
D. 99205
🟢 C. 99204
🔴 Explanation: Code 99204 represents a new patient office visit
requiring a comprehensive history and examination with moderate
complexity medical decision-making, or meeting equivalent time
thresholds under current guidelines.
, Which organization maintains and updates the HCPCS Level II
code set used for billing supplies, injectables, durable medical
equipment, and services not included in CPT?
A. American Medical Association (AMA)
B. Centers for Medicare & Medicaid Services (CMS)
C. World Health Organization (WHO)
D. National Center for Health Statistics (NCHS)
🟢 B. Centers for Medicare & Medicaid Services (CMS)
🔴 Explanation: CMS is responsible for the maintenance, annual
updates, and operational oversight of the HCPCS Level II code set.
A patient undergoes an arthroscopic surgical repair of a torn
rotator cuff of the shoulder. Which CPT code describes this
arthroscopic procedure?
A. 29807
B. 29827
C. 29881
D. 29888
🟢 B. 29827
🔴 Explanation: Code 29827 represents arthroscopic shoulder surgery
involving rotator cuff repair. Code 29807 is for Bankart repair, 29881 is
for knee meniscectomy, and 29888 is for anterior cruciate ligament
reconstruction.
Under the HIPAA Privacy Rule, which entity is primarily
responsible for establishing safeguards to protect the
confidentiality, integrity, and availability of electronic protected
health information (ePHI)?
A. Office of Inspector General (OIG)
B. Covered entities and business associates
C. State medical licensing boards
D. American Health Information Management Association (AHIMA)
🟢 B. Covered entities and business associates
🔴 Explanation: Covered entities and their business associates must
