Medical Billing & Coding Lesson 22
Correct Questions & Answers (Verified)
Comprehensive Study Guide for Certification Success
Date: June 29, 2025
Prepared by: Medical Coding Education Team
,Contents
1 Introduction to Medical Billing and Coding – Lesson 22 . . . . . . . . . . . . . 2
1.1 Key Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Detailed Coding Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 ICD-10-CM Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 CPT and HCPCS Conventions . . . . . . . . . . . . . . . . . . . . . . . 2
3 Modifier Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1 Key Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.2 Application in Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Billing Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.1 Claim Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.2 Denials Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5 Compliance and Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.1 Key Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5.2 Ethical Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6.1 Case Study 1: Office Visit with Procedure . . . . . . . . . . . . . . . . . 4
6.2 Case Study 2: Bilateral Shoulder Injection . . . . . . . . . . . . . . . . . 4
6.3 Case Study 3: Diabetic Supplies . . . . . . . . . . . . . . . . . . . . . . . 4
6.4 Case Study 4: Endoscopy with Biopsy . . . . . . . . . . . . . . . . . . . 5
6.5 Case Study 5: Complex Surgery with Complications . . . . . . . . . . . 5
7 Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
8 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1
, 1 Introduction to Medical Billing and Coding – Lesson 22
Lesson 22 advances learners’ understanding of medical billing and coding by focusing
on detailed coding practices, modifier applications, billing processes, compliance regula-
tions, and real-world case studies. This study guide provides 130 verified questions and
answers, each enriched with detailed explanations, clinical context, regulatory references,
and practical applications to prepare learners for certification exams (e.g., CPC, CCS,
CBCS) and professional practice. The content is aligned with Quizlet resources and
industry standards to ensure accuracy, relevance, and exam readiness.
1.1 Key Objectives
• Apply detailed ICD-10-CM, CPT, and HCPCS coding conventions.
• Master modifier applications for complex billing scenarios.
• Understand billing processes, including claim submission and denials management.
• Ensure compliance with HIPAA, False Claims Act, and NCCI edits.
• Analyze practical case studies to bridge theory and practice.
2 Detailed Coding Conventions
Lesson 22 emphasizes precision in coding to ensure accurate billing and compliance.
2.1 ICD-10-CM Conventions
• Combination Codes: Single codes for multiple conditions (e.g., E11.40 for type 2
diabetes with neuropathy).
• Sequencing: Principal diagnosis first (e.g., I21.9 for myocardial infarction), followed
by secondary conditions (e.g., E78.5 for hyperlipidemia).
• Laterality: Specify right, left, or bilateral (e.g., M17.12 for unilateral primary os-
teoarthritis, left knee).
2.2 CPT and HCPCS Conventions
• CPT Modifiers: Clarify procedures (e.g., -25 for separate E/M service).
• HCPCS Specificity: Detailed codes for supplies (e.g., A4253 for blood glucose test
strips).
2
Correct Questions & Answers (Verified)
Comprehensive Study Guide for Certification Success
Date: June 29, 2025
Prepared by: Medical Coding Education Team
,Contents
1 Introduction to Medical Billing and Coding – Lesson 22 . . . . . . . . . . . . . 2
1.1 Key Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Detailed Coding Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 ICD-10-CM Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 CPT and HCPCS Conventions . . . . . . . . . . . . . . . . . . . . . . . 2
3 Modifier Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1 Key Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.2 Application in Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Billing Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.1 Claim Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4.2 Denials Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5 Compliance and Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
5.1 Key Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5.2 Ethical Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
6.1 Case Study 1: Office Visit with Procedure . . . . . . . . . . . . . . . . . 4
6.2 Case Study 2: Bilateral Shoulder Injection . . . . . . . . . . . . . . . . . 4
6.3 Case Study 3: Diabetic Supplies . . . . . . . . . . . . . . . . . . . . . . . 4
6.4 Case Study 4: Endoscopy with Biopsy . . . . . . . . . . . . . . . . . . . 5
6.5 Case Study 5: Complex Surgery with Complications . . . . . . . . . . . 5
7 Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
8 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1
, 1 Introduction to Medical Billing and Coding – Lesson 22
Lesson 22 advances learners’ understanding of medical billing and coding by focusing
on detailed coding practices, modifier applications, billing processes, compliance regula-
tions, and real-world case studies. This study guide provides 130 verified questions and
answers, each enriched with detailed explanations, clinical context, regulatory references,
and practical applications to prepare learners for certification exams (e.g., CPC, CCS,
CBCS) and professional practice. The content is aligned with Quizlet resources and
industry standards to ensure accuracy, relevance, and exam readiness.
1.1 Key Objectives
• Apply detailed ICD-10-CM, CPT, and HCPCS coding conventions.
• Master modifier applications for complex billing scenarios.
• Understand billing processes, including claim submission and denials management.
• Ensure compliance with HIPAA, False Claims Act, and NCCI edits.
• Analyze practical case studies to bridge theory and practice.
2 Detailed Coding Conventions
Lesson 22 emphasizes precision in coding to ensure accurate billing and compliance.
2.1 ICD-10-CM Conventions
• Combination Codes: Single codes for multiple conditions (e.g., E11.40 for type 2
diabetes with neuropathy).
• Sequencing: Principal diagnosis first (e.g., I21.9 for myocardial infarction), followed
by secondary conditions (e.g., E78.5 for hyperlipidemia).
• Laterality: Specify right, left, or bilateral (e.g., M17.12 for unilateral primary os-
teoarthritis, left knee).
2.2 CPT and HCPCS Conventions
• CPT Modifiers: Clarify procedures (e.g., -25 for separate E/M service).
• HCPCS Specificity: Detailed codes for supplies (e.g., A4253 for blood glucose test
strips).
2
